© Alex Remnick/The Star-LedgerSandy Marujo's cousin Sergio Branco has leukemia and needs a bone marrow transplant. The family waged a battle to have Branco's COBRA insurance reinstated. It was cancelled because of a 26-cent shortfall on an insurance payment.
Twenty-six cents.
Most of us could scrape that up from under our couch cushions or on the floor of a car.
Sergio Branco has 26 cents, too. The question was whether or not he would be permitted to pay it.
Branco, a 33-year-old father of three, was a truck driver for Russell Reid, a Keasbey-based waste-management company.
"In his spare time, he would play with his children, liked having barbecues and people over for gatherings," his cousin Sandy Marujo said. "He is a big kid at heart."
In January, Branco wasn't himself. He didn't feel right.
"He complained about bone pains and being extremely fatigued," Marujo said. "He decided to go to the emergency room."
The Edison man underwent several tests, which indicated he had a very weak immune system. It could be leukemia, the doctors said.
A few days later, a bone marrow test confirmed the diagnosis: acute myeloid leukemia. The disease, left untreated, travels fast and can kill within months, or even weeks, of diagnosis.
Branco started a series of treatments including chemotherapy and transfusions, and he took three months off from work under the Family and Medical Leave Act (FMLA).
Doctors soon said he'd need a bone marrow transplant to prolong his life. They found a 10-point match - the best possible match. The transplant and related care for the disease would cost more than $500,000.
Good thing the family had health insurance through Branco's job, they thought.
But when his three-month leave under FMLA ended, Russell Reid fired him, Branco's family said.
At least they'd be able to continue health insurance coverage through COBRA, short for the Consolidated Omnibus Reconciliation Act. Under COBRA, a terminated employee can continue the same health insurance coverage he had while employed, but the terminated employee is responsible for paying the full premium.
The bone marrow transplant was set for Aug. 16, and Branco's wife, Mara, took care of securing COBRA coverage.
The law is very specific about how COBRA must be handled.
Employers must notify plan administrators of a qualifying event - such as termination of employment - within 30 days, according to the Department of Labor. Plan participants and beneficiaries must be sent a notice saying they can continue benefits no later than 14 days after the plan administrator receives word that a qualifying event has occurred. The individual then has 60 days to decide whether or not to take COBRA, and another 45 days after that to pay the initial premium.
Branco was fired on April 30, so he had until June 30 to decide whether or not he wanted COBRA. After that, the payments would be due.
© Mara BrancoSergio Branco and his son Tristan at Tristan's first birthday party last year.
"You have 60 days to elect coverage following the 'Loss of Coverage Date' or the 'Notification Date,' whichever is greater," and, "Your first premium payment will be due no later than 45 days after the date of your election to the Health Benefits Continuation Plan."
It also said premiums must be paid up to and including the current month in order to keep coverage current. That would mean payments were not due until July.
The letter listed premium amounts for family coverage, but the Brancos only wanted coverage for Sergio. So Mara Branco called Paychex, the third-party benefits administrator that was handling COBRA on Russell Reid's behalf, to ask about the premium for just Sergio.
The cost would be $518.26 per month.
So on or about May 24, Mara Branco filled out the paperwork and mailed a check to Paychex for the first month of coverage.
She wrote the check, dated May 24, for an even $518, inadvertently missing the 26 cents.
Paychex cashed the check on June 11.
The family thought all was well, and Branco continued to receive treatment. But later in June, the hospital told Branco he didn't have insurance coverage.
Surprised and thinking there was an error, Mara Branco contacted Paychex.
© Mara BrancoSergio Branco in June 2013, six months after he was diagnosed with leukemia.
"They're playing with my husband's life," she said.
Mara Branco noted they were still well before the payment deadline, but she said Paychex told her it was instructed by Russell Reid not to accept any more payments from the Brancos.
Mara Branco said she took that information to Rich Gross, Russell Reid's human resources rep.
"The whole time he said Paychex is giving me false information," Mara Branco said. "I told him if he'd just make a phone call everything would be alright. He said he'd see what he could do."
But apparently nothing was done. Paychex still said it couldn't accept payments.
Branco also contacted the Department of Labor.
"DOL called human resources three or four times and each time a higher boss called, and told them the mistakes they made," she said she was told. "Rich Gross told the DOL 'I will see what I can do,' but the next day he e-mailed DOL and said they're still not putting (Sergio) on the insurance."
Through it all, there was never any written notification that the payment was short. The Brancos weren't told of the cancellation in writing until they received a letter dated July 2.
Some time later, Paychex returned the $518 payment.
GETTING NOWHERE
The Brancos didn't cash the $518 check, and additional contact got them nowhere.
Sergio Branco's doctor also pleaded for help on their behalf.
He advised the companies that Branco "will most certainly die in the very near future if he does not proceed to transplant; therefore I am writing to request that every effort be made to reinstate his health care insurance coverage."
That didn't help. Russell Reid and Paychex did nothing.
The Brancos turned to attorney Jeffrey Resnick of Sherman, Silverstein, Kohl, Rose & Podolsky in Moorestown. Resnick filed a motion on the couple's behalf in court last week.
"With these COBRA cases, the notice has to be exact according to the statue, and here there were some notice violations," Resnick said, adding that Paychex did cash the $518 premium check.
Resnick said the couple tried to make right on the payment. With two young children, a teenager and a very sick husband, Mara Branco made an innocent mistake by excluding the 26 cents from the payment, he said.
By law, Branco should have been notified of the delinquent 26 cents before coverage was terminated, and that didn't happen, Resnick said. They should have been given an option to pay.
Plus, the law also says coverage can't be terminated for "non-payment of a de minimis amount."
"There's no technicality for the employer on this. What they should have done was say, 'Okay, you gave us $518. We're going to give you another however many days to pay the 26 cents,'" Resnick said. "He's not looking for a handout or a free ride. He's willing to pay the $518.26."
Without insurance, the $500,000 treatment "may as well cost $100 million," he said.
"They know he's literally in a life and death situation and for 26 cents, they're denying him the right to get the health insurance coverage he needs," he said.
Several days before Resnick filed the court papers, we reached out to Russell Reid to talk about the case.
"There's nothing to comment on at this point," human resources rep Rich Gross said. "We're still trying to figure it out."
What's to figure?
The guy tried to pay. His check was cashed. Reinstate his coverage - the coverage he paid for in good faith.
We asked Gross if he had told Paychex not to accept payments from the Brancos, but he refused to answer the question. We also asked about the calls from DOL.
"They've given us some feedback, but the feedback has been incorrect," he said without giving further clarification.
We also reached out to Paychex, which asked for time to review the situation. About 12 hours after we last spoke to Gross, Paychex had an encouraging answer.
"Paychex is working diligently with our client and other appropriate parties right now to reinstate Mr. Branco's coverage," spokeswoman Laura Saxby Lynch said.
We asked for clarification. Did that mean Branco would be reinstated?
"We are very ardently working on the situation with all parties including the carrier, and the decision ultimately rests with the carrier," Saxby Lynch said.
More delays and more finger-pointing while a man's life is on the line. All over 26 cents.
CHANGE OF HEART
Then things changed late Friday.
"The Department of Labor said the company will reinstate him from May till now," a relieved Mara Branco said. "They said the company did it wrong. I am super happy. It's like a weight has lifted off my shoulder. It's better than winning the lottery."
Branco said Paychex told her she could mail payments for May, June and July and she would receive more paperwork about the August payment.
The family said it will not pursue the court case, and the transplant is still scheduled for Aug. 16.
They promise to keep us posted.
There are scumbags and there are scumbags. Russell Reid, go to the head of the line.