Woman recovers $22k from HMO

Happy couple Dino Amodio and Barbara Bordeaux are now free from $22,000 in debt. Their HMO refused to cover Bordeaux’s medical expenses. Senator Klein helped with their appeal. Photo by Victor Chu

Senator Jeff Klein came to the aid of an Allerton Avenue woman whose stay at a local rehab center was supposed to be covered by her HMO. She almost ended up footing a $22,000 bill.

Barbara Bordeaux was shocked to learn that a two-month stay at Eastchester Rehabilitation at 2700 Eastchester Road would not be paid by her provider, Touchstone. She was being treated for severe depression and anxiety.

Bordeaux and her longtime boyfriend Dino Amodio filed a federal appeal thorough Maximus Federal Appeals – a Medicare Appeals Council – after being turned down for coverage of the expenses in January.

They also reached out to Jeff Klein’s office, which corresponded with the appeals panel. On March 20 Touchstone’s decision was overturned, and the HMO will now pay the bill.

“It’s shameful that healthcare in this country is so often defined by a culture of bureaucracy which patients must fight against to get the services they need,” Klein said. “Healthcare should be affordable and more accessible. I’m happy that I was able to step in on Barbara’s behalf, but I’m sorry that my intervention was necessary at all. The healthcare system should alleviate our concerns, not contribute to them.”

The appeal was processed about two weeks after Amodio and Bordeaux went to Senator Klein’s office and asked for help.

“She had Medicare, and her HMO was Touchstone,” Amodio said. “I was under the assumption that the insurance would take care of it. When I went to see the accountant at the rehab center, he said that she would have to be held responsible. He said her claim was denied.”

Amodio said that he was glad that Klein was able to get his companion help in this matter. While he said she had savings to cover the expenses, it would have really eaten a hole in her nest egg.

“I am sure that Senator Klein’s intervention really made the difference,” Amodio said. “Whatever letter came from his office, it really moved Barbara’s appeal along quickly. God only knows how long we would have been tied up with this.”

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