Jeneane Life owns the Carlisle House Inn in Nantucket and divides her time between Massachusetts and Indiana, which is her primary residence.
Last September she had trouble breathing and went to Nantucket Cottage Hospital, thinking she had COVID-19.
"They came into the ER room when I was waiting for my COVID diagnosis and said, you have cancer. I said to them, no, no, you have the wrong room," Life recalled. "They did a scan of my lungs and they accidentally found, got a glimpse of my right kidney, found a softball-sized tumor attached to the kidney."
Stunned and scared, Life relied on a hospital liaison who helped her navigate the situation in the five weeks leading up to her surgery.
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"As part of that process, they got my insurance and were checking with the insurance company to make sure I was covered," said Life. "They sent it up the pipeline to the insurance company and they said they were calling for pre-authorization and they told them no pre-authorization was required. So we proceeded with the surgeries."
Nantucket Cottage Hospital is a member of Mass General Brigham and surgery to remove her tumor and kidney took place in Boston last October. Afterward, she got a bill for $96,000.
“That's college education for my sons. I'm not destitute, but that's why I paid for monthly insurance," said Life. “I'm self-employed. I pay nearly $800 a month to insure myself. I thought I was doing the right responsible thing, handed over my insurance card when I went in."
Life's insurance company, Anthem Blue Cross and Blue Shield, denied coverage because she was out of network. She appealed and said she got documentation from the hospital that they contacted Anthem on October 8, 2021, to obtain pre-surgery authorization, but were told it wasn’t required.
"I must have filed three or four different appeals this entire time of having zero medical care. I had no follow-up appointments because no one could agree where I should go and who I should see and what I should do," said Life.
"I spent a lot of days crying, just not believing that they wouldn't just focus on this, look at the case, look at the fact that they had said it was OK to go ahead with the surgery."
She contacted NBC10 Boston Responds after trying to get the situation resolved for 10 months.
“It was a last resort. I needed my medical follow-up. I needed to get the bill paid because it had gotten to the point where it was going to destroy my credit,” Life said.
We contacted Anthem and they took a second look at the case.
“Within three, four weeks of talking to you and telling you the story, they had a woman from the executive concierge team at Anthem Blue Cross Blue Shield call me to tell me that they were reviewing it all,” said Life. “And then I got a letter in the mail saying that they'd paid the bill.”
In that letter Anthem said it was making an exception, “unfortunately, your provider was previously misinformed about the benefits available for you under your plan. Your plan does not include out-of-network benefits except in the case of an emergency. Due to this miscommunication, Anthem will approve the prior services.”
An Anthem spokesperson told us:
“Our top priority is ensuring those we serve have access to healthcare. Some benefits plans do not provide coverage for care provided by a hospital outside of that plan’s care provider network. We encourage members and their healthcare providers to contact us so we can verify the benefits under their particular insurance policy.”
“I cried for joy when I found out that it had finally gotten taken care of, so thank you,” says Life. “It sounds a little corny, but in a way, financially, you saved that part of my life and healthwise, because now I've got medical follow-up again. I was not getting medical care.”
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