7 On Your Side wipes out grandfather's $92K surgery bill after health insurance mix-up
STATEN ISLAND (WABC) -- A Staten Island grandfather ended up in a costly tug-of-war between two insurance companies after a life-saving heart procedure left him with a hefty bill.
In 2023, HVAC contractor Peter Fatale began feeling shortness of breath on the job. As a devoted father and grandfather, he wasn't taking any chances, so he consulted a cardiologist.
Fatale's doctors were able to open an artery in his heart with a stent. After his successful surgery, Fatale thought he was out of the woods as a policyholder with Aetna, as well as a supplemental Medicare plan with Emblem.
But when the 61-year-old received a $92,000 bill, he said he nearly went into cardiac arrest a second time.
"My insurance said, listen, we're not the primary payer. So they took the money back from the hospital, but then the other insurer didn't pay it," he told Eyewitness News. "They didn't pay it because they're saying they're not the primary payer. So who is?"
Fatale said he was stuck ping-ponging between the two companies, trying to get one of them to pick up the bill.
"How could you have two valid insurance plans and neither one wants to pay? Now I have to pay $92,000 with two insurances," he said.
Fatale appealed his case to both companies and was denied. That's when he turned to 7 On Your Side.
"I watch you guys every night, and I see the results you get for people. And it's not just one particular area, it's anything. You get results. So I said, I have nothing to lose," he told Nina Pineda.
7 On Your Side contacted both of Fatale's insurance companies to clear up the misunderstanding and received a response within 24 hours. Aetna picked up the majority of the hefty sum, while Emblem filled in the rest. After nearly a year of fighting, Fatale was covered.
"I think it was a miracle of God, I thought it was an intervention," he said. "Thank you, Nina, we love you! You can come for dinner anytime."
7 On Your Side spoke to both insurance companies, who stated:
"We were proud to partner with Seven-on-your-side to ensure that the insurance plan for the member's primary coverage was alerted and the problem resolved."- EmblemHealth Public Relations Director Alex Gomez. "Aetna is committed to ensuring accurate coverage for our members, and we have reprocessed these claims with a favorable outcome for Mr. Fatale. We appreciate his patience as we studied his particular situation and worked toward a smooth resolution." - Aetna spokesperson
ALSO READ: 7 On Your Side helps homeowner paying over $80k for solar panels that weren't turned on
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