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Kevin Cullen

A bill to choke on

By Kevin Cullen
Globe Columnist / September 13, 2011

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It was just a typical day in middle-class America. Eric Zoltan, a software developer for Hewlett-Packard, was working in the office of his Framingham home. His wife, Melanie, who works at Brandeis, was in the kitchen, and their toddler son, Daniel, was with her, sitting in his high chair, noshing on a tortilla chip.

“It’s a good thing Melanie didn’t leave the kitchen,’’ Eric Zoltan was saying, “because Daniel didn’t make a sound. He was just flailing his arms.’’

It was the silence that make Melanie turn around, and when she did, she saw that her son was turning blue. He couldn’t breathe. He was choking.

Melanie had been trained in how to give the Heimlich maneuver, but when she tried it on Daniel nothing happened.

Eric grabbed the phone and called 911. The dispatcher said an ambulance was on the way.

Melanie decided to try the Heimlich again, this time with more force. She pressed into Daniel’s abdomen with a quick upward thrust and hoped for the best.

The tortilla chip dislodged and never had Eric and Melanie Zoltan been more overjoyed to hear their son cry.

Soon after, the ambulance showed up and the EMTs were concerned that Daniel might have aspirated some of the chip into his lungs, or had suffered some internal bleeding from the sharp edges of the chip, so Melanie got into the ambulance with her son and off they went to the hospital.

After a few hours in the emergency room, Daniel got a clean bill of health and went back home with his very relieved parents.

Two weeks later - actually, on Daniel’s second birthday - the Zoltans received a bill from the ambulance company for $1,785. And 80 cents.

They sent that bill, like others accrued from Daniel’s not so excellent adventure, off to their insurance company, Anthem Blue Cross of California.

Anthem sent a lovely letter back, telling the Zoltans to get lost, that they weren’t paying for the ambulance ride. Eric Zoltan called Anthem and asked why, and the woman on the other end of the line told him that the ambulance company that took Daniel to the hospital was “out of network.’’

So, basically, the insurance company was saying Melanie Zoltan should have turned to her blue-faced, dying child, wagged a finger, and said, “Now, Daniel, you need to stop choking to death right this instant, because Mommy has to make some phone calls, to find an ambulance service that is covered by our insurance policy.’’

This sort of thing increasingly is becoming less an isolated horror story and more the norm.

Anthem is hardly the only insurance company that operates in a Kafkaesque world, where the eminently reasonable is deemed unreasonable, where you are forced to spend countless hours on the phone, talking to strangers who know nothing about you but who seem very good at saying no to you.

“I wish our story was unique,’’ Melanie Zoltan was saying, “but I posted the basics on Facebook and heard back from about 10 of my friends who had similar experiences with other companies.’’

I exchanged several e-mails yesterday with a very nice guy at Anthem named Darrel Ng, asking him if his company really expected the Zoltans to comparatively shop for ambulances while their son was choking to death. He later called back to say that while he couldn’t talk about individual cases, “I’d suggest you call Mrs. Zoltan again.’’

I did, and Melanie Zoltan said she had just got off the phone with some very nice person at Anthem who said there had been an oversight and now that they knew it was a “true emergency,’’ Daniel’s ambulance ride would be covered.

A good day’s work. Pass the chips.

Kevin Cullen is a Globe columnist. He can be reached at cullen@globe.com. Follow him on Twitter at @GlobeCullen.