I-Team helps Chino Medicare recipient recover $15,000 from insurance company

Michelina Jack had a workplace injury a few years ago. 

“I broke both my ankles, tore my knee, broke my back,” she said.

Jack is now on permanent disability and Medicare. Nine surgeries later, she knows it’s important to choose the right Medicare plan. She chose Aetna Advantage. 

“Looking at the plan and what they offered, the doctors that I had or would be seeing, were covered under Aetna Medicare,” she said.

Jack recently had three knee procedures for pain relief. But first, she called Aetna to confirm the procedures were covered. She says they told her yes.

But later, Aetna denied the claim, saying the procedures weren’t covered under her plan. Jack was now on the hook for the bills, which she said were nearly $15,000.

“That’s dipping into savings, dipping into retirement, borderline wondering if I’m going to make my mortgage payment,” she said.

The I-Team reached out to Aetna. It said it initially gave Jack wrong information – the procedures should have never been covered. Because of its mistake, it paid her claims.

There are a lot of decisions to make when it comes to Medicare coverage. Stephanie Fajuri, with the nonprofit Center for Healthcare Rights, said figuring out the best option can be tricky. 

“I have literally trained rocket scientists at JPL who have the same questions as everyone else. It doesn’t matter what anyone’s educational background is, Medicare is so confusing,” she said. 

Fajuri said there’s no “best” plan. 

“Sometimes even spouses have two different types of Medicare coverage because of the prescriptions they’re taking, or because of the specialist or doctors that one or the other needs to maintain,” she said. 

Fajuri’s number one piece of advice before you enroll in a plan: make sure your doctor and hospital accept it. And be sure to confirm this every year. 

“Because the last thing anyone wants is to join a plan or change their coverage only to learn they can no longer see the specialist that’s been treating them for 20 years for their diabetes,” she said.

As for Jack, she might switch plans. She says the emotional pain of getting an approval and then a denial, made her physical pain even worse. 

“I wanted to be pain free, and to be there for the family, here in the present for them, not messed up because I'm so messed up with pain.,” she said. 

Medicare open enrollment ends Dec. 7. You can get free help from the Center for Healthcare Rights by calling 800-434-0222.