California woman denied health insurance for condition she doesn't have

[babylonsister]

California woman denied health insurance for condition she doesn't have

By Anita Creamer | The Sacramento Bee

snip//

Consumer advocates consider their story emblematic in many ways of complaints that plague the entire health insurance industry.

"We've seen people denied for things as minor as heartburn," said Anthony Wright, executive director of Health Access California, a statewide health advocacy coalition. "It gets to the point where living is a pre-existing condition.

"The system is fundamentally broken if insurance can be denied to anyone who actually needs coverage."

The Scagliones moved a decade ago from Los Angeles to Lake of the Pines, a community of wooded lots and winding roads. Michael, now 51, established a fishing tackle manufacturing business, while Valerie set up an online marketing company. Their 13-year-old daughter, Samantha, attends Magnolia Intermediate School. Twins Nikki and Kylie are 6.

"Our health insurance costs three times our mortgage," Valerie Scaglione said. "That's crazy."

The Scagliones were shocked when Blue Shield approved Michael and the twins for coverage, but not Valerie and Samantha. Letters from the insurer pointed to Samantha's bronchitis last year and a suggestion that Valerie had been treated for rosacea as reasons for disqualification.

"I've never had that a day in my life," Scaglione said of the blotchy skin condition. "They say Sam has a cherry-colored birthmark. It's not there. They're listing things that aren't even correct."

When Scaglione tried to see that their medical records with UC Davis Medical Group reflected accurate information, Blue Shield refused her requests to appeal its decision.

"There are no rules," said Wright, the health advocate. "Insurers can deny coverage for any reason. The industry isn't standardized."

more...

http://www.sacbee.com/ourregion/story/2236082.html

[babylonsister]

1. This was unrec? Do we have bc/bs employees in our midst? nt

[Joanne98]

2. I unreced the unrec for ya!

[imdjh]

4. Fixed by counter rec

[Phoebe Loosinhouse]

7. Insurance threads get unrecs within 30 seconds. I've noticed it when I post stuff

What possible reason could anyone have to unrec this informative thread?

I recc'd it.

[babylonsister]

16. I wouldn't be surprised if there are insurance industry

people around here; they might be here specifically to do just that.

[DBoon]

paid trolls are everywhere (nt)

[The Hope Mobile]

33. I wonder if we could set a minimum number of posts before someone can unrec?

That should eliminate most of the trolls doing it. Has this ever been suggested? Anybody know?

[Bjorn Against]

79. I know when I first signed up I couldn't rec anything until I had several dozen posts

This was long before the unrec feature was added but I assume the restriction still exists. That being said it does not take that long for someone to build up a post count large enough to rec and unrec threads, any smart troll could remain under the radar long enough to unlock that feature.

[The Hope Mobile]

114. I was thinking maybe a couple hundred posts before you could unrec!?!?

:shrug:

Most probably don't hold out that long. I've seen a few I suspected well into the hundreds of posts and a couple over a thousand but its rare. Right now, we seem to be inundated with short visit trolls. I'd like to see them at least have to work for it.

[bobbolink]

59. It should have been obvious that this would be the result.

It happens with other things... like poverty.

Yet, this is what DUers seem to want. Go figure....

[d_b]

81. qft

[DBoon]

102. Quantum Field Theory?

Are the trolls like Schrodinger's cat?

[CoffeeCat]

74. Oh hell yes, they're here...

...every industry that has a corrupt lobbying presence, has trolls on the Internet--posting
messages and countering the truth that is written about them.

The pharmaceutical industry is notorious for doing this. Of course there are insurance shrews here.

