Bamboozled: The paper chase

Imagine going to the doctor for a check-up. Or for a sprained ankle. Or for the sniffles.BB branding

After you check in with the receptionist, you hear the dreaded words: your health insurance policy has been terminated.

You’d be surprised. Confused. Worried.

For the past two years, that’s what doctor’s visits have been like for Theresa Gonnella, a 74-year-old Bloomfield widow.

Gonnella is covered under a Medicare Horizon Blue Cross Blue Shield plan, and her premiums are paid by the Newark Housing Authority. Gonnella’s husband Peter worked for NHA for 40 years before retiring in 1994, and as part of his benefits, health insurance premiums for his wife would be paid for her lifetime.

He died in 2001. And the premiums were still paid.

92209Then something happened. Or changed.

Gonnella started receiving notices the coverage was terminated. Unpaid doctor’s bills rolled in.

‘‘I was a nervous wreck,’’ Gonnella said. ‘‘Some of my bills were already going to collections. I just couldn’t get it off my mind.’’

The circus begins

Gonnella’s daughters have been on the case. Every quarter when termination notices come in, they call NHA. They call Horizon. The account is reinstated. But not permanently.

It happens the next quarter.

So each quarter, a circus of phone calls begins. Doreen Gonnella, the daughter who helps Theresa Gonnella with her paperwork, contacts Horizon to find out why the policy was terminated. Each time, records indicate the policy was terminated for non-payment.

Then Doreen Gonnella contacts NHA, which always finds a copy of the cancelled check. NHA faxes it to the Gonnellas and the Gonnellas fax it to Horizon.

The policy gets reinstated. But by the time the paperwork is straightened out and the account is properly credited, the next premium is due, and it’s invariably not credited to the correct account.

‘‘It starts all over again for the next quarter,’’ said Maria Rosamilia, Gonnella’s other daughter.

It goes beyond frustration about all the phone calls.

‘‘My mom had a lot of sleepless nights and she was afraid and ashamed to still go to the doctors,’’ Doreen Gonnella said. ‘‘We really had to push her.’’

The daughters can’t understand why no one has found a lasting fix. That’s when they contacted Bamboozled.

The solution

Bamboozled contacted the Newark Housing Authority to see what was going wrong.

After looking into Gonnella’s account, NHA spokesman Tory Gunsolley said because of HIPAA, the Health Insurance Portability and Accountability Act of 1996, which protects patient privacy, Horizon was unable to discuss the case with NHA. Therefore NHA was unable to learn if the premiums were credited to the correct account.

‘‘On the check stub is her name and her ID number so I don’t understand what we can do from a processing standpoint to help Horizon,’’ Gunsolley said.

Next, call: Horizon.

As Gonnella’s daughters suspected, the solution was simple.

Horizon’s billing system has been sending bills to Gonnella even though she doesn’t directly pay the bill. Gonnella would fax the bill to NHA, which would send a check for the payment. But one little thing was missing when NHA paid: the coupon.

The coupon, found on most bills you probably receive, is the part that you detach and return with your payment. It includes information about your account, and it’s used to credit payments, sometimes electronically, to the proper account.

‘‘The coupon is important. The premium checks go to a vendor, whose system is set up to read the coupon itself. Even if the member provides additional information, the vendor wouldn’t see that because the system is designed to read the coupon directly,’’ said Horizon spokesman Dan Emmer.

When the Gonnellas faxed the bills to NHA, it included the coupon part of the bill. But when NHA sent the payment, it didn’t attach the coupon — in-house accountants probably didn’t notice the perforation marks on the faxed copy. When Horizon would receive NHA’s payment for Gonnella’s policy, without the coupon, the payments were not credited for Gonnella. Ergo the delays. And the unsettling termination notices.

Horizon contacted the Gonnellas, and together they decided Horizon would directly send the bill to NHA, and therefore NHA would have the coupon.

‘‘We’ve also taken further steps internally,’’ Emmer said. ‘‘We essentially put a flag, an alert, in our system, so if the Housing Authority sends the check without the coupon we’re able to flag it so that the bills will be paid on time.’’

The Gonnellas are relieved, and hopeful.

‘‘I do feel like it’s finally been fixed, but I’m still a little wary until I see that it is going to get to the point where she’s not terminated every quarter like she has been,’’ said Doreen Gonnella.

We’ll let you know how it turns out.