Woman Fights for Refund After Surgery

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For Sandra Solazzo, 2018 was a difficult year. She lost her mother in July and had a hysterectomy in October after doctors made an alarming discovery.

“They found out that I had a fibroid on the back of my uterus the size of a melon,” Sandra said.

The surgery went well and more than a year later, she had recovered well.  But she was still fighting for the thousands of dollars she paid out of pocket for the procedure.

“It’s hard,” she said. “It’s hard to get answers.”

Sandra said she signed up for insurance through the marketplace in January 2018 and chose a policy with Ambetter because they had a vision plan.

“And I liked that idea along with healthcare,” she said.

She said she paid her monthly premiums on time and didn’t know there was a problem until she got a check in the mail later that year.

“I think I got $170 back,” she said.

When she asked about the refund, Sandra said she learned her policy had been canceled in June, after she lost her tax credit and had been sent a bill for $1,200. 

“I never got that bill,” she told NBC 6 Responds.

Her request for reinstatement was denied in September. A month later, Sandra said she had the surgery anyway and paid thousands of dollars out of pocket, hoping she would be able to get that money back once things were sorted out.

“I was really hoping,” she said.

She filed a complaint with the state and in November was told her policy was being reinstated effective January 1, 2018.

“It’s a little bit of relief,” she said.  “I was thinking, OK, I’m going to get some money back.”

She said she sent Ambetter several member reimbursement forms, but was told Broward Health had to send the claims.  So she asked Broward Health to file a claim, so Ambetter could process it, but she said that request was denied.

“I was like, this is crazy,” she said.

So she asked NBC 6 Responds for help.

“I would like to see Broward Health file the forms, even though they’re 180 days old now and try to get me my money back for at least the surgery,” she said.

Broward Health told NBC 6 Responds they would look into Sandra’s situation. 

Ambetter sent the following statement: Ambetter from Sunshine Health is committed to ensuring our members have access to high-quality healthcare.  While we cannot discuss individual member cases due to health privacy laws, we encourage both members and providers to contact us with any questions or concerns.

After NBC 6 Responds reached out, Sandra got a call from Ambetter saying Broward Health had agreed to submit the claims and void the self-pay agreement Sandra had signed on the day of her surgery.

“I was really surprised at how quickly I was contacted by the company after NBC 6 Responds got involved,” she said.

Sandra said she eventually received the call she was hoping for when Broward Health called to say they were sending her a check for more than $4,800 – a partial refund of the $10,000 she had originally paid.

If you’re having an issue with an insurance company, you can always do what Sandra did and file a complaint with Florida’s Department of Financial Services’ Division of Consumer Services by clicking here.

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