In 12 years, Triangle man missed only 1 health insurance payment. He lost coverage

Cord Silverstein had been a Blue Cross Blue Shield North Carolina member for 12 years when he missed one monthly payment this summer and lost coverage — for himself, his wife and his daughter — for the rest of the year.

The Morrisville resident thought he had set up automatic payments, but it didn’t work. He had paid his bill in May, but not in June. Blue Cross sent him a letter July 7 to tell him that his policy was canceled. Six days later, on July 13, he contacted the company’s customer service department, credit card in hand, ready to pay his bill. But it was too late.

“It just seems to me, someone, somewhere could have been like, ‘Hey, you know what, this guy’s been a good customer of ours for a very, very long time — more than a decade — and a mistake was made by him,’” Silverstein told me in a video call. “‘Can we give the guy a little bit of a break, him and his family?’”

Apparently not. Blue Cross referred Silverstein to the Health Insurance Marketplace, where he purchased the policy, and told him that they couldn’t reinstate his policy unless the marketplace gave him a special enrollment period and a new policy ID.

Special enrollment periods are times outside open enrollment when you can sign up for health insurance. You only qualify for these if you’ve had certain life events — such as moving, getting married or divorced, adopting or having a child — or if you’ve lost eligibility for Medicare or existing health coverage, including job-based, individual and student plans.

Failure to pay your bill doesn’t count as one of the qualifying events.

Now Silverstein has to wait until open enrollment to sign up for a new health insurance policy that won’t go into effect until 2027.

He’s already feeling the effects of losing coverage. He bought temporary insurance that will help during health emergencies — for example, hospital stays after a stroke or car accident.

But it doesn’t cover pre-existing conditions, including Silverstein’s need for a transfusion every three months. He looked into paying for the treatment out of pocket, but because it costs around $15,000-$20,000, Silverstein had to cancel the next appointment.

“I messed up, alright. But you know, the mess-up is that I just didn’t pay a bill, OK,” Silverstein said. “And I think everyone in our lifetime has probably done that once, if not more.”

Caitlin Donovan, media representative for the nonprofit Patient Advocate Foundation, which offers case management services to help people access and pay for healthcare, said she didn’t know how common Silverstein’s situation is — how many people lose insurance because they miss a payment.

“It’s not going to be zero,” Donovan said. “But in general, I would say definitively that our healthcare system is so confusing and so complicated that people make financial mistakes within it all the time, and it costs them either money or their coverage or their future treatment.”

Silverstein had 25 days after the bill due date to pay his monthly premium. That’s actually longer than what’s laid out in North Carolina law — 10 days for individual plans that aren’t subsidized with a tax credit, Barry Smith, deputy director of communications for the state Department of Insurance, told me via email.

But some people have more than three times as long as Silverstein had. Those who have a marketplace plan, use the premium tax credit and have paid at least one full month’s premium during the benefit year have 90 days to settle up.

Silverstein didn’t use the premium tax credit, which helps lower your monthly bill, because he didn’t qualify for it. His income is too high.

If your income is between 100% and 400% of the federal poverty level, you may qualify for the premium tax credit. When you use it, the marketplace sends an amount you specify — whether it’s all or part of your credit — directly to your insurance company as an advance payment. This lowers the amount you pay your insurance company each month. If you use more of the credit than you qualify for, an amount based on income and household size, you’ll have to pay the difference when you file your federal taxes.

And because he owns a business, an AI marketing agency called Integrate AI, he doesn’t have insurance through an employer, and funds aren’t automatically deducted from his paycheck.

Blue Cross used to charge his credit card automatically. But when the insurer stopped accepting credit cards for automatic payments, he switched to paying bills manually by bank transfer for a few months, before deciding to automate the process.

Silverstein learned the hard way. It doesn’t matter how long you’ve been loyal to your health insurance company, or how often you’ve paid your bill on time: If you miss a single payment, you’re in danger of losing health insurance.

As Silverstein pointed out, the consequences of that are far greater than getting locked out of your Netflix account.

“This is somewhat life and death we’re talking about here,” he said.

The way I see it, there are two big lessons we can learn from Silverstein’s story. One, if you think you set up autopay, make sure you actually did — especially if your insurer, like Silverstein’s, has recently changed the way it accepts payments. And two, figure out how much of a grace period you have with your policy.

I asked Blue Cross if it notifies customers that they haven’t paid their bill. Here’s the response I received:

“We recognize the importance of maintaining health coverage and work to keep members informed about their payment status and any actions needed to avoid a lapse in coverage. While we cannot comment on an individual member’s circumstances, Blue Cross NC has established processes to notify members when premium payments become past due and to communicate the potential impact to their coverage if those balances are not brought current. Members receive billing statements that reflect their outstanding premium balance and explain that coverage may be terminated if payment is not received within applicable timeframes. Members receiving Advance Premium Tax Credits (APTC) also receive additional required notifications.”

Silverstein sought help from Blue Cross, the marketplace and the Department of Insurance, to no avail.

But if you’re having problems with your health insurance, you may be able to receive help.

The department is limited in how it can help. For example, it can’t act as your legal representative or intervene in a lawsuit on your behalf.

What it can do is require your insurance company to respond to your complaint; make sure that the insurer is complying with state laws and policy requirements (and if it’s not in compliance, require the company to make corrections); help you understand your insurance policy; recommend steps you can take to resolve your issues if the department doesn’t have the authority to resolve them; and refer you to the Healthcare Review Program, if your situation involves a noncertification decision.

These NC grocery stores & pharmacies give discounts for getting a flu shot

Your electric bill is up. Is it because of the heat or Duke Energy?

©2026 Raleigh News & Observer. Visit newsobserver.com. Distributed by Tribune Content Agency, LLC.