Sick but Insured? Think Again

[kurth]

Sick but Insured? Think Again
Lawsuits accuse insurance companies of retroactively dumping families that rack up large bills. Firms defend their policies, but the state is investigating.
By Lisa Girion, Times Staff Writer
September 17, 2006

When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs. Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.

"We're in big trouble," Leslie said. Shortly after Selah's medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively, refusing to pay for treatment, including surgery the insurer had authorized in advance. The company accused the Shaeffers of failing to disclose in their coverage application an undiagnosed bump on Selah's chin and physician visits for croup. Had that been disclosed, the company said in a letter, it would not have insured Selah.

The Shaeffers say they weren't trying to hide anything. When they applied for coverage, Selah did not have a tumor, at least as far as they — or any physician — knew. The doctor visits occurred after Leslie filled out the paperwork, and they seemed routine, the Shaeffers say. They believe Blue Cross was looking for any excuse to dump their daughter and dodge her bills. Cancellations such as Selah's are fueling a new backlash against health plans. In a series of recent lawsuits, policyholders say they were illegally terminated, causing substantial financial hardship and jeopardizing their healthcare... The suits accuse health plans of dumping sick policyholders without evidence that the consumers intentionally omitted information about their medical condition or history. They also accuse insurers of using applications that are vague and confusing by design, trapping consumers into making mistakes that can be used to cancel their coverage later.

The complaints involve individual policies — the type of coverage sold to people who work for themselves or for employers who don't offer health benefits. Unlike many work-based plans, which are open to qualified employees regardless of health, insurers in California and many other states can reject applicants for individual policies based on their conditions or health histories. After an applicant is accepted, a state law prohibits health plans from canceling unless the policyholder lied to obtain coverage. Aside from appealing to the company that dumped them, subscribers' only recourse is to complain to state regulators or sue. After an insurer yanks coverage, it can be difficult, if not impossible, to get a policy from another carrier...

http://www.latimes.com/business/la-fi-revoke17sep17,0,1214150.story?coll=la-home-headlines

[Deja Q]

1. I think EVERY American needs to dump their health insurance now

I have a coworker who often says "What's the point of having it if they keep reducing the benefits and jacking up the rates?"

Maybe these vultures will go out of business, as they deserve to.

People buy insurance to use it when they have to. And insurance is a business like any other; bad situations DO happen. That's why they charge big rates. To save and hunker down for them bad things to happen; bacause that's where the money comes from.


(socialized medicine is bad again, how? :crazy: )

[kurth]

2. Yep. "Blue Cross parent WellPoint reported $751 million in net income

in the second quarter, a 34% year-over-year increase."

[Gregorian]

11. I dumped Blue Cross six months ago.

My rate went up over fifty percent. And I said good bye.

[OzarkDem]

27. Oh, there's a good idea (not)

Unless you're disabled, over 65 or have a very low income, private health insurance is your only option. It would be very bad advice to tell someone to give that up with no alternative.

Better to work to reform the system, giving up your health insurance won't accomplish anything.

[davekriss]

53. I agree, bad advice

18,000 fellow American citizens die each year because of no insurance and thus a lack of access to adequate health care. That's one Vietnam every three years, or six 9-11's each year.

[NotGivingUp]

35. i've had this thought several times in the past. if everybody

would just drop their insurance at the same time, these companies would be screwed.

[ScreamingMeemie]

43. If I were to dump my insurance right now...my family would be in a

world of financial hurt. It is rock and hard place for so many of us.

[donco6]

51. For those with existing conditions, that's not possible.

I would never be covered again, by anyone.

[alarimer]

58. And they make piles of money off the premiums

They're just too cheap to pay out when someone actually needs insurance. Health care needs to be taken out of the hands of the bean counters and for-profit corporations.

[NVMojo]

3. I think it is not just the insurance companies, it's healthcare providers

and their outrageous costs. I just had a sinus surgery about 3 months ago and the bill from the hospital was $12,000. for 3hr surgery and the bill from the surgeon was $18,000. The bill from anesthesia was $1,000. and pathology bill was $400. Now I can tell you that I would have rather suffered than put our family into debt if we did not have health insurance. As it was, we had 20% in deductibles to pay.

