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Does your health insurance cover all local hospitals? Maybe not

Lisa Riegel found health insurance for her family that, in the end, didn't cover everything it said it would. (WSYX/WTTE)

A Powell family who signed up for a "family" insurance plan learned their family wasn't covered the way they thought.

"We picked Medical Mutual (of Ohio)," said Lisa Riegel. She says a broker helped her choose the best medical insurance for her, her husband Brian, and their children 14-year-old Paige, and 11-year-old Luke.

In December of 2016, they bought Medical Mutual's Ohio Heath Plan through the Affordable Care Act exchange because their doctors were on it.

"So we signed up and it's not a cheap plan. It's gonna end up, by the time we pay deductibles and our monthly, it's around $22,000 a year out of pocket," said LIsa.

In January of 2017, Paige developed health issues that needed testing at Nationwide Children's Hospital.

"And I, to my alarm, found out that no longer were any of the pediatric specialists or Children's Hospital covered," said Lisa. "And that is pretty much when I pulled the fire alarm because we bought a family plan with the understanding that we would have options for our family."

Lisa contacted Six On Your Side. She also posted about it on Facebook, and quickly realized other families were experiencing the same problem.

"My Facebook just blew up. People sharing their stories," she said.

Lisa believes Medical Mutual of Ohio changed the plan between the time she bought it and the time she needed it.

"And I think the part I was most frustrated by is that I felt like I bought a really good product and then when in January, when I tried to use that product, it was a profoundly different product than what I purchased," she said.

Six On Your Side reached out to Medical Mutual and they arranged a conference call with two of their top executives. Kathy Golovan is Chief Health Officer and Executive Vice President for Medical Mutual of Ohio. And Dr. Tere Koenig is Executive Vice President and Chief Medical Officer.

While they deny Lisa's plan changed, they admit certain "blips" in Lisa's customer service. However, they insist the Riegels got just what she paid for - an inexpensive H-M-O providing just basic pediatric care.

"If you want Children's Hospital in your network then you're going to have to have a much richer-costing plan and I think that's what people have to decide when they do their research," said Dr. Koenig.

Medical Mutual eventually agreed the care Paige needs is medically necessary, so it granted a waiver allowing her to be seen by specialists at Nationwide Children's.

Lisa's grateful but believes an insurance plan marketed for a "family" should cover the "family" wherever they go.

"Had I known from the get-go that the plan only included adult facilities, I would not have signed up for it because my kids are still kids," she said.

Insurance companies offer waivers if a specialist or hospital is not on their list but the care required is considered medically-necessary. But experts say the bottom line is to really research the plans, and if you use a broker like the Riegels did, you need to carefully double-check their work.


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