CENTENNIAL, Colo. — A Centennial couple told Denver7 they feel scammed because their son's birth wasn't covered by the hospital's liability insurance.
This holiday season marked some firsts for McClinton and Bree Heil. Their son Haynes celebrated his first Christmas and New Year.
“I delivered my baby at Rose Medical. Great hospital, great team, and the nurses were amazing,” McClinton Heil said.
Although giving birth was a great experience, what happened after was not so great for the couple.
In November 2023, before the birth of their son, the couple purchased hospital coverage insurance through MetLife. Hospital indemnity insurance is a supplementary insurance policy that can cover a consumer's hospitalization expenses.
“We're online [and] I saw that the tagline on MetLife's actual website was “Hey, are you pregnant?” You should sign up for this for next year,” McClinton said.
The couple expected to reach the height of their happiness in June 2024, so they took out additional insurance.
“Everything was fine until June. We had a baby, so then I went to get a refund. And then I spent three months jumping through hoops back and forth with MetLife. Let's say MetLife ultimately denies the allegations,'' McClinton said.
In September 2024, the Heils were told, in part, that “your claim is denied because the asserted condition was caused by or arose from a pre-existing condition.” I received a letter.
“They basically said it was a pre-existing condition that she was pregnant the year before we enrolled in benefits,” McClinton said.
“I never thought pregnancy would be considered a pre-existing condition. It sounds like epilepsy, but it's not pregnancy,” Bree Heil said.
The Heils filed a complaint and received an answer justifying the denial of the claim.
“We have confirmed with your employer that your employer has posted informational materials on its internal registration website in advance of the 2024 plan open enrollment season. “We have reviewed and determined that the MetLife Group Hospital Indemnity Insurance Plan contains a citation or statement that there are applicable pre-existing condition limitations,” the letter said.
Denver7 reached out to MetLife to review the pre-existing condition restrictions listed in the Heil family's policy. In the “Definitions” section, pregnancy is considered an “illness” within the policy.
“I was always pregnant before I signed up. Why didn't you tell me that first instead of various emails and phone calls?” Bree said.
“Hospital coverage plans can pretend to be a type of health insurance,” says Govind Persad, an associate professor of health law at the University of Denver's Sturm School of Law. “The problem with these plans is that they are not subject to the regulations of the Affordable Care Act, so they have a lot of latitude in defining what is considered a pre-existing condition.”
“I completely understand why someone would feel cheated,” Persad added.
“It's not really about the money. It's more about informing the community so they don't get scammed,” McClinton said.
People who have questions about adding a supplemental insurance plan should first check whether the plan is covered under the Affordable Care Act and whether it covers pre-existing conditions, Persad said. said. If you receive insurance through your employer, you can contact your human resources department for clarification.
Persad said you should always read the fine print on your insurance plan.
“people are busy. “They're doing a lot of different things, but they may not be in a position where they have the expertise to look into the finer points of health insurance plans,” Persad said. I think the initiatives that I know of have some kind of monitoring program that provides that. If you reach out to them, you might be able to help people understand. ”
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