It's a ripoff. We need a healthcare bubble to burst NOW!!!

[kurth]

13. $160 for a tetanus shot

A neighbor - who is covered by a large-deductible Unicare PPO - had to pay $160 out of pocket for a freakin' tetanus shot at his doctor's office. His son paid $35 for the same thing at his college's clinic.

[onecent]

37. I can go to the countyhealth clinic for free in Liberty, Missouri...isn't

this still an option for people?

[proud2BlibKansan]

56. How long do you have to wait?

Off topic, but if you live in Liberty, I hope you are planning on voting for Sara Jo Shettles!

[Greyhound]

16. How do you think the providers got to raise their fees so high?

That was phase one of the insurance industry taking over health care. They lured physicians into their web by offering to pay rates far above what their existing fee structure called for.

The insurance industry has so screwed up the whole field that hardly anyone realizes how we got here in the first place. :think:

[knitter4democracy]

23. Talk to a doctor about insurance

You think patients hate it? You have never seen such normally nice people so angry until you bring up insurance. Most insurers pay right at cost or only a wee bit higher. The only way doctors are making it (and I'm talking the majority, not super specialists or docs who do a lot of cash-only procedures) is by upping the volume. It's like Walmart--they are rich because they sell so much, not because their profit margin is high.

That, and doctors get it on both sides--patient insurance companies that they have to accept in order to have patients at all and malpractice insurance that they are forced to carry or can't have hospital admitting priveleges.

More and more are clamoring for a national health care plan, and some are even going insurance free (either by working for the VA or armed services, like my old OB, or by opening insurance free practices). Doctors are furious and know that the system is badly broken and want change. It's hard for them to enact change, though, when they're working 80 hour weeks and have laws on insurance coverage over their heads.

[Greyhound]

38. Exactly, they screwed it up for everybody except themselves.

Don't even start on the usurious rates they extort from everybody. Why is it so difficult to see the problem? The entire system is taxed to the breaking point and there is only one party benefiting from it, duh. :dunce:

[knitter4democracy]

40. They sure are.

Just look at their overhead numbers (usually around 30%) and compare them to Medicare (around 5%, last I checked). That overhead is going to shareholders and higherups.

[ikojo]

62. Back in the day before HMOs doctors and hospitals

would itemize and charge for every little thing. Because most people had a plan that paid 80% after a deductible, leaving the patient responsible for 20% after the insurance company paid, doctor's fees got out of control. Under that structure people did not utilize medical care as often because the cost was shared. If I was responsible for 20% of the cost of an MRI, you'd best believe I'd think twice about getting one!

If the MRI is considered an xray or diagnostic test and I have no co-pay, of course I'm going to ask for one and because most doc's are afraid of malpractice suits for not trying any and everything, they will comply with the request. Not all MRIs need to be precertified through the insurance company and anyway it's the physician's responsibility to obtain any precertifications, not the member's.

Enter the HMO's and managed care: now the co-pay was a set amount...$10 or so to see a primary care physician and more to see a specialist. All care was to go through the PCP (they were the gatekeepers). Under some managed care plans PCP's were incented NOT to refer people to specialists and since their income depended on NOT referring, many did not refer patients to a specialist.

Now most HMOs are open access (meaning there is no gatekeeper PCP) and members can make an appointment with a specialist. However, the insurance company micromanages what that specialist is allowed to do.

Everyday all HMOs have a team of nurses who visit hospitals to read medical charts of patients on their plan. They read the notes to determine whether the patient should be discharged. If the nurse feels the patient should be discharged (and this person is using guidelines established by Rogers and Milliman) but the doctor feels differently, the additional days the patient spends in the hospital are not paid by the insurance company. The hospital is forced to appeal to the insurance company and must do so within a specified period.

[knitter4democracy]

26. There are some good reasons for those costs.

I agree, some costs are just padded on to see if the insurance company will pay for them and then you if they can. That's true.

The reality, though, is that healthcare is really expensive. My hubby is under pressure from the partners at the practice where he works to sign a new contract that would cut his salary by $25K a year. They're saying that, even though he's bringing in over a hundred thousand dollars in billing a quarter, he's not paying for himself and all the support stuff (his share of the nursing costs and other costs).

