BOSTON (CBS) — Imagine paying hundreds of dollars a month for health insurance you can’t use. The I-Team found that is a painful reality for thousands of Massachusetts residents, many of whom were forced to make some tough choices about their health.
Shaun Maciel is one of those thousands. Her Falmouth backyard was covered with snow when she first wanted to see a doctor about the pain she was having in her stomach.
“I need to have a scope go down my throat and look into my stomach and see what’s going on, and I can’t have it done,” she said.
Patrick Clapham of Peabody went months without high blood pressure and ADHD medications.
“I had to drop out of my classes because I couldn’t get through them without my medication,” he said.
Both Shaun and Patrick were insured through the Massachusetts Health Connector, a marketplace of affordable care options for the uninsured, or at least they thought they were. They both paid premiums, but had a difficult time actually using the insurance.
Shaun paid $331.30 a month and for more than three months, she was not able to make an appointment because the insurance carrier claimed she was not covered.
She began making phone calls to state officials back in February. Shaun called the Health Connector, the attorney general, and the governor, but she couldn’t get any help.
“The governor’s office can’t even get something done. Where do I go? I go to Channel 4 because they are going to get something done,” she said.
The I-Team reached out to the Health Connector and a few weeks later, Shaun was offered a partial refund of her premiums. We also learned the Health Connector was dealing with about 3,000 similar cases.
“We’ve been digging out of a lot of operational difficulty this year,” explained Louis Gutierrez, who took over as director of the Health Connector in January.
He told the I-Team his agency has spent a half-million man hours trying to fix a broken system.
“People have gone through a lot of difficulty, so to those individuals I would offer our sincere regrets,” he said.
In an effort to improve his agency’s efficiency, Gutierrez added more customer service agents and existing workers are being retrained. The office also recently announced an ombudsman program to help work through customer service issues.
To those who paid premiums they couldn’t use? “We are committed to a fair and equitable resolution of those cases,” he promised.
But Maciel didn’t think there was anything fair or equitable about her partial refund, so the I-Team continued to fight for her. Eventually, the Health Connector agreed to refund all of her premiums, more than $1,000 worth.
She was finally able to make that appointment with her doctor, more than eight months after she first tried to resolve the situation.
“It’s been very stressful for me, and I’m sure that it hasn’t helped the stomach condition,” she said.
According to Gutierrez, his office resolved most of those 3,000 cases, but he told the I-Team the agency has a long way to go before he will be satisfied. However, he does expect this year’s open enrollment to go much more smoothly. We will find out in November.