Jeneane Life owns the Carlisle House Inn in Nantucket and divides her time between Massachusetts and Indiana, which is her primary residence.
Last September, she was having trouble breathing and checked herself into Nantucket Cottage Hospital, thinking she had COVID-19.
“They came into the emergency room while I was waiting for my COVID diagnosis and said, you have cancer. I told them, no, no, you’re in the wrong room,” Life recalled. “They did a scan of my lungs and they accidentally found, saw my right kidney, found a tumor the size of a softball attached to the kidney.”
Stunned and scared, Life relied on a hospital liaison who helped her navigate the situation in the five weeks leading up to her surgery.
“As part of that process, they got my insurance and checked with the insurance company to make sure I was covered,” Life said. “They sent it down the pipeline to the insurance company and they said they were asking for pre-clearance and they told them no pre-clearance was required. So we did the surgeries.”
Nantucket Cottage Hospital is a member of Mass General Brigham and surgery to remove his tumor and kidney took place in Boston last October. Subsequently, she received a bill for $96,000.
“It’s college education for my sons. I’m not destitute, but that’s why I paid monthly insurance,” Life said. “I’m self-employed. I pay close to $800 a month for insurance. I thought I was doing the right thing responsibly, I handed over my insurance card when I walked in.”
The life insurance company, Anthem Blue Cross and Blue Shield, declined coverage because it was out of network. She appealed and said she got paperwork from the hospital showing they contacted Anthem on October 8, 2021 for pre-op clearance, but was told it wasn’t necessary.
“I had to file three or four different appeals during this whole period without medical attention. I had no follow-up appointments because no one could agree on where I should go, who I should see and what I had to do,” Life said.
“I spent many days crying, not believing that they wouldn’t just focus on this, looking at the case, looking at the fact that they said it was OK to go ahead with the operation.”
She contacted NBC10 Boston Responds after trying to resolve the situation for 10 months.
“It was a last resort. I needed my medical follow-up. I needed to get the bill paid because it had gotten to the point where it was going to destroy my credit,” Life said.
We contacted Anthem and they re-examined the matter.
“Within three or four weeks of speaking to you and telling you the story, they had a woman from the Anthem Blue Cross Blue Shield executive concierge team call me to tell me they were looking into all of it,” Life said. “And then I got a letter in the mail saying they paid the bill.”
In that letter, Anthem said it made an exception, “Unfortunately, your provider has already been misinformed of the benefits available to you under your plan. Your plan does not include out-of-network benefits except in emergency. Due to this miscommunication, Anthem will approve previous services.”
An Anthem spokesperson told us:
“Our top priority is to ensure that those we serve have access to healthcare. Some benefit plans do not cover care provided by a hospital outside of that plan’s network of care providers. We encourage members and their healthcare providers to contact us so that we can verify the benefits of their particular insurance policy.
“I cried with joy when I found out it was finally taken care of, so thank you,” Life says. “It sounds a bit corny, but in a way, financially, you saved this part of my life and my health, because now I have medical follow-up again. I was not receiving medical attention.
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