[Enthusiast]

90. Yup.

You can't even suggest drug prices are unjustified without someone popping up to say "The pharmaceutical industry needs those high profits so they can conduct research and development". This is everywhere on the internet/

[unapatriciated]

99. My Son took two very expensive drugs for more than ten years.

He was diagnosed with Dermatomyositis (1991) that could not be controlled with the standard treatment of predinsone.
My Insurance denied both these drugs as not fitting their protocol for treatment. It took months of fighting to get approval for 'off formulary' with a co-pay of $40.00 for Methotrexate and a co-pay of $60.00 for Cyclosporine (without coverage cost for these two drugs over a thousand a month, he was taking eight other medications as well).
Not too mention fighting 'reviews' every year, which left me without coverage during the time it took to fight the review.
I could understand the high cost for Cyclosporine since at the time it had only been approved for use in cancer patients for about eight years and it was a brand new treatment for severe Dermatomyositis.
Methotrexate had been approved for use almost forty years, yet it was still very expensive.

http://en.wikipedia.org/wiki/Methotrexate
http://en.wikipedia.org/wiki/Ciclosporin

[Enthusiast]

104. I hope your son is alright now. nt

[unapatriciated]

100. sorry computer hiccup double post.

[Ignis]

20. No clue, but it does seem like odd behavior.

+1 rec to counter it.

[Cleita]

23. I've noticed that too. n/t

[Cleita]

24. ...

[chatnoir]

8. Countered the Unrec w/a Rec

No idea how anyone could unrec this.

But DU has become a stranger place lately.

[Art_from_Ark]

87. Well, I have unrecommended two posts in the past two days

(my first two unrecommends, by the way), and both were registered as "recommends". So it could very well be a bug in the system.

[OswegoAtheist]

26. counter recced n/t

Oswego "no really, nothing to read here" Atheist

[Old Codger]

31. Another rec

Nor needed but piss on the ass-wipes who would unrec this.... Insurance companies are totally unregulated in any way that resembles common sense or common decency ...

[Piewhacket]

38. me too

[nadinbrzezinski]

39. To be fair the unrec system does not work

not that I expect the owners or management to get it.

And yes I saved that for a while... but it does not work

[Alameda]

64. I agree, what is the point? It's silly and unproductive.

[rebel with a cause]

42. Just because you are a bc/bs employee does not mean that

you are a bc/bs fanatic. :rofl:

I know a bc/bs employee (not a administrator or big wig) that says almost daily "I feel dirty. I want to quit." But what can they do. They need employment and jobs are scarce.

[dotymed]

44. I don't think there

should be an "unrec" button on any post. If you want
to recommend it fine... but what purpose does an
"unrec" really serve except encourage people to be
hateful. Either "rec"it or not...

[CoffeeCat]

75. It also gives power to trashers...

...to corporatists, and to the special-interest groups that are
destroying this country.

I have never complained about anything on DU. I love the site and I feel that
we're lucky that it's here. However, I strongly disagree with the unrec
feature. It gives power to powerful forces that want to squelch dissent.

I strongly disagree with the unrec feature. As the previous poster said, if
you don't like something--fine, don't rec.

However, if a lot of DUers like something--let them rec it and allow it to
rise to the top. Why allow plants, paid shills and other corrupted individuals
to affect the site and what ends up on the Greatest Page? Why give those
people any power at all?

[dotymed]

96. I too, enjoy the site.

I'm not complaining, just opining. But D.U. is a good site and
great to have.

[elocs]

86. Obsessing about Recs is silly and bringing attention to UnRecs is just what the ones who do it want.

Remember one of the first internet rules: Don't feed the trolls! yet concerning UnRecs it is constantly being done here. It is now just after 3 a.m. and this thread has over 300 Recs so it is doing just fine. Why within the early minutes of any thread is it necessary to bring up UnRecs?

For those who don't like UnRec, don't use it, but we know that for now it is here to stay. It does give those who disagree with a thread the opportunity to indicate how they feel. There was never any obligation here at DU to justify a Rec, so why should it be for UnRec? What if someone were to post an OP that said, "Dennis Kucinich Sucks!", shouldn't the vast majority of DUers being able to indicate their disagreement with that or should a minority be able to send it off to the Greatest Page. Even so, we are Democrats and we don't march in lockstep like the Republicans. Just because someone UnRecs a thread which you think is from the mouth of god does not make them a freeper.

