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St. Paul couple thought they did everything right, were dropped by insurance with a baby on the way

Corey and Caitlin Gaffer of St. Paul hold their new baby, Maggie, after enduring a stressful struggle with insurance before her birth.

Corey and Caitlin Gaffer of St. Paul hold their new baby, Maggie, after enduring a stressful struggle with insurance before her birth. The Gaffer family

When Caitlin and Corey Gaffer of St. Paul decided to have a baby, they were going to do it right.

They went through MNsure—our state’s Obamacare exchange—and found a HealthPartners policy that would cover the hospital they picked out for the birth. They did regular check-ups, paid their bills, and went to bed secure in the knowledge that they were doing this “adulting” thing the correct way.

Then, in September, five or six months into Caitlin’s pregnancy, they got a letter from HealthPartners. It said they’d missed one payment in August.

And the company was dropping them.

This was news to them. They distinctly remembered making that August payment. So they did what adults do. They picked up the phone and called HealthPartners to straighten this out. The healthcare providor told them MNsure was the one who dropped them, and they’d have to talk to the folks over there.

They did. But MNsure promptly told them the problem wasn’t on their end, and that the couple would have to talk to HealthPartners… which they did.

So it went, back and forth, with half-hour to 45-minute hold times whenever they changed hands. Then, out of the blue, they got a letter from their hospital: They’d sent their August payment to the wrong address. The money went to the hospital, not to HealthPartners.

They tried calling and explaining that it had all been a simple mistake, but it was no use. HealthPartners wasn’t taking them back. It was time for a new strategy: pay for everything out of pocket until January, when they could re-enroll. So far, Caitlin and the baby were healthy, so it seemed like they might be able to skate by without insurance for at least a little while before the big day.

That is, until Caitlin felt something she’d later describe as similar to the feeling of her water breaking. When she got home and checked herself out, she discovered that wet feeling was actually blood. Corey called 911.

At the hospital, doctors cautioned the couple that if the bleeding continued, the baby might be in trouble and have to come out early. Furthermore, they’d have to take Caitlin in an ambulance to a different hospital in order to take care of it.

All without health insurance.

After an ambulance ride and five stressful days in two different hospitals, the new plan was this: Don’t go into labor until January, and get new insurance as fast as they could.

A sympathetic MNsure staffer allowed them to retroactively enroll with another company. But after days of phone calls and detailed notes, the best they could do is go with a company that covered one—not both—of the hospitals they’ve already been to because of the surprise bleeding. No matter what, they were already out at least $10,000.

It would have to do. They scrambled to enroll. They were on the phone for a few hours a day for weeks—not just with insurance providors, but with their senators, and the media, and pretty much anyone who would listen.

Finally, for the first time in months, they got a break. A new insurance company accepted them, and on January 23, pretty much the day after, Caitlin gave birth to a healthy baby girl: Maggie Gaffer.

“It was the birth of our daughter, so it was unbelievable,” Corey says. But it was also clouded in a fog of confusion and stress. The day been marred by the insurance snafu, and months later, the couple is still trying to figure out what they owe, and to whom.

There’s another wrinkle to this story. One of the people the couple reached out to for help is Dan Weissmann, host of An Arm and a Leg, a podcast about the cost of health care.

After going through the story with Caitlin and Corey, he reached out to HealthPartners to try to figure out what happened on the company’s side. Shortly after, the St. Paul couple was surprised by a call from HealthPartners offering to help them.

 

“Well, you can give me a year of free therapy,” Caitlin said.

That didn’t happen, but the company did offer to reinstate them. Meanwhile, Weissmann said he never really got a response to his inquiry. HealthPartners did send City Pages a statement saying the company is “continuously listening to our members and making improvements based on their feedback.”

“We’ve apologized to the family, reinstated their coverage, and view this situation as an opportunity where we can do better,” it said. “We are grateful they’ve chosen us to provide their health coverage for 2019.”

Caitlin and Corey are mostly grateful it’s over. They’ve learned probably more than they ever cared to learn about health insurance, and they know if they ever have another child, it’s probably going to be a different experience.

Still, they realize they got pretty lucky.

“When we tell our story, so many people come back with a story of their own,” Caitlin says.

And some of those stories may not have endings like this.