Now, we know that to be a blatant lie, but we have seen the numbers for the practice, and they're not making all that much money, considering how much they're billing. The profit margin just isn't that high. By the time they pay for the heat and electricity (high costs, since they have a lab and X-Ray machine, etc.), the nurses and other staff, and the two staff doctors, the partners are doing well but aren't super filthy rich like you'd think with all the money coming in.

My hubby has to make a high enough salary just to pay off his $175,000 in med school loans and all the consumer debt from residency (it was super tight for a family of four on his salary, and there were two moves involved, and too many times we had to resort to credit cards). When our first house didn't sell for almost a year, that didn't help, either. My hubbby's in negotiations with the partners, but we might have to move again this spring for him to start at a new job.

That's the reality of healthcare from the other side of the desk.

[OzarkDem]

28. It's a vicious cycle

Private insurance companies dump high cost patients onto either government paid systems or health care providers. Hospitals are racking up huge costs for providing coverage to those without health insurance, with little or no help from the government. They have to make up the cost of uncompensated care somewhere.

[lavenderdiva]

4. we need Universal Healthcare now...

I don't understand a lot of people's fear of it. My Repub MIL, who has great insurance by the way, can give you a litany of reasons why we shouldn't have it, and how it would negatively affect her ability to get into her doctors at a moment's notice. To hell with the rest of us...

[Warpy]

5. THIS is why the lame ass plan the party is sticking with,

that modified Hillarycare, has GOT TO BE DUMPED.

For profit insurance companies will ALWAYS find a way to delay care or deny it completely, to shed unprofitable clients, to do anything they can to pad the bottom line at the expense of human beings.

The system is irretrievably broken. It can no longer be fixed or even patched together to last another few years. It is BROKEN.

Single payer NOW.

[Rosemary2205]

6. Welcome to "for profit" healthcare.

where the ultra rich who hold 80% of the shares of insurance companies demand your 4 year old die of cancer so they can afford to buy another yacht.

Assholes.

[RB TexLa]

7. Yes the problem is there but there is also a big problem with people

not being truthful on applications, and those who are truthful shouldn't have to pay even more for their coverage due to fraudulent actions of others.

[sandnsea]

17. Sick is sick, yes?

So are you saying this little girl should die if she'd been turned down by insurance companies? The system would've treated her anyway, the cost is still absorbed by everybody. Whether through insurance premiums or taxes, everybody still pays. We need a system where anybody can get covered and whatever premium or tax is based on income. You can't expect a waitress to pay hundreds of dollars a month for insurance premiums when her employer doesn't offer insurance.

[ThoughtCriminal]

20. Catch-22 for the sick

Be honest and get denied coverage, or leave off an illness and get denied coverage. Private insurance companies, it seems will do almost anything it seems to deny an expensive claim.

The last time I applied for an individual plan, the application demanded a list of every medical treatment, every prescription, every doctor visit for every member of my family going back to birth.
Three lines were provided on the form, but I could attach addtional information. If I left anything out, the application warned, we could be denied coverage or dropped.

[Warren DeMontague]

33. That's right. We should cut the crap, dismantle the insurance "industry"

and insure everyone, equally. No questions asked.

Single Payer. NOW.

[Warren DeMontague]

34. Your "fraudulent action" is getting health coverage for a 4 yr. old girl

The ones who are morally deficient are the insurance companies that refuse to insure sick kids; not the parents who will go to any length to make sure their kids are insured.

[Iowa]

42. I reject that mindset...

"...those who are truthful shouldn't have to pay even more for their coverage due to fraudulent actions of others."

First, there doesn't appear to have been any "fraud" committed here.

Second, even if the family described in the OP committed "fraud", I have absolutely no problem with fraud when
--it's committed as a last resort,
--in reaction to a corrupt system that is built upon fraud,
--on behalf of a child (or any loved one),
--by a desperate family
Power to anyone who can find a way to get what they need to survive within this corrupted system. By hook or by crook. Whatever it takes. If it adds to my bill - I don't give a shit. And if it eventually results in the collapse of the whole f**ked up corporate health insurance system, I'll cheer its demise.

