8:56 PM EDT, August 12, 2013
Jennifer Frankenberg recently learned that she had been approved to receive much-needed health insurance from Anthem Blue Cross.
She also learned that she'd been denied coverage because of preexisting conditions.
All in the same day.
On one level, this is a fairly routine story of corporate incompetence. But it's also a stark illustration of what's currently wrong with our healthcare system and some of the ways that the healthcare reform law, for all its imperfections, addresses these problems.
"I feel duped, angry and generally kicked around," Frankenberg, 43, of Laguna Hills told me after Anthem raised and then crushed her insurance expectations.
She has every right to feel misused. For the last few years, her family has been paying Anthem at least $1,565 a month for insurance under the COBRA program that temporarily extends coverage for people who lose their jobs. That coverage expired at the end of July.
Frankenberg's husband, Rich, recently turned 65, so he was able to seek shelter in the Medicare system. But Frankenberg had to apply to Anthem in mid-July for a new individual insurance policy for herself and her 10-year-old son.
The company got in touch by phone July 26.
"The woman was very bright and cheerful," Frankenberg recalled. "She said, 'Welcome to Anthem! You and your son have been approved!'"
The service rep went on to say that because Frankenberg's son was born with a brain tumor, which has since gone into remission, his monthly premium would be $356, twice as high as expected. Frankenberg was willing to accept that.
"I was just glad we had insurance," she said.
That same day, though, she received a letter from Anthem notifying her that her own application for coverage had been rejected. The reason: Frankenberg was taking antidepressants and had been treated for uterine fibroids — non-cancerous growths in her uterus.
She contacted the Anthem salesman who originally sold her the insurance policy.
"He looked on his computer and said it showed that I had been approved and that I'd been notified of this by phone," Frankenberg told me. "But he said that a letter had been attached saying that I had been denied.
"He said I shouldn't worry about it. He said Anthem would honor the phone call."
That would be the stand-up thing to do in such a situation. But it's not what Anthem did.
The next day, the same service rep who'd called with the good news that Frankenberg had been approved for coverage called back to say that a mistake had been made. Frankenberg's application had been denied, the rep said, and that was Anthem's final word on the matter.
"She wouldn't explain to me what had happened," Frankenberg said, "and she wouldn't let me speak with a supervisor."
Not only is that a shabby way to treat someone who's been paying you more than $1,565 a month for several years, but it shows a breathtaking coldheartedness considering that, just a few months from now, Anthem won't be able to turn down someone in Frankenberg's position even if it wants to.
Thanks to the Affordable Care Act, a.k.a. Obamacare, insurers won't be able to deny coverage to anyone as of Jan. 1.
In fact, it was the reform law that required Anthem to insure Frankenberg's son. Since 2010, the new federal law has prohibited the exclusion of any child under 19 regardless of past medical issues.
In California, the law currently allows insurers to charge kids with preexisting conditions up to twice what other kids are charged for the same coverage — as Anthem is doing with Frankenberg's son — but that too will soon change.
As of January 2014, no one, whether young or old, can be charged more than anyone else for health insurance.
Darrel Ng, an Anthem spokesman, said the service rep messed up by informing Frankenberg that her coverage had been approved.
"As a result of this, we have provided additional instruction to our advisors to reduce the incidence of this type of human error," he said.
Ng also said Anthem would now honor the original call and insure Frankenberg after all.
That's laudable. Happily, it soon will be the law.
Last week's column about American Airlines coming up short in dealing with a passenger's family emergency prompted plenty of similar anecdotes from other travelers — most involving American dropping the ball in their case as well.
Jack DeLuca of Newport Beach had a different story to tell. He said American came through with flying colors when he recently had to arrange tickets after his son had a heart attack.
But if there's one airline that appears to stand out on the compassion front, it's Southwest. I received a number of emails relating how the discount carrier stepped up when passengers needed a helping hand.
Westchester resident Kevin Ivey said Southwest employees showed unfailing respect and sympathy when he and his wife had to travel recently to Nevada after his brother died of a heart attack.
Glendale resident Catherine Montoro said she and her husband received the same level of courtesy when they had to change their travel plans after their newborn granddaughter experienced complications in a Northern California hospital. There were no extra fees and no hassles.
"You need to be with your family," Montoro recalled a Southwest service rep saying. "Just give us a call when you're ready to go home."
That's how it's done.
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