Problem Solvers fix insurance glitch for woman with cancer

Problem Solvers fix insurance glitch for woman with cancer »Play Video
Marcia Hawkins

SEATTLE -- A local woman facing cancer is told she has no health insurance even though she's paid for it, and now the KOMO 4 Problem Solvers are looking into the state health exchange to find the mistake.

"I found out on the 28th of last month that I have cancer," said Marcia Hawkins as she headed to her first oncology appointment to find out how Group Health plans to treat her breast cancer.  It's a frightening diagnosis made more so because she was told she has no health insurance.  

"I need tests to find out if it's traveled to other areas of my body," says Hawkins, "hey, can't do any of those tests because I'm not covered."

But Hawkins did buy insurance. She'd been on the state's Apple Care health plan and, after getting a full-time job, she bought insurance through Washington Health Planfinder, the state's exchange.  She even has proof; a receipt for payment dated April 17, 2014 with the date of April 18 listed next to, "updated eligibility decision."  But no one sent notification to Group Health.

After more than a week of phone calls, Hawkins was getting nowhere except more stressed feeling as though her treatment was also going nowhere. "Just not knowing whether it's terminal or how aggressive it is, I mean that might be overly dramatic but at this point I don't know."

So she turned to the Problem Solvers.  Less than half an hour after we contacted Washington's health exchange, the state had located proof of Hawkins' health insurance coverage and sent it on to Group Health.  When we informed Hawkins that she was insured she wondered, "Really?  Just like that?"

Initially, a spokeswoman with the state's health exchange told us payment had to be made by the 23rd to start coverage by the 1st.  But after we told her that Hawkins had paid on the 17th, the state then said special circumstances like Hawkins' can take up to 14 days to approve; something Hawkins says no one ever mentioned.

She's just relieved she can now focus on her health, not her health insurance.  

"Such a relief, thank you so much," she said.

Because of patient privacy laws, Group Health couldn't talk specifically about Hawkins case but sent this e-mailed statement: "The team at Group Health is able to do what others can't.  Due to our unique model of care - a health plan that is joined with a group of caregivers and medical experts - we are able to put the patient's care first.  We know circumstances can change in the lives of each individual who selects Group Health, and as a result, we make it a priority to continue to provide care at our Group Health Medical Centers around the state during those times of transition."

The state also e-mailed a statement which is here in its entirety: "Customers enrolling in a Qualified Health Plan outside of the standard open enrollment period qualify for a special enrollment only if they have a 'qualifying life event.' This may include getting married, having a baby or having a change in income such as getting a new job or losing your current one that provided health benefits.

Any individual seeking special enrollment must complete an application on Washington Healthplanfinder, select a Qualified Health Plan, submit payment and provide proof of their qualifying event. Proof may be something as simple as hiring documentation or a marriage certificate.

After the customer submits documentation, Exchange staff will review the documents within 14 days.  In this situation, the documents were reviewed today, about a week after they were received.  Given the client's difficult situation, we worked directly with Group Health staff to quickly expedite verification and finalize the enrollment.

It is critically important that any individual seeking special enrollment consideration both completes their application with Washington Healthplanfinder and submits the necessary documentation as quickly as possible. This will help ensure the continuation of their existing health coverage."