Oklahoma Senate candidate Andrew Rice, on his family's recent tussle with their health insurance provider after their 11-month-old son was hospitalized for pneumonia (via BlueOklahoma):
One month later we learned that our health insurance company was refusing to pay the $10,000 hospital bill because they said our baby Parker had a "pre-existing condition." I'm not kidding. When we argued that baseless reason away, they changed their excuse to "improper notification" by the treating physician, and said it was not a big deal because the hospital would just "write it off." They don't think it is a "big deal" to avoid providing the coverage we pay them for every month, and instead have the Oklahoma taxpayer foot the bill. That tells you something about how they see the world.
Not until they learned that Apple is a physician did the insurance company bureaucrats finally admit they had made a mistake and agreed to pay the legitimate claim....
The career politicians in Washington do not have the courage and integrity to reform this system, while 47 million Americans go uninsured and those of us who are insured must fight a system that is structured to deny claims first and ask questions later! (emphasis mine)
When you contrast Andrew's record with that of current Sen. James Inhofe as Senate2008Guru has done, the need for real change becomes crystal clear.
We have had our own family battles with insurers, and they usually end at the point where I mention both my husband and I are lawyers and can read our coverage provisions -- and say the words "bad faith." It is beyond annoying to have to go through this while paying substantial monthly premiums for coverage. Especially given that most folks throw up their hands in disgust and just pay for things that ought to be covered.
Which is really the point, isn't it? Profit by attrition.
Let's ask tough questions on health care, beginning with those that Ian points out in this thought-provoking post on our current system and potential changes. And this one about costs to all of us. Because it isn't just Andrew Rice: Jane has battled her insurer on whether her surgery to remove invasive breast cancer and subsequent chemo was "medically necessary." I've had hassles with my chronic lupus diagnosis, but not to the extent that Jane has the last year or so. My point? We are both well-informed consumers who aren't afraid to speak up if there is an issue...and yet we haggle, too.
So long as insurance companies are for profit enterprises, their goal will not be the best health care possible. It will be this -- not paying claims. That is the truth of it, because that is how they profit. For real change, we need better, smarter folks elected to represent OUR interests, not just the biggest contingent of lobbyists and campaign cash.
You can contribute to Andrew Rice's campaign here -- one of our many excellent Blue America candidates. You can also make a big difference campaigning on behalf of progressive candidates in your area. Real change happens one election at a time...here's to a whole lotta good change in the near future.
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Hi Christy.
Hi Christy…
Redd!!!!
Morning all. Good to see you MissAnn — how are things with you these days?
Health Care Reform!
Yeah! Look at Gilda Reed in LA-01 she is fighting the good fight!
Not much to say - you said it all: Take the profit out of health care.
These days when a person needs medical care, they need a doctor and a lawyer. I think “bad faith” and complaint to the State Insurance Commission only work if the insurance co thinks that the persons has the resources to follow up.
I remember that. I was quite amazed. What moronic nonsense…
Is this a specialty field of law now? Fighting insurers for denial of medical coverage?
I was so horrified by the idiocy of saying to a state Senator and doctor that they shouldn’t worry about their medical bill because the hospital would just write it off. Jeebus, that’s insulting on far too many levels, not the least of which is how it would affect their credit rating and the insurance company customer service person could clearly care less.
Sometimes, you just want to throw up your hands and laugh at the absurdity…
Worth saying every time this subject comes up. Insurance is the ultimate moral hazard industry. Earns higher profits but not fulfilling its function. Not unique to medical insurance. Just ask any Katrina survivor (including Trent Lott).
And why the Ds want to make “insurance” the arbiter of universal medical care is a mystery to me.
Fabulous. I am heartened by our Yahoo group in LA. Great things are happening. New folks are running for the Dem central committe. The grassroots are trying to basically create a party from nothing. Very very exciting. The folks that have been in charge here in Louisiana have been letting the party die a slow death. Well I am here to say we are a swing state and always have been.
Mom is doing well with her cancer. She is traveling and enjoying life again.
We still have lots of work to do in the state of LA, but things are looking up for me. New Orleans is as fabulous as ever. We have about 150 more restaurants than before Katrina. Probably all good too!
Hope you are having a great New Year!
I think “bad faith” and complaint to the State Insurance Commission only work if the insurance co thinks that the persons has the resources to follow up.
What - you don’t have a friend or family member who’s a lawyer?
Think about it. *Sure you do*. heh.
That’s where we turned a corner in the way people regard Health Ins. Not only is it too costly but now they don’t even pay the goddamned bills.
I am, as a matter of fact. And I am happy to say that I am eight pounds down and counting on my New Years “get healthier and exercise more” resolution. Boo yah!
Thank you for the post. Healthcare is a mess.
As someone who is fast approaching 65 I have been inundated with “information” pamphlets. I am utterly and totally confused. The only this I know is that I am going to get royally screwed it is just going to be by who. The system sucks.
Good Post CHS
I’m hip to this, and this needs to be brought to the front. Hell of an issue for a progressive presidential candidate. Do we know anybody like that ?
