Obamacare snarl could bankrupt NJ couple

Posted at 1:23 PM, Mar 05, 2014
and last updated 2014-03-05 13:23:31-05

NEW JERSEY (PIX11) — We first introduced you to Fred Rosamilia in the fall when a group of doctors at a prominent New Jersey hospital refused to give him a bone marrow transplant. Not because he didn’t have insurance. He did. But because it would run out AFTER his operation.

The doctors told him it would be “unethical” for him to get the operation and then not have coverage for the drugs he would need later.

Fred ditched the medical team and hospital and got his transplant, and a few more rounds of chemo to boot. And on January 1, his wife signed them up for Horizon Blue Cross and Blue Shield. They chose the “gold” plan under the Affordable Care Act.

They pay $800 a month for a gold plan; the government gives them an $800 a month subsidy because Fred doesn’t work and Lynne doesn’t have a huge salary either.

They felt the insurance plan would be worth it, though. It would give them low co-pays for all the visits, and there are lots of them.

“When we told our doctors we were going to be sticking with the Horizon plan through Obamacare they said ‘great, we participate with Horizon.’ So we said ‘home run!’’”

Only once the bills started coming in, turns out their gold plan was not the gold standard. Horizon Blue Cross only participated with the Rosamilia’s doctors on the less expensive, higher co-pay, silver plan, something Lynne found out while Fred was nearly unconscious post transplant, and something even the billing department at the hospital couldn’t understand or explain.  And then the other shoe dropped.

“I overheard nurses say to each other they can’t touch Fred til we talk to billing. That put me in tears,” recounts Lynne. Fred was in an extremely delicate part of his recovery, and even though they had insurance, they were virtually uncovered since their plan didn’t participate with the doctors.  The hospital did.  The silver Horizon plan did.  But the gold Horizon plan did NOT.  Lynne was dumbfounded.

And then when she started to look at the numbers, she realized they had two months of cancer treatment bills, with virtually no coverage.  “The billing department said, ‘we are learning with you on all of this. It’s all new to us, too.’”
After petitioning through the Affordable Care Act hotline, Horizon did finally let the Rosamilia’s switch to silver.

I turned to Fred, who has just the lightest dusting of stubble on his chin, still no eyelashes, courtesy of the continuing chemotherapy. I ask him how frustrating is this to be going through cancer treatment while navigating the medical minefield that threatens to bankrupt the couple. “I look at it this way, I take care of one thing at a time,” he says philosophically.