ENCINITAS, Calif. — Angel Coronel is learning to speak, eat and walk again.
The 38-year-old goes to the Scripps Health brain injury rehab program every day and needs to spend two more months in the program.
“It means everything,” he said before tearing up to explain the limbo he’s now in.
Coronel, who is recovering from a brain tumor and stroke, is one of an estimated 125,000 patients stuck in the crosshairs of a dispute between Anthem Blue Cross and Scripps Health.
The two have been fighting for months about price increases and red tape and failed to reach a new contract. As of January 1st, Scripps became out of network for Anthem members.
Scripps gave Coronel a notice letting him know his rehab is no longer a covered service. It will cost him $1,146.60 in out-of-pocket fees for a single day of care, the document says.
“It just felt like they took my quality of life away,” Coronel said, adding he can’t afford the nearly $70,000 it will cost him over the next two months to finish the rehab.
Health insurance providers are legally required to continue giving patients with serious chronic conditions in-network rates for a limited time. But patients must apply for the continuation of care and there’s no guarantee it will be approved immediately.
Coronel’s aunt Lisa Ryan said someone recovering from a brain injury can’t comprehend the process or know how to fill out the paperwork.
“I spent the whole day on the phone trying to figure out exactly what our options were going to be. If Angel had to do that, he would not have been able to do that and he would have been stuck,” she said.
Anthem said the company is working directly with Coronel to ensure he can keep getting his care at Scripps. But as of Friday afternoon, the Oceanside resident said the insurance company still hadn’t given him approval to attend the rehab program.
“I kind of feel a little hopeless at the moment,” he said.
A Scripps spokesperson declined to comment on this story saying Anthem is the decision-maker on continuum of care requests.
Coronel had a message for both organizations.
“Put people first before profits.”
