An Arizona State University graduate student in Arizona took to Twitter when his insurance company stopped covering his medical bills for treatment of his advanced colon cancer.
After 31-year-old Arijit Guha’s medical care exceeded the $300,000 cap on his student health insurance policy, he was left with another $118,000 in out-of-pocket expenses. Because of his age, he was not protected by the Affordable Care Act’s provision allowing students to stay on their parents’ health insurance until age 26. The $400-a-month plan he enrolled in was the only student health insurance option offered by his school.
In 2014, Guha wouldn’t have had a problem paying his medical bills. That’s when the ACA outlaws maximum annual and lifetime coverage. But because the rule is not yet in effect, Guha felt his only recourse was taking his case public via Twitter. Using the handle Poop_Strong, he eventually drew Aetna’s CEO Mark Bertolini into the battle. The health insurer, sensing a public relations disaster, soon folded and agreed to pay all of Guha’s medical expenses.
But don’t shed any tears for Aetna – they are one of several companies required to collectively refund more than $36 million in health insurance premiums to Arizona consumers this year due to the ACA’s medical loss ratio provision. The provision requires insurance companies to spend a minimum of 80 percent of premium dollars on actual health care for consumers and small businesses, instead of administrative costs (including Bertolini’s $4.7 million salary) and profits. It’s even higher – 85 percent – for large businesses.
While we applaud Guha’s victory, we know there are thousands of other stories are out there of others who have tapped out their health insurance plans’ annual or lifetime caps. Sadly, many didn’t have the know-how – or strength, given a debilitating illness – to fight their insurance company.
Guha puts yet another human face on the promise that health care reform is poised to deliver.