‘Very scary’: Cancer patient in limbo after insurer Friday Health Plans suddenly folds
A little over two months before her scheduled double mastectomy, Jean Fenolio received notice that the state was terminating her health insurance.
Diagnosed with advanced stage 3 breast cancer in January, Fenolio had already reached her out-of-pocket maximum for the year by July. A gig worker, Fenolio was counting on her insurance to pay for upcoming treatments, including the bilateral mastectomy scheduled for Oct. 2, followed by reconstructive surgery and potentially more radiation treatment.
But an email from the Division of Insurance informed her that her insurer, Friday Health Plans of Nevada Inc., was being liquidated following “hazardous financial conditions” and an inability to repay debts or achieve solvency. She would need to find a new insurer before Sept. 1, and the $4,500 she had already paid in deductibles and co-payments would not carry over.
“I wasn't expecting to have to pay out for anything else,” Fenolio, 46, said in an interview. “It's all very up in the air. And it's very scary. And it's frustrating. I just have to keep telling myself, it'll work out. It'll be OK.”
Fenolio is one of approximately 3,000 Nevada residents who were enrolled with health insurer Friday Health Plans of Nevada Inc. and must now find new health care coverage before the end of the month. State officials announced the company’s liquidation on July 25.
An analysis by S&P Global found that the company faltered amid unsustainable low pricing and rapid growth. Researchers cited by the news outlet indicated that Friday Health Plans was among two companies that created an unsustainable pricing approach in an attempt to capture a significant share of the marketplace following the implementation of the Affordable Care Act.
Silver State Health Insurance Exchange Executive Director Russell Cook said that as of Aug. 17, nearly 44 percent (1,170 out of 2,670) of people enrolled with Friday Health Plans have re-enrolled with a new insurance carrier. He added that the state is actively working to contact the remaining roughly 1,500 people to offer assistance with the transition process.
Though she had some initial difficulties using the website for the state’s insurance marketplace, Nevada Health Link, to get coverage, Fenolio said once she reached a call center, operators helped get her onto a new insurance plan that will begin on Sept 1.
But that’s just the first step.
Along with her previous payments not carrying over, Fenolio said it’s unclear if she will need to get reapproved for her upcoming cancer treatments, including the bilateral mastectomy. She made sure that her existing doctors were within the new insurance carrier’s network, but didn’t know how to confirm the insurance would cover her treatment.
“If I can’t get this figured out, and I can’t keep this appointment, I don’t know how long it’s going to take for me to actually get this done,” Fenolio said.
Rise and fall
In January, Nevada Health Link listed Friday Health Plans as among the “7 Nevada health insurance providers offering the best health plans in the state.”
The state health insurance marketplace described the insurer as “perfect for gig workers, freelancers, and small business owners who want to buy their own health insurance.”
In the days following the announcement of Friday Health Plan’s liquidation, the page changed to list only six providers, omitting any mention of the insurer it had previously praised.
The company launched in Colorado in 2015 before expanding to other states and is facing liquidation in Colorado and Texas and receivership in Georgia, Oklahoma and North Carolina. On June 2, the insurer announced that the company grew “incredibly quickly” but could not scale its financial infrastructure to match the growth.
Researchers interviewed by S&P Global posited that Friday Health Plans’ demise would lead to higher health insurance costs for the estimated 355,000 customers in seven states who were on the insurance.
In Nevada, Friday Health Plans of Nevada offered individual health coverage on and off through the Nevada health insurance exchange but was not a Medicaid provider.
Continuity of care
As part of the announcement of Friday Health Plans liquidation, Nevada Health Link opened a special enrollment period between July 25 and Oct. 31 to allow Friday Health Plan customers to select a new insurer on the marketplace, avoiding a coverage lapse. The state insurance marketplace’s regular open enrollment period starts Nov. 1 and runs through Jan. 15, 2024.
Russell recommended that Friday Health Plans enrollees ensure that any new insurance carrier includes their existing providers. He added that those receiving treatment for life-threatening illnesses who cannot find a new insurance carrier with a network that includes their existing health care providers should contact Nevada Health Link’s call center for assistance.
