Cover Me

Kathern Cathey thought she had an insurance policy that would save her life. Not exactly.

For its part, Cinergy is an agent for and sells its customers the New York-based American Medical and Life Insurance and Illinois-based Guarantee Trust Life Insurance.

According to the Texas Department of Insurance Web site, which lists nationwide violations for all insurance companies licensed to do business in Texas, these Guarantee Trust violations include a $10,000 penalty for changing renewal dates on Medicare supplement policies in Wisconsin in 1993; a $25,000 penalty for modifying the "paid to" dates on supplement policies in Minnesota in 1993; a $10,000 advertisement violations penalty in Iowa in 1994; a $23,000 penalty for "policy violations" in Florida in 1996; and in 2004 a $5,000 penalty for "violations found in a target market conduct examination of [the] company's Medicare supplement insurance business in Maryland."

While most Cinergy policies appear to be underwritten by American Medical, a 2007 filing with the Florida Office of Insurance Regulation shows that Cinergy used to offer Guarantee Trust-underwritten policies via the United Consumer Awareness Association (which, of course, is registered in that Missouri office).

Cinergy's "member services" number doesn't appear to provide good service for its members.
Daniel Kramer
Cinergy's "member services" number doesn't appear to provide good service for its members.
While she waits to hear if she'll get the surgery she needs, Kathern Cathey relies on painkillers to make it through.
Daniel Kramer
While she waits to hear if she'll get the surgery she needs, Kathern Cathey relies on painkillers to make it through.

The current president of the United Consumer Awareness Association is Thomas Force, who was the CEO and general counsel of American Medical and Life until 2007. Force's Long Island address is also the address for a company called Patriot Health, which marketed wholesale noninsurance benefit plans customized by United Health Programs of America...which packaged discount plans for Patriot Health, which marketed the plans to Cinergy (back when Cinergy was still providing ­medical discounts) via membership in the United Consumer Awareness Association, which also offered a supplemental insurance product underwritten by Guarantee Trust Life.

Crystal clear.
_____________________

Consumers shopping for limited medical insurance plans might want to pay attention to what M.D. Anderson spokeswoman Julie Penne told us when we asked about Kathern Cathey and Cinergy.

"Cinergy offers limited health insurance," Penne wrote in an e-mail. "While American Medical and Life is licensed by the Texas Department of Insurance, Cinergy does not appear to have such a listing. Some of Cinergy's plans may be underwritten by American Medical and Life, but M.D. Anderson is not obligated to accept any insurance that does not meet our requirements for coverage...Here's the bottom line: If we had accepted this patient under Cinergy, the patient would have had significant personal financial responsibility because of the limitations of her coverage. As such, M.D. Anderson asked for a deposit."

St. Luke's spokeswoman Jessica Michan could not confirm Cathey's story, but she indicated that, through the hospital's Patient Financial Assistance Program, "St. Luke's will provide partial or full financial assistance for medically necessary care in accordance with Texas law and hospital eligibility guidelines to patients who require hospital care or medical services, and cannot afford such care or services because of limitations in their health insurance or personal finances."

Which means that Cathey might have a shot at St. Luke's after all. In the meantime, she says, her only other hope is Ben Taub, which has a considerable waiting period.

She says she's tried to clarify her coverage information by calling Cinergy, but winds up in telephone hell.

It's always "hold please. Let me transfer you to this one, please," she says. And meanwhile, she says, "At night I can't sleep. I have to just prop myself up on pillows, take pain pills and just almost every night I have to cry myself to sleep because I'll be in so much pain."

If you didn't know Cathey before the cancer, you might think she looks fit. Her weight looks healthy. But then she'll refer to a photograph of her and some friends hanging on the wall in her living room, when she was 40 lbs. heavier and more likely to smile. She forces herself to eat — mostly light foods like popsicles and Jell-O cups.

"When I eat...sometimes it just feels like it's just hung here," she says, pointing at her throat. "It's choking me." She says a baby probably eats more than she does.

During her interview with the Press, she rocked back and forth in pain, alternating between clasping her arms over her stomach and cradling her head in her hands.

When the Press called the "member services" number on her Cinergy card, we couldn't get much further. When we asked for coverage information for the Cinergy Health Preferred Individual 1000 Plan (courtesy of the National Congress of Employers), we were routed to someone at American Medical and Life Insurance, who told us that Cathey should have a benefit booklet. But it appeared that Cathey misplaced the booklet some time ago, and she doesn't have Internet access at home, so downloading a new copy wasn't possible at the time.

The woman told us this was a matter for Cinergy, not American Medical. She gave us the phone number for Cinergy, which was the same phone number that led us to her. When we explained this, and the overall difficulty in determining her coverage, we were told, "Like I said, she should have a benefit booklet."

And she really should. Because then she might see her schedule of benefits, which clearly states that "Benefits provided are supplemental and not intended to cover all medical expenses. This is not a substitute for comprehensive health insurance." (A later call to American Medical got a more compassionate response: The Press spoke with Michael James, the company's general counsel, who expressed sympathy for Cathey's situation and said he would have her benefits booklet overnighted to her. He also said he would contact his company's claims department and review her policy to make absolutely sure she was receiving all the benefits she's entitled to).

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