A doctor’s scribbled note leads to patient losing health insurance - Houston Chronicle

After Mark Liebergot’s heart attack in May, a surgeon inserted three stents in the right side of his heart to ease the blockage but warned him he would soon need a coronary bypass to unblock the left side. He was rattled, but took comfort knowing he had insurance after going without for years.

Then, on Sept. 20, six days before his second heart surgery, he got a letter from his insurer, Pivot Choice, a short-term health plan, saying he had been dropped. Not only was parent company, Companion Life Insurance Company, rescinding coverage for his scheduled surgery, it was retroactively denying all pending claims, including the roughly $200,000 in initial billed charges that remained unpaid from his May surgery.

Companion Life accused the 59-year-old Houston roofing contractor of misrepresentation on his April 2018 application by omitting that he had chronic obstructive lung disease or COPD, according to the letter. “Rescission acts to terminate insurance as though it was never in force,” the letter said.

“I was in shock. They had already approved me for my bypass,” Liebergot said, whose condition by then was deteriorating. “I guess they’re seeing $200,000 for my stent surgery and they know I’m about to go into another heart surgery and they went looking for a reason to get out of it.”

Liebergott’s case serves as a cautionary tale of how the the Trump administration’s rollback of rules governing the Affordable Care Act could revive certain insurance business practices — including rescission— that leave patients vulnerable to tens or even hundreds of thousands of dollars in medical debt, health experts say.

Plans compliant with the ACA rules prohibit medical underwriting in which insurers charge more or reject customers altogether based on present — and past — health status. But now, non-compliant plans have gotten a boost from the Trump administration as limited coverage short-term plans have been extended to year-round and the penalty for not having comprehensive coverage has been eliminated.

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And while the ACA did not eliminate rescission, it did aim to make it rare, as in cases of intentional fraud rather than consumer oversight or mistake, said Ken Janda, a former insurance executive in Houston and now a consultant

“In the bad old days insurance companies would request all medical and go through them and hunt for reasons to disqualify someone,” Janda said. “It was something the Affordable Care Act was designed to stop.”

At issue in Liebergot’s case is a doctor’s note from two years before. During a September 2017 check-up, Liebergot told Dr. Swapan Banerjee he sometimes wheezed at night and suspected a flare-up of his seasonal allergies. Liebergot was also a smoker.

Banerjee wrote “bronchitis, COPD,” in the patient file but Liebergot insists he was never diagnosed nor were either conditions mentioned. “I know about COPD. My mother had it. If someone told me I had it I would remember,” he said.

But that scribbled notation was apparently enough proof for Companion Life that Liebergot had lied when he marked “no” in a box on his application that asked if in the past five years he had a “diagnosis, symptoms, an abnormal test result or received treatment, medication or consultation” for a lengthy list of medical conditions, including COPD.

The cancellation letter stated: “If you had accurately responded to the above referenced question your coverage under the Short-Term Medical Policy would not have been approved.”

Companion Life declined to comment.

Banajee also declined to comment because of patient privacy laws, but Liebergot said he called the doctor after being canceled and was told the notation was not meant as an official diagnosis, but rather a reminder to keep an eye on the wheezing.

Liebergot had always been mostly healthy and skipped insurance for years. As he neared 60, though, he thought he should buy a policy. In April 2018, he went online searching for plans and after submitting some personal information, his phone started ringing. An agent in North Carolina sold him a short-term Pivot Choice plan for just under $300 a month with a $5,000 deductible.

Initially, Liebergot had to re-enroll every three months. In December 2018, his agent told him the law had changed and sold him a short-term plan that was year-round for $343 a month.

“If something really bad happens this will cover it?” Lierbergot asked his agent. “He said ‘yes,’ that’s what got me to sign on.”

About five months later, he had what he thought was terrible heartburn. When it didn’t go away he went to urgent care and was told he was having a heart attack. He stayed three days at Clear Lake Regional Medical Center where the stents were inserted.

A few months after his first surgery, he started getting overdue medical bills. He called his insurer and he said he was told the claim was in process. Around the same time, the insurer asked for a list of doctors he had seen in the past few years. Later, he received the letter telling him he was uninsured.

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Liebergot’s bypass surgery was successful and he is now recovering. He talked to a lawyer about fighting the insurance company but is not confident he could win. Mostly he worries about his credit rating, which will likely be destroyed. It is unclear how much he will ultimately owe because his total costs are still pending but fears total charges could top a half million dollars.

HCA Houston Healthcare, parent company of Clear Lake Regional Medical Center, did not comment specifically about Liebergot’s case due to patient privacy laws, but said in a statement it offers discounted care for uninsured patients, which may apply in these types of instances. “It’s important for those choosing a health plan to understand the coverage they’re purchasing, including potential limitations and the out-of-pocket costs for which they would be responsible,” the statement said

“I guess I knew I had messed up by getting this cheap stuff, but I was told I would be OK,” Liebergot said, “I got it in case something major came up and it would be covered. Well, it did and I wasn’t.”

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