Think about it and let's stop wasting time and space obsessing whether a thread gets a UnRec and just get on with discussing the subject of the OP.

[dotymed]

95. Personally, I have never used the unrec. button.

I was not "obsessing" about anything. Merely stating
an opinion. I have seen posts that deserved recognition, be
"unrec'd" to death. Anyway, my solution, and it is
not my call, would be to vote on a post. The
"unrec," IMO, has too much power. Just my opinion,
like anatomical parts, definitely not my obsession.

[elocs]

110. I was not referring to anyone personally obsessing, but that does happen too often

especially with threads that go on to have a multitude of Recs and end up on the Front Page. So in those cases how does UnRec have too much power, especially when it provokes others to Rec the OP? Those who are truly trolls and use UnRec for their purposes love to have it pointed out that somebody UnRec-ed a thread.

Again the example, "Dennis Kucinich is an Idiot" for an OP. Should the trolls or freepers then have the power to pony up the required 5 Recs and send it to the Greatest Page in spite of what the vast, vast majority of DUers believe?

UnRec is a done-deal and for now it is here to stay. If anyone doesn't like it, then don't use it, but don't put the spotlight on it to the delight of trolls or freepers.

[Jim Sagle]

72. Probably. We also have a herd of five buck an hour DLC hogwash dispensers.

[Pab Sungenis]

77. Yeah. And Baucus Bill supporters, too.

I rec'd however.

[Enthusiast]

89. We have them. nt

[McCamy Taylor]

97. Insurance industry has people at DU, I am convinced.

[mikelgb]

98. Yes. They prefer to be called Blue Dogs.

[joeycola]

3. rosacea!! good grief!!

[imdjh]

6. It's the leading cause of rosacea. nt

[Phoebe Loosinhouse]

11. And if you have a prior case of rosacea, you could require treatment for rosaacea.

But, I just had a thought. What if they happen to know of nasty side effects from some rosacea drugs/treatments? Is that a possibilty?

[Liberal_in_LA]

29. good grief!

[Phoebe Loosinhouse]

30. Well, I really can't come up with another reason why they would reject

someone using rosacea as an excuse. I don't think the medicines or the treatments are particularly expensive. Sometimes the "butterfly mask of lupus is mistaken for rosacea.

Secret DNA testing we don't know about? (I'm joking but I'm not - I put NOTHING past some of those bastards)

The point is, no one should be rejected for anything. Insurance companies only want to insure the young and the healthy.

[Quasimodem]

55. It's nothing to get alarmed about.

:sarcasm: :sarcasm: :sarcasm:

This is just a natural progression of the system the insurance companies have set up. They have eliminated just about everybody they can for preexisting conditions, so now is the time to refine their disqualification standards by eliminating people for non existing conditions.

It makes perfect sense to a grammarian.

[MrModerate]

70. It's chronic, with no known cure. Treatment just goes on and on . . .

And so they have to continue to pay. Can't have that, can we?

[joeycola]

15. what is? I was treated years ago by a dermatologist but not now.

[katkat]

27. rosacea

It's redness on the face, usually around the chin and nose. Often incorrectly attributed to excessive drinking. How that could be considered a health risk, the mind boggles. There are some topical creams for it, some of which work for some people. If it gets annoying enough, there's a laser treatment which costs a few hundred dollars and generally works.

[wolfgangmo]

50. It can also be a byproduct of high or (usually) low stomach acid.

Thus showing that you take Rolaids, which in turn covers up ulcers, which you got from the stress of not knowing if your coverage is good which will lead to a stroke which will cost money which means that the CEO will have to wait a day before he can afford the solid gold faucets on his 17th yacht.

Coverage denied!

[lib_wit_it]

84. Actually, for most people with Roseau, nothing works. And, as for the laser treatment, it's not

often covered by the so-called health insurance companies. My new overlords, at Aetna, won't even pay for the meds.

It's not life-threatening, but it is far more than just a little facial redness, as has been suggested in this thread. Anyone who had rosacea and got rid of it is extremely rare and extremely lucky.