Third, when you say, "those who are truthful shouldn't have to pay even more for their coverage due to fraudulent actions of others", what you are REALLY saying is, "those who are HEALTHY shouldn't have to pay even more for their coverage due to those who are SICK. And that is the foundation of the entire screwed up health care system we have now, and it's long past time we tear it down brick by brick.

As our country moves toward full-blown fascism, and as corporations continue to tighten their grip, more of us will face moral dilemmas regarding matters of pain, suffering, life, and death - for ourselves or loved ones. I have no problem whatsoever with people who stick it to the corporate system - who do what they need to do to survive. And I will never turn on anyone who breaks the rules and does what needs to be done to protect people - even if it means I get a bigger screwing on my bill. We are on the cusp of descending into a time when the old rules won't always apply - when the needs of people will regularly conflict with established rules and laws - we're part-way there now.

People first.

[burythehatchet]

46. you are the enemy

[RB TexLa]

57. because I am against people fraudulently entering contracts?

I have no idea if the people in the OP committed fraud or not, I made the statement regarding the overall problem with people providing false information when entering an insurance contract.

[Lydia Leftcoast]

63. Why are insurance companies allowed to deny payment to people

who are really sick?

The parents didn't lie. And even if they did, does that mean that an innocent 4-year-old should die of a treatable illness?

Let me tell you about some reality. When I first went self-employed, I tried a number of insurance companies, and they were willing to enroll me with the provision that I couldn't get coverage for ANYTHING I'd ever had before (depression once with no recurrences, broken bones) or was at risk for (breast cancer, according to them, because of a NEGATIVE biopsy).

Their business method is to charge sky-high premiums based on age, regardless of whether the individual is healthy or not, and then up the premiums if the individual actually makes any claims, and dumping the individual if he or she REALLY needs insurance.

The whole system is so corrupt, full of bloodsucking hypocrites who put out PR that makes them seem like selfless angels of mercy, when they'd rather see a person die than have to pay out significant amounts.

I'll tell you what shameless hypocrites insurance executives are. They write op-eds about how U.S. medical costs are so high because people don't get enough routine preventive care, and then DON'T PAY FOR PREVENTIVE CARE.

It is virtually impossible to find an insurance policy that doesn't have a deductible of $300 and only slightly less impossible to find one that has a deductible of less than $1000.

In order to afford my monthly premiums at my age, I have to accept a $5000 deductible, and get this, I'm still responsible for 20% above that. This is despite the fact that I'm a healthy non-smoker who is the furthest thing from a hypochondriac that you'll ever meet.

And I'm in Minnesota, supposedly one of the "good" states for insurance. If this is good, I'd hate to see what the "bad" states are like.

Fraud may exist, but it is a tiny problem with the system compared to corporate greed and callousness.

[kiahzero]

68. Life is more important than a contract.

Allowing a person to die to avoid breaching a contract is fundamentally immoral, and any reasonable justice system would hold such a contract to be unconscionable.

[meldroc]

8. Why are insurance companies allowed to do this?

If we're going to go with health care that's handled through private insurance, insurance companies should be forced to accept every single person who can pay premiums, and they should be forced to charge exactly the same premiums to every single customer - be that customer a healthy 20-something who's had nothing worse than a mild flu, or person who has cerebral palsy, requires a heart transplant, and racks up $100,000,000 in medical bills. Charge them exactly the same, and make the insurance companies pay every single fucking dime of expense when they file claims.

I don't care if it drives them out of business. If insurance companies can't make money doing this, maybe we should find another way to pay for our health care.

[RB TexLa]

9. There would be no individual insurance offered under those conditions n/t

[meldroc]

14. Like I said...

If insurance companies can't make money doing this, maybe we should find another way to pay for our health care.

[sandnsea]

18. Some states have a pool for these folks

Oregon does, so I imagine CA does too. Problem is that it's too expensive for most median and low income workers anyway, plus people don't know it exists.

[ThoughtCriminal]

19. Arizona has group insurance for small biz & self employed

through a state program. It's not always easy to find doctors who participate, the premiums and deductables are high, but it still beats any individual plan we checked out.

[kineneb]

44. CA does have plan

for the self-employed, but it is so expensive and is for catastrophic use only. The "middle class" insured by it are on their own for regular medical expenses.

