KNOXVILLE, Tenn. (WATE) — A Knoxville woman is in the middle of a dispute with her insurance company and its critical illness policy.
Betty Ferguson has had the insurance for over a decade. She filed a claim five months ago when she underwent open-heart surgery, but she is disappointed with the payout.
The insurance policy she has is from her former employer, Vanderbilt Mortgage. When Ferguson retired in 2014, as a precaution, she continued paying for critical care coverage with UNUM.
As a cancer survivor, she knows how important critical care insurance can be. However, she said critical care coverage has some apparent limits.
“I kept the critical illness and I’ve paid 89 dollars a month ever since 2010. Never missed a payment, it’s an automatic bank draft,” said Betty.
The policy benefit covering critical illness would pay a maximum of $10,000. Her open heart surgery, on December 27, left a long scar but the operation saved her life after her cardiologist noticed a problem at his office on December 23.
“They would not let me come home because they said I was a walking time bomb. If it ruptured, I wouldn’t make it,” said Betty.
Her open heart surgery took seven hours, then another 23 days in the hospital recovering. Betty’s primary insurance company paid a big part of her bill. Remembering that small critical Illness supplemental insurance policy with UNUM, she filed a claim. However, the payout was not what she expected.
“They sent me 25%, which was $2,500,” said Betty.
Betty expected the full amount of $10,000. She called UNUM.
“The girl on the phone was very sweet. She said it paid 25%, that it didn’t pay 100% because I didn’t have a heart attack. But I said, I had open-heart surgery, that’s worse than a heart attack,” said Betty.
“It’s just not right. I don’t know what you can do, but it’s not right,” said her husband, Jack Ferguson.
“She said if I had stents put in – like Jack had two stents the year before – I would have gotten $10,000, but since I didn’t have a heart attack, it wasn’t considered critical illness,” said Betty. “I have paid them faithfully for critical illness insurance. I feel like I should have been paid 100%. This is my dispute form, I appealed it.”
However, she lost the appeal. WATE reached out to the insurance provider, UNUM says “we have carefully reviewed this case and stand by our decision. While we acknowledge open heart surgery is a serious surgical procedure, under the clear language of the Group Critical Illness policy, open heart surgery is covered at 25%, the amount Mrs. Ferguson received.”
“I can make it without it, but it is not right. I don’t go down without a fight. I feel like that $10,000 dollars should be paid to me,” said Betty.
In its decision and explanation to WATE, UNUM was clear that the type of surgery Ferguson underwent did not qualify for 100% coverage under its critical care policy. Insurance experts say if you are scheduled for surgery, and if possible, contact your insurance provider ahead of time, and ask how your surgery would be covered under your plan, that way you know in advance and there are no surprises.
As for her health, Ferguson says with therapy several times a week, she continues to regain endurance and strength.