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Old 08-13-2013, 01:56 PM  
Cave Johnson Cave Johnson is offline
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Dying Man Denied Health Coverage Over Missing 26 Cents

American health care, WE'RE #1!!!1!!!

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When Sergio Branco was diagnosed with acute myeloid leukemia earlier this year, his family knew the resulting medical expenses would rack up quickly.

Which is why, the Star-Ledger reports, the Edison resident and his wife Mara did everything they could to ensure that he was fully covered by a health insurance provider.

Unfortunately, after three months of leave to undergo chemotherapy, the 33-year-old truck driver was fired from his job at the waste management company Russell Reid.

Luckily, the Brancos had a fallback plan: Keep Sergio's health coverage going by signing up for coverage under the Consolidated Omnibus Reconciliation Act, or COBRA.

ThinkProgress explains:

Employers pick up a big part of the tab for their workers’ health insurance premiums (that’s why it’s “employer-sponsored”). Under COBRA, however, terminated employees must cover the entire cost of their health insurance premium themselves — which means that health care becomes a significantly bigger expense for people after they lose their job. Workers receive written notification that they are eligible for COBRA coverage, and have 60 days after that point to decide whether they want to accept it.

With Sergio scheduled to undergo a $500,000 life-saving bone marrow transplant in mid-August, Mara knew it was critical to apply for COBRA coverage right away.

And so she did, sending a check for $518 to Paychex, Russel Reid's third-party benefits administrator.

Except that in her rush to maintain Sergio's health insurance, Mara inadvertently neglected to write down the full monthly premium amount on her check: $518 and 26 cents.

Neither she nor Sergio knew anything was amiss since Paychex happily cashed the couple's check, but a few weeks later Sergio was abruptly informed by the hospital that he was no longer covered.

Thinking it was just a matter of sending Paychex the missing 26 cents, Mara was shocked when a representative told her the company could not accept any additional payments from the Brancos per Russell Reid instructions.


Mara's next call was to Russell Reid’s human resources rep Rich Gross.

"The whole time he said Paychex is giving me false information," Mara told the Star-Ledger. "I told him if he’d just make a phone call everything would be alright. He said he’d see what he could do."

Gross did nothing, Mara said, and neither did the Department of Labor.

Even a letter from Sergio's doctor saying plainly that the young father would die without the transplant had no effect on the parties involved.

It wasn't until reporters and attorneys got involved that Paychex suddenly changed its tune.

Last week, just days before the transplant was set to take place, the Brancos got their health insurance back.

"The Department of Labor said the company will reinstate him from May till now," Mara is quoted as saying. ""They said the company did it wrong. I am super happy. It’s like a weight has lifted off my shoulder."

The Brancos have since decided not to pursue legal action.
http://gawker.com/dying-man-denied-h...nts-1122761781
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Old 08-14-2013, 06:33 PM   #31
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What is it about ADP you donít like?
The company I work for switched to ADP a couple of years ago.
What little I have to do with it is as an online time/labor record keeping program.
Mostly paycheck errors.
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Old 08-16-2013, 08:55 AM   #32
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btw... you care to weigh in on the thread itself? You agree with dickless that the actions of a 3rd party benefits management company are legitimate cause to indict the health care or health insurance industries?
Sorry, didn't circle back on this thread until now.

I don't think the actions of this particular entity are an indictment of the system. I think the system has been wildly dysfunctional for many years for a variety of reasons. This particular situation is basically just a thimbleful of water added to the Pacific.

As to this particular party's actions, I would argue that their accepting and cashing the check, without the $.26, constituted acceptance and obligated them to provide the COBRA coverage at issue. No idea if that would hold up at the end of the day, but if I were their lawyer, I'd also ask them if they REALLY want to go before a jury and have to explain why they let a patient die over $0.26....

That's not a case anybody would want to defend.
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Old 08-16-2013, 08:57 AM   #33
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Originally Posted by HonestChieffan View Post
Terminal stuff ends up in death. Obammycare will decide who and when we get care. Its just how it is.

Thanks for this post, regardless of the fact that it has absolutely nothing to do with anything actually being discussed in this thread.
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Old 08-16-2013, 08:57 AM   #34
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Originally Posted by Amnorix View Post
Sorry, didn't circle back on this thread until now.

I don't think the actions of this particular entity are an indictment of the system. I think the system has been wildly dysfunctional for many years for a variety of reasons. This particular situation is basically just a thimbleful of water added to the Pacific.

As to this particular party's actions, I would argue that their accepting and cashing the check, without the $.26, constituted acceptance and obligated them to provide the COBRA coverage at issue. No idea if that would hold up at the end of the day, but if I were their lawyer, I'd also ask them if they REALLY want to go before a jury and have to explain why they let a patient die over $0.26....

That's not a case anybody would want to defend.
Cashing a check very rarely constitutes acceptance. I do agree with the rest of your point, though.
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Old 08-16-2013, 09:04 AM   #35
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Originally Posted by Saul Good View Post
Cashing a check very rarely constitutes acceptance. I do agree with the rest of your point, though.

I understand. Obviously the amount may not have been in dispute, and they didn't write "full and final payment" or anything on the back of the check.

But the $.26 being nominal, and the check being cashed with, apparently, no notice back to the former employee, I think you've at least got an argument that it constituted acceptance.
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Old 08-16-2013, 09:52 AM   #36
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Originally Posted by Amnorix View Post
I understand. Obviously the amount may not have been in dispute, and they didn't write "full and final payment" or anything on the back of the check.

But the $.26 being nominal, and the check being cashed with, apparently, no notice back to the former employee, I think you've at least got an argument that it constituted acceptance.
Writing "full and final payment" really doesn't mean much, either. However, I believe that there are protections in place for the consumer when the discrepancy is a nominal amount.
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Old 08-16-2013, 11:50 AM   #37
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Originally Posted by Saul Good View Post
Writing "full and final payment" really doesn't mean much, either. However, I believe that there are protections in place for the consumer when the discrepancy is a nominal amount.

Agreed, though such things, or "accord and satisfaction" and such, can work in some relatively limited circumstances. But yes, usually they aren't very helpful.
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