Woman stuck with $135k bill sues Nationwide Insurance over policy
KITSAP COUNTY, Wash. -- Meet Ruth Bjorklund. The Bainbridge Island woman used to think she had good health insurance, but now she's stuck with a $135,000 bill. So she's suing the company in federal court.
Bjorklund signed up for group insurance with Nationwide Insurance through her non-profit employer.
"Eight months later, I had a seizure and was airlifted to Harborview (Medical Center), and discovered I had a brain tumor and needed surgery right away," she said.
And what came next nearly gave her a heart attack. Her insurance billed her for $135,000. It appears her policy paid only $1,000 a day for the hospital stay and $2,000 total for the surgery.
"It was an incredibly overwhelming experience, and I hope people are careful with these discount plans," Bjorklund said.
Insurance Commissioner Mike Kreidler says Bjorklund's plan spelled out the limitations, but in an language nearly foreign to the layperson.
"Being an insurance company actuary with a PhD would probably help you read it. It wasn't black and white; it wasn't real clear," he said.
Bjorklund is taking Nationwide to federal court. It turns out the insurance company failed to file needed paperwork with the state. And at the time Bjorklund bought the plan, there was allegedly another problem.
"Limited medical benefit plans like this one were illegal when they were sold as stand-alone policies," said Bjorklund's attorney, Eleanor Hamburger.
Kreidler said the violation is one that comes with heavy consequences.
"In some cases, we have fined them hundreds of thousands of dollars for this violation; it is not just a slap on the hand," he said.
None of the fines Kreidler refers to would benefit Bjorklund; however, he said he may be willing to lower the size of the company's fine if it agrees to help her pay off her debt.
Nationwide Insurance said it cannot comment due to ongoing litigation.
Limited medical benefit plans have been legal in Washington state since July 2007. But the plan must carry the following warning: "This coverage is not comprehensive and will not cover the cost of most hospital services."
Bjorklund signed up for group insurance with Nationwide Insurance through her non-profit employer.
"Eight months later, I had a seizure and was airlifted to Harborview (Medical Center), and discovered I had a brain tumor and needed surgery right away," she said.
And what came next nearly gave her a heart attack. Her insurance billed her for $135,000. It appears her policy paid only $1,000 a day for the hospital stay and $2,000 total for the surgery.
"It was an incredibly overwhelming experience, and I hope people are careful with these discount plans," Bjorklund said.
Insurance Commissioner Mike Kreidler says Bjorklund's plan spelled out the limitations, but in an language nearly foreign to the layperson.
"Being an insurance company actuary with a PhD would probably help you read it. It wasn't black and white; it wasn't real clear," he said.
Bjorklund is taking Nationwide to federal court. It turns out the insurance company failed to file needed paperwork with the state. And at the time Bjorklund bought the plan, there was allegedly another problem.
"Limited medical benefit plans like this one were illegal when they were sold as stand-alone policies," said Bjorklund's attorney, Eleanor Hamburger.
Kreidler said the violation is one that comes with heavy consequences.
"In some cases, we have fined them hundreds of thousands of dollars for this violation; it is not just a slap on the hand," he said.
None of the fines Kreidler refers to would benefit Bjorklund; however, he said he may be willing to lower the size of the company's fine if it agrees to help her pay off her debt.
Nationwide Insurance said it cannot comment due to ongoing litigation.
Limited medical benefit plans have been legal in Washington state since July 2007. But the plan must carry the following warning: "This coverage is not comprehensive and will not cover the cost of most hospital services."