This is a case where it actually pays to be really poor. If a family needs medical care for a child, it does not pay to work (or at least earn much). Medi-Cal will cover poor children of working families, up to a certain income level.

Sad to say it, but that family is probably screwed. If they want medical help for their child, they need to dump their assets, now. Sell the house, declare bankruptcy, quit work. That is the only way they will be able to "afford" medical care for their child.

Been there, done that. Was not fun, but Hubby has really good medical care now.

[Lydia Leftcoast]

64. So does Minnesota, but its premiums are as high as

those from the insurance companies. (This is different from MinnesotaCare, which is the state's version of Medicaid.)

[ThoughtCriminal]

10. We had a very similar situation 15 years ago

With our son. He had a large growth on his neck - it turned out to be benign thank goodness, but the expenses ran several thousand dollars. At that time, the insurance through our employer had something like an 18 month exclusion for pre-existing conditions (this is pre-HIPAA). Some jerk at the insurance company disqualified all claims because our son had a case of strep throat a year or so before we enrolled. Despite letters from multiple doctors testifying that the lump could not possibly be related, the insurance company refused to pay the bills and we started to get calls from collection agencies. We started to make payments ourselves and went into some serious debt (this prevented us from buying a house at the time). Fortunately, my employer got involved and threatened to sue the insurance company and after many months they agreed to pay their part.

I would only buy individual insurance as an absolute last resort, and if buying group insurance, make sure it is HIPAA approved. The "Group" insurance for self-employed that you see advertised on late-night cable TV is likely not to be HIPAA approved and as I understand it, they can exclude pre-existing conditions. They may define "pre-existing condition" as pretty much anything, even if the medical evidence proves otherwise.

[peacebird]

12. my company changed insurance policies when I was 6 months pregnant.

The new insurance company tried to claim "pre-existing condition" and refused to pay for my sons birth - until my boss threatened to pull the entire company back away from them. They knew at the time of the policy change that I was pregnant and so was another woman working there. The correct questions had been asked (re: covering our pregnancies), but the insurance company seemed to think they could jerk around employees and that our boss would not speak out.
Insurance companies can be complete slime.

[kiahzero]

69. "Can be?" (n/t)

[GreenTea]

15. Welcome to the republican fascist corporate world-Where deregulation

that those who voted for Reagan, it began....Corporations have almost no regulations now and do and charge as they please...With a fascist republican one-party control creating laws & legislation to protect the corporates and to fuck the working people...They've almost complete destroyed unions...the corporate republicans will be going after Social Security after they steal the election in November....saying the voters gave the republicans a vote of confidence----NO, they fucking stole it.

[yasmina27]

21. that's why I'm stuck where I'm at

My daughter was diagnosed at age 3 of growth hormone deficiency. Thank goodness for attentive pediatricians who caught this so early - most kids aren't diagnosed until their early teens, then it's too late for them to catch up to what should have been their normal growth.

Anyway, about 2 years ago, we received a bill for 3 months of the medicine through a screw-up with the insurance company and the pharmacy. I won't go into all the boring details of the snafu, except to say that

1) The bill was more than $10,000.
2) The pharmacy absorbed the cost.

If we were to ever lose our insurance, there is no way my daughter could get her medicine. If I were to change jobs, it is unlikely that the insurance company would cover her due to her "pre-existing condition". So I'm stuck until she's old enough to be out on her own and they won't cover her anyway.

That's OK. Fortunately, most of the time I like my job (teaching middle school French).

[CrispyQ]

29. That is such a tragic statement about our country & the shape we're in!

"If we were to ever lose our insurance, there is no way my daughter could get her medicine." :cry:


It pisses me off that so many are more concerned with gays than the health care crisis we are facing. Compassionate conservatives my ass. Their compassion extends only to their own.

What will your daughter do when she is older? If an employer offers insurance can the company refuse to cover her? Or do they limit it to a specific condition they won't cover?

I'm glad you like your job! :hug:

[donco6]

52. Same situation for me.

I was diagnosed with non-Hodgkin's lymphoma several years ago. Chemo was successful. But I doubt any other company would touch me with a 10 foot pole. 8 years to retirement, sigh.

