CBS: Private Insurance Company delays/denies insured woman until it kills her

[Thorgrim]

Originally Posted by WickedLou9

The reason that they denied the money for the transplant was because where wasn't ebough evidence that should would survive even with the transplant. As a business it is a logical decision. Presicely why medical insurance should be socialized. If you are that person you will take a 20% chance over no chance at all I guarantee you. No one should ever be denied a potentialy life saving treatment because it doesn't make sense financially. It's not a financial decision. It never should be. Money is not more important that peoples lives.

I disagree with your characterization because it's not logical for an insurance company to repay when your house was flooded in Texas when there is a probability it will be flooded again

You paid your insurance money...they call it insurance for a reason, you were worried about flooding, a company promised you payment if you were flooded

This is even a worse case, she paid for insurance for medical costs...the company had all the chances in the world to say "no, don't give us money...don't sign up, we can't insure you medically" they didn't, they went for her money, and then delayed and denied until she died and they made a profit

In other words, insurance, over the long run, makes a lot of money because a lot of people never need that really expensive surgery...however it's not just an empty promise to get money

Now, my one relative paid tens of thousands of dollars in medical insurance over decades, she died of a heart attack...no one's fault, but the insurance company made a ton of money without doing jack shit

Another relative comes in, and she needs heart surgery, now she's paid a lot, but overall her medical costs will exceed what she paid, however, remember all the other customers they're making tons of money off of...

They can pay for my relative...or in this specific case...pay for the liver transplant...and still be a profitable business making good decisions

But that's not enough for these people, they can't just be profitable, they have to be greedy and petty, they have to delay, they have to deny, then delay again, then argue over bills, then...you get my point

[7960]

Originally Posted by WickedLou9

your glasses are not the same as someone dying from some illness.

So I'll call my life insurance guy and tell him I'm going to opt for the $10k plan and pay $2/month. And then when I die my wife should protest outside their office, saying she deserves the $1M payoff?

It's not about glasses. It's about what that family chose.

[WickedLou9]

Originally Posted by 7960

So I'll call my life insurance guy and tell him I'm going to opt for the $10k plan and pay $2/month. And then when I die my wife should protest outside their office, saying she deserves the $1M payoff?

It's not about glasses. It's about what that family chose.

So now you are just making up stuff? SO the people in this story bought bargain basement insurance that didn't cover the transplant? Hm nope. So what is your point?

[7960]

Originally Posted by WickedLou9

So now you are just making up stuff? SO the people in this story bought bargain basement insurance that didn't cover the transplant? Hm nope. So what is your point?

CIGNA initially declined to pay for the transplant for Nataline because her plan did not cover "experimental, investigational and unproven services," her doctors said.

Yes, I'm saying it was not covered under her plan.


:edit:

Let me fix that. It was covered until she got an infection and was put in a coma. Then things changed. Every day people who are cleared for surgery are told they have to wait because something else came up. I think CIGNA is making a mistake by now saying the anti-rejection drugs are the reason. They should be saying it's because the infection and complications from the bone marrow shit she had done earlier. Everything I keep reading pretty much says they changed from yes to no when she was put in a coma to help combat the problems from the infection after the bone marrow surgery.

Also, I've seen where she "secured a donor" but I haven't read anything that said it was her brother who was going to donate part of his liver. Link?

[Thorgrim]

Originally Posted by WickedLou9

So now you are just making up stuff? SO the people in this story bought bargain basement insurance that didn't cover the transplant? Hm nope. So what is your point?

As pointed out in the youtube of the news broadcast, insurance companies like to claim anything expensive as "experimental"

Having someone with a failing liver get a healthy one...it's really unproven science, we've never seen it work

As a side note, they didn't reject the bone marrow transplant, which is supposedly much more scientifically sound than a liver transplant

by "sound" I mean cheaper

[JaJae]

If you take the position that this is a tragedy and a fault of a flawed healthcare system, universal healthcare makes matters far worse. The solution is to fix our current system rather than switching over to one where more people will die waiting for care.

For serious care in the US only 8% of patients have to wait more than four months to have surgery. In Canada that number is over one-third, in Britain that number is over 40%. More people die per capita in those two countries due to lack of care than we have here in America.

