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Aetna reinstates customer who made $64 error

January 17, 2010|David Lazarus
  • Even after Stacey Owens realized her premiums had risen and tried to catch up on her payments, Aetna refused to reinstate her.
Even after Stacey Owens realized her premiums had risen and tried to catch… (Nancy Pastor / For The Times )

Los Angeles resident Stacey Owens found out after a recent doctor's visit that her health insurer, Aetna, had canceled her coverage, ostensibly because she'd missed a monthly payment.

Never mind the heartlessness of leaving people uninsured because of something as potentially trivial as a misplaced bill.

No, the problem in this case is that Owens, 25, never missed a payment -- and she has the bank records to prove it.

Yet when she confronted Aetna with what clearly appeared to be a clerical error on the company's part, Owens said, the insurer dug in its heels and refused to reinstate her coverage.

This wasn't a minor inconvenience. Owens is a thyroid cancer survivor and requires medication to keep her body running smoothly. She also sees an endocrinologist for regular checkups.

"I'm not a person who can go without health insurance," Owens said last week. "I need to be able to see the doctor."

As lawmakers continue wrestling with -- and watering down -- bills intended to overhaul the U.S. healthcare system, stories like Owens' illustrate the need for change. Just about all Americans are just one bureaucratic bungle away from going without coverage.

Owens was insured by her parents until she graduated in 2006 from Mount Holyoke College in Massachusetts with a degree in film and TV production. She was covered by Aetna after being employed as a production assistant at Warner Bros. in mid-2007.

The job ended about five months later when production finished for the TV show she was working on. Owens continued her Aetna coverage under COBRA, the federal program that allows people to maintain health insurance for at least 18 additional months, albeit paying substantially higher premiums.

Owens said she found out that her coverage had been canceled only after a doctor's bill was rejected by Aetna in November.

She called the company and asked what was up. Owens said she was told by a service rep that her policy had been terminated because of a missed payment for October.

This simply wasn't the case. According to bank records produced by Owens, she wrote a check for $472.99 to Aetna on Sept. 28. The check was deposited by Aetna into a Citibank account in Delaware on Nov. 1.

Yet even when Owens appealed Aetna's cancellation of her coverage and asked to be reinstated, she was told -- via a form letter -- that there was nothing the company could do to help her.

While she pressed for reinstatement, Owens said she was careful to continue mailing monthly payments to Aetna. And Aetna kept mailing them back.

Finally, Owens brought her case to me. I took it back to Aetna.

"We could have done a better job with this situation," admitted Anjie Coplin, a company spokeswoman, after reviewing Owens' file.

The problem, Coplin said, resulted from a roughly $32 increase in Owens' premium that took effect in August. Although Owens continued sending in monthly checks, she neglected to pay the higher amount for two months.

She began paying the higher premium -- $472.99 a month -- as of October. But by then, at least in Aetna's eyes, it was too late. She was short by about $64 for the previous two months combined, and that was reason enough to have her join the 47 million other people in this country lacking health coverage.

Owens said she never received advance word that her premium was going up. She said she received a letter from Aetna in October saying that her rates had risen as of a couple of months earlier.

"That was the first I heard of it," Owens said.

Again, the paperwork backs her up. Aetna sent me a copy of the letter it sent Owens. It's dated Sept. 30 -- two months after the rate increase took effect.

I asked Coplin why Aetna didn't simply untangle the situation after Owens appealed her canceled policy. After all, the company's letters repeatedly told Owens she hadn't paid her bill, even though she knew she had -- and the company had even deposited her October payment.

"That was our mistake," Coplin acknowledged. "We took the check. It should have been returned."

So why wasn't Aetna more proactive in reaching out to a customer who clearly was making a good faith effort to pay her bills?

"I wasn't part of the appeals process," Coplin replied. "But in the future, we need to make sure our communications are more clear."

She said Aetna would reinstate Owens' coverage -- providing she now submits nearly $1,900 to cover four months of returned payments.

Coplin also said Aetna would retroactively cover any medical costs that accrued while Owens was uninsured. About $330 in prescription drug costs were run up during this time.

As for whether Owens' trouble represents a systemic problem, Coplin said Aetna did the best it could. The payment process is automated, she said, making it impossible for the company to contact customers personally in the event of a missed or insufficient payment.

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