[RB TexLa]

59. You are not "stuck"

If your dependant has had creditable coverage for 12 months and you change to another group plan that falls under the HIPPA regulations, the 12 or 18 month waiting period for pre existing condition coverage would be satisfied by the previous coverage.


Under HIPAA, a new employer’s plan must give individuals credit for the length of time they had prior continuous health coverage, without a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period (18 months for late enrollees)

http://www.dol.gov/ebsa/newsroom/fshipaa.html

[AX10]

22. It all started with Reagan and deregulation.

See, this is what happens when you don't have rules to keep powerful corporations in check.
Universal Health coverage will be coming.

[IdaBriggs]

24. To get an ultrasound at one local facility costs $600, while the same

procedure across town costs $110. I got a little hot under the collar about the $600 bill at one point, and made a sarcastic comment that I didn't want to BUY the damned machine, I just wanted a tech to use it for ten minutes (actually, closer to five). Anyway, I went onto E-Bay, and discovered the equipment could be purchased BRAND NEW for about $1500!!! I'm still torqued about the situation -- with infertility treatments, it was going to be about FIVE TO SIX ultrasounds before we were done, and if I hadn't double checked the bill, that would have been THOUSANDS of dollars (instead of hundreds). Oh, and both facilities perform dozens of these procedures every morning. Grrr.....

[Tess49]

30. Decent diagnostic ultrasound machines cost in the

neighborhood of $100,000 dollars. Sometimes more. New cheap models, with poor resolution, and limited capability run about 30,000 dollars. I know this with certainty, as I work in this field.

[IdaBriggs]

48. Then you might want to check out E-Bay.

I just double-checked with the search "ultrasound" and it came up with 159 options. I lowered it down to "medical equipment" (for 37), and they all look reasonable. This one caught my eye for $1499: http://cgi.ebay.com/Toshiba-Sonolayer-ultrasound-w-1probe-OBGYN-NO-RES_W0QQitemZ190031514353QQihZ009QQcategoryZ11816QQrdZ1QQcmdZViewItem?hash=item190031514353

"Up for auction here is this Toshiba Sonolayer Ultrasonic imaging machine. This unit comes with 1 ultrasound probe/scan head (a 5mhz probe). This unit was removed from a hospital facility in excellent working condition, and was used mostly in the OBGYN department. We were told by hospital staff that it was used up to the date it was removed from the facility until it was liquidated for financial reasons. This is a no reserve auction, so the highest bidder will receive this item..period! This is a smaller ultrasound unit, so the mobility is great...if you need a unit that could be loaded in and out of a vehicle fairly easily, this one should be perfect.

"The sale of this item may be subject to regulation by the U.S. Food and Drug Administration and state and local regulatory agencies. If so, do not bid on this item unless you are an authorized purchaser. If the item is subject to FDA regulation, I will verify your status as an authorized purchaser of this item before shipping of the item." All sales are as is and final. Please only bid if you intend to pay for the item. We will ship this item world-wide. We recommend shipping this item via Van Line. We can assist in the shipping arrangements as needed. Winning bidder is responsible for all applicable shipping/packing/customs fees."

Of course if you want "brand new" you can pay $2,695 and get this model "factory direct" -- http://cgi.ebay.com/NEW-ULTRASOUND-INCREDIBLE-PRICE_W0QQitemZ190030649065QQihZ009QQcategoryZ11816QQrdZ1QQcmdZViewItem?hash=item190030649065

I'm not saying its "top of the line" -- I'm saying it appears to be functional, and for my purposes, I didn't need "the best" -- I needed "good." :shrug:

ON EDIT: 2nd link didn't copy; fixed it.

[Tess49]

49. yeah, these small machines are readily available, but don't

do much. One probe is like having a car with one tire. They use these small machines in ER's sometimes to look for fluid etc. I've used machines ranging from the best to the worst. No radiologist would rely on one of these small units -- you can miss too much with them. But thanks for the links. That was interesting. If you are having fertility studies, you really need a TV ultrasound unless you are super thin. To be honest, we don't always use all of the features that come on the upscale units, but it's nice to have them when you need them. Hope your studies go well.

