Kathryn,
Please add me as a colleague so I can send you a PM.
Thanks,
Billy
I didn’t know that…can you provide some actual data for my reference?
As you’ll see below, I always substantiate the claims I make…
The private insurance industry is so much better because what Medicare did here, you can not do in the private insurance industry. It is illegal.
You’re wrong here, Tim. The government used a ******** excuse to deny a claim, and insurance companies do the same exact thing all the time.
You’re correct that insurance companies don’t use this same excuse (as it wouldn’t make sense for a private insurer to deny a claim based on earnings), but private insurance companies deny claims all the time based on rationales far, far worse than that.
Some common tactics and examples:
– A very common tactic among insurance companies is to deny a procedure to a very sick person until they are pretty much dead.
For example, Nataline Sarkisyan died when Cigna refused her liver transplant, claiming it was “too experimental”. Her doctors claimed that the surgery wasn’t at all experimental, and protested the insurance company. As did thousands of other people. The insurance company finally agreed to the surgery hours before the girl died.
Here is a reference: http://en.wikipedia.org/wiki/Nataline_Sarkisyan
– Another common tactic is “recission” (taking away of coverage for some reason). Often the reason is completely frivolous, and often the insurance companies wait until you have an expensive procedure request before they do it.
For example, Robin Beaton got approved for a double mastectomy for her breast cancer treatment, and then days before her surgery the insurance company rescinded her coverage. They claimed that a dermatologist once wrote something on her chart that indicated she had a pre-cancer and she didn’t disclose it. The dermatologist never said that she had anything but acne (and never said that she had anything pre-cancerous).
Didn’t matter what the doctors said, the insurance company played judge, jury and (almost) executioner.
Here is a reference: http://www.youtube.com/watch?v=dT_2GjSkzHE
– Another example is Oddo Raddatz, who was diagnosed with stage four non-Hodgkin’s type lymphoma. In the midst of his chemotherapy treatment, his coverage was canceled and he was not able to receive the stem cell transplant needed to save his life.
He was told that his coverage was canceled because he failed to disclose that a doctor had once noted in his file that a CT scan showed a small aneurysm and some insignificant gallstones. The problem was, he was never told about these finding, so there was no way he could disclose them.
He died because the insurance company dropped him for reasons beyond his control, because they wanted to save money.
Here is a reference: http://www.npr.org/templates/story/story.php?storyId=105680875
– Wittney Horton is another example of the above. She was dropped when the insurance company found a note from a doctor in her file that she never saw. Of course, she was only dropped *after* she got sick.
Here is a reference: http://www.youtube.com/watch?v=LCYPC2BMmB8
– Here is an example of an insurance company that dropped an entire line of coverage most likely to avoid paying for the coverage of a single member…that member will now likely die:
http://www.washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/
– Okay, getting tired of all the typing, so I’ll just include another link to another example here:
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/07/AR2009090702455.html
Now, you’ve provided one example, and I’ve provided a half-dozen or so examples. And the examples I’ve provided you claim don’t happen because it’s “illegal”…
This is what keeps private insurance companies in line and keeps them from committing crimes like this case of estoppel here.
Then how do you explain the examples above?
In many of the cases above, the insurance company was sued, and in many of the cases, they lost.
But, the actuaries at the insurance companies were smart enough to know that the payouts for the lawsuits would be less than paying for the denied treatments.
Therefore, the insurance companies are happy to get sued and lose, as they save money that way. They don’t seem to care much for the people who die in the meantime.
