Cancer Patient Succeeds in Fight Against Health Insurance

Legal Aid Society of Orange County’s Health Consumer Action Center (LASOC-HCAC) assisted Lily* a 51-year-old monolingual Vietnamese speaking woman, who was battling bone marrow cancer, with an erroneous medical billing issue.

While Lily was recovering at a skilled nursing facility due to a fall, her medical bills were mistakenly submitted to and paid by her former health plan instead of her current plan. Months later, she was dismayed to receive a billing statement in the amount of $13,000 from her former health plan. Her insurance company demanded the money that they authorized in error and refused to waive it.

Lily sought help from friends due to her limited English proficiency, and even tried, unsuccessfully, to navigate the legal system on her own. After exhausting all of her resources, she filed a complaint with her former insurance company but was denied. Lily was devastated, and with a final straw of hope, Lily called LASOC.

LASOC-HCAC took Lily’s case, thoroughly reviewed the information and evidence, and was determined to find a way to assist her. LASOC-HCAC felt Lily had a solid defense due to her efforts to terminate her initial plan, as well as the fact that the insurance company’s authorization of the payment without checking to see if her coverage was current. LASOC-HCAC filed a complaint to the Department of Managed Health Care (DMHC), and soon after, DMHC issued a favorable decision.

Lily was overjoyed when she learned the insurance company agreed to waive the recoupment and retrieve her accounts back from collections. With LASOC-HCAC’s help, Lily was able to avoid a lawsuit, maintain her credit record, and finally, concentrate on her path toward recovery.

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*Name has been changed to protect identity.