Updated 

Obamacare error delays Vegas woman’s surgery


LaTrina Reed is slowly bleeding out.

Nearly a dozen growths are devouring the Las Vegas woman’s uterus and ovaries, and Reed, 49, hasn’t had a break from blood flow since February. She said she constantly feels like she’s about to give birth. She needs a biopsy on a potentially cancerous ovarian cyst. Reed’s ovary is twisting out of place; she said doctors told her it could quickly lose its blood supply, rupture and threaten her life.

A hysterectomy and cyst removal would cure Reed’s condition.

There’s just one catch: The surgery costs $30,000, and Reed has had no health coverage though she has paid seven months’ worth of premiums to Nevada Health Link insurance exchange, the marketplace through which consumers buy subsidized insurance under the Affordable Care Act, or Obamacare.

Reed’s insurer, Health Plan of Nevada, had no record of her.

A single mom, Reed has paid $1,700 in out-of-pocket medical costs in 2014. Her employer, a four-person gaming-supply company that can’t afford employee coverage, has ponied up another $2,500 to help. But that $30,000 is insurmountable. Reed’s desperation was mounting.

“I walk around in pain all the time. I feel like I’m starting to crack up. I don’t understand why I keep paying for something and no one is doing anything,” Reed said Wednesday. “I get a statement each month. They ask me to pay more, and I’ve done that. Still nothing. No paperwork. It’s literally like I’m in China, speaking to someone who doesn’t understand a word I’m saying. I don’t exist, but they’re taking my money.”

Reed’s situation changed late Thursday, after the Las Vegas Review-Journal began looking into her insurance troubles. Thursday morning the paper contacted the exchange, Health Plan of Nevada and exchange contractor Xerox for comment. Within two hours, Reed said, Health Plan of Nevada called to tell her she had been added to its system and had a member ID number.

Reed said late Thursday that she was relieved that her situation seemed to be resolved. But she also said she is angry that the exchange strung her along for months when her problem could have been fixed in just two hours.

“When you’re messing with people’s lives, you need to step in and address the situation,” she said. “I’ve been fighting this for how long? I’ve been making monthly payments for how long? That’s what’s hurtful.”

The Review-Journal has written about other Health Link customers who have had trouble getting bills covered after heart attacks and premature births. But Reed’s case is different. Although serious and in need of treatment, her condition is not yet a life-or-death emergency that a hospital would treat regardless of ability to pay. Because of that, one couldn’t even schedule her procedure.

When asked for comment Thursday morning, Nevada Health Link representatives said they were trying to fix Reed’s insurance issues.

“We are well-aware of Ms. Reed’s enrollment situation, and have been actively working with her and her carrier to help resolve this issue,” exchange spokesman Tyler Klimas said.

Health Plan of Nevada officials in a statement late Thursday said they are “moving with urgency to have Ms. Reed’s procedure scheduled immediately and are committed to ensuring that she is provided ongoing access to health care services. Ms. Reed’s issue was a result of us not receiving all the necessary information in a timely manner and all parties appreciate Ms. Reed’s patience to resolve this issue.”

A company spokeswoman said Reed’s procedure would be scheduled by the end of the day Thursday, but Reed said at 5 p.m. that she was still waiting to hear back from the surgery center.

Representatives with Xerox, the contractor that built the exchange’s website, said late Thursday that they would not comment “out of respect for patient confidentiality.”

Xerox’s system is supposed to send insurers enrollees’ details and premium payments. Yet, some consumers say carriers never received their sign-up information or their money, and there’s no record of them in any system. The mix-ups have been so frequent and intractable the exchange board fired Xerox in May, and will instead use the federal exchange’s system for November’s open-enrollment period.

Just how widespread the sign-up problems are is unknown. The exchange board pulled from its Thursday meeting agenda an update on a Xerox report on unreconciled cases in which the contractor can’t trace accounts, identify enrollees or calculate the right premium tax credit. Board members said the analysis had begun, but was not complete enough to discuss.

Exchange director Bruce Gilbert told the board that health care technology consulting firm PCG Boston will be in Nevada next week, meeting with insurers to identify what is causing reconciliation issues and how to fix them faster. Gilbert said the problem caseload was “in excess of 10,000” on July 31 but had dropped to just over 6,000 by Wednesday.

Also, the Las Vegas law firm of Callister Immerman &Associates has estimated as many as 6,000 of Nevada Health Link’s 38,000 enrollees may be paying for coverage they’re not getting. The firm filed a class-action lawsuit in April over the policies. Reed has joined that lawsuit.

Now, she’s waiting for her surgery. Until she is well, she can’t help with shipping or packaging at work. Her boss, Melissa Thammavongsa, estimates Reed has lost $15,000 in productivity, a difficult drain for such a small business. Thammavongsa herself has also taken time off to rush Reed to the hospital.

Even as she awaited her surgery scheduling Thursday, Reed fumed about struggles she and other health link customers have endured.

“They’ve disrupted people’s lives. That’s what’s so frustrating.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.

 

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