[sakabatou]

5. *facepalm*

Once again, our system sucks.

[tsuki]

9. k&r. There ya go. nt

[louis-t]

10. Don't ever admit you've gone to a chiropractor.

Another insurance co. put an exclusion on a policy for anything back related because I answered a question from my agent about seeing a chiro.

[wolfgangmo]

51. Unless your provider billed insurance for you.

Or unless they have electronic medical records (which the insurance companies will be sure to have copies of)

Then the only answer to any medical question is "not to the best of my knowledge at this time."

[quakerboy]

76. Do tell them: Recision

Not telling them is worse than telling them.

If you tell them, they either deny you or exclude things. No coverage, but you still have your money

If you don't tell them, you get to pay them for years, and then when you need them, they will terminate your policy. No coverage, and they have your money.

[raccoon]

93. Same here. Makes me wonder if my insurance is worth having. nt

[Stephanie]

12. You can be denied for rosacea?

What about dandruff? Flat feet?

[babylonsister]

13. Acne, too.

:crazy:

And they'd probably try dandruff if they could get away with it. Which I guess they can, seeing as they're making the 'rules' up as they go along.

[jeff47]

37. I got denied for being bald.

Technically, I was denied because I had taken Propecia.

[raccoon]

94. !!!???? Why, do they think Propecia causes other stuff? nt

[rebel with a cause]

46. Flat feet are not as bad as high arches.

My feet have extremely high arches which have resulted in weak ankles, multiple bone spurs, torn ligaments and so on. In other words, they are a mess. Should have been in special shoes all of my life according to the specialist that I saw when it was too late to do anything about it. It seems the doctors from my childhood didn't know about this.

[katkat]

60. high arches

Well, I got to be in my sixties before I was informed that I had extremely high arches and my feet were therefore "a mess." I have a rather jaundiced view of this, even though it is apparently responsible for more than my share of turned ankles over the years. Some exercises to strengthen the ankles and improve balance, a bit of care when walking, that's all I'm doing. I think it's one of those full employment for doctors problems, which is to say, not a problem.

[rebel with a cause]

63. I was a little younger than you when I found out my problem.

It has progressed over the years and exercises do little for me, although I can do some sitting down. My muscles/tendons tear when most exercises are done. No stairs at all have helped (torn Achilles tendon), and little walking. No more than an hour on my feet is all I can bear, and that is twice as much as I am suppose to do. Of course, I also have a deteriorating spine that is very painful. The spine is a hereditary thing as is the high arches.

As far as it being a job for doctor's, it must not be in my case because I am not under any specialist care. The last time I went to one they laughed when they look at the x-rays pf my feet. They had never seen spurs at the point my are at, and I am not in the place to have surgery. I have changed my life to oblige my health problems and I have a high pain tolerance so I am doing fine.

[katkat]

73. yikes

And I don't think I'd want a doctor who found my health problems funny.

[rebel with a cause]

80. I have come to the place that I tolerate the specialist

I have to have and stay away from those that can do me no good.

Honestly, I don't know if he thought it was funny, or he was just in shock from what he saw. He wasn't the first specialist I had seen with my feet and all of them had weird reactions to them. Years ago, my spurs (in both feet) actually looked like the spurs on a rooster. What they look like now I don't know plus I have another type on the back of my heels. He was the last specialist I saw for the feet because without surgery they are not changing, and foot surgery is not in the picture. Oh well, what doesn't kill us makes us stronger.

[Posteritatis]

57. You can be denied for having been assaulted; I imagine anything else is fair game. (nt)

[angstlessk]

14. So, basically, they still get to charge for a "family plan" but deny coverage to two members

of said family? Father and twins is considered family, aren't they?

[NC_Nurse]

17. The Blues suck big time.

[rebel with a cause]

48. Not taking up for the Blues but

I think they differ according to the state they are in. I know people who still swear by them here, but I think that may be because of how they use to be. I remember when people use to take certain jobs just to get coverage with them. They use to be that good.

