Best Healthcare In The World? Insurance Company Almost Lets NJ Dad Die … Over 26 Cents

Bone Marrow Transplant Denied Over 26 Cents

You’ve been laid off, pay for COBRA coverage, and suddenly you need a $500K bone marrow transplant. Thank goodness for health insurance … or maybe not. Photo by Alex Remnick for the (NJ) Star Ledger via NJ.com.

A New Jersey garbage truck driver almost saw his life slip away from him over 26 cents.

Thirty-three-year-old Sergio Branco took a three month leave of absence (thanks to the Family and Medical Leave Act) from his job with Russell Reid, a waste management company, after finding out that he had fast-spreading type of leukemia. Soon, his doctors informed him that he would need a bone marrow transplant to save his life. Luckily, they were able to find him a donor with a perfect match and scheduled the transplant for August 16th.

A $500,000 transplant. Thank goodness for health insurance.

Or maybe not.

After Sergio’s three month leave of absence was up, his company fired him. Unsurprised, his family at least took heart in the knowledge that they could continue their health insurance coverage through COBRA (Consolidated Omnibus Reconciliation Act). They’d have to pay the whole premium, but it was better than paying the full $500,000 for the transplant.

Soon after Sergio was fired, a letter arrived letting them know they had until June 30 to decide whether or not they wanted the coverage. Of course they did, so on May 24, Sergio’s wife Mara sent in her check for $518 to pay for the first month of coverage for Sergio.

But she forgot the 26 cents.

Whatever the reason–she was preoccupied with the kids, her sick husband, supporting the family, etc–the bill for $518.26 wasn’t paid in full. So, despite the fact that they were still within the time allowed to pay before the option for coverage was gone, and despite the fact that the check Mara sent in was cashed, Sergio’s coverage was terminated, leaving him unable to pay for the transplant. It wasn’t until the hospital notified them that the Branco family found out about the cancellation.

When Mara contacted the company handling the insurance coverage, Paychex, to find out what happened, they told her about the 26 cents. When she tried to pay it, Paychex wouldn’t accept payment, saying that Russell Reid, Sergio’s old company, told them to accept no more payments from them. Mara called Russell Reid, and they denied the accusation. She was soon left with no choice but to get the Department of Labor involved, who also got the run-around from both companies involved–all while a man’s life hung in the balance. Finally, at the beginning of July, they received written notification that Sergio’s insurance was cancelled. Their payment of $518 was sent back to them.

Finally, the Branco’s had no choice but to get a lawyer.

The lawyer changed everything. The law says insurance coverage cannot be cancelled over a “de minimis amount,” not to mention that Paychex never sent the appropriate notices under the law. Soon, Paychex and Russell Reid had no choice but to reinstate Sergio Branco’s insurance coverage. His transplant is still on track for August 16.

What’s worrisome about Sergio’s case, while there are a few things that aren’t right here, is that even after the Department of Labor was involved, they were still unable to really get anything fixed until they employed an attorney. Considering their situation, attorney’s fees are likely a hardship on the family that they should never have had to incur. Further, with everything else in their lives, with all of the stress involved in raising children while dealing with a terminal illness, the ultimate insult is to pull their coverage over an amount that can be found at the bottom of the dryer.

The lesson here seems to be: ‘Don’t get sick, and don’t stress out if you do.’