[IdaBriggs]

54. Honestly, they look pretty much the same as the ones used in both

infertility clinics. :shrug: (And I am not super thin anymore ... sigh.) On a positive note, we're ten weeks pregnant with twins tomorrow, so we're pretty happy. :)

[Tess49]

60. Hey, how about that! Congrats! You'll be having lots of

sonograms. Several growth studies, plus biophysical profiles are likely, too. You'll know these babies well before they are born.

[knitter4democracy]

41. Cash procedures keep Ob/Gyns in business.

Ob/Gyns have some of the highest malpractice rates in the business. In most states, a patient can sue for a birth trauma or malpractice concerning the pregnancy and birth up to the age of 18 or even 21. That bill wasn't just paying for the tech and the machine but for malpractice, too.

My old Ob/Gyn is no longer in private practice but instead a flight surgeon. He made the switch when the insurance company doubled his malpractice fee from $50K one year to $100K the next with no warning. He had put more away, planning on a fee increase, but he hadn't planned on having it doubled. It's not like he was sued or anything--they just doubled it. He left private practice, and he was one of the best in the entire Cleveland area at the time.

Cash procedures, like infertility treatments, varicose vein fixing, etc., keep many docs in practice. Those procedures are subsidizing everything else.

[OzarkDem]

25. GOP is working to gut consumer protections

that protect sick people from getting this kind of treatment.

Many of the new so-called universal health insurance plans being touted by GOP leaders are a scam. The private insurance industry is looking to fleece government and consumers with "health care reform" the same way pharmaceutical companies fleeced them with Medicare reform.

The idea is to get feds and state governments to require everyone to buy private health insurance with government subsidizing premiums for low income and unemployed people. Once everyone has bought into these plans, the insurance companies will start stripping out benefits.

Access to affordable health insurance is not a guarantee of access to health care, period. Dems shouldn't fall for this shell game.

[Odin2005]

31. All private insurance is a scam as far as I'm concerned

Private insurance is like a guy who lends you an umbrella when it is sunny then asks for the unbrella back when it starts raining and then asks for a fee for having the umbrella even though you never used it.

[NotGivingUp]

47. great analogy!

[Warren DeMontague]

32. SINGLE PAYER HEALTH CARE.

Oh, and by the way...

SINGLE PAYER HEALTH CARE. NOW.

[RedEarth]

36. K&R

[Bozvotros]

39. Here's a scam that happened to me....

One of the questions on the questionaire for temporary insurance is whether you have ever been diagnosed with or treated for a "mental illness."

You ever look at the DSM IV, the manual on mental disorders? If you aren't in there someplace, you aren't really reading it. Nicotine addiction is in there, alcohol abuse, alcohol intoxication, caffeinism, adjustment disorders, female sexual arousal disorder, male orgasmic disorder, premature ejaculation, insomnia, psychological symptoms or stress affecting medical condition. In short lots of benign human conditions are listed there and if your doctor has ever given you something for sleep or a mild depression, or anxiety or to help you quit smoking, then he likely coded it. And even if he didn't, his giving you the prescription is proof you were treated.

If you check no on that question and then need the insurance for anything significant, the insurance company will get your entire medical record and look to see what meds you were ever on or why you saw the doctor and if they find one thing you can get denied. They can go back as far as they want and delay payment for months and months, subjecting you to pressure from the medical providers. And these companies can do this even if the condition being treated has absolutely no relation to your so called "mental disorder."

My particular experience included the company altering a telephone contact form where I disclosed a medication and the reason I took it and to be sure it wouldn't be considered a "mental disorder." They assured me it wouldn't. But when I needed to use it for an emergency procedure they altered the form with comments I never made. I had to hire an attorney which cost me nearly 6000 bucks to cover a 12000 bill. The company finally agreed to settle but refused to pay my attorney costs and were willing to go to court. My attorney essentially said that a billion dollar company has ways to insure they get "justice" and that I should just accept their offer.

Be very careful when you buy temporary insurance and get documentation of every contact and conversation before you commit.

edited for spelling

[Lindacooks]

45. I just don't understand why somebody hasn't 'gone postal' on the

insurance industry.

The way they mess with people's lives, and deny lifesaving treatment, in my opinion they're murderers. Why an enraged family member hasn't done something violent is beyond me.

And no, I'm not endorsing it. I'm just wondering.