The US badly needs to invest heavily on its future: education and health care, for starters.
‘morning CHS. Thanks for the post. This is a big, big deal for CBL and I. Our cost for covering her and our 16 year old son on my employer provided policy has just gone from $605.00 a month to $660.00 a month. When GWB took office our (CBL and I) company paid $587.00 a month for a family of 4. The new coverage is not even comperable to what we had before. However, we are finally reinsured after 3 extremely tense years without. Thanks again for highlighting this issue.
I am for total universal health care. But I do remember a time when insurance companies were not so hard to deal with. In 1987 my first husband, a physician, became neurologically impaired and eventually passed away. We had health care through Allstate (i think)and it was a very good policy. But in the middle of his illness the policy was rewritten for the rest of the family. They were bound legally to continue his medical care. I see this moment in time as the beginning of the end of a fair and substantial health care industry. It has been degraded by pure greed and purchased politicians. I guess my point is one that we all accept. Over time the insurance industry has won the right to kill us with their concern for the bottom line.
Vote for the candidate who will effect the most positive change in this amoral, fascist country we have become.
We have a friend who had two serious medical problems while living in Oklahoma and had no insurance. The doctors treated him great, but the hospitals are still after him to pay his bills. Even after declaring bankruptcy. “Writing it off” means the insurer doesn’t have to worry, but the patient still does, years later.
I’ve told this story before. My employer wanted workers to contribute more to the cost of health ins. (understandable). The union fought it (also understandable). We had no contract because of this issue for 2006 and 2007. Well, it’s been settled and we lost. Also, adding to the picture, I was promoted effective 1/1/08. I’ve now rec’d my first 2008 paycheck. Taking into account 3yrs worth of raises and a modest promotion, my net is down about $5.00/wk.
Indeed so.
Christy, succinctly stated and, ‘universally,’ the ‘truth’.
Our ‘leaders’ should be ashamed to accept their stellar benefits while many have none and the rest are hostage to simple, unrestrained greed.
Indeed. I find this inexplicable (from a common sense point of view only of course.)
in this amoral, fascist country we have become
You know, there was a time not long ago when my spine went wacky hearing “fascist” as an adjective for this country. It’s telling that that no longer happens. And a darn good thing, because I doubt my insurance company would cover spine wackying.
I worked in the billing office of a medical facility for fifteen years. I spent more hours trying to collect on unpaid medical claims from insurance companies than you can imagine. I think if everyone, and I mean EVERYONE, were required to share in this excruciating job, we wouldn’t have this problem anymore. The insurance industry is at the top of my list of criminal cabals and the politicians that cover for them are equally liable.
The only way that we will get single payer is if “Big Business” decides it is in their best interest and throws the insurance companies under the bus. The idea that “tax payers” would assume all of big business health obligations and costs pisses me off but that is probably what it will take. As an example, for every dollar that GM spends for health care, Toyota spends 1 cent.
We should collectively stop paying our health insurance. Oh yea, this is not voluntary anymore is it? We will stop paying health care costs because there is no money in the average American’s income as it spirals down into poverty.
This subject is one reason why I support Edwards over the other two front runners. And it is the reason he is not getting airplay on the corporate news hours. He is not afraid to tackle the issue because he made a career of fighting the big guys. Hillary has way too many health insurance sponsors who have decided to make nice with her and thereby preserve their profits (and existence.)
my guess is that health care costs is one factor in jobs going offshore.
This kind of behavior is what keeps me from signing up with any health insurance provider. (I’d like to have insurance, but …. I’ve heard way too many stories of coverage denied or care delayed. Or hospitals and doctors spending far too much time trying to get reimbursement from the companies.)
Christy -
When does the insurance company, which normally records its income and expenses using the accrual method of accounting, record a filed claim as a liability? How does it record claims in process that await approval? Are those claims treated as contingent liabilities? If so, they will not appear as liabilities, although, if I recall correctly, contingent liabilities should be disclosed in footnotes to the insurance company’s financial statements.
That was going to be my next point - that once business saw that they would benefit from a single taxpayer, then they would push for that reform.
Until recently, this average American was paying nearly $800/month for individual medical coverage. And when I submitted one of my very few claims (for orthotics to deal with a multi-sprained, and then arthritic foot), it was denied. $400. Half of one month’s premium.
As a self-employed small biz owner, I had to switch to a high-deductible policy last year. Monthly premiums for regular HMO (Kaiser) were just getting too high - $1000 for a healthy family of four. So now the premiums are half that, for what amounts to catastrophic coverage only. Up to $7k per year we are cash out of pocket. But hey! We get to use a health “savings” account, so it’s all tax deductible… The HSA model works only if you can manage to feed the account to the full amount ($5850 in 2007) which still leaves a coverage gap - our version of the Medi-Care donut.
Edwards has pledged to take congress’ healthcare away until they pass universal healthcare for all.
Surge Edwards…surge!
