March 16, 2014

It looks like Fox News has found themselves a genuine victim. Annette Frey is not a victim of the ACA, but she is a victim nonetheless. There is no question that Frey is having some real issues with her health insurance and has every reason in the world to be frustrated.

Her story

Frey is a cancer survivor who found herself in a vortex when her insurance company cancelled her insurance because it wasn't compliant with the ACA. She did her homework and went looking for a new policy on the New York health exchange, but she had some very specific requirements. She wanted a policy that included her doctors in their coverage network, and she undertook the due diligence to make sure that whatever policy she selected would include her doctors. Ultimately she settled on a policy issued by United Healthcare -- the most expensive on the exchange -- because she was able to verify that her doctors were 'in network.'

Continuing on...

Once she picked a plan that included her primary care physician in late December, she was then told she couldn’t actually use the insurance for several weeks. When Frey pushed back, she was then told she would be able to see her doctor for a Jan. 8 appointment.

“I was assured that everything was ok,” she said. “I said I needed confirmation I was insured and could see the doctor and that I needed to know that to be able to sleep at night.”

She says she was given that assurance and on Jan.8 she went to see her doctor.

But following the visit, she received a notice from United that denied her claim, once again saying her doctor, the one whose name was now printed on the insurance card they sent her, was not in-network. That dispute remains unresolved.

For their part, United Healthcare shrugged and said, "Gosh, we're really sorry that her doctor opted out of the exchange plans but what can we do?"

Who's to blame?

This woman survived cancer, but UHC is doing their damndest to make sure she can't get preventive and follow-up care.

I'd be pissed off about it too, and ready to climb onto any television network that would air my story. You bet, and I don't blame Frey a bit for doing so.

But Cavuto is another story. Cavuto is taking a victim of an insurance company and making her into a victim of the ACA. Even she admits the ACA is helpful because her cancer wasn't a factor in being able to obtain health insurance, but Cavuto really wants to give UHC a pass and blame it all on the ACA.

How to fix it

United Healthcare should not get a pass on this, and New York should be actively investigating their activities. This is the same company that screwed policyholders for 15 years by shorting payments to out-of-network providers, if you recall. They settled that one, but it's clear they play games with their networks to maximize out-of-pocket costs to their policyholders in order to maximize profits.

Speaking of profits, let's have a look at theirs. Since January 1st, their stock value has increased by nearly 5 percent and are on track to pay a dividend to shareholders. There's no evidence whatsoever that they've been financially harmed by the full implementation of the ACA. In fact, the opposite appears to be true, and stock analysts are definitely bullish on them. But screwing policyholders isn't the right pathway to profits, and they should learn that now.

That doesn't fix Frey's problem, and it's a real one. But she's looking in the wrong places to get help, and Cavuto didn't help her at all with that. Ms. Frey, I would suggest contacting this office right away:

State Insurance Commissioners Office
160 West Broadway
New York, NY 10013
Main Phone: 1-212-480-6400

Be forceful. It's clear UHC is screwing you, and you should get assistance immediately from the insurance commissioner. Believe it or not, these companies actually do take inquiries from the insurance commissioner's office seriously. Stay on them, and make them do the right thing. While you're at it, you might also want to reach out to your state Attorney General and request an investigation into how UHC contracts network doctors, and whether United Healthcare misrepresented their network to you when you signed up. Misrepresentation is grounds for them to refund all of your money and let you find a policy that has your doctors in their networks.

The ACA won't fix these problems on a national basis, and there will be more stories like this until people demand more of their insurers. Only state-based remedies are available because each state is the final arbiter of the ACA implementation rules. Progressives wish it were otherwise. We wanted a federal plan that didn't submit to the whims of states, but Max Baucus fixed that for us really well along with the Senate when they rejected the option for a Medicare buy-in or the public option we all wanted.

Finally, remember this:

" of the things I understood when we decided to reform that health insurance market, part of the reason why it hasn’t been done before and it’s very difficult to do, is that anything that’s going on that’s tough in the health care market, if you initiated a reform, can be attributed to your law. " - President Obama, 11/14/2013

Your problem isn't the Affordable Care Act, Ms. Frey. Your problem is with United Healthcare and the other insurers in New York, who seem to be intentionally limiting networks in order to frustrate people who purchased insurance on the New York exchanges.

On a personal level, I hope they straighten this out for Ms. Frey and that her cancer is forever gone. May she live a long and happy life, with no fear of pre-existing conditions exclusions and great health care.

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