Virginia woman diagnosed with erroneous health condition lost insurance. Then she was in a bad accident.

RICHMOND, Va. -- Pamela Plumb buys private health insurance because she’s retired and not yet able to qualify for Medicare.

She’s never had a problem until a surprising rejection letter arrived in the mail at her Northern Neck home in March.

The letter detailed a mysterious medical diagnosis, which Pamela Plumb said was news to her.

“We regret that we are unable to offer coverage to you for the following reason, history of rheumatic mitral insufficiency,” Pamela Plumb read to CBS 6 from the letter.

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“Were you shocked when you saw that?” CBS 6 investigative reporter Melissa Hipolit asked Pamela Plumb.

“Yes because I’ve never had any diagnosis of that,” she replied.

Plumb immediately called Bon Secours Health System and attempted to find out where the diagnosis came from.

Her husband, Jeff Plumb, said Bon Secours told the couple they needed to try to figure it out themselves.

“We had to go do all the calls and foot work as far as going through all her providers. Every one of her providers said the same thing. We see this on your record, we didn’t put it there, we can’t remove it,” Jeff Plumb said.

So Pamela Plumb lost health insurance on April 15.

She was in the hospital a couple of weeks later.

“Yes we had a very bad traffic accident,” Pamela Plumb said.

“It was raining that day and hit a wet spot and hydroplaned and rolled the truck,” Jeff Plumb added.

The initial bill for the hospital stay with VCU without health insurance was $22,000.

Jeff Plumb said VCU worked with the couple and adjusted the bill down to a little under $10,000.

“Retired it took a hit, but it was paid,” Jeff Plumb said.

And yet, the Plumbs said they never should have had to pay nearly $10,000 out of pocket.

“It’s not fair,” Pamela Plumb said.

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Finally in September, after what they describe as months of back and forth with Bon Secours, they learned from Alan Bailey, a Vice President at Bon Secours, an incorrect code was placed on Pamela Plumb’s record by a third-party billing company used by the health system called Ensemble.

The incorrect code showed Pamela Plumb had a cardiac condition, which caused the insurance company to deny her coverage.

“I didn’t do anything wrong and all the records show that I don’t have that code, and for them to take months to fix it is ridiculous,” Pamela Plumb said.

Because of that, the Plumbs believe Bon Secours should compensate them for the thousands of dollars they had to pay VCU.

“They didn’t offer to pay for anything to reimburse us for whatever we paid for, it’s just not fair,” Pamela Plumb said.

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The couple said Bon Secours forwarded their information to the claims department for consideration.

In a letter from the claims department, a Bon Secours employee told the couple Ensemble employees are not employees or agents of Bon Secours, and so the health system could not respond to the couple’s claim on Ensemble’s behalf.

She said their concerns were escalated to leadership at Ensemble and their customer service team would be reaching out, but the Plumbs said since receiving that letter, they’ve heard nothing.

“Since you received this letter have you heard anything from the claims department?” Hipolit asked.

“No, no,” Pamela Plumb replied.

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Just another source of frustration from a situation that the Plumbs said feels wildly unfair.

“It was not something that VCU did, that my wife did, that we did, the point of error was on Bon Secours’ side and their billing company,” Jeff Plumb said.

CBS 6 asked Bon Secours about what happened to the Plumbs, and if they plan to compensate the couple for what happened.

We also asked what Bon Secours plans to do to ensure this doesn’t happen to another family, but all a spokesperson said is that Bon Secours handles patient and billing complaints personally and privately.

CBS 6 also reached out to Ensemble and a spokesperson essentially said the same thing, stating that because of HIPAA laws, it is their policy to handle all billing matters personally and privately.

Then less than an hour before the story was set to air during CBS 6 News at 5 p.m. on Friday, Dec. 8, Melissa Hipolit received word from Bon Secours that there may be an update to this situation.

She called the Plumbs soon after, and they told her they had just heard from Vice President Alan Bailey. He told the couple Bon Secours was going to make them whole for the situation and pay their bill from VCU.

“I appreciate them taking care of it, but it shouldn’t have taken this long, and it should not happen to anyone else,” Pamela Plumb said.