Reader shares his tale of persistence CASEY: State health agency helps Floyd resident get $1,761 reimbursement from insurer

I'm a sucker for stories about the little guy taking on "the system" and winning. Many readers appreciate those, too. Today, we have another one, courtesy of Rob Neukirch in Floyd County. It involves health insurance, but not his.

You might recall a column last year, when Neukirch spent months tangling with the U.S. Postal Service to collect $100 worth of insurance over some smashed ceramic cups he had mailed to California. Ultimately, he won that battle.

This time, Neukirch successfully got reimbursed to the tune a lot more - by his nephew's Medicaid insurer, Aetna.

It's a long story that involves no small amount of persistence. And it happened after Neukirch wrote a complaint letter to Janet Kelly, Virginia's secretary of health and human services.

The matter involves Neukirch's 58-year-old nephew, Matthew. He's the youngest child of Neukirch's oldest sister, who's deceased. Matthew's father is deceased, too.

A few years ago, Neukirch discovered Matthew - who was raised in Connecticut and has led quite a rough life - was homeless and living on the streets of Shreveport, Louisiana. At that time, they reconnected through Facebook.

Then last summer Neukirch learned Matthew was ill with stage 4 colon cancer. Sleeping under an overpass at the time, Matthew had no health insurance. He couldn't fly because he had no identification.

So Neukirch bought him a bus ticket to Virginia. Matthew lived with Neukirch for about a year. And Neukirch helped his nephew establish identification through the state of Connecticut, get health insurance through Medicaid in Virginia, and apply for federal disability payments through Social Security.

Initially, the latter agency rejected Matthew's disability claim. Although Neukirch disagrees with his congressman, Rep. Morgan Griffith, on political issues, he praised Griffith's office staffers for their constituent service. They helped clear a roadblock that was preventing Matthew's disability benefits.

Through Cardinal Care of Virginia, Matthew signed up for Medicaid offered by Aetna, because that program "said they provided transportation if needed," Neukirch said.

That was a significant issue, because Matthew has no car, and Floyd's about 75 miles roundtrip from the most convenient cancer treatment center, Blue Ridge Cancer Care in Pulaski, Neukirch said. (It's part of LewisGale Hospital Pulaski.)

"As it turns out, yes, they will send a van but may cancel a pickup even as late as the day of treatment," Neukirch told me. (The service is offered through another company Aetna contracts with called Modivcare.)

That was unsatisfactory. So as a result, "I just continued to drive (Matthew) myself, with as many as 40 trips before finding out - not from Cardinal Care but from another patient - that they reimbursed for gas mileage."

At that point, Neukirch began gathering documentation for the rides he'd given to Matthew. Robin Thompson, director of the Blue Ridge Cancer Care office, printed out pages of Matthew's previous appointments and she wrote a letter vouching for Neukirch's transportation efforts.

He sought reimbursement through Modivcare, and also through through Aetna.

On the telephone with a representative of Modivcare, Neukirch explained the situation. "They said, "Sorry sir, we can't honor those trips" because they were too long ago.

"Modivare would go back only three weeks," Neukirch said. "They said, 'Sorry you didn't know about reimbursement. ... I was determined to get that backlog of money."

So Neukirch wrote the company a letter, including the documentation from Blue Ridge Cancer Care, and requested mileage reimbursement. This was on June 11.

That day, he also wrote a letter to Janet Kelly, Virginia's secretary of health and human resources, and included a packet documenting Matthew's appointments and Neukirch's rides.

"After three days of countless phone calls with Aetna, I have been told there is no hope for trip reimbursement," he told Kelly in his first letter, in June. "I don't understand why the system is punishing me. As soon as I learned about reimbursement, I applied."

In that letter, Neukirch noted the 41 round trips for which he had not been reimbursed added up to an estimated $1,230 in mileage reimbursement. "Obviously, that money would go a long ways to buying gas, etc.," the letter added.

On July 14, he wrote Kelly again, asking where the matter stood. He didn't hear from her, but after the second letter, he heard from Aetna.

"I have to think it trickled down from Kelly's office, because out of the blue, this woman from Aetna called," Neukirch said. He had not written the insurer a letter - although he had spoken to them on the phone earlier.

Wednesday, Kelly's office told me that they had forwarded Neukirch's letter to the Virginia Department of Medical Assistance Services, or DMAS.

"DMAS reached out to the member's managed care health plan," said Kendra Keith, a spokeswoman for DMAS. "Given this member and his uncle's circumstance and as a gesture of good will, the health plan provided the member with a one-time exception to their policy and reimbursed for the trips."

A woman who called from Aetna first walked Neukirch through a formal claim with Modivcare - which was denied. (Neukirch later learned that in August, Modivcare filed for Chapter 11 bankruptcy.) After the second claim denial, the Aetna rep called Neukirch and said she would get Aetna to cover the costs and send Neukirch a check.

"I thought, I'll believe it when I see it," Neukirch said. "She told me to be patient and sure enough, the check came (Monday)! I really couldn't believe it."

Neukirch got so wound up in relating the above saga he neglected to mention the amount of the check. Turns out that was $1,761.20 - which will indeed pay for a lot of gasoline.

Matthew has had rounds of both chemotherapy and radiation and is doing OK, Neukirch told me. These days, his nephew is renting an apartment in Floyd County from another relative.

Aetna "did me a solid by writing a check when they didn't have to," Neukirch said - apparently, after some cajoling by the Department of Medical Assistance Services. Bonus: It was for more than Neukirch estimated he was owed.

He closed the email by thanking yours truly. My efforts to help readers with matters like these inspired Neukirch to seek his own reimbursement.

He wrote: "I figured Dan Casey is like a dog with a snake and, darn it, so am I!"

Dan Casey (540) 981-3423

[email protected]

@dancaseysblog

Dan Casey (540) 981-3423 [email protected]@dancaseysblog