A Cathlamet family whose son is recovering from a traumatic brain injury recently lost its health insurance coverage after Kaiser Permanente recognized that its address is outside of the company’s service area.
Kaiser representatives say the company’s decision to terminate the policy did not relate to Beau Carlson’s nearly $1 million in medical bills, but family members are calling the situation “fishy” and “frustrating.”
“I know they are going to tell me that their hands are tied … but I know there’s something that’s not right here,” said Leihanna Carlson, family matriarch.
The Carlson family has been insured with a private family policy under Kaiser since 2011, she said. During that time, they’ve lived at their home in Cathlamet. They also own Carlson and Sons Logging, also based in Cathlamet.
Beau Carlson, 16, suffered a traumatic brain injury in September during a high school football game. Since then, the family has accrued almost $900,000 in medical bills, his mother said.
Kaiser has paid most of Beau’s medical bills without any major hiccups, Carlson said. But on Feb. 5, the family received a letter stating their policy would be cancelled at the end of that month.
“I thought maybe it was a glitch,” Carlson said. “This just came out of nowhere.”
Kaiser Permanente of the Northwest Region covers residents in Cowlitz and Clark counties. The Carlson’s Cathlamet home is located in Wahkiakum County, just about three miles outside of the Cowlitz County border.
When Carlson called the company to ask why her family had been dropped, a Kaiser representative cited the family’s address.
Carlson signed a release last week allowing Kaiser to discuss the case with The Daily News.
In a prepared statement sent to The Daily News on Thursday, Kaiser spokeswoman Debbie Karman said, “We value every Kaiser Permanente member and sincerely wish we could continue to provide care for the Carlson family; however, we are not permitted to sell individual and family plans outside of our designated service area.”
Karman’s statement pointed to “improved technology and processes for identifying when a member is not within our service area” as the reason why the company just found out the Carlsons are not eligible for Kaiser coverage.
Other Kaiser representatives told Carlson that the company “didn’t have a system in place that necessarily tracked that information accurately. They recently updated the system,” she said.
Kaiser spokesman Mike Foley said Friday that there was no direct connection between the system catching the out-of-area address and Beau’s recent medical bills.
Carlson said she thinks the company’s decision was “negligent on their part.” The family filled out a yearly form to confirm their address, she said, and the Cathlamet zip code had “never been an issue.”
“We’ve lived in this house for eight years. Eight years (Kaiser) accepted us as customers. … To me, that’s what’s fishy about it. They’ve had eight years to catch us living outside of their service and they didn’t (see it) until they started paying,” Carlson said.
She added, “I feel like they are discriminating against us. They just paid over $900,000 for Beau.”
Insurance companies are legally allowed to drop customers that live outside of their area, said Stephanie Marquis, spokeswoman for the Office of the State Insurance Commissioner. And in a case like this, a company is not obligated to notify their customers of the policy termination — although Kaiser did send the family an advance notice of the cancellation.
The Carlson family has yet to find a new health insurance provider, Carlson said. However, after The Daily News contacted the company for comment last week, Carlson said Kaiser agreed to reinstate the family’s coverage through May 31 while they look for a replacement.
“I feel like they are putting a two-month Band-aid on their screw ups, and it’s really still just hurting our family long-term,” Carlson said.
The Carlsons are considering starting new policies with Premera or Regence, Carlson said, but it’s “heartbreaking to switch everything. ... To have someone having to get to know my children all over is so incredibly frustrating.”
Carlson also fears having to pay “outrageous” rates because Beau’s head injury qualifies as a patient with a pre-existing condition. Moreover, Beau is still considered an “active patient,” and he is continuing to see neurologists for follow-up visits to track his recovery, Carlson said. The family will need to find a way pay for check-ups this month, again in six months and once more in a year, she said.
“He is still a fragile kid. Only seven short months ago he nearly lost his life, not once but twice,” Carlson said.
“This just took a completely stressful period in our life and added to it. When is it enough already?”