Impatient

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How many people does it take to fix a Covered California glitch?

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Like many young, healthy people, Alison Chavez had what she called an "oh-s---" insurance plan. It had a high deductible, and was intended to protect the 36-year-old triathlete in case she got into a bike accident, or injured herself while running trails.

But last summer, Chavez was diagnosed with cancer in her left breast. She also learned she had the BRCA 1 gene, which indicated a high predisposition for cancer in her other breast.

When Covered California opened for enrollment in October 2013, Chavez  jumped at the chance to get a new plan. It had a lower deductible, and covered her medications, like the expensive nausea pills she needed after chemotherapy.

She had a double mastectomy in November.

Everything was great, right?

Well, Chavez ran into a problem: She said several of her doctors and hospitals had stopped - or planned to stop - taking Covered California plans due to their low reimbursement rates. So at the end of March, she purchased a private health plan that would allow her to continue seeing her doctors.

Chavez selected the new plan to start May 1, so she would still have her Covered California plan when she underwent one more surgery in April. She had developed a hole in her skin, on the underside of her breast, which exposed her implant to air and put her at risk of infection.

That’s when she ran into more trouble.

The day before Chavez' surgery, the hospital couldn't preauthorize her insurance. It turned out that Covered California had already dropped her plan, and it would take an estimated two weeks to fix it, she said.

She fired off an angry letter and posted it on her Facebook page and the Covered California page:

I am a recovering cancer patient that needs a surgery and I need it now and adding on 'layers' that I can't penetrate due to mistakes that I did not make that are leaving me without needed medical care is not okay.

I made it through my cancer diagnosis, my BRCA1 diagnosis, 16 chemo sessions, a double mastectomy, a few other surgeries, 9 months of weakness and sadness, but I have never cried like I did today on the phone with the Covered CA reps.

Chavez' friends saw the message and jumped in to help. The son of a friend’s friend advocated on her behalf in Sacramento. A friend of a friend at Blue Shield took up her cause.

Another friend started a petition on Change.org, called "Covered California - fix your life threatening administrative error now." It garnered 750 signatures.

Covered California fixed the problem four days after her surgery was cancelled. It was rescheduled for April 9.

That day, Chavez posted:

So - Surgery #5 is in 12+ hours. I'm pounding water (okay, Crystal Light), about to eat a pint of Chocolate Malted Crunch ice cream (yes, from Thrifty's - my "last meal"!) - and I'm looking forward to my drug-induced "nap" tomorrow (it sounds like heaven). So what if my nap involves a surgeon cutting open my chest cavity and swapping out an implant (again). It's still going to be a lovely nap, and it's not like I haven't done this before (last month). Thank you all for your support! Xoxo — feeling ready (again).

The post got 279 "likes."

"I probably will never know what avenue worked, or maybe it was a combination of them," she told Impatient two days after her surgery. "But I felt really happy that all these people had gone to bat for me."

 

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