I-Team header

I-Team

<b>I-Team:</b>  Insurance Shocker

I-Team: Insurance Shocker

Aaron Diamant

When employees sign up for health insurance through their companies, most just assume the cards they get are worth something, but an I-Team Investigation found, in Wisconsin, insurance companies can actually cancel a group's coverage without telling the group's members.

When doctor's diagnosed Dan Szerbowski of West Bend, who made a living laying tile, with colon cancer, he thought he had health insurance.

"Nobody let me know," Szerbowski sighed in a March interview.

So, when his doctors told him he needed expensive surgery, Szerbowski gave the hospital what he figured was a valid insurance card and had the operation.

"I was laying in my bed when I got a phone call to my room from the billing department at the hospital," Szerbowski recalled. "That's when they said they were having issues with my insurance."

So, from the recovery room, Szerbowski called his boss at Newburg Tile, Howard Bruss.

"He said, 'It's all taken care of. Don't worry about it.' And I said, 'are you sure?' He said, 'yes, you have insurance. I promise. You just worry about getting better, taking care of yourself.'" Szerbowski said.

Bruss did sign his employees up for health insurance three months earlier, but the very first check Bruss wrote to secure coverage from United Healthcare bounced. When that happens, it's like the policy never existed.

"We just were in shock," said Szerbowski's wife, Sharon. "We couldn't believe that he let this happen."

Making matters worse, Bruss seemingly never said a word to anyone. It left the Szerbowskis, who never got the chance to find other insurance, drowning in a nearly $200,000 debt.

"I don't know how we'll ever, ever pay for this," Sharon admitted. "Truly, unless we go bankrupt. I don' t know how we're ever going to pay for this."

When we finally found Bruss, we asked him why he never told any of his employees that the insurance had lapsed. He told us he didn't tell his employees, because the insurance company never told him.

However, under Wisconsin law, when an insurance company cancels a group's coverage, it has to notify the policy's administrator, in this case, Howard Bruss.

The I-Team got ahold of the cancelation notice United Healthcare sent Bruss two months before Szerbowski got sick. With it was another letter Bruss was supposed to give his employees.

That second letter warned, "all covered members in your group have been canceled," and "you will be responsible for any claims for health services incurred by you or your dependents."

The I-Team showed Bruss those letters.

"I'll tell you right now, I don't know what this is. I've never seen that in my life," Bruss said.

Bruss went on to say that had he went to the hospital last at the same time as Szerbowski, he would have thought his insuranace was valid, too.

Whatever he thought, a spokesman for United Healthcare swears the company sent Bruss those letters, but Szerbowski's family can't believe United Healthcare never sent Dan a heads-up directly.

"Right now, he'd be sitting in a completely different boat if he just got one phone call from somebody at United Healthcare saying, 'You know what? We revoked your policy,'" argued Szerbowski's stepdaughter, Jennifer Schmidt.

Turns out, United Healthcare didn't tell Szerbowski it canceled his policy, because it didn't have to.

"People have to know that they don't have insurance," exclaimed State Representative Sheldon Wasserman of Shorewood. "This is a life and death situation."

Wasserman, himself a physician, was floored to find out, under state law, insurance companies only have to notify a policy's administrator, not the individual group members.

"They send out notices for everything else about different health programs and this discount and this discount. They can't send out a letter that's more important than saying that your insurance is not being paid for," Wasserman wondered.

It means, there's no fail-safe for consumers if the boss doesn't say anything to the people working for him.

"That just should not be taking place in the State of Wisconsin," said Wasserman. "It's wrong and we're going to do something about it."

While changing state law may help other families from getting caught off-guard, the Szerbowskis are still stuck.

"The reality is the bills are still there," Schmidt said. "Someone's got to pay them."

Some single bills are as high as $31,000.

The one bright spot: Szerbowski's latest CAT scan shows his cancer may be gone. Now, he's back at work laying tile, but still without health insurance. Szerbowski still worries about what would happen if his cancer came back.

"I don't know what I'd do, because nobody's going to touch me with a 10 foot pole right now," said Szerbowski.

So far, the I-Team's research hasn't found any state which requires insurance compnaies to tell individual members when it cancels a group's policy. That means, right now, Szerbowski's only recourse is to sue his employer for breach of contract.

The Szerbowski family has set up fund to help cover Dan's medical expense at West Bend Savings Bank branches.
This content requires the latest Adobe Flash Player and a browser with JavaScript enabled. Click here for a free download of the latest Adobe Flash Player.

On Demand