NewsWe Follow Through

Actions

‘Like they're giving me life back’: Scripps Health patient caught in Anthem dispute gets brain rehab covered

Angel Coronel was facing thousands in potential medical bills
Angel Coronel
Posted
and last updated

OCEANSIDE, Calif. (KGTV) — A Scripps Health patient recovering from brain surgery will get his expensive rehabilitation covered following reporting by ABC 10News.

In January, Angel Coronel faced a daunting dilemma: pay tens of thousands of dollars to finish a critical rehabilitation program or stop getting care.

“It was almost pretty much like my life was taken away at the moment,” said Coronel.

His family contacted ABC 10News after Scripps gave the 39-year-old a quote letting him know his daily visits to the brain injury clinic in Encinitas would cost him over $1,000 each time through the end of March.

Starting Jan. 1, Scripps Health became out of network for over 100,000 patients with Anthem insurance. The two organizations fought for months and failed to reach a new contract.

Screenshot 2025-01-28 at 2.01.21 PM.png
Oceanside resident Angel Coronel is learning how to walk with a cane and do simple tasks like making a sandwich following brain surgery.

State law requires insurance providers to continue covering care temporarily for some patients when a hospital goes out of network.

Pregnant women, patients with serious chronic conditions and those who had a surgery scheduled are supposed to have their care uninterrupted.

But in Angel’s case, that didn’t happen.
“The last day was super hard. It's just not knowing what was very terrifying. Not knowing if you can continue the care, especially in my situation where I couldn't walk, (and have) problem(s) speaking," he said.

The Oceanside resident said Anthem had his care plan under review in January and it was “silence pretty much” from the insurer. The process was going to take months, leaving him in limbo.

But that changed after our story on him aired on Jan. 3.

“I do feel that if the story didn't air and then I would not be getting the treatment now, I would probably still (be) fighting and battling with the insurance company," Coronel said.
Coronel said after our reporting, his phone started to buzz.

“I noticed I was getting a lot of phone calls from Anthem and talking to like caseworkers to kind of see what they can do to help me," he said.

Anthem said if a member was getting treatment for a serious or complex condition before Jan. 1, they may be able to continue care at Scripps for a limited time.

The insurer said patients or their doctors can reach out to Anthem to request continuity of care by calling the company at the toll-free number on the back of their Anthem member card.

“Our members are our top priority, and we are committed to ensuring they receive access to quality care,” an Anthem spokesperson wrote.

Scripps declined to comment on Coronel’s case, saying Anthem is the decision-maker on the continuum of care requests.