[FlaGranny]

91. That's before they became for-profit

entities. I had BC/BS years ago and they accepted everyone for coverage and paid very well when you needed them. The profit motive changes everything.

[rebel with a cause]

106. I believe that in Illinois they are still not-for-profit,

but they are very anti-union here while in some other states their workers are unionized. For them to be anti-union is funny to me because I feel it was unions that got them so big in the work places in the first place. :shrug:

[unapatriciated]

103. and this is why allowing insurance to be sold across state lines will not lower cost.

Insurance companies will set up shop in states with status quo friendly laws.

[rebel with a cause]

107. Call me what you will but I say....

regulations, regulation, regulations on corporations. It is the only way to go to get this crazy 'what's best for us (the company)' attitude that rules this country. People talk about socialism and equate it to the liberals, but they need to attend a Wal-mart employee meeting, or any of those that go on in most work places now, where the emphasis is on workers doing what is best for the company because they belong to a team and they owe the team. Come to think about it, maybe it is more like the communist did. :shrug:

[unapatriciated]

109. Yes regulation, but with health care I would go a step further.

Remove the Insurance Companies and expand medicare for all.
On Wally World don't shop there never have never will. Their humane rights record is one of the worst in the corporate world. Coca-cola (I don't buy their products either and they have many) is another one that needs to be held accountable for their business practices.

http://walmartwatch.com/blog/archives/wal_mart_inducted_in_to_the_corporate_hall_of_shame1/
http://www.globalexchange.org/getInvolved/corporateHRviolators.html

[NC_Nurse]

108. I know they differ some state to state, but they have for the most part moved

with the rest of the industry. I remember when I was in NC, they were supposedly "non-profit" but consistently made millions (one year in particular, $20million).
Did they refund part of their subscribers premiums? NO, they did not. They said they were going to open some low-cost clinics with the money. I never heard
anything more about where the money went. One year they got busted for paying for a bunch of their execs to go to a pro-golf tournament as VIP's, and it wasn't a small amount either.
Blue Cross Blue Shield of AL is my current insurer, they are apparently a virtual monopoly in the state of AL and you can tell by the coverage. It sucks.

The Blues have been one of the biggest lobbyists against reform, because they are making a killing pretending to not be in it for the money. If only.

I think you may be right that there was a time when they provided decent coverage. Maybe they still do somewhere. They sure advertise about their compassion a lot.

[rebel with a cause]

113. I will agree with you and go a step further.

There is no such thing as a not-for-profit business or organization. At least I have never known of one. I worked for an agency that was a non-profit youth facility. There was a chain of them in Illinois. The big guys made bundles of money and the workers were paid good enough wages but were expected to sacrifice everything for the agency. (the workers not the big shots) When the agency dropped in the amount of money they were pulling in (due to administrations lack of forethought) it was the workers who were expected to put in more time for less money and it was the youth that got poorer service. In other words, profit was not only expected it was demanded. It may not have been counted as profit but it was just that. Workers who were on straight wages (not paid for hourly work)was told they might only have to work anywhere from a few hours a week up to sixty. Yeah, most of us put in at least eighty hours a week while getting paid a straight wage for forty. Some of us put in up to 140 hrs a week, and forced to lie about it on our schedules. A few of us tried to turn them in to the authorities but were given no help.

In other words, I have no faith in any business or organization. In fact I don't trust anyone. I am a misanthrope and getting more one every day.

[NC_Nurse]

115. I am right there with you. The word disillusioned barely covers it. Being in the

"healthcare" business has seen to that for me. It should be called something else because caring often has nothing to do with it.

[flamingdem]

18. A BIG FU TO THE CRIMINALS AT BLUE SHIELD nt

[Turbineguy]

19. Gosh....

I wonder.... should I let them know I have no ovaries?

Nah, a guy's gotta keep a few secrets.

[kestrel91316]

21. This, in spite of the fact that under CA law, one theoretically CANNOT

be denied medical insurance for any pre-existing condition. But companies find ways to get around the law.