This is akin to saying "Look a nuclear reactor melted down, let's utilize Russia's system of safety..." It's only going to make the probability far more prevelant. The better solution would be to fix our own system where this has a far less chance of happening. Also, countries with universal healthcare often prevent their citizens from receiving non cost effective treatments all the time. They also have to wait a very long time for their treatment. That's why they Canadians come here. Even if they have the money to pay for the treatment, they're denied. And if the government does cover it, they have a much greater chance of dying while waiting for their surgery than they do in the US.

[JaJae]

Also as an interesting side note. I have a couple friends from Canada, but they attend school in the Minn. They like Canada's healthcare system because they're broke college students. But when someone serious happens they'll be in America for treatment. They recognize that Canada's healthcare system is inferior to America's, but it's free. If they're worried about something and need good treatment or a proper diagnosis they see American doctors. Everyone in their family is the same way. So essentially in my experience people presented with the option prefer to use the American health-care system. If they have a cold they'll go to Canada rather than pay their co-pay. But if serious you can bet your sweet ass they'll be crossing the border to America for their healthcare.

Taking extreme cases of unstable patients in comas needing organ transplants and then saying America needs to switch to universal healthcare in the same argument is really an oxymoron.

[7960]

Originally Posted by JaJae

Also as an interesting side note. I have a couple friends from Canada, but they attend school in the Minn. They like Canada's healthcare system because they're broke college students. But when someone serious happens they'll be in America for treatment. They recognize that Canada's healthcare system is inferior to America's, but it's free. If they're worried about something and need good treatment or a proper diagnosis they see American doctors. Everyone in their family is the same way. So essentially in my experience people presented with the option prefer to use the American health-care system. If they have a cold they'll go to Canada rather than pay their co-pay. But if serious you can bet your sweet ass they'll be crossing the border to America for their healthcare.

Most of my family lives within an hour of canada and many of them employ canadians. I agree with this post 100%.

Taking extreme cases of unstable patients in comas needing organ transplants and then saying America needs to switch to universal healthcare in the same argument is really an oxymoron.

The thing is there's no way to say it without having it turned into "So she should die then?!!?!?!?" Fact of the matter is she was going to die. If not when she did then in 6 months. Is there no limit to how much should be spent to prolong her life 6 months?

[kinggovernor]

Originally Posted by WickedLou9

The reason that they denied the money for the transplant was because where wasn't ebough evidence that should would survive even with the transplant. As a business it is a logical decision. Presicely why medical insurance should be socialized. If you are that person you will take a 20% chance over no chance at all I guarantee you. No one should ever be denied a potentialy life saving treatment because it doesn't make sense financially. It's not a financial decision. It never should be. Money is not more important that peoples lives.

but that is exactly what will happen with socialized medicine, the program has to have a budget. Resources are not limitless and the government will have to choose when to use its scarce resources, and it will be wasteful on low probability procedures because it will take resources away from other programs.

[DosEquis]

I am not sure why insurance company stuff confuses people. The way they make their money is to not pay for things.

Should that be part of the foundation our healthcare works off of? I dont know, probably shouldn't.

[JaJae]

The way they make their money is by charging more than they pay out.

[Thorgrim]

I don't see how this involves any proposal i've seen to cover the uninsured...as this case is about insured people

this was about money, not being covered by insurance or not...

and yes, everyone knows businesses make money by taking in more than they spend...

How do business's expand profits? One way is to rip people off, see used cars salesmen...now do you want a used cars salesman as your doctor or teaching your kids?

A similiar thing happened when they tried "charter schools" in...I believe Arizona...they told everyone to come, but then realized handicapped kids are just way too expensive and cut back all their programs...completely ripping off the community who thought they were going to come in and save them money

That's why you don't give greedy salesmen the job of educating your kids

Now, looking at this case, that's why I don't want health insurace...any...because everyone I look at, I know they'll try to scam me into paying tens of thousands of dollars while denying/delaying every legitimate medical expense I have

[7960]

has anyone answered this?

Also, I've seen where she "secured a donor" but I haven't read anything that said it was her brother who was going to donate part of his liver. Link?

[Linzyhop]

I used to work in insurance. this shit happens a LOT more than people know about. if insurance ever denys a claim and you believe you have the right to it, sue. they count on people not suing.

isn't there a john grisham book about a situation like this too????