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Man with potential heart condition gets dropped from health insurance over $11.27

Posted at 10:33 PM, Aug 06, 2015

GRAND RAPIDS, Mich.-- A West Michigan man with a heart condition is out of health insurance all because of a rate change of $11.27.  He has thousands of dollars of medical bills to pay back, and no health coverage until January of 2016.

Dale Peplinski said his employer did not provide health insurance this year because of the 40 percent increase due to the changes in healthcare. Therefore, Peplinski went to sign up for insurance through the affordable care act, and as far as he knew he was all set. Two months later Peplinski said his insurance cancelled with no warning.

Memorial Day I had a health condition come up and I go into the emergency room and give them by Blue Health Network card. The lady says. ‘I have bad news. Your card has been denied,’” said Peplinski.

Dale Peplinski had numbness in his left arm, and chest pains so bad he could barely breathe. He left the hospital that day with three things:  bills up to $2,000, no explanation for what caused the heart attack-like symptoms, and that his health insurance had been cancelled 4-months prior on January 31st.

“I was just blindsided. I knew nothing about any of this until Memorial Day,” said Peplinski.

Peplinski first signed up for health insurance through the Griswold Group in Grand Rapids.

“Well I didn’t trust myself to go online and dot my own i’s and cross my own t’s, so I thought I would go there and have them guide me through it,” said Peplinski.

Peplinski thought the Griswold Group had him all set up. He paid monthly invoices for November, December, and January, but what he didn’t know is that his rate changed. The rate increased by $11.25.

“They should have had me down as a 48-year-old male, but they had me down as 47-year-old male and evidently it makes $11.27 cents difference. It comes down to $11.27,” said Peplinski.

Somewhere along the line Peplinski said his age was entered incorrectly, and when it was corrected his rate for insurance went up causing him to be $11.27 short in January on his premium. Peplinski said he was never notified of that change.

“What is disturbing is when I called Blue Care Network and went downtown to their office on Cascade. They told me I should have been notified by the Griswold Group,” said Peplinski.

The ‘finger pointing’ game followed that got nowhere, because he only had 30 days to pay the $11.27. Peplinski can’t enroll in coverage until January, which means his heart condition will have to wait. On top of that, he’ll be fined at the end of the year by the federal government for not having insurance.

“This just can’t be. This just can be. You can’t think it would happen to you, until your living it,” said Peplinski.

Fox 17 News reached out to the Griswold Group to see if they take any responsibility for the age being wrong in his original application. They did not send us the original paperwork for Peplinksi’s application as we asked, but instead referred us to talk to Blue Cross Network.

“They have a 30 day grace period and it doesn’t matter if it’s $11  or $1100  or even $.11,  we are required by law that if they don’t’ pay that premium in full within that 30 day period they face cancellation,” said Rick Notter of Blue Cross Blue Shield.

Fox 17 News asked Blue Care Network if they are held responsible for lost mail. Peplinksi claims he never received a letter in the mail notifying him of the rate change or the cancellation. Blue Cross Blue Shield said if Peplinski can prove the mail got lost he can appeal the cancellation. When Fox 17’s Cassandra Arsenault asked how you can prove you didn’t receive mail, the Blue Cross Network said that’s not a question for them.

Blue Cross Blue Shield said Peplinski has limited options, and their hands are tied due to federal law.

“If your electricity gets turned off you can pay it in full and they will turn it back on. With health insurance you have to wait for the open enrollment period.  As a carrier we have to abide by those laws and rules. We are definitely not in the business of wanting to cancel polices,” said Notter.

There is some light at the end of the tunnel. Fox 17 News talked to Elizabeth Schinderle of the US Department of Health and Human Service, who sent us this e-mail that said they will have someone from their casework resolution team look into Peplinski’s file. Meanwhile Peplinski hoping his heart stays healthy as the days pass.

“It’s a huge concern. I am just trying to lay low and not do too much and just hope every day the good lord lets me wake up,” said Peplinski.

The reason Peplinski cannot be re-enrolled for the misunderstanding is because the Affordable Care Act is set up so people can’t beat the system. They encourage people to have coverage for the whole year, so that people don’t just enroll to take care of medical problem, and then just drop it right after it is taken care of, and they are healed.