Kaiser canceled patient after payment

February 12, 2009 5:59:15 PM PST
What do you do when you pay for health insurance and then find out that you've been dropped from the coverage? That's what happened to one Bay Area woman, so she called 7 On Your Side's Michael Finney for help.

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It's not a good feeling to know you're not covered if something goes wrong. Well, this woman didn't even know she was dropped from her health plan and once she found out, she couldn't get back in.

Suzanne Hargrave of Oakland sold her interior design business two years ago so she could home-school her 12-year-old son. However, when Suzanne left her job, she also lost her health insurance. So, she signed up for an individual health plan at Kaiser, called the Steps Program, which provides low cost coverage. Things worked out great until one day she got on the phone with Kaiser.

"They said well you know your insurance has been canceled. Why? I don't know why?" said Hargrave.

Kaiser said it was because she hadn't paid her monthly premium, but in fact Hargrave had paid. Here's the cashier's check for $156. It showed Kaiser cashed it back in September when it was due. Still, Kaiser could not find any record of payment.

"They flat out denied reinstatement," said Hargrave.

Kaiser says patients cannot be reinstated to the low cost plan once they're terminated for failure to pay, but Hargrave said it was Kaiser's mistake.

"It was absolutely ridiculous because I had done everything I was supposed to do on this end, and they had canceled my insurance," said Hargrave.

Hargrave kept calling Kaiser to straighten things out, but months went by and still no health coverage.

"If something went wrong and I needed the coverage, I wouldn't have it so I was very uncomfortable," said Hargrave.

Hargrave didn't have any emergencies, but she paid out of pocket for an eye appointment in November. Then she called 7 On Your Side who contacted Kaiser and it looked into her case. Kaiser said Hargrave's $156 payment wasn't posted to her account as it should have been. Kaiser refunded that payment, and agreed to pay for her eye appointment. Not only that, Hargrave was back in the Kaiser Steps program in January.

"They did reinstate me and I did a trial I went over and made an appointment with an eye doctor," said Hargrave.

And she was covered for that appointment. Now Kaiser is temporarily closing the Steps Program to new members because it is packed, which is a sign of the economic times, with more people out of work.

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