We the Patients

New Parents Owe $400,000 Due to Misinformation Provided During Enrollment – June Caspi, NYC

I don’t know about you but becoming a parent is pretty exciting. You can’t wait to meet this new person who is about to become a part of your life forever. As a new chapter of your life begins, it also comes with concerns you didn’t previously have. “Do I have everything I need?” “To breastfeed or not?” “How will I manage a (seemingly) never-ending stream of sleepless nights to come?”

One thing NO parent should be worrying about: will having this baby put me into medical debt?

Even worse than financial insecurity is a sick baby. June Caspi’s parents were terrified when their daughter entered this world with life-threatening medical conditions that kept her in the hospital for the first few months of her life. Running back and forth between their home, work and the hospital, June Caspi’s parents were blindsided when their mailbox started to fill with huge medical bills. How could this be happening? June’s father enrolled her in good health insurance (the same insurance he and his wife were on). With a little research, they quickly realized due to misinformation about when June’s insurance started, June was uninsured the month she was born. As a result, the invoices for June’s medical needs totaled nearly $400,000.

June’s parents were crushed with the enormity of the situation.

June’s father was miserable. Not only was his infant daughter extremely ill and facing perhaps a lifetime of medical issues, but he was being asked to come up with almost half a million dollars. “For a long time, it was surreal,” he recalls, “like a shadow hanging over me. I started thinking I would be in debt for the rest of my life. It was a nightmare.”

June’s father was at a loss; he called a patient advocate for help. Together they applied for financial assistance, which reduced the bill by $98,000. Still on the hook for $300,000 he appealed the decision. His argument was twofold:

  1. His family just couldn’t afford to pay that much in medical bills
  2. He followed protocol at enrollment and should not be penalized for the misinformation of when June’s coverage would actually start

After bringing this argument to both the New York State of Health and the insurance plan’s legal counsel, the hospital provided charity care which reduced the balance to $15,000. The patient advocate kept fighting. After many months of phone calls and letters and negotiations, the health plan finally agreed to pay the great majority, and the hospital wrote off the rest.