[lib_wit_it]

85. Laws are for poor people, silly! /m

[WinkyDink]

22. "living is a pre-existing condition": That about sums the for-profit insurance cos. right up.

[KamaAina]

53. 'Twould make a fine bumper sticker, that.

:eyes:

[Cleita]

25. Seriously, we the people, have to do something about this.

It appears our elected representatives don't want to. So what should we do if in the end they throw us under the bus? The best I can come up with is to squeeze them dry. It would take some real hardship and sacrifice on our part and on the part of doctors. We would need to cancel our insurance and doctors would need to refuse to take it. We need something else instead. There have been suggestions of paying practices a monthly retainer to get all the health care done when you need it, but it doesn't cover hospitalization and tests or prescription drugs and treatments. Maybe free clinics in the interim like the Haight Ashbury Clinic from the sixties, which still is operating could be a solution.

[katkat]

28. medical records

Say, don't people have a legal right to see their medical records?

[wolfgangmo]

54. See - yes.

Correct - yes.

But then try to get an insurance company to change it's mind, despite the fact that you can show that they made factualy errors.

Repeat after me -- THEY DON'T GIVE A FUCK AND NO ONE IS TELLING THEM THAT THEY HAVE TO, SO BEND OVER AND TAKE IT.

Sorry, but I really do beleive that is a motto in the insurance company. You don't really have to bend over. At least not for me.

[FarLeftFist]

32. ALL 60 DEMS ON THE SAME PAGE???

http://www.thedailybeast.com/cheat-sheet/item/health-care-reforms-big-gain/what-you-missed/?cid=cs:headline3

[postulater]

34. I saw a guy who was kicked out of the army

for a spinal problem he absolutely did not have.

CT scan confirmed the absence of the problem (before MRIs were available). Theabsence was also obvious on his xrays.

He appealed through the Red Cross and was re-instated.

[LynneSin]

35. My mother has rosacea, it's not even a life-threatening disease

or one that requires alot of medical treatment. Some folks can live their entire life with rosacea and never have any issues other than the Ruddy skin. And for those who seek treatment, it's usually just an ointment that will minimize it.

I'll probably deal wtih rosacea, I seem some of the same issue with my face that my mother had.

[lib_wit_it]

88. Not to defend the Ins. Companies, but, while not life-threatening, rosacea can be horrible for those

with more than a mild case. It's not just redness, it can be painful, as well. As for what it can do to your face, how would any of us like to deal with this:

[Joe Chi Minh]

36. Simple equation. Poor people too stressed, very prone to sickness.

If we continue to trick them, regulators will be watching over our shoulder and hammer us. Best exclude them, if necessary, for sneezing.

[tigereye]

40. wow if this isn't reason for a class-action lawsuit or something along those

lines, I don't know what is...


That's awful. Hopefully, the new law will stop those kinds of abuses.

[wolfgangmo]

56. It won't stop diddly.

All it says is that they cannot deny you for a pre-existing condition. It says nothing about how much they can charge you for the coverage they offer.

Trust me when I say that they will be working on formulas for how much to charge to get the healthier people to take it and the less healthy to fuck off and die on the public dime somewhere.

[tigereye]

61. well, not denying people goverage based on absurd criteria is a start

I think as things progress there will have to be some limits on highway robbery rates... For me if they could figure out that health coverage and health care are not the same, that might be good as well.

[Shireling]

41. I don't understand

how this country can be so primitive. It is time to move out of the cave and enter the age of enlightenment. "Sicko" needs to be seen by most of the country.
:eyes:

[cascadiance]

43. Those facing foreclosure are told to challenge lean holders for proof of title...

... which often gets lost or otherwise isn't available in these subprime mortgage scams, and can legally fight foreclosures that way. It's just that most don't know about it and let themselves get "run over".

Perhaps we should have some lawyers look at the burden of proof here too. Perhaps there are laws on the books that would require the insurance companies to furnish proof that there are documents that support their contentions of these false conditions. If they don't exist, they should be made legally liable to provide full coverage and also damages as well...

