Insurance Fraud NEWS
Man dies after using $33,000 insurance check to go on binge
April 24, 2019, Raleigh, NC
Jennifer Alba sifts through the boxes of photographs and documents. It's a collection of what once was, and what her life has become. A mother sorting through pain.
There's her son, Joseph, as an infant, smiling, dressed in a onesie with his bright blue eyes matching the blue backdrop. He was her firstborn, a gift who came into her life when she was just 17.
Not too far away lies the document from a middle school recommending that he be suspended for the last few weeks of school after being caught with marijuana. He was 13.
It was the start of a lifelong struggle with drug abuse that his mother desperately wanted him to break. Over the next 16 years, Alba says, her son spent dozens of nights in jails, cycled through nearly 20 stints in rehab and served two prison terms.
Alba pulls out a bank receipt for a deposit her son made in late August 2017. At 29, he was a DJ who played music at dive bars and strip joints. A good haul was 100 bucks a night. But this deposit was for more than $33,000.
She shakes her head.
Blue Cross and Blue Shield of North Carolina had sent her son a check for $33,399.76. It was for emergency care after he'd broken his jaw in a bar fight seven months earlier.
The check, which included $2,405.28 in interest, was more than he made in a year.
"Dirty money," his mother says.
Over the next four days, her son made three cash withdrawals totaling $13,000. Alba has the receipts.
On September 2, 2017, the day after his last withdrawal, Joseph Hockett II was found dead.
Alba says her son had used the cash to go on the biggest binge of his life. Housekeepers found him in Room 135 of the Suburban Extended Stay of Wilmington.
A bottle of whiskey and a rolled-up dollar bill with white powder were found in the room, according to the autopsy report. The cause of death: cocaine and heroin toxicity.
'A cloud of grief'
Alba reached out to CNN after reading a recent story detailing how Anthem and its Blue Cross entities send checks to patients for out-of-network care instead of reimbursing the providers directly.
Another woman told CNN that a family member received a check for more than $240,000 after out-of-network surgery. The practice has forced some providers to sue patients to recover the money.
Critics say it's a tactic insurers use to pressure providers into joining their networks and accepting lower payments -- one that puts patients in the middle of the fight by sending money straight to them.
The insurance industry says the policy is designed to protect patients from surprise bills and exorbitant charges from out-of-network doctors and hospitals.
For Alba, the story crystallized the questions she had after her son's overdose.
It also compounded her grief: She had helped him sign up for insurance to avoid the tax penalty originally mandated by the Affordable Care Act.
"I didn't realize insurance would be part of his death," she says.
Alba says her son was the last person who should have received such a large amount of money. Her son's life mattered, and she's determined to let the powers that be know something must change.
"I've been in a cloud of grief for the last year and a half," she says. "I'm angry at Blue Cross Blue Shield because they gave him money that wasn't his ... [and] it killed him."
At the time, Alba had no idea about the Blue Cross check. It was only after police turned over his belongings and she went through them that she pieced together the money trail.
Among the items she says she found, in addition to the receipts for the $33,000 check and cash withdrawals for $7,000, $3,000 and $3,000:
• A PDF on his computer showing a $6,096.14 check voucher from Blue Cross in April 2017.
• A $14,104 check from Blue Cross in June 2017.
• A spreadsheet showing that Blue Cross owed him $73,400.01 for some three dozen medical services in 2017.
"They were sending the checks directly to him and not paying the hospitals," his mother says, "which to me is absolutely absurd, and it's careless, and it's just ridiculous."
Even after his death, the money kept coming. Nearly a year later, in June 2018, Blue Cross sent his estate a check for $2,496.95.
In all, Alba says, she is aware of at least $56,096.85 in checks from Blue Cross.
North Carolina insurance commissioner: This is 'a real problem'
Making matters worse, Alba says, Blue Cross knew that her son had an addiction problem when it sent him the money. The June 2017 check for $14,104 arrived shortly after Hockett had checked out of rehab following a relapse. Alba also has Explanation of Benefits forms showing that Blue Cross covered at least one of Hockett's visits to rehab in his final months.
Sending tens of thousands of dollars to a person with an addiction, she says, is "like dangling a piece of meat in front of a lion and telling him not to eat it."
"Why would you give a person with mental health and addiction problems cash like that?" she asks. "It's careless. It's morally wrong. It's horrible. I don't know of any other way to put it."
Blue Cross and Blue Shield of North Carolina refused to answer questions about Hockett. The insurer also declined to discuss why it sent large checks to someone with addiction problems, whether checks have been sent to other people struggling with addiction, or whether anyone else has overdosed and died after receiving such sums.
"While we cannot comment on the specifics of a case due to privacy laws, we recognize this is a tragedy and extend our condolences to the family," Blue Cross spokesman Austin Vevurka said.
Vevurka said the insurance giant tries to negotiate with out-of-network providers for urgent or emergency care on amounts over $25,000. But, he said, "if they refuse, we pay the member because that is who we are contractually obligated to pay."
"We have applied this policy to numerous providers in the state and have typically successfully negotiated payments directly to the provider as a result," he said.
That's news to Cody Hand, a senior vice president with the North Carolina Healthcare Association, which represents more than 130 hospitals and health systems in the state.
Hand says he's not aware of Blue Cross ever negotiating with any out-of-network providers on payments of more than $25,000.
Blue Cross sends the money straight to patients "so that they can force people into their network. They're pretty blatant about that," Hand said. Almost every other insurance company pays out-of-network providers directly, he said.
"Blue Cross is using the patients as a bargaining chip," Hand said.
It's a practice his association wants to see changed.
So does Mike Causey, North Carolina's insurance commissioner.
"Generous insurance benefits and lump sum payments with few restrictions on out-of-network providers are a real probl