“Our staff can then reach out to the insurance carriers in your area, as well as your treatment center, to see if an arrangement can be made to secure the continuity of your existing care,” he said. “While we cannot guarantee an ideal resolution in every case, Nevada Health Link is committed to doing everything we can to support our enrollees throughout the transition process.”
Russell added that most insurance carriers require prior authorization for significant operations like a mastectomy, and that there isn’t a “standard mechanism” in place to transfer those prior authorizations between insurance carriers.
“We are aware of this issue, and we are currently finalizing an email to each of our health carriers asking for assistance streamlining prior authorizations for procedures that might have been scheduled while the impacted consumers were still enrolled with Friday Health Plans,” Russell said.
He said Nevada Health Link was planning on sending out the email this week, but reiterated that it’s vital for Friday Health Plan enrollees to ensure that prior authorization requests are resubmitted to their new insurance carrier.
He said the insurer may require additional information surrounding previous treatments or diagnoses before a prior authorization can be approved, but noted the state will be asking carriers to obtain the information proactively to ease the burden on customers.
As for deductibles, Russell said those payments will reset when a new policy is purchased from a different insurance carrier. In Colorado, Denver Heath has agreed to honor deductibles from members of Friday Health Plans, but officials with the Nevada Division of Insurance said they are not aware of any Nevada-based health insurance groups pledging to do so.
“Initially we were hopeful that a portion of Friday’s assets could be used to offset the financial impact of this transition, but based upon the most recent information available to us it appears unlikely that any monies will be available for this purpose,” he said.
But he noted that consumers who were directly enrolled with Friday Health Plans may qualify for subsidies through the state insurance marketplace that could substantially lower their premium and service costs for the remainder of the year, and certain plans may be more affordable based on how much consumers have already paid out of pocket toward medical expenses.
Paycheck to paycheck
Fenolio and her long-term partner Pete Atkins are gig workers, the type of people Friday Health Plans catered to. Together, they conduct property inspections for mortgage companies in Southern Nevada. She and Atkins value living independently and had avoided getting health insurance for years, opting to pay out of pocket if they needed to visit a doctor.
But when Fenolio started to notice unusual bumps in her breasts, she figured it would be smart to go to an OB-GYN more consistently, and an insurer could help her afford that.
Friday Health Plans had marketed itself as a “simple” plan that offered users telehealth, unlimited primary care visits and $0 co-pays. Atkins said the company lived up to that motto. He said there were very few issues, and the insurance mechanics were easy to understand. The company always paid the bills on time, and Fenolio was able to receive the care she needed.
But even with insurance, cancer treatment is expensive. Atkins and Fenolio live paycheck-to-paycheck, and when they found out about the need (and cost) for cancer treatment, they did what they usually do: they budgeted.
Fenolio would call providers ahead of time to figure out the co-pay cost. She and Atkins stopped eating out and drinking with friends. They dipped into their savings. As money dwindled and rent prices went up, they moved into Atkins’ father’s home, cutting back on costs in every way they could.
Finally, out of savings and after moving to a new insurance carrier that would require a restart of all co-pays, deductibles and out-of-pocket costs, Fenolio created a GoFundMe.
“I'd have to say for a good week, I pondered. Do I, do I not?” she said. “It's hard to have to ask friends and family members and people that you haven't talked to in years, ‘Could you please help me?’”
On the GoFundMe page, Fenolio describes the unexpected loss of her insurance when she had five more weeks of chemotherapy ahead of her before she could get surgery and all the other costs associated with cancer treatments.
She estimated that the new premiums and out-of-pocket expenses would total close to $10,000 and said if people donated more money than she needed to cover her medical expenses, she would donate it.
“I do plan to donate whatever I can to other cancer patients that need it,” Fenolio said. “I'm not the only one that this is happening to.”
Atkins said throughout the chemo treatments, Fenolio comes into the hospital smiling, and she leaves smiling. Even with the pain, hair loss and energy-draining nature of radiation zapping healthy and unhealthy cells, he said she’s meeting it head-on — like a “superhero.”
“She has to deal with [the cancer] every day. And you have a goal in sight, and then somebody comes and kicks it out from under you,” he said. “That’s hard because I can’t fix it.”