[eggbeater]

50. The really F-ed up part of all this

is that somewhere, there is a real person (I almost used human, but that would be incorrect) sitting at a desk every day, going home to his wife and kids at night, with dreams, and hopes,,, and he has the nerve to cut off the life saving medical treatment for a child.

what a bastard, I hope he gets hit by a bus on the way home and his insurance fails to cover the Emergency treatment.

who can do some research and find out who this low life peice of crap is? he needs phone calls and letters. 24 hours a day 7 days a week until he either realizes that he is worthless and quits, or he reinstates that medical coverage.

ARHHHHHHHHHHHHGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG

[Lydia Leftcoast]

65. My brother the doctor says that it's actually some low-level clerk

with no medical training who is following a chart to allow or deny coverage.

Of course, this clerk is following decisions made by greedheads higher up.

[proud2BlibKansan]

55. Insurance companies are EVIL

[ikojo]

61. The former CEO of California Blue Cross Blue Shield

(parent company Wellpoint) did VERY well when Wellpoint merged with Anthem Blue Cross Blue Shield...very well indeed....


http://findarticles.com/p/articles/mi_kmusa/is_200411/ai_n8610332

snip

Commissioner John Garamendi was the last major stumbling block to the $16.4 billion deal, delaying the merger of a piece of the company, Blue Cross Life & Health, over which he had jurisdiction. His main concerns were costs to policyholders and the size of executives' golden parachutes, estimated at $200 million to $600 million.

WellPoint CEO Leonard Schaeffer alone is expected to get a package worth $53.5 million in cash, stock options and pension payments when the deal is completed.

[Lydia Leftcoast]

66. Just think how many sick people could be helped with

$53.5 million in cash.

And I bet he wasn't hurting BEFORE he got the stock options.

Single payer now.

[ikojo]

70. I agree...trust me all the profits for an insurance

company is channeled in an upward direction. The CEOs do quite well as in all American industries.

[insane_cratic_gal]

67. Pre-existing condition bullshit

they tried to do this to me when I was pregnant with my daughter 8 yrs ago It wasn't BC it was Atena I had to threaten to sue them if anything happened to me or my baby due to the stress they were putting me under.

I got pregnant right before my coverage kicked in (though I didn't know it at the time that I was pregnant. You can't disclose something your not aware of).

They ended up covering it but it was a nightmare for 8 months

[Lydia Leftcoast]

71. Also "pool" bullshit

As an individual policy buyer, I'm not part of any "pool," so the insurance company acts as if they're saving up my premiums in a little drawer for me alone, when of course, the truth is that it's all corporate income.

The "pool" fiction is why insurance companies feel they can charge even healthy and prudent older people like me five times as much as they charge some 20-year-old who smokes, eats junk food, and goes rock climbing and motorcycle riding.

It's all about finding excuses to charge people more money.

I'm a firm believer in single payer, but if we had to keep private insurance companies, I would make them renew their corporate charters with stipulations such as a requirement to plow all profits into reducing premiums or raising benefits, forbidding any bonuses or stock options for management, and limiting executive compensation to 50 times that of the lowest paid employee.

"But...but" say the corporate tools, "you'll never get good executives that way."

Hmm, are we getting good executives now? Seems to me we're just getting incredibly greedy, heartless executives.

[never cry wolf]

72. I and my family got rescinded

BC/BS cut us off... We had had them for 8 months (I am self employed.) We made a minor clain and someone decided to review our history...

7 years ago my then 37 year old wife contracted pneumcoccal pneumonia, the same that killed jim henson... she was in ICU for a month in an induced coma... another 2 weeks in the hospital and then follow up PT... quarter of a mil in bills, maybe 20k out of pocket for me (not to mention lost business time.)

3 years after that i had a bad episode of diverticulitis... spent the month of may in the hosp to the tune of 60k, 15 k out of pocket...

after all I was payine 1,500/month for insurance but we had a minor claim (under 1k) and they dug and dug to find a way to boot us....

it's ALL about profit...

neither my wife nor I can get health insurance because we are not a part of a "group"... our problems were not chronic but acute... but they cost the insurance co. money... we gambled, they lost (not like we won except financially)

same shit as auto insurance... if you use it the rates rise... if ya use it too expensively you are dropped...