April 12, 2001--
State investigators are looking into why many Utah residents have suddenly lost their health insurance.
It isn't yet clear what happened, or who may be to blame, but the news has come at the worst possible time for at least one family.
News Specialist Carole Mikita has the story.
Ryan Jones pedals his stationary bike for five minutes every day. It's all the exercise he can manage for now and about as far as he can go, confined to his hospital room for four weeks following a bone marrow transplant.
He is battling leukemia for the second time, while his parents are fighting their health plan provider.
This letter dated, January 18th, from Employee Leasing Management, authorized the transplant. Three days before the procedure, the company rescinded the offer.
Jennifer Jones/ Losing insurance: "YOU HAVE NO AUTHORIZATION FOR THIS TRANSPLANT. AND IF YOU PROCEED, ANYONE ELSE MAY REFUSE TO COVER IT, AS A PRE-EXISTING CONDITION."
Knowing how emotionally draining Ryan's cancer was on the entire family, hospital administrators said, "Go ahead and have this procedure done. We'll have our lawyers look into it."
Jennifer Jones: "NO ONE EXPECTS THAT THEIR CHILD WILL BE DIAGNOSED WITH CANCER. LIKEWISE, YOU ALSO EXPECT THAT WHEN YOU PAY YOUR INSURANCE COMPANY A PREMIUM, AND THEY PROMISE YOU A SERVICE, YOU EXPECT THAT THAT WILL BE THERE AND YOU WILL BE ABLE TO COUNT ON THAT SERVICE TO GET YOU THROUGH A TIME LIKE THIS."
Ryan's bone marrow transplant cost a quarter of a million dollars, and now Jones family members have no way to pay for it.
They are not alone. The State Consumer Health Assistance Division has taken calls from hundreds of people affected by this.
Employees, like the Jennifer Jones, pay premiums to Employee Leasing Management, which covers them with insurance. It provides the funds through another company, Physicians HealthNet, which pays the claims.
PHN is now operating under a new name, MD MedCare, and is apparently not honoring claims. The State and Department of Labor are investigating both companies.
ELM has let those on its health plan know as of April 30th, they are no longer covered, but it is willing to help them find a new plan.
Company managers faxed us this statement:
"We are aware of the negative impact this situation is having on idividuals. (We) are committed to ensuring our member's doctors are paid in full for covered services..."
Jennifer Jones is now looking for a new insurance company.
Jennifer Jones: "I BEGRUDGE EVERY MINUTE THAT I SPEND ON THE PHONE TRYING TO TRACK DOWN THIS INSURANCE INFORMATION. I WANT TO FOCUS MY EFFORT ON HEALING MY SON, AND HELPING HIM HEAL. AND I THINK THAT'S WHERE THE EMPHASIS NEEDS TO BE RIGHT NOW."
Ryan and his family do not yet know if the bone marrow transplant has been successful. But they wait with hope.
Follow-up story, numbers to call.
