A San Diego mother whose daughter was severely injured in a crash said she almost missed the deadline to pay for her daughter’s health plan after an insurance company kept giving her the runaround.
“I literally [called the insurance company] every hour. Every time we’ve called, the computers have been down. The very few times that the computers are up, they don’t have the necessary paperwork [for me to submit a payment],” said Solmaz Modeer, explaining her battle to keep her daughter, 22-year-old Nikki Sanaty, covered by her health plan.
According to Modeer, Sanaty is currently hospitalized, in the Intensive Care Unit with severe brain trauma. Sanaty sustained critical injuries in a head-on crash Jan. 3 on State Route 56.
Modeer said her daughter is in stable but critical condition at Scripps Memorial Hospital La Jolla, still on a respirator and slowly learning how to breathe on her own again.
“We don’t know if she’s going to wake up,” the mother said, between tears.
Dealing with Sanaty’s hospitalization has been extra difficult for Modeer due to complications with her daughter’s health insurance coverage.
Right before Sanaty’s accident, Modeer said she had canceled her daughter’s Anthem insurance plan and signed her up for Blue Shield insurance through Covered California.
Covered California told Modeer the changes had gone through. But, when Modeer called Blue Shield to make the first insurance payment, she said she was told her daughter was not in their system.
Somehow, her daughter’s paperwork either got lost or backlogged.
This began a long, exhausting series of phone calls from Modeer to the insurance company. Many times, she said she’d wait on hold for hours to talk to someone. Once she got through, Modeer said the company would tell her their computers were down or they couldn’t accept her payment for one reason or another.
This was especially worrisome for the mother because the deadline to pay the insurance premium was Tuesday, Jan. 28.
If she didn’t make the payment, her daughter would go without coverage – something the family simply can’t afford with Sanaty in the ICU.
Modeer believes there is a disconnect between Blue Shield and Covered California and somewhere, someone, really dropped the ball in her daughter's case.
“Either on one side they didn’t push the send button or on one side somebody has not pushed the receive button,” said Modeer. “But there is a disconnect in between. There is a big crack, and people are falling into the crack.”
Desperate for help and tired of the runaround, Modeer reached out to NBC 7 to share her story.
NBC 7 called Blue Shield and quickly, things changed.
“Immediately after NBC 7 left, I got a phone call from a Blue Shield executive director and she called to take a payment. She took a payment in less than a few minutes,” said Modeer.
Blue Shield told NBC 7 they are experiencing delays in Sanaty's case and other cases since Covered California went into effect.
Though the company said it couldn’t comment on the specifics of Sanaty’s case, it did release the following statement to NBC 7 on Tuesday:
“We believe all Californians deserve access to high-quality health care at an affordable price, and coverage they can depend on in the event of an emergency. We have put several measures in place to reduce the delays some members and new enrollees are experiencing receiving new ID cards and making payments. These measures include expanding customer service hours, easing online payments and working directly with providers to verify eligibility for patients who need immediate access to care.”
Now that Sanaty is properly covered again, Modeer said she can get back to caring for her daughter and aiding her recovery. The mother hopes her story reminds other parents experiencing similar health insurance issues to keep fighting.
“Everybody has to remember that they have to be persistent. Don’t settle for a no. That’s what I believe,” she added.
Though Sanaty remains hospitalized, Modeer is hopeful her daughter will recover in the next few months. She keeps track of her daughter's progress through this website, which includes journal entries written by Modeer and photos of Sanaty.
According to the Covered California website, there have been more than 625,000 enrollments in Covered California health insurance plans from Oct. 1, 2013, through Jan. 15, 2014.
When the health care exchange first launched in October, its provider tool experienced some glitches, with some considering the tool slow and inaccurate. A new version of the provider tool was launched shortly thereafter.