I just had my dentist yesterday tell me while giving me a cleaning that insurance companies have been playing games with physicians too. She believes that they try to time when they pay back doctors for services too, and have a lot of "delaying" techniques saying things like they "lost" the X-rays that the doctors submitted to them for payment amongst other things, and that these "lost" documents that would delay payments and force the physicians to resubmit paperwork would all seem to happen around the same time periods...

I have some tooth decay starting in my wisdom tooth which is in a spot that they'll need to pull it rather than fill it. He said I have around six months before I have to get it pulled. I'm on COBRA right now, and figure that perhaps with my present insurance (which I'm told pays rather well for dental services) that I should try and get it under my COBRA coverage soon, even if I get dental coverage in my newer company as it probably won't pay as much.

I've got other things that might be considered "pre-existing conditions" that I will also need to probably take care of soon, even though normal advice was to wait to "see if a problem condition happens". I don't want to wait forever and when it does happen not have coverage at all and go broke then.

All of the crap we're having to deal with now. Even if we have some newer plans going into effect later, I think Congress needs to pass some liability bills NOW that will clarify the rules of what these guys can and can't get away with. If they don't, these companies are going to go crazy trying to profiteer us to death (LITERALLY!) the next 2-3 years before the newer plan kicks in to "get while the gettings good".

[wolfgangmo]

58. I run a clinic

Insurance companies always screw the docs by delaying the payments.

Let me give you an example.

Doc submits paperwork. Insurance company has 6 months to approve or deny. Insurance company finds small mistake on paperwork 2 days after they get it but file it away and don't respond until 5 months and 28 days have passed. Then they deny the claim.

Doc sees denial and calls to get verification of reason for denial (denial is for unclear meaning in diagnosis). Doc consults 6 month old notes. Waits on phone for 2 to 3 hours. Gets human with no education or clue. Told claim is unclear in meaning because a "t" is not crossed on one of the forms. Doc being inexperienced does not ask if there is ANYTHING ELSE. (this is not far fetched - I have seen this happen) Doc corrects form and resubmits.

Insurance company again takes 5 months and 28 days to respond. Claim denied. WTF? says doc. Again the form is rejected because it is unclear. Doc reviews 1 year old chart notes and holds on phone for 2 to 3 hours to get human with no education, no clue, and a hearing problem. Doc, having learned his lesson asks what problem is, finds out an "i" was not dotted, and then finally asks if there is ANYTHING ELSE WRONG. Doc is told a list of problems, all at least as reasonable as the T's and I's not being crossed/dotted.

Doc resubmits bill and waits 5 month and 28 days. Claim denied. Procedure is considered experimental for this procedure. This decision despite the fact that it has been standard of care for over 3 decades. Doc resubmits form.

I case anyone here thinks this is a joke, it is not. This actually happened to a doc we worked with. It took him almost 3 years to get paid for the work he did. You try keeping an office open if your customers don't pay. With any other job, you could sell the debt, take them to court or otherwise write off the problem, but services are not considered business losses by the IRS and you cannot by law submit the bums to court for shirking their payments.

In other words the bums get away with this daily.

It is the main reason our clinic no longer bills insurance for patients.

[Alameda]

65. Many places insist the patient pay the bill if the insurance

company does not pay within 30 days.

[wolfgangmo]

67. Many places may do that but we are in the business of providing health care.

So for us the decision to get paid up front was a no brainer. It turns out that if patients submit that they are MUCH more likely to get paid than if we submit and we provide every patient with a reciept with the procedural and ICD codes right on it to make it easy for them. Our paperwork flow is a trickle compared to the waterfall it used to be.

Today we focus on patients. In the bad old days we used to focus on insurance companies. Many pratices still do spend most of their time practicing what we now call insurance based medicine. In other words, they craft their practice of medicine to making sure that they conform to what the insurance companies want and not what is in the best interests of their patients.

[Alameda]

116. but many times the person who has the insurance, has it

because they can't afford the total cost up front.

