Jessica* recently gave birth to a beautiful, healthy baby; her and her husband’s second child. However, when Jessica attempted to pay the health care costs associated with her pregnancy, she encountered some technical difficulties on her health care provider’s end. “We had been contacting [the insurance plan] for two weeks trying to make a payment,” explains Jessica. “They kept telling us they were having technical difficulties with their computer network.”
Unable to pay her bills online or over the phone, Jessica’s only option was to mail a check, which she hoped would make it to her provider before the end of her grace period. But when Jessica called her health care provider to confirm if they had received her check, she was informed they had not received payment yet; therefore, her policy would be cancelled.
“I had been going through post-partum,” reveals Jessica. “The stress of that alone is enough without having to also face your insurance company now denying coverage due to a deadline for payment within less than 24 hours.”
Without healthcare coverage, Jessica and her family were left with over $35,000 in medical costs, mostly from her stay at the hospital where her baby was delivered. “Just the hospital stay alone was $15,000,” affirms Jessica. With a household monthly income of only $4,000, it would be impossible to pay these bills.
A referral by Covered California led Jessica to the Legal Aid Society of Orange County’s (LASOC) Health Consumer Action Center (HCAC), a specialized program dedicated to helping low-income clients access the health care system in Orange County.
On Jessica’s behalf, HCAC filed a grievance with her former health care provider. When her grievance was denied, HCAC filed a complaint with the Department of Managed Health Care (DMHC) highlighting Jessica’s continuous contact with her former health care provider as well as her numerous attempts to pay her bills.
“Jessica went through a tough time trying to handle this issue while also taking care of her newborn,” says LASOC Attorney, Angela Leong. “She definitely needed a health advocate to go through all the grievance and appeals procedure to finally get that $35,000 bill out of her life.”
Within just a few weeks, DMHC granted Jessica her reinstatement request, allowing Jessica and her family to regain coverage. HCAC played an integral role in advocating for Jessica and her family’s right to health care access, and with their help, Jessica can now rest easy knowing her family is covered.
“Angela was very helpful, understanding, and comforting, which was a relief,” says Jessica. “It was nice to talk to someone who was willing to listen and help, whereas my health care provider was just closing the door.”
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*Name has been changed to protect identity.