CHARLOTTE, NC (FOX 46 CHARLOTTE) – A Charlotte-area man is scratching his head after getting an insurance summary saying he might owe nearly $600 dollars monoclonal antibody therapy.
Michael Sandala is a husband and father of two who’s meticulous about his health.
“I’m a type one diabetic, which means I’m insulin-dependent,” Sandala explained.
When he got COVID back in September, despite being vaccinated, he just wanted to feel better.
Sandala’s primary care nurse recommended monoclonal antibody therapy.
“You don’t have to do this, there’s no charge for you, and if you would like, I think it would greatly benefit you,” Sandala recalled.
So he signed up at StarMed and confirmed multiple times that the treatment would be free; asking both the nurse and the doctor at his appointment.
Sandala said, “I asked him the same question: ‘is there any cost for this?’ he says ‘no, this is a program that’s being done to actually alleviate the burden on the hospitals.’”
The therapy worked and Sandala felt better within days.
“You feel like you’re on top of the world again,” he said.
But as he learned just this past Saturday, his insurance company doesn’t see the “free” part in the same way.
*He said, “I’m sitting here and I opened up my mail, I noticed that there was a claim of benefits coming in from my insurance provider Horizon Blue Cross Blue Shield of North Carolina.”
The mail contained an Explanation of Benefits for nearly $600-dollars for the monoclonal antibody therapy Sandala received months ago. It’s not a bill, but to Sandala, it might as well be.
“It’s the holidays and I’m saying to myself ‘Well, this is a bill that’s probably going to be rolling in sometime in either late December or possibly January and it couldn’t come at a worse time,” he said.
FOX 46 spoke with StarMed CEO, Mike Estramonte who said he’s equally puzzled about the claim.
He explained that under the Federal CARES Act, Medicare and Medicaid are covering all COVID services 100 percent and the majority of insurance companies are too.
Estramonte said, “During the pandemic, during what’s considered a Public Health Emergency, StarMed will not be sending any COVID-related balance billing.”
However, when Sandala called his insurance company, he said they were adamant that he’d be getting a bill.
Sandala said, “They basically advised me that this was an out-of-network charge and regardless of what is allowable for them billing that, that I would be fully responsible to pay the full amount that was due.”
Estramonte said that even if an insurance company happens to send a balance back to StarMed, their company won’t be passing that along to patients.
He just doesn’t want things like this to scare away people who need help.
“These are game- changers and for anybody to be discouraged from receiving one of these cares, where it could be life-saving potentially, it makes me sad that people are getting discouraged by inaccurate information or information that just doesn’t make sense,” Estramonte said.
As Sandala gets ready to call his insurance company again, he hopes companies start to practice more transparency.
“I guess we’ll have to figure out at that point how Blue Cross is going to direct this and it’s really in their hands,” he said.