Family With Rare Medical Conditions Denied Obamacare Coverage, Now Struggling With New Plan’s Expense

  • Ken Davert has spina bifida. Melissa “Missy” Davert and their two children have a condition that makes their bones fragile and susceptible to breaking. 
  • When the Davert family was told their insurance for their children would be cancelled, they turned to Obamacare and were denied. 
  • Now, with a fixed income, the family is worried about being able to afford the out-of-pocket maximum for the private insurance their children need.
  • “… we’ve overcome many obstacles in life. And now it’s a shame that one of the obstacles we have to overcome is our own government to pay for health care,” Ken Davert said.

Every member in the Davert family has a medical condition requiring special care. But after losing their preferred insurance upon the enactment of the Affordable Care Act and being denied federal coverage, the Michigan family is now worried about high costs associated with their new private plan.

According to The Bay City Times, Ken Davert has cerebral palsy and his wife, Missy, and their 15-year-old fraternal twins all have a condition called osteogensis imperfecta, which makes their bones very fragile.

davert family
The Davert family has unique physical struggles with medical conditions and changes in health care due to the Affordable Care Act has added insurance to their list of difficulties. (Image source: YouTube)

The newspaper reported that the couple receives disability payments and are covered under Medicare. The state’s Children’s Special Health Care Services covers issues related to the teens’ bone condition but not their other health needs.

“We received a letter from Blue Cross maybe four months ago stating that their plan was going to be canceled due to new requirements of Obamacare,” Missy Davert told The Bay City Times. “I can imagine they didn’t fit criteria of the new plan. There were some particular benefits the new act didn’t cover.”

So, the family applied for Obamacare. The Bay City Times reported that their first application was lost and their second came with a rejection. In response, the family is filing an appeal, which could take three months for the federal exchange to answer.

missy davert
Melissa “Missy” Davert on the phone with a federal health insurance exchange navigator. (Image source: YouTube)

“What we did in the meantime, because their insurance was ending Dec. 31, we had to go out and buy a separate plan directly through Blue Cross/Blue Shield,” the teens’ mother told the newspaper. “The president had come on TV and said, ‘If you like your plan, you can keep your plan, we won’t require you to get marketplace insurance for another year.’ But Blue Cross/Blue Shield would not continue their plan, despite what the president said.”

The family’s issue with this new plan is its out-of-pocket maximum. Before, coverage cost the parents $2,500 for both teens, the Times reported. Now, it will cost $5,100 each — $10,200 total.

“It’s great insurance if you don’t have to use it, that’s how I look at it, but you never know from day to day if you’re going to need it,” Missy Davert told the Times.

davert children
The Davert children, Michaela and Austin, are 15 years old and understand how much their medical expenses can add up. (Image source: YouTube)

Based on their family’s medical history, meeting the maximum out-of-pocket expense relatively common.

Watch this video from the Mackinac Center for Public Policy about the Davert’s insurance issues (via Michigan Capitol Confidential):

“We have such a unique family and we’ve overcome many obstacles in life. And now it’s a shame that one of the obstacles we have to overcome is our own government to pay for health care,” Ken Davert said in the video, laughing in disbelief.

The Bay City Times reported that it is unclear exactly why Blue Cross cancelled the Davert’s previous coverage.

Last week after the family’s plight was seen on some websites, the newspaper reported that they were contacted by  Paul Tibbits, a representative with the Federal Health and Human Services Agency. Tibbits told the Daverts he thinks a glitch in the federal marketplace system might have mistakenly denied their children Medicade coverage. When she tried to re-enroll again after this conversation, Missy Davert said the site still wasn’t working.

Overall, the family told the newspaper they are figuring out how to make it work financially. Ken Davert is going back to work, something he can only due part time due to the symptoms associated with spina bifida.

“It’s frustrating to me. It seems more and more our government has become a controlling power when the power is supposed to be with the people,” Missy Davert told the Times. “I’m not saying this law isn’t good for some people. I’m really happy for those people [being helped], and I’m not trying to take away what they’ve gained, but it’s also hurting many people.”

Watch this video from a couple years ago, in which the Daverts share more about their family and life:

Read more of the Davert’s story in the Bay City Times’ full article.