Two cases involving my co-workers

CASE #1

Middle age mother experiencing some declining health symptoms headaches, eyesight etc,

Diagnosis: high blood pressure (Hypertension)

Insurance claim status: DENIED - preexisting condition even though she has no medical history of such.

Prognosis: Not good, she has kids and can't afford the meds out of pocket. Makes "too much" to qualify for any assistance. She can't afford a lawyer to sue "her" "insurance" company.


CASE #2

Middle age single male (part time climbing partner) experiencing significant knee pain causing some impairment.

Diagnosis: torn cartilage (meniscus tear)

Insurance claim status: DENIED - clause in "fine print" excludes this type of surgery or caps reimbursement at "$1,000" for out patient procedure.

Prognosis: Not good. Pay for it yourself or let it limit your activity and contribute to overall health decline.

These are 2 true cases from my co-workers. They pay $110-$140 every month for "health insurance" with a rather high copay that basically does nothing for them but does provide good returns for share holders and ceo's.

Life in modern 'merica, gotta love it.

I still can't believe that health insurance companies are allowed to be for-profit corporations.

Sorry to hear about your friends. But I'm sure FW and canyondweller will be along shortly to tell us how nothing is wrong.

This shit has been going on forever,some times if you keep calling,
and raising hell,you can get them to cover it,but most people will
give up! And that's just what they want.

Ahh, now that's a point worthy of debate. Keep it private, but regulate it, and force these companies to be non-profits with no listing on the Dow Jones (or any market).

You're either 1.) Not disclosing all appropriate details
2.) Aren't being completely truthful 3.) Aren't being told the full story by said coworkers

Dmuja,
HBP will not effect your eyesight. Is she a diabetic?

It can in conjunction with other symptoms.

Fairweather, do you have any basis for accusing dmuja or his co-workers of lying or being wrong?

Here's a compilation of news stories that suggest insurance companies may regularly do what dmuja reports above. Los Angeles city attorney

NEWS SECTION

ABC
Delgadillo Files Lawsuit Against Blue Shield
July 17, 2008

Associated Press
City Attorney Asks Blue Cross to Substantiate News Release Claims
March 3, 2008

Lawsuit alleges scheme by health insurer to cancel policies
February 21, 2008

Cuomo to Sue Major Health Insurers
February 14, 2008

American Medical News
California Appeals Court Rules against Insurer's Rescission Practices
February 11, 2008

Capitol Weekly
Administration Fails to Reinstate Health care in Illegal Insurance Cancellation Cases
April 3, 2008

Senate Hearing to Probe Regulation of Health Care Industry
March 27, 2008

State Probes Blue Cross
February 25, 2008

CBS News
Insurer Gave Bonuses For Dropped Policies?
November 9, 2007

Daily Kos
LA City Attorney Files $1 Billion Lawsuit Against Blue Shield
July 17, 2008

CNS
LA City Attorney Sues Blue Shield of California
July 17, 2008

Daily News
City Suit Targets Blue Shield for Canceling Policies
July 17, 2008

Financial Times
LA Launches Action Against Health Insurer
February 21, 2008

CNN
Mom Wins Fight for Autism Insurance
April 1, 2008

Forbes
LA Sues Health Net Over Cancellations
February 21, 2008

Good Morning America/ABC News
Battling Blinding Disease and Insurance Company
June 18, 2007

Internet Press
LA City Attorney Sues Blue Cross Over Cancellations
July 17, 2008

KTLA
Blue Shield Sued for Canceling Policies
July 17, 2008

Los Angeles Daily Breeze
LA Sues Insurance Company
February 21, 2008

Assess Risk in Health Plans
January 27, 2008

Los Angeles Daily News
Health Net Target of Delgadillo Suit
February 21, 2008

Candidates Look to State as Debate Grows about Universal Health Coverage, Industry Reform
February 2, 2008

Los Angeles Times
Congressional Committee to Probe Health Insurers
July 18, 2008

LA City Attorney Files Suit Against Insurer Over Cancellations
July 17, 2008

Healthcare Insurance Probe Grows
March 5, 2008

Cutting Off Health Insurance?
March 1, 2008

Penalty Cuts Insurer Profit
February 28, 2008

Health Net ordered to pay $9 million after canceling cancer patient's policy
February 22, 2008

Heat is on Health Insurers
February 14, 2008

State Steps up Scrutiny of Insurers
January 30, 2008

Is This a Healthy Way to Choose Who Gets Care?
January 20, 2008

Health Insurer Tied Bonuses to Dropping Sick Policyholders
November 9, 2007

Blue Cross Cancellations Called Illegal
March 23, 2007

MarketWatch
Statement on City Attorney Action
July 17, 2008

When Health Insurance Gets Taken Away
March 6, 2008

Medical News Today
Health Insurers Admit Need For External Review Of Rescission Practices, USA
February 27, 2008

Modesto Bee
Blue Shield Sued for Cancellation Policy
July 17, 2008

Money Magazine/CNN
Think You're Insured? Maybe Not.
March 15, 2007

LA City Attorney Sues Health Net Over Cancellations
February 21, 2008

The Neutron Bomb of Health Insurance
February 13 2007

msnbc.com/NBC News
9 Things Insurers Don't Want You to Know
How to protect your health and family from loopholes and lapses
August 15, 2007

