Mother Struggles to Get Health Insurance for Injured Daughter – Again

Solmaz Modeer went through the same problems in 2014 when she switched her daughter's health coverage

A San Diego mother says for the second year, she’s had to fight the Covered California system to get health insurance for her daughter, who was badly injured early last year.

Until Wednesday afternoon, 23-year-old Nikki Sanaty did not have insurance for 2015 – coverage she desperately needs.

A crash last January left her with severe brain trauma, and at one point, doctors told her mother Solmaz Modeer that Sanaty would be brain dead for the rest of her life.

β€œMy memory is slow, but it’s building on itself,” said Sanaty. Modeer calls it a miracle.

Her improvement, the mother said, is largely due to the coverage she’s received from Blue Shield through Covered California.

But the insurance was hard-fought, both in 2014 and this year. Modeer said at the start of 2015, Nikki was kicked off her plan and mistakenly placed on MediCal. Covered California has acknowledged that some applicants were wrongly diverted to MediCal coverage.

When Modeer tried to fix the problem, she was forced to spend days on the phone once again, trying to clear up a lack of communication between the health exchange and Blue Shield. She was given the runaround, she said.

"Covered California did their job, did their work and signed us up effective Jan. 1, but then Covered California somehow cannot get this information to Blue Shield, so Blue Shield knows we have this coverage but they cannot take the payment from me,” said Modeer.

For someone who needs continuous therapy and brain treatment programs like Sanaty, a few days without coverage is a big deal.

In this past week, Sanaty had to cancel oral surgery scheduled to fix the teeth she broke while biting down on the intubation tube in the ICU.

"I understand that we will correct our system as mistakes happen,” said Modeer. β€œWe happen to have those mistakes happen to us, but we're having the same mistakes repeated from last year. This is exactly the same mistake, the same problem, so what have we learned from last year?"

Sanaty's health care cost around $3 million last year and could cost a million this year.

When NBC 7 inquired about the Sanaty's problem Wednesday, Covered California fixed the problem immediately.

Officials with the exchange admitted the process is complicated and occasionally there are bottlenecks, but they say they're getting better.

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