Victoria Man Denied Medical Procedure

Carlos Villalobos

cvillalobos@newscenter25.com

Updated: 12/05/2013 3:51 pm

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Arthur Martinez hasn't been able to eat solid food for weeks.

He has a problem with his esophagus. He was scheduled to have a procedure at Citizens Medical Center to find out the cause of problem, but the day before the procedure he was told he would have to pay almost $900 out of pocket to get it done.

The news shocked him, and with funds low, put the procedure on hold.

"What, I can't believe this you know. I was like in shock. Can they do this," Amelia Martinez said.

Martinez's wife, Amelia, said she didn't understand the hefty out of pocket fee when her husband has medicare.

Concerned over her husband's well being, she contacted us.

"I didn't know what to do you know, I just want to find out what's wrong with him," Martinez said.

To get some answers, I went to Citizens Medical Center.

Vicky Harjes is the director of patient access at Citizens Medical Center.

She said there was some confusion over Martinez's healthcare coverage. He believed his coverage would pay for his procedure, which wasn't the case.

"I'm not sure if he know he only had medicare A and what exactly the benefits were. We find a lot of patients don't know what insurance cover," Harjes said.

The problem is no one explained this to Martinez until we got involved.

An hour after we started investigating, Harjes made a call to the Martinez family, and all their problems were solved.

Arthur will have his procedure as planned and to pay for it, will go on a payment plan.

Harjes said situations like these are all too common with many people not knowing just what their insurance will pay.

"The more you can learn about your insurance the better. Insurance is complex, and it is difficult to understand," Harjes said.

"I didn't know that it didn't cover. He's got medicare, so I thought it will probably going to pay, but no it didn't," Martinez said.

If you have expensive bills that don't add up, you can email me at cvillalobos@newscenter.com or at my twitter @CVillalobosKAVU. 
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