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Family delays medical care as insurance problems persist 3 months later Analytics Table

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Nearly three months after moving from New York’s Essential Plan to a new health insurance policy, a West Bloomfield woman says unresolved deductible problems continue to delay medical care for her family. Lorri Newman is among approximately 450,000 New Yorkers affected by the July 1 Essential Plan changes. She and her husband went from paying no monthly premium to paying about $450 a month, along with significantly higher out-of-pocket costs. “It has been a huge adjustment,” Newman said. “My husband went back to work to manage that. And we’re still waiting on benefits that we are entitled to in that policy.” Newman said the couple has delayed several medical needs while waiting for Excellus BlueCross BlueShield to correct their deductible information. “I did delay a surgery,” she said. “My husband has to get just eyeglasses, things of that nature. Durable medical equipment—you just can’t get it until these deductibles are met.” “We put these services off until this is straightened out,” Newman added. Excellus previously told Newman that her 2026 Qualified Health Plan deductible and out-of-pocket maximum would be reduced by half. She said her portion was not adjusted until early September, about two months after the new policy took effect. “I was actually told that they were waiting for the Silver plan enrollment period to switch over,” Newman said. “That was August 30, and once that enrollment ended, then I was included in the bulk with everybody else.” Newman said she can now move forward with the surgery she postponed, but she is still waiting for approximately $400 to $500 in refunds or credits for earlier expenses. “I’ve been waiting almost three months for that $400 to $500 to get returned,” she said. “I shouldn’t have to wait 30 days, let alone 90 or 120.” But Newman said another issue remains unresolved: her husband’s deductible. Although they are covered under the same two-person policy, she said his deductible has not been corrected. “Hey, this is great. You got me fixed. But hey, you forgot my husband,” Newman said. “It’s a policy with two people on it, and they took care of my portion, not my husband’s.” Newman said her husband has been denied some services while his account continues to reflect the higher deductible. One medical item would require the couple to pay approximately $3,000 upfront, she said. “Until this is corrected, the service provider is expecting that outlay of cash,” Newman said. In a statement, Excellus said plan designs can differ and affect how members’ expenses are calculated. “Deductibles and out-of-pocket accumulators apply differently for individual, two-person, and family plans,” the company said. Excellus said it has worked with NY State of Health to follow evolving guidance and help members understand their coverage options. The insurer encouraged members with questions to contact a broker, enrollment assister or health plan representative. READ MORE: https://13wham.com/news/local/ontario-county-woman-says-insurance-problems-persist-months-after-essential-plan-changes _______________ Stay up to date with our social media: 13 WHAM on Facebook: https://www.facebook.com/13WHAM 13 WHAM on Twitter: https://twitter.com/13WHAM 13WHAM on Instagram: https://www.instagram.com/13whamtv/?hl=en 13WHAM on TikTok: https://www.tiktok.com/@13wham?lang=en 13 WHAM Daily Local News Digest: https://www.youtube.com/playlist?list=PLuTJB6tta5ar3Fu5CumAvlvVunEP6bc9A For more information, visit https://13wham.com/ Have a news tip? Send it directly to us: Email us: [email protected] Call the Newsroom: (585) 334-8700 WHAM is a NY based station and a ABC Television affiliate owned and operated by Deerfield Media, Inc and receives certain services from an affiliation of Sinclair Broadcast Group. Sinclair Broadcast Group, Inc. is one of the largest and most diversified television broadcasting companies in the country today. #13WHAM #News #Rochester #NewYork

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