Think your health care is covered? Beware of ‘junk’ insurance plan

L ook ing ba ck , Sam Bloechl knows that when the health insurance broker who was helping him find a plan asked whether he’d ever been diagnosed with a major illness, that should have been a red flag. Preexisting medical conditions don’t matter when you buy a comprehensive individual plan that complies with the Affordable Care Act. Insurers can’t turn people down or charge them more based on their medical history.

But Bloechl, now 31, didn’t know much about health insurance. So when the broker told him a UnitedHealthcare Golden Rule plan would cover him for a year for less than his marketplace plan — “Unless you like throwing money away, this is the plan you should buy,” he recalls the agent saying — he signed up.

That was December 2016. A month later Bloechl was diagnosed with stage 4 nonHodgkin’s lymphoma after an MRI showed tumors on his spine.

To Bloechl’s dismay, he soon learned that none of the expensive care he needed would be covered by his health plan. Instead of a comprehensive plan that complied with the ACA, he had purchased a bundle of four short-term plans with three- month terms that provided only limited benefits and didn’t cover preexisting conditions.

With this year’s open enrollment period well underway, millions of people are looking for coverage on the federal and state marketplaces. Sometimes it’s hard to tell the difference between comprehensive plans sold there and “junk” plans with limited benefits and coverage restrictions.

“These plans continue to proliferate,” said Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization. “People need to be careful, whether they’re buying by phone or on a website.”

Bloechl assumed he was buying a comprehensive plan that would cover him for a life-threatening illness, although at the time he had no inkling he was sick. But when doctors said Bloechl needed a stem cell transplant, Golden Rule denied the request.

The reason: He had visited a chiropractor for back pain before he bought the plan. Bloechl had blamed the pain on the heavy lifting that came with running his Chicago landscaping business. But Golden Rule argued that he had sought medical treatment for a preexisting condition — cancer — so the plan didn’t have to cover it. It didn’t matter that he hadn’t been diagnosed when he purchased it.

The insurer didn’t cover any of his other bills for chemo and radiation either. Bloechl appealed the decision, but his appeals failed. He had more than $800,000 in bills for care — and that’s before the stem cell transplant he desperately needed.

UnitedHealthcare refused to discuss this case with KHN unless Bloechl signed a statement waiving his right to privacy. But he told KHN he did not feel comfortable signing a legal document provided by the insurer.

“Our agents work with individuals to help them understand their health insurance options and select a plan that best meets their needs,” said UnitedHealthcare’s communications director, Maria Gordon Shydlo, in an email.