Many caught in system’s cracks

Newly married Kristin Gunsallus asked her insurer how much maternity coverage she had under her policy.

The reply: None.

“It never crossed my mind that it wouldn’t be covered,” she says now.

Kristin, 39 and a Navy veteran, switched to a family policy with her husband’s provider, Blue Cross and Blue Shield of Georgia. The company would provide maternity benefits, but only after a year, which Blue Cross says is standard practice for such policies.

In what the couple said was both a delight and a surprise, Kristin got pregnant three months later. They began budgeting for what they believed would be a $10,000 to $15,000 out-of-pocket expense.

But Kristin developed severe toxemia. She spent nine days in the hospital and delivered baby Alexis seven weeks early by emergency Cesarean section. Blue Cross paid for the baby’s stay in the hospital neo-natal section. But after paying $10,000, the couple still has $60,000 in unpaid bills. The hospital calls daily about its $35,000 portion. The couple has appealed, saying Kristen’s toxemia was a life-threatening situation. Blue Cross declined to comment, saying it will review the case.

Anne Gilson of Marietta can’t get insurance, because Georgia doesn’t have what many states do — laws and subsidies that require and support insurance for the sick.

Gilson, 60, who formerly co-owned a small business with her husband, had uterine cancer and a hysterectomy last year. She couldn’t get individual insurance. Gilson even asked whether an insurer would offer a policy that would exclude cancer coverage.

No carrier would come near her.

She’s waiting to reach 65, when Medicare is available.

Coverage holes put Kay Boyett in the crosshairs of a collection department.

Boyett, 64, of Waycross has an individual policy through Mid-West National Life Insurance, one of two insurers in Georgia affiliated with Texas-based HealthMarkets. HealthMarkets paid $20 million in fines last year to settle a multistate investigation of its sales practices.

Boyett’s policy carried a $5,000 deductible for hospital care. She says it doesn’t pay for doctor visits or preventive care. “It was all I could afford.” When she was hospitalized in 2007 with blood clots in her legs, she ended up with a $4,000 bill, plus other medical costs.

She couldn’t pay it.

A hospital has turned her over to collections.