WHAT
WE DO

Our goal with the Financial Assistance Initiative is to help consumers with complex medical problems navigate the healthcare system. At the end of the day, if we can't find a solution, our Endowment, which is currently in the funding stage, will be utilized to pay debts as resources allow. At this time, see below for examples of how we've been able to help up until now.

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The $750,000 Health System - Insurer Misalignment

A constituent in New Jersey had a premature baby born and immediately rushed to the NICU for 4 months. $750,000 in medical bills were forwarded to the family because between the birth and discharge the hospital system and insurer stopped working together causing the whole visit to be "out of network" for the family. We were able to get power of attorney for healthcare and negotiated between both parties to have all claims covered in-network helping the family not be saddled with debt.

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The $150,000 Coding Error

A constituent in Pennsylvania began a plan year with zero medical conditions and a busy workload in construction. Early in January 2019 he fell off a curb and landed on his side resulting in kidney damage. Upon admittance, to the hospital, it was discovered that for his whole life his body had been operating with only one kidney. Although this was something he was born with and had no prior knowledge, his providers labeled the event a Chronic Kidney disorder. Due to his income, he had purchased a health insurance plan that was more affordable but did not cover preexisting conditions. Almost a year went by as the word chronic turned into a witchhunt for the insurer to prove he knew about the condition. All the while the local hospital system, surgeon, and other stakeholders were sending him to collections. The family paid what they could as they had the means but the bills kept coming. Our partnership with a local PA Senator's health policy constituent services team resulted in the medical code being corrected in the system and claims being paid in record time upon getting involved.

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The $10,000 Temp Job

When you have a unique skill set it isn't uncommon for reliance on a Temp agency to have income while you seek out the right job for your qualifications. Due to regulations that require "employers" who have 50 or more employees to offer health insurance, a constituent was presented with a benefits package upon onboarding with an agency. The Problem? In situations like this, Temp agencies are concerned about placement and contracts with employers. Their assumption is the benefit they offer won't get a lot of utilization and is much more of a stopgap until the worker finds permanent work. While that is the goal, in the meantime if an event happens, the benefit needs to be able to cover services. A constituent came to us because upon signing up with the agency, his daughter was to get several procedures completed. To the Tune of $10,000 which wasn't covered by the health plan. Our solution? We helped them file for financial assistance at the hospital and contacted the post opp doctors to make sure the policies would also carry weight at the provider level. They were able to remove a financial burden that had stressed them by systems that were in place they previously weren't aware of.

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Dual Medicare Service Costs

Husband and wife were turning 65 in 2020. As with most of us, they weren't born the same day. More commonly spouses are a few years apart, but in this case, it was a few months. The wife had enrolled in a Medicare Advantage plan in August with deductibles, copays, and coinsurance requirements. The husband, turning 65 in November decided a traditional medicare supplement was more fitting for his situation. He liked the concept of paying a little each month to have very little out of pocket throughout the year in unknown expenses. His wife decided she wanted the same and attempted to start Medicare Supplement in November, the same as her husband since she was eligible still under her Initial Enrollment Period to change her mind. The problem was that upon enrolling in Medicare Supplement, the Drug plan she enrolled in to complement the supplement had not notified the medicare advantage carrier that they needed to cancel her original plan. Regulations require this to happen, but it was missed in the mix. With the old company not being canceled, she received bills for $1,500 for the one month she had both plans. Since the old company, the new company, and the drug plan were involved, no one wanted to help rectify the situation: they all blamed each other. After some time she was told to reach out to the Centers for Medicare and Medicaid Services(CMS) to get this fixed. She did, and they even pushed her back to the insurance companies. Our solution? The short answer is Patty. The long answer is our wonderful internal contact at CMS that was able to go in and cancel the old plan, notify the new plan, and get the hospitals involved to resubmit their claims and get them paid. Because of Patty, this constituent had no expenses to pay even with the mixup. 

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*Our lawyers have asked us to remind you, that we are in your corner to fight and get things right. Past experience does not guarantee future results.. Our mission is to work on your behalf, but we can't control the response of the specific parties involved in your situation. With our involvement, our constituents hold us harmless of the responses of third parties.