After Arline Feilen's husband, father, and mother died within a few years of each other, Feilen one day found herself so grief-stricken that a friend sent her to the hospital out of concern for her safety—and because Feilen's association health plan (AHP) didn't cover mental health services, she was left with an over $20,000 hospital bill, Laura Ungar reports for NPR's "Shots."

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Feilen's story

In 2013, Feilen's husband died by suicide, and in 2016, she lost her father to cancer. Then, February 2019, her mother passed away at the age of 89.

"We were like glue, and that first Mother's Day without her was killer," Feilen said.

A few days later, Feilen drank around eight or nine beers in several hours and sent concerning texts to her sister and some friends that raised concerns Feilen could hurt herself, Ungar reports. Eventually, a friend called an ambulance, which took Feilen to Northwestern Medicine Central DuPage Hospital.

Feilen arrived in the ED and was later moved to a shared room in the hospital's inpatient psychiatric unit the following day. She spent five nights in the hospital, undergoing a series of tests, including bloodwork, an abdominal ultrasound, and an electrocardiogram. She also received counseling and began taking an antidepressant.

Once she got home, she stopped drinking, continued taking her medication, and continued counseling, Ungar reports. Feilen said she saw her mental health crisis as "another mountain I've climbed" and her grief began to subside.

The bill comes

Then, Feilen received her bill. Initially, the bill was for $29,894.50, which included $16,480 for her room in the psychiatric ward and $3,999 for her stay in the ED. After the hospital learned her health plan didn't cover mental health, her bill was reduced to $21,634.55.

Officials from Northwestern Medicine issued a statement, saying the health system offers patients a variety of financial assistance programs. "In this case, we have tried numerous times to connect with this patient to provide guidance and assistance," the statement said.

Feilen said that she spoke to a social worker with Northwestern and began filling out a form for financial help but stopped when she worried that she would not qualify.

An association health plan leads to a high bill

Feilen's health insurance came through an AHP purchased through Affiliated Workers Association. The Obama administration attempted to cut down on these plans over concerns that they did not offer comprehensive coverage and could leave enrollees on the hook for high costs. However, the Trump administration last year issued rules that expanded access to the plans as a way to give U.S. residents additional low-cost insurance options. 

AHPs are formed by employers and self-employed individuals in different industries. Under a rule issued by the Trump administration, AHPs are considered large-group plans. That means they are exempt from certain Affordable Care Act (ACA) regulations, such as the law's essential health benefit requirements, which requires insurers to cover certain benefits, including mental health and substance use disorder treatment.

When Feilen was shopping for health insurance years ago, she said she started looking into ACA plans on Healthcare.gov but found them confusing and gave up.

According to Jennifer Snow, acting national director for advocacy and public policy for the National Alliance on Mental Illness, it can be difficult for consumers to know whether a health plan is ACA compliant. Some plans sold outside of Healthcare.gov may be labeled as "Obamacare" but not cover the law's essential health benefits, Snow said.

"You have to be really careful you don't accidentally buy one. They're always cheaper," she said. "But if it seems too good to be true, it probably is."

Sheri Boehle, an insurance agent who handles Affiliated Workers Association, said a number of people purchase AHPs for a short period of time, and that it can be a great option for people looking for protection for catastrophic health problems.

Boehle added that customers are always given a brochure explaining exactly what is and isn't covered. Feilen said she received a brochure saying mental health wasn't covered but thought that was fine because she didn't think she'd need it.

Now, Feilen said if she could go back in time, she would have bought insurance that covered mental health. "I would definitely recommend it. You don't know what life is gonna bring you," she said. "I never imagined in a million years that I'd need mental health care" (Ungar, "Shots," NPR, 10/31).