A Colorado couple say they feel scammed after their son’s birth was not covered by their hospital indemnity insurance.
This holiday season was marked with several firsts for McClinton and Brie Heil. Their son, Haynes, celebrated his first Christmas and New Year’s.
“We had the baby at Rose Medical. Amazing hospital, great team there, nurses were fantastic,” McClinton Heil said.
While it was a great birth experience, what came after wasn’t so great for the couple.
In November 2023, prior to their son’s birth, the couple enrolled in hospital indemnity insurance through MetLife. Hospital indemnity insurance is supplemental insurance that can reimburse a consumer for a hospital stay.
“We went online [and] 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.
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Since the couple was expecting their bundle of joy in June 2024, they signed up for the supplemental insurance.
“All was well until June. We had the baby, and then we went to get reimbursed. And let’s just say three months of jumping through hoops with MetLife back and forth, and they eventually denied the claim,” McClinton said.
The Heils received a letter in September 2024 that stated in part, “Your claim is being denied because the condition claimed was caused by or resulted from a pre-existing condition.”
“They basically said it was a pre-existing condition that she was pregnant the year before we signed up for the benefit,” McClinton said.
“I just never would’ve thought pregnancy would have been considered a pre-existing condition because it sounds like epilepsy, you know, but not pregnancy,” Brie Heil said.
The Heils filed a complaint and received a response justifying the claim denial.
“We confirmed with your employer that in advance of the open enrollment season for plan year 2024, your employer posted informational materials on their internal enrollment website. MetLife reviewed those materials and confirmed they contain a citation or statement that there is a pre-existing condition limitation applicable to the MetLife group hospital indemnity insurance plan,” the letter read.
Scripps News Denver reached out to MetLife to review the pre-existing condition limitations listed in the Heils’ policy. Under the “definitions” section, pregnancy is considered a “sickness” within the policy.
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“I was always pregnant prior to signing up, so why wasn’t that just initially communicated as opposed to going through all these different emails and calls?” Brie said.
“Hospital indemnity plans can sort of masquerade as being health insurance,” explained Govind Persad, associate professor at the University of Denver Sturm College of Law. “The problem with these plans is that they have a huge amount of latitude to define what is considered a pre-existing condition because they’re not subject to those Affordable Care Act regulations.”
“I can completely understand why someone would feel scammed,” Persad added.
“It’s not really about the money. It’s more about letting the community know, don’t get scammed,” McClinton said.
Persad said anyone with questions about adding a supplemental insurance plan should first check to see if the plan is covered under the Affordable Care Act and if it will cover pre-existing conditions. If you receive insurance through your employer, you can reach out to your human resources department for clarification.
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Persad said you should always make sure to read the fine print of any insurance plan.
“People are busy. They’re doing a lot of different things, and they may not be in a position where, you know, their expertise is in looking at the fine print of health insurance plans,” Persad said. “There’s an organization called the Colorado Consumer Health Initiative that I know has some sort of watchdog programs where I think they offer that. If you get in touch with them, they may be able to help folks in understanding.”
This story was originally published by Amy Wadas at Scripps News Denver.
Source: Family feels scammed after birth isn't covered by hospital indemnity insurance
