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March 25. 2014 10:21PM

Nurse wins 'David and Goliath' fight after being left uninsured

CONCORD— A local woman is gaining national publicity for successfully challenging an error in the processing of her health insurance that left her uninsured through no fault of her own.
 
 
"It felt like David and Goliath," Terry Wetherby, a retired nurse living in Concord, said Tuesday. "It's been going on since Feb. 28, when I realized I had no insurance and hadn't had any since Jan. 1, even though I thought I did and was sending in payments."
 
 
The same problem affected at least 100 other Granite State residents who smoke cigarettes, and admitted as much when they applied online for Obamacare at healthcare.gov.
 
 
Anthem cancelled their policies earlier this month with no explanation. Only after the N.H. Insurance Department and federal officials intervened did Anthem acknowledge that smokers had been assigned non-smoker rates and their policies were cancelled.
 
 
The insurance company accepted no responsibility for the error, but in a March 18 letter to the Insurance Department agreed to restore coverage to the smokers at the non-smoker rate, at least for the rest of the year.
 
 
Anthem, the only insurer offering plans on the Obamacare online exchange for New Hampshire in 2014, attributed the problem to the system used to update rates with the Centers for Medicare and Medicaid Services.
 
 
"The root cause of the issue was in the system through which carriers submit data to CMS," said Christopher Dugan, spokesperson for Anthem Blue Cross and Blue Shield. "We have been assured that the issue has been resolved going forward."
 
 
The Center for Medicaid and Medicare insists that Anthem made the mistake and is correcting it by sending new information to the central clearinghouse for Obamacare.
 
 
Terry Wetherby applied for coverage on the website in November, and was approved for a plan that took effect on Jan. 1, with a monthly premium of $709. After subsidies, the 64-year-old was left with a premium of $26.
 
 
All she wanted was coverage that would carry her over to Medicare until she hit 65 in October. What she got instead, after paying two months of premiums, was a refund check from Anthem for $26 dated Feb. 20 with a two-word explanation: "Contract Cancelled."
 
 
Wetherby started a month-long effort to find out what happened and make it right. She contacted Anthem, the state's entire congressional delegation, the governor, the Insurance Department, and anyone else who would listen.
 
 
She started a Twitter feed with tweets to media outlets, elected and appointed officials, and regulators, hoping to get some answers. A reporter for the national news website, Pro Publica, picked up on the tweets and told Wetherby's story in an online article posted Monday.
 
 
By the time Pro Publica reported on Wetherby's dilemma, she had succeeded through sheer determination in resolving the situation and restoring coverage for herself and at least 100 others. But it wasn't easy.
 
 
Dugan would not confirm that the 100 smokers would be renewed at smoker rates in 2015.
 
 
"We are working closely with the exchange to process these applications and enroll the affected individuals as soon as possible," he said. "Anthem will also be reaching out to the affected individuals directly with additional information shortly."
 
 
The spokesman for the N.H. Insurance Department says there is no doubt the 100 or so policyholders affected checked the "smoker" box on their health insurance applications.
 
 
"We are pleased that Anthem has agreed to do the right thing on behalf of these consumers even though the company feels the glitch was not of its making," said Danielle Kronk Barrick, director of communications.
 
 
A spokesman for the Centers for Medicare and Medicaid Services said there is no doubt where the problem originated.
 
 
"While we understand the templates are complex, this was an error committed by Anthem," said Aaron Albright, director of media relations at CMS.
 
 
Wetherby, who worked as a nurse at Concord nursing homes before her retirement in 2013, did not set out to become another Obamacare horror story. She said she has been a supporter of Obamacare over the years and still is.
 
 
"I really believe that everyone should be insured and that it should be affordable," she said. "Obamacare was supposed to stop insurance companies from cancelling you, and here I was, paying my premiums, and they cancelled me anyway."
 
 


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