[krister]

111. How can that possibly be legal? (Well, because our reps are morons and crooks)

There needs to be a site dedicated to the testimonies of people like you.

I'm glad that I made it down to your post before tiring of the thread.

[Bozita]

45. Hugh K&R - Wish I could do it again.

[Dont_Bogart_the_Pretzel]

47. I wonder when they will (try to) deny insurance on pregnant women.

[Stephanie]

49. Q: Have you ever had sex? A: Um, yes...

DENIED!

[rebel with a cause]

52. They have been doing that for ages..

I have known a quite a few people over the years who had to fight insurance companies for coverage of hospital bills when their babies were born.

Sometimes they didn't win and had to pay the cost themselves. :shrug:

[Dont_Bogart_the_Pretzel]

66. I'll bet the Duggars's don't have to worry about insurance.

... Just how do the Duggars afford having 18+ children? You know, before TLC?

[wolfgangmo]

69. They don't pay taxes

And they can give people a tax write off for any donations. They have established themselves as a church with all the tax benefits that go with it.

Which is kind of like how Michelle Bachmann and her "therapist" husband were able to afford having 23 foster kids. They had many at a time and made the foster kids take care of all household chores including taking care of the other kids. And then they pocketted the $1100 per month (plus full medical for the family) that the state provides for taking in foster kids. It's also why they were able to pay off their house in only a few years on only one meager salary.

Yup, like all good evangelical right wing welfare queens, they exist by sucking at the public trough.

[rebel with a cause]

78. Yeah, I read about the Duggers long before TLC.

He use to be in politics, I believe, and I also believe they are a part of those evangelicals that want to have a lot of children to rebuild the right wing/white culture and make sure it stays in control. I cannot stand them or their show. Also, there are a lot of foster families that do it solely for the money. One of the things that has been wrong with the child welfare system for a long time.
Man, I feel negative tonight. :(

[Hassin Bin Sober]

105. One of my co-workers whole FAMILY was "rescinded" during a pregnancy ...

... due to one of those small cherry-colored birth marks on one of the other children. The parents, during a routine check-up, consulted a doctor regarding the birth mark and were told the child would grow out of it and to leave it be. They never gave it another thought (the wife is a nurse) and apparently failed to mention it on whatever application they filled out to obtain the policy. Blue Cross used it as an excuse to rescind during the wifes pregnancy - my co-worker calls his daughter the $20,000 dollar baby.

[wolfgangmo]

68. That would be 1978.

Denying coverage to pregnant women for pregnancy related health problems is SOP.

[Kansas Wyatt]

62. Someday, at some point, everyone will have a medical problem....

Therefore, the Insurance Industry reserves the right to deny coverage to anyone.* **

*In the event of declining inflated and over-priced insurance policy revenues, the Insurance Industry also reserves the right to lobby the U.S. Government to force everyone to buy their insurance policies. If you have been previously denied coverage, you will be forced to pay 5 times more for your policy, and your insurance may or may not cover you during your time in need... Don't worry, you may be better off dying, rather than chasing your never ending evasive settlement.

**Just wait until the Insurance Industry factors in your credit rating as a way to shove it up your ass even more, when it comes to "predicting" your poor health.

[tomm2thumbs]

71. nearing 250!! Go go go!!

[democracy1st]

82. K & R

[andym]

83. So much for non-profits-- Blue Shield of CA is a non-profit

But they're still misbehaving as if they had shareholders demanding profits.

[onlyadream]

92. Are you kidding me???

If they're not going to insure people for health "problems" such as having a skin condition, then we're all fucked. And they'll be fucked too b/c who'll be left to pay the premiums? Unless the other poster is correct in that past potential treatments could cause something much more costly down the road.

[and-justice-for-all]

101. Fucking evil fucking Insurance monsters....they make me sick..nt

[unpossibles]

112. why are stories like this not being pushed by the msm?

Oh that's right - they get too many advertising dollars from those who would rather bury the stories (and the people).