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This cancer patient says dealing with his insurance is ‘worse than chemo’

February 9, 2017 - crohns
This cancer patient says dealing with his insurance is ‘worse than chemo’

For nearly half of his life, Aaron Bramley has battled life-threatening illnesses. His adult life has been punctuated by doctors appointments, diagnoses, medications, treatments, heartache, and frustration. But now he says hes fighting the hardest battle of his lifewith his insurance company.

Given his medical history, Bramley understands the insurance landscape better than most.

At 19, he was diagnosed with Crohns disease, which marked the beginning of what would be many health struggles to come. His medication kept the major symptoms of the inflammatory bowel disease at bay for a number of yearsuntil 2011, when he was diagnosed with Hodgkin's lymphoma, found to be caused by the medication treating his Crohns.

In 2013, Bramley was in remission from Lymphoma and went to the Mayo Clinic in Minnesota to establish a course of treatment for his Crohns. With his insurance at the time, Blue Cross Blue Shield, things went off without a hitch. But when his Arizona-based companyRidgewood Interactive Communications, where he is director of digital mediaswitched to Health Net for its health insurance coverage in 2014, things got increasingly complicated.

Im not a troll, Im advocating.

The health insurance system at large is set up in a purposely confusing and convoluted way, Bramley, now 32, told the Daily Dot in a phone interview. Money is able to disappear into the pockets of the company without accountability.

Bramley found himself back at the Mayo Clinic in August 2015 to adjust his treatment because it wasnt working as well as he had hoped. When he received a call from the clinic about one month later saying that it couldnt get in touch with Health Net to process his claim, he knew something was amiss. One month later, on Oct. 30, Bramley was hit with another bombshell: a cancer diagnosis. A biopsy done by his doctor at home in Austin, Texas, revealed he had stage 2 squamous cell carcinoma, best explained as skin cancer in the soft tissue around the anus.

When he received a $2,200 bill from the surgeon for the biopsy, which he claims should have been covered, he finally found out that his 2015 claims were all being processed locally in Arizona instead of out of state as his plan allowed. That left him with a mountain of bills for medication and procedures that he was forced to pay for out of pocket, and calls from many doctors offices confused about why they couldn't get in touch with anyone at Health Net to process his claims. He even once received a bill from the Mayo Clinic for $19,000.

This type of flagrant error for an entire year, I have not experienced before, he says.

The last thing a person going through treatment for cancer wants to do is spend hours on the phone trying to clear up issues with their insurance provider. But in the past few months, thats become the norm for Bramley. Hes been passed around from people in call centers overseas, to his companys assigned representative, to members of Health Nets escalation team, and ultimately to Larry Wong, the company's vice president of customer service. Months later, he's still without definitive solutions or answers.

In his small company of five or six people, most people have not had serious issues , Bramley says. Nothing on the scale Ive experienced.

Health Net has a one-star rating onConsumer Affairs website. (In fairness, other large healthcare companies like Aetna, United, and Blue Cross Blue Shield boast the same rating.) One recent reviewer called it a sorry excuse for a company. Another warned run and run fast from signing up. Just last week, Scripps News Washington Bureau and WCPO released an investigative report about problems with the Veterans Administration (VA) in Cincinnati. It explains how veterans were given the choice to go outside of standard VA care and pursue care from two private insurance companiesone of them being Health Netto avoid long wait times for appointments and procedures. In the end, veterans with the private options were forced to endure even longer wait times and hours on the phone with representatives.

Despite a game of perpetual phone tag, his situation remains unresolved. Since mid-September, Ive been on this mission to figure out whats happening, he says. And the latest part of that mission has involved using popular blogging platform Medium to share the details of his insurance saga.

He shared the first of his three-part series on Feb. 10,with the provocative title, With Respect Working with Health Net is Worse than Chemotherapy. In the post, he shares an email he sent to Jay Gellert, CEO of Health Net, the subject of which is the same as the blog post. It begins I write to you in some distress. He details his many struggles navigating the system and how impossible its been to solve his problem, all while battling cancer.

He writes:

So I ask you, whats wrong with this picture? Why should a cancer patient who is receiving chemotherapy and radiation for a potentially fatal illness be responsible for doing the job of a health insurance company? I seriously considered declining the health care coverage offered to me by my employer. I almost made that decision purely on the basis that were going with HealthNet again.