NBC
LA City Attorney Files Lawsuit Against Health Net Inc.
February 21, 2008

New York Times
Insurers Agree to Develop a Set of Standards in Rating Doctors
April 2, 2008

3 Leading Executives Resign at Insurer Under Inquiry
January 26, 2008

Health Spending Exceeded Record $2 Trillion in 2006
January 8, 2008

It’s Not Just the Uninsured
November 17, 2007

Reuters
LA City Attorney Sues Blue Shield
July 17, 2008

LA City Attorney Sues Health Net Over Cancellations
February 21, 2008

NY AG Probes Health Insurers Over Reimbursement
February 14, 2008

Sacramento Bee
Blue Shield Sued Over Deceptive Practices
July 17, 2008

Lawsuit Alleges Scheme by Health Insurer
February 21, 2008

San Francisco Chronicle
Blue Shield Sued for Allegedly Canceling Policies Illegally
July 17, 2008

LA Says Health Net Illegally Halts Coverage
February 21, 2008

San Jose Mercury News
UnitedHealth Facing Big Fine for Thousands of Alleged Violations
January 30, 2008

USA Today
Individual Health Policies Leave Many Behind
July 17, 2008

Candidates Go Opposite Ways on Health Care
March 26, 2008

States Act to Protect Individual Health Insurance Coverage
February 21, 2008

People Left Holding Bag when Policies Revoked
December 13, 2007

The Wall Street Journal
More Heat on CA Insurers Dropping Policies
February 21, 2008

NY AG on UnitedHealth Database: Garbage In, Garbage Out
February 14, 2008

Measuring a Doctor's Quality Remains an Art
January 29, 2008

Washington Post
More Hitting Cost Limit on Health Benefits
January 27, 2008

Hypertensive Retinopathy can happen in folks with HBP who have had it undiagnosed, untreated, and/or have very elevated HBP for sometime. Most often it occurs with diabetics and involves elevated bloodsugars.

We have Kaiser, and love them. No one here has ever experienced such shit as that. The insurance companies get paid to fuck you over, not to help you. One thing that you need to realize, is that if you go to a Government system, the same shit will be happening. Oregon has a system to catch the folks who would fall though the cracks: and theres plenty of stories of people NOT getting transplants and being allowed to die cause they won't pay for it... etc etc on and on.

Moral is, don't expect any one to take care of you but you. Save your sheckels cause when the shit hits the fan, money talks and bullshit walks (with exceptions). Good luck to your co-workers dmjuka.

I have been involved with many nurses and married to two.
It is standard procedure for insurance companies to deniy valid claims. They know that many people will never try to go beyond that initial rejection.

Jesus....how many times have you been married?

Mattp- Damn you're giving me a headache!

Item two in Dmuja's list does not seem fraudulent at all. My guess is that the insured did not read his coverage and his surprise is simply the result of his own irresponsibility. That is not being familiar with his coverage.

Second WRT Item #1 – W/o more information (here I am betting FW is correct) there is no way to know if Dmuja’s story is at all reflective of reality.

These two issues aside, your statement “Here's a compilation of news stories that suggest insurance companies may regularly do what dmuja reports above” is not persuasive in the slightest. How does that list prove that insurance companies “regularly” do what Dmuja reports? Do you have any idea how many claims are handled per hour by insurance companies in the USA?

The weird thing here is: The people that are arguing for a Healthcare coup by the government are the same people that are the most mistrustfull of the government and question them the most.

Another weird thing is you have been banned multiple times from this site....yet you are still here.....

Can't keep me down bitch!

Thats not what your boyfriend said.....

So, why don't all the folks - there are apparently millions out there - who really think insurance companies are evil bloodsucking bastards, start your own non-profit payer system. This would be a private, non-profit whose goal was to "pool" health care costs in a fair system. Anyone who wants "in" to this system should be allowed to do so through employers, etc.

Who wants to bet that such a company would go out of business before too long, or would have to make similar decisions about denying coverage as we see above.

All the talk about the "government" being more fair, and solving this problems is bullshit. Either the government will have to deny services to cut costs, raise "premiums", or be in the red and take money from other tax revenue sources.

I do.

Good lord! Are you suggesting that the government would be IN DEBT providing vital services to its citizens. Clearly this state of affairs should be reserved for bloated institutions like the "defense" industry!

The Economist is carrying a story ( http://www.economist.com/business/PrinterFriendly.cfm?story_id=11919622# ) about medical tourism.

Some are going abroad to get quality health care at lower prices. As the article states this is not a substitute for health care reform in the US but hopefully will serve as a catalyst for these reforms.

I'll bet those other countries don't have such high malpractice insurance and rapacious lawyers. Reform indeed!

perhaps you have a point. according to factcheck.org, bush didn't when he made a similar claim back in 2004:

FactCheck.org

can you explain what the cost of malpractice insurance is, and what part that plays in the overall economy?

The problem with the entire health care system is it gets to pick and choose who they care for. I am not talking about ER’s….but more the bigger picture. Claims getting denied for pre existing conditions? Or not giving insurance for pre existing conditions? WTF…..what about just saving lives no matter who pays for it. What about a system that EVERBODY gets health coverage? Not just the lucky few who have jobs or money……isn’t this the ultimate goal?