dmuja Posted August 24, 2008 Share Posted August 24, 2008 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. Quote Link to comment Share on other sites More sharing options...
rob Posted August 24, 2008 Share Posted August 24, 2008 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. Quote Link to comment Share on other sites More sharing options...
pc313 Posted August 24, 2008 Share Posted August 24, 2008 (edited) 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. Edited August 25, 2008 by pc313 Quote Link to comment Share on other sites More sharing options...
pc313 Posted August 25, 2008 Share Posted August 25, 2008 Quote Link to comment Share on other sites More sharing options...
KaskadskyjKozak Posted August 25, 2008 Share Posted August 25, 2008 I still can't believe that health insurance companies are allowed to be for-profit corporations. 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). Quote Link to comment Share on other sites More sharing options...
Fairweather Posted August 25, 2008 Share Posted August 25, 2008 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. 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 Quote Link to comment Share on other sites More sharing options...
Tokogirl Posted August 25, 2008 Share Posted August 25, 2008 Dmuja, HBP will not effect your eyesight. Is she a diabetic? Quote Link to comment Share on other sites More sharing options...
akhalteke Posted August 25, 2008 Share Posted August 25, 2008 Dmuja, HBP will not effect your eyesight. Is she a diabetic? It can in conjunction with other symptoms. Quote Link to comment Share on other sites More sharing options...
mattp Posted August 25, 2008 Share Posted August 25, 2008 (edited) 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 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 Edited August 25, 2008 by mattp Quote Link to comment Share on other sites More sharing options...
Tokogirl Posted August 25, 2008 Share Posted August 25, 2008 Dmuja, HBP will not effect your eyesight. Is she a diabetic? It can in conjunction with other symptoms. 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. Quote Link to comment Share on other sites More sharing options...
billcoe Posted August 25, 2008 Share Posted August 25, 2008 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. Quote Link to comment Share on other sites More sharing options...
Bug Posted August 25, 2008 Share Posted August 25, 2008 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. Quote Link to comment Share on other sites More sharing options...
kevbone Posted August 25, 2008 Share Posted August 25, 2008 and married to two. Jesus....how many times have you been married? Quote Link to comment Share on other sites More sharing options...
Peter_Puget Posted August 25, 2008 Share Posted August 25, 2008 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? Quote Link to comment Share on other sites More sharing options...
akhalteke Posted August 25, 2008 Share Posted August 25, 2008 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. Quote Link to comment Share on other sites More sharing options...
kevbone Posted August 25, 2008 Share Posted August 25, 2008 The weird thing here is: Another weird thing is you have been banned multiple times from this site....yet you are still here..... Quote Link to comment Share on other sites More sharing options...
akhalteke Posted August 25, 2008 Share Posted August 25, 2008 The weird thing here is: Another weird thing is you have been banned multiple times from this site....yet you are still here..... Can't keep me down bitch! Quote Link to comment Share on other sites More sharing options...
kevbone Posted August 25, 2008 Share Posted August 25, 2008 The weird thing here is: 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..... Quote Link to comment Share on other sites More sharing options...
KaskadskyjKozak Posted August 25, 2008 Share Posted August 25, 2008 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. 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. Quote Link to comment Share on other sites More sharing options...
kevbone Posted August 25, 2008 Share Posted August 25, 2008 who really thinks insurance companies are evil bloodsucking bastards I do. Quote Link to comment Share on other sites More sharing options...
prole Posted August 25, 2008 Share Posted August 25, 2008 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. 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! Quote Link to comment Share on other sites More sharing options...
STP Posted August 25, 2008 Share Posted August 25, 2008 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. Quote Link to comment Share on other sites More sharing options...
KaskadskyjKozak Posted August 25, 2008 Share Posted August 25, 2008 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! Quote Link to comment Share on other sites More sharing options...
blurpy Posted August 25, 2008 Share Posted August 25, 2008 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? Quote Link to comment Share on other sites More sharing options...
kevbone Posted August 25, 2008 Share Posted August 25, 2008 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? Quote Link to comment Share on other sites More sharing options...
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