After one week, Bramley hadnt heard a word from Gellert. So he decided to take a different approach: a YouTube video. In the video, also shared via Medium, he invites Gellert to a meeting he already has set up with Larry Wong. The video is filmed as Bramley is about to head into a cancer treatment.

In Bramleys third Medium post, he expresses frustration about continuing to get the runaround from Wong and a member of the escalation team named Skye Davis. And still no word from Gellert. When Davis called to cancel a phone call between him, a representative from the Mayo Clinic, and Bramley, it sent the already frustrated man over the edge.

So let me understand this. You have been working on my case for a week and a half and you have nothing to show for it, other than canceling the meeting that I worked to set up? I asked.

He went on and on about how he doesnt want me to feel like they arent working on it, and some other customer service 101 psychology calm-down tactic (Hey, were making progress. Hes had training!) Then he said that he would be in touch with me when he had any information.

Since accountability is my mission, I asked him, When can I expect an update from you?

I should be able to get something to you by early next week.

Bramley has been tweeting all of his media at Health Nets official Twitter account in hopes that someone over there might help relay his message. I hope they have a social media person whos listening instead of just broadcasting, he says.

Im not a troll, Im advocating, he says of his near-constant tweeting at Health Net. Advocates you have to address. You have to open a dialogue and talk to them. Theres nothing more dangerous to a company that a determined enemy. Im not going away until I get some answers.

On Thursday, Bramley had his scheduled call with Wong. The two spent an hour on the phone, but in an email recapping the conversation, Bramley shares that little progress was made. He told Wong about his three hopes for the future of Health Net, broken down into three significant goals: "reduce the total average call time by 25%in two yearsand by 50%in 5 years...Make a public-facing timeline for resolving issues when they arise...Reduce the total number of problem-related calls by 25%in two yearsand 50%in five years."

Wong reportedly told him, I can tell youve put some thought into these, Im not sure about the numbers but any Customer Service lead would think these goals are great. But, as to be expected, Wong was unable to commit to concrete changes.

"With that, I told him that since they are unable to commit to anything, the disappointment I now feel is going to be part of my story moving forward," Bramley says. "A tremendous missed opportunity for them to set an example amongst insurance companies. He didn't seem bothered by that."

The Daily Dots effort to speak to someone about Bramleys situation served as a microcosm of his own struggles. We first reached out to Wong on Wednesday to no avail. We were able to reach Davis, who acknowledged he was familiar with Bramleys case. He then referred us to Brad Keifer in media relations, who would not acknowledge Bramleys case until Bramley signed a release form. In the meantime, we asked some general questions about Health Nets call center statistics and customer care. Wong later called back and also recommended we speak with Kiefer. Bramley emailed over the form shortly thereafter on Wednesday evening. At 7:42pm ET on Thursday, Kiefer got back to us with the following response:

Health Net is absolutely committed to providing an excellent customer experience, and we regret the frustrations that Mr. Bramley experienced.

We have worked closely with Mr. Bramley to address the issues he brought to our attention. And we are looking into our processes and procedures to determine how to prevent them from recurring.

Improving the customer experience is an ongoing process at Health Net, and we continually take steps to improve our service levels and address members issues promptly.

We wish Mr. Bramley and his family well.

No tangible progress has been made on Bramley's case, but he plans to continue documenting the latest developments, or lack thereof, on Medium, and to keep battling cancer. He cited one particularly difficult experience last year with giving him the perspective needed to push forward.

On Dec. 21, he was scheduled to have a chemotherapy treatment and his pregnant wife, Alison Thomasson-Bramley, needed to have three tumors removed from her neck. Hedropped her at the hospital, went for the chemo, and came back to find that what was supposed to be an outpatient procedure had taken longer than expected. The following day, he went for radiation and a five-hour chemo infusion, and then went to pick up Allison from the hospital where she'd stayed overnight.

Some wonder how he's survived it all. Its amazing, you can. People are impressive. They can handle everything, Bramley says. When I tell my story to a lot of people, they say, Youre amazing. I cant believe youre doing that.' But its what humans do. We survive. We live through things.

Photo via Aaron Bramley

Read more: http://www.dailydot.com/lifestyle/aaron-bramley-health-net/