NBC6 Takes Action: Woman Wins Fight for Delayed Reimbursement

After years of struggling to get the medical claim reimbursement she was owed, a viewer felt out of options. She reached out to NBC6 Responds, and with their help, she finally received relief. NBC6’s Alina Machado has the story.

By Sheenu Gupta On Nov 8, 2024 Share with new partner:

Diana Gonzalez continues to navigate the healing process after the heartbreaking loss of her father in 2020.

“What happened to my dad was tragic,” she said. “He got sick, he got worse, he got leukemia – that shouldn’t have happened.”

Diana explained that her father had traveled to Colombia during the height of the pandemic, intending for a brief visit. However, while there, he unexpectedly fell ill and needed urgent medical treatment. Confident in his health coverage, Diana confirmed that he was insured through Humana, a policy that should have covered his care abroad. Yet, despite having this safety net, obtaining the necessary support proved to be a challenge.

“They said, well, you know, since it’s out-of-state coverage, we would pay for it, but you have to pay for it upfront, so I did,” Diana said.

Diana ended up paying almost $14,000 out of pocket for her father’s medical expenses while he was in Colombia. After returning home, she submitted a claim for reimbursement to her insurance provider. According to Diana, the claim was eventually approved, giving her hope that she would recover the significant amount she had spent on his care.

“I received three checks, but they were under his name,” she said.

By the time the reimbursement checks arrived, Diana’s father had sadly already passed away. She reached out to Humana, explaining the situation, and was assured that, with the legal documents she provided, they would reissue the checks in her name. Following their instructions, Diana returned the original checks. When she received one of the new checks, she immediately called Humana again to inquire about the remaining payments, hoping the process would soon be resolved.

“It’s in the system,” she said she was told. “It’ll take some time because it has to go through another account.”

This process began in 2021, and what Diana hoped would be a quick resolution turned into a three-year ordeal. For the next several years, she found herself calling Humana every few weeks, each time waiting in hopes of receiving the remaining reimbursements. Despite her persistence, the issue dragged on with no clear end in sight. Frustrated and feeling out of options, Diana eventually decided to turn to NBC6 Responds for assistance, hoping they could help her finally resolve the matter.

“It was something that was approved and they’re just giving me the runaround,” she said. “I always hear stories that you guys are always on top of things and resolve it. If it can’t be resolved then, you know, I don’t know what else to do.”

NBC6 contacted Humana on Diana’s behalf. They told NBC6, in an email, “…federal privacy regulations restrict what information Humana can share about individuals and their medical care” adding that they “…always encourage our members and authorized family members or caregivers to contact us with questions or concerns…”

Soon after NBC6 got involved, Diana received a response from Humana.

“The representative did call me to tell me that the check is being processed and that I should be receiving something in the next 48 hours,” she said.

A few days later, she checked her mailbox.

“And I couldn’t believe it,” Diana said. “I saw a Humana envelope.”

Inside, she found a check for the remaining $8,800, putting an end to her yearslong wait.

“I’m just happy that it got resolved with your help,” she said. “I mean, I really appreciate NBC6.”