ZEPHYRHILLS, Fla. — A necessary surgery. An unexpected bill. A Zephyrhills woman told us she owes more than $150,000.
Madeline Rogers contacted the ABC Action News I-Team after seeing the series "Patient No More," which highlighted medical insurance denials.
SERIES | Patient No More
“I was told every time, denied. Denied. Denied," Rogers told the I-Team when she tried to appeal a health insurance denial for a surgery. “Somebody has got to intervene and stop what's going on with this health care system.”
The I-Team met Rogers at her home in Zephyrhills, a place that brings her peace. But before the surgery on her colon, even a walk with her dog, Miley, brought fear.
“It's just a horrific thought to think that, you know, you could just be walking along one day, and all of a sudden, your guts explode, basically. And if you don't get to the hospital quick enough or they can't get everything straightened out inside, you die," Rogers said.
She had her first scare in 2022.
"It could have killed me"
"A diverticulitis attack that — I had a perforation in my colon," Rogers said. “The worst pain you ever had in your life. If you could imagine eating a glass broken bottle and it going through your insides."
Rogers had to have surgery.
"The doctor explained to me if I did wait and I had another attack, then I could wind up permanently on a colostomy, where I could never have a normal body again or become septic and die," she said. "When I did have the operation, I had an abscess on the outside of my colon, that if that would have ruptured, it could have killed me.”
That surgery was in December.
"The day before my surgery, they called me to cancel because they said they still haven't received approval from my insurance company," Rogers told the I-Team. "And so, upon arriving at the hospital, I had to give them $26,000 before they would admit me for the surgery.”
Rogers said she was "floored".
"But I knew it was something I absolutely had to do, so I really didn't have a choice in my mind at all," Rogers said. “Also, I had spoken to the insurance company about the approval, and I was told on a recorded line, do not worry if you don't have the authorization ahead of time. As long as the doctor deems it's medically necessary, you won't have any problems.”
She did.
"They aren't paying anything"
“Oscar insurance has sent me an explanation of benefits saying that I owe $150,000, and it’s my responsibility, and that they aren’t paying anything," Rogers said.
Rogers, with the help of her doctors, went through two appeals and one peer-to-peer review, writing letters to Oscar Health, her insurance company.
“They should not be allowed to get away with this. There's no way," Rogers said.
While AdventHealth, who handled Rogers' surgery, would not provide us with details on her care, they sent a statement saying:
"Our top priority is providing high-quality, compassionate care to every patient we serve. We understand the frustration and stress of denied insurance claims. While insurance coverage decisions are ultimately made by the patient’s insurer based on their specific policy, we remain committed to supporting our patients throughout the appeals process, including providing necessary medical documentation and advocating on behalf of our patients whenever possible. We want to ensure that all patients receive the care they need, and we will continue working toward solutions that best serve our community."
When asked what message she has for Oscar Health, Rogers said, "What they're doing is wrong. On every level."
“They are finally doing what they were supposed to do"
Then, two days after the I-Team met with Rogers and one day after the I-Team contacted Oscar Health, Rogers said, "They've approved my claims."
This, after months of Oscar Health telling her on three different occasions, for three different reasons, that coverage of the surgery was denied.
“I was shocked. I was floored to hear from them so quickly," Rogers told the I-Team.
Hours later, the I-Team received an email from Oscar Health's Vice President of Communications, saying, "We take our responsibility to our members seriously. Madeline Rogers' procedure is covered, and Oscar's clinicians continue to work with her doctor. We hope she continues to respond well to her treatment plan."
The I-Team requested an interview with Oscar Health but never heard back.
Rogers wants other patients to know there's hope if they keep fighting.
“Justice. They are finally doing what they were supposed to do," Rogers said.
"If there had just been a trooper up there, maybe this whole thing could have been avoided."
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