Updated 

Class-action lawsuit over missing insurance coverage gathers momentum


A class-action lawsuit filed over missing insurance coverage is picking up steam.

The local law firm of Callister + Associates filed the lawsuit April 1 with two clients who paid premiums to the state’s Nevada Health Link exchange months earlier and received no coverage. The ranks of parties had grown to more than 20 by April 11.

Other consumers are watching with interest. One who’s considering reaching out to the firm is Irene McHone, an exchange buyer we’ve written about twice: The first time in January, to share her story of paid premiums and no coverage, and the second time in February, to note that her case was close to resolution.

Apparently, we spoke too soon.

McHone has had trouble getting medications filled because the exchange is saying her coverage has been terminated for nonpayment, said her broker Pat Casale, of Pat Casale and Associates.

Another of Casale’s clients is set to join the lawsuit as well.

Terry Ann Uwaine has paid nearly $540 in premiums, yet has no carrier. She chose a gold plan, but the exchange has been billing her for a bronze policy, which requires higher out-of-pocket costs. The exchange also put her in a Nevada Health CO-OP plan by default — the same issue that spurred the class-action lawsuit, and a problem that Casale said he’s seeing more than ever.

Before you call a lawyer, though, you might want to call a broker, Casale said. Brokers have a backdoor hotline they can use to get immediate exchange attention for difficult cases.

“Most consumers don’t understand what questions to ask,” he said. “They can complain, and they might hear answers like, ‘Just re-enroll.’ That might not be the right answer for them.”

■ A reader called for help enrolling in Medicaid coverage. She works during the state insurer’s office hours, so she can’t sign up in person. Applying online isn’t an option either, because she has no computer.

We reached out to Rachelle Church, a social services manager with the Nevada Division of Welfare and Supportive Services, which runs Medicaid.

Church said the agency hopes to have the technology and staff to take new applications over the phone, something it can’t do right now.

There’s one exception to that phone rule, though. If you have an active, existing case with the division for another program, such as energy assistance, childcare subsidies, the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families, the division can take information for a Medicaid application and process it over the phone.

If that’s not your case, Church recommended going to a public library after work hours and using a computer there to sign up. Libraries with the Las Vegas-Clark County Library District are open from 10 a.m. until 8 p.m. Monday through Thursday, 10 a.m. to 6 p.m. on Friday, and 10 a.m. to 6 p.m. on Saturday and Sunday. Henderson’s libraries have roughly the same hours, but they’re closed on Sunday and Monday.

Consumers can also call Nevada Medicaid’s customer service center at 702-486-1646 and request a paper application via snail mail. Just fill it out and mail it back, or have a family member or friend drop it off in person at division field offices at 611 N. Nellis Blvd., or 1040 W. Owens Ave.

■ Copper plans are in the news lately.

If you didn’t see the copper choice when you bought coverage through Nevada Health Link, that’s because the plans don’t exist yet.

The copper plan was actually proposed last fall, but it’s gotten attention only recently. You may hear more about the option as the next exchange open-enrollment session nears, so we want to give you the rundown.

Sen. Mark Begich, D-Alaska, proposed copper plans in November as an alternative to the existing bronze, silver, gold and platinum coverage. The idea? To let younger, healthier consumers who don’t go to the doctor much opt for a plan with higher out-of-pocket costs, and lower premiums. Where the bronze plan covers 60 percent of a member’s costs, the copper might cover 50 percent.

Local insurance brokers seem underwhelmed at the potential addition.

For one thing, the premium difference may not be that great, Casale said. And increasing out-of-pocket costs defeats the purpose of keeping coverage more affordable.

“It won’t work. Consumers are getting more intelligent by the day,” he said.

Besides, bronze plans — the most affordable of the metal-tiered plans — aren’t a big seller, Casale said. Just 18 percent of exchange plans sold were bronze policies, he said. Silver plans, the next tier up, made up 63 percent. Members prefer silver plans because their deductibles can be several thousand dollars lower than bronze deductibles, and silver coverage is likelier to pay more of the cost of smaller, routine expenses such as lab tests and X-rays. And premiums on some silver plans may just be a few dollars a month more than bronze versions.

Christopher Carothers, president of Carothers Insurance Agency in Las Vegas, agreed, saying that his analysis of existing plans shows tweaking the formula a little wouldn’t push many people who haven’t purchased insurance off of the fence and into buying.

“The reason they say they don’t have insurance is because they can’t afford to pay the premiums,” he said. “Even if they could afford to pay the premiums, they couldn’t afford to go to the doctor (because of out-of-pocket costs).”

Carothers said entire families are walking away from plans with premiums as low as $200 a month, because they’re worried about high deductibles.

“This is not enticing enough for them to get past it,” he said. “I’m not sure where a copper plan would come into play, or even a tin plan, for that matter.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.

 

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