The unlikely scenario happened, and one of the family needed more than just routine medical care. Claims came in that exceeded the individual deductible of $5,500, and they didn't pay. They're saying that the deductible is $11,000. I'm working with the state insurance commissioners office now.
The final entry of the saga.....
Today I sued BlueCross BlueShield of NC. But, alas, I lost my case.
In between when I realized the HSA policy I bought would not honor the individual deductible, and the case in small claims court today, they had me running around, wasting a lot of time....
First, they said it would be up to the federal marketplace to fix it. I got a "HICS escalation" that went nowhere. That took a month and a half. Then I got the NC DOI to contact BCBSNC on my behalf, and that also went nowhere.
The state department of insurance (NC DOI) looked promising because I had found a case of a guy in Arizona (also on the federal marketplace) who had the exact same complaint: misled by the insurance company product materials about how the individual deductible would work on an HSA-eligible policy. In that case, the injured party got a remedy: the insurance company honored the individual deductible:
Health Net Reviews (search for 'zack of Anywhere') . But I think Wayne Goodwin, Insurance Commissioner in NC, is just a lap dog for BlueCross BlueShield of NC. He rolled-over for the insurance company.
In my case this morning, I showed that the 2014 brochure (linked to from healthcare.gov) lacked disclosure of what they call the "family agregate deductible" on HSA-eligible policies. The 2011, 2012, and 2013 all
had the disclosure, but the 2014 brochure
did not. There was, in fact, nothing on the healthcare.gov site that called-out the defect in the policy, but there were some instances where the deductible that showed was the family deductible only (and the individual deductible was not showing on that page). I'm not sure the judge understood that even the plans that would honor the individual deductible would still just show only the family deductible on those screens. In other words, just
not mentioning the individual deductible doesn't mean that it isn't in effect for that policy.
But it is what it is. I spent $130 bucks to sue them, and it was somewhat satisfying to drag them into the courtroom and make them listen to me harp on this for an hour, hehe! I got my day in court, as they say.
I'm greatful that it's over now, since I've been wasting so much time and gastric juices on this. The good news is that instead of being out $5,500, that figure is now down to $2,500, since my wife and I have racked-up $3,000 worth of "free" medical expenses that otherwise would have been out of pocket. And the year ain't over yet!