I need help with my theory here. If I take the 18,000 people a year in California who DIE from lack of coverage or failure of coverage and figure out this cost across the country and then multiply is by eight years of corruption I get over a million dead. I this is not a perfect way to come to this number but the only way I know how to do it.
one million dead.
oops I meant to say single payer, not single taxpayer @34.
Same opinion here. Where does Obama fit into this mess?
Here I go, talking to myself. P.S. The orthotics are a hedge against surgery. Looking only at dollars . . . . oh, never mind.
My salary hasn’t changed since Bush was appointed to office. With no place else to go, I’m glad just to be working. While I suppose I should show gratitude to the Republics because I’m not being forced into a gay marriage, it’s hard to feel anything but threatened by the economic situation they created.
People should understand that once someone develops a “condition,” they become a liability to their insurer, who then wants to get rid of them, i.e., wants them to die.
Bush seems to enjoy yhe deaths of others.
Welcome to the GWB ownership society. You own your own healthcare but you can’t afford it.
IMO, If a Dem becomes President, who it is will have little effect on the health care debate. It will come down to Congress and Big Business. All of my political contribs are going to progressive challengers for Congressional Seats.
I with you!
this is a subject dear to my heart because I have what I believe is a perspective that is not discussed but needs to be;
a the health of a companies labor force is important for their bottom line, just as maintenance of their machinery
why does their macinery get maintenance from the company and people do not?
the answer, the workforce’s health is an expense of the idustry and instead of paying that expense they defer the cost onto the middle class
health care must be provided by industry not the individual
now, you get that part of the discussion and I GUARANTEE “republicans” will get on board for a single payer national health care program
Yes it is. One of the leading law firms in this field is in Southern California. I actually specialize in insurance litigation but not medical insurance.
My question on this is always isn’t the denial of a claim saying it is not medically necessary the unlicensed practice of medicine, especially since most of the people making these decisions are not doctors. Something to consider.
I’m going to place my bets on John Edwards for President. Proverbial bets, that is, since there isn’t any MONEY left to put on the table.
I’m with you on this. That and $4 will buy you a hotsy-totsy latte.
Great point.
Bill Durston for congress!!!!! He is in district 3 running against Dan Lungren. He is an er doc, vet, and very progressive. Bill is the most honest man I know. Never would he turn into a blue dogger. Universal health care is one of his mantras. Here is his statement on health care:
“I believe that access to necessary medical care is a basic human right, not a privilege based upon one’s ability to pay. The United States spends 2 to 3 times more per capita on health care than the other leading democratic countries of the world, yet ranks below average in overall measures of quality, and is the only country that does not provide some form of universal health care coverage for all its residents. Throughout my career as an emergency physician, I have provided the best possible care to my patients without regard to their financial status. As a U.S. Representative, I will continue to be a patient advocate, and I will work toward a system of universal health care under which all U.S. residents receive comprehensive, affordable medical coverage.”
hmmm…sounds very promising!
As I was being treated for a ministroke, I had one doctor who was originally from Africa tell me I’d need an MRI and a drug such as Plavix. Then another doctor came in, realized I was uninsured and said, “You can take aspirin and have a CT instead.”
I looked at the nurse and said, “OK, never mind, if you’re going to deny me proper care I’ll just die.” So she went and got the social worker and started some financial aid paperwork.
Please remember this if you get in a situation like that (and you can still talk). Make some noise!
Here’s the link to Edwards’ positions on health care.
“Mandate” us till we wake up one morning with nothing! All a taken by corpogovernment! Keep up the good work CHS!!
Yes, another among the reasons Edwards is deserving of our support.
Further, it is not just the ‘economy’. It will take fundamental changes in the economic system and in the distribution of wealth to bring about the changes we need as a people, not just for our personal economic and physical well-being but for the restoration of democracy itself.
Edwards is, I think, far more aware of this and more likely committed to its undertaking than either Clinton or Obama appear to be (or would be allowed to be - sort of like the meaning of ‘is’ if you catch my drift).
Most of these doctors have contracts they sign with the insurance companies in order to get in-network wirte offs and such. Are there protections, inserted into the body of the contracts, for this kind of suit?
OT somewhat: In addition to healthcare plans, the Democratic front-runners have now crafted economic stimulus packages, and per Krugman:
Among other things, Edwards embraces/promotes a national strategy for cancer survivorship. Elizabeth, of course, but also my David, FDL’s Jane, and . . . ?
IMHO the whole health care system is broken. When I went to nursing school(the dark ages at a hospital school), the majority of hospitals were NOT for PROFIT, usually run by some religious group. I wrote two comments over at kos about my recent experience in the so called “Best” health care system in the world… ya right..
Since I met you at Yearlykos
Have cancer and can’t get chemo unless I pay
I support anyone who is willing to take on this giant. As a person who was a part of this system, someone who worked in the belly of the beast, who left in disgust. Please we need to fix it,
The insurance companies can also count on our inability to fight them or notice the BS while we are sick. Imagine, having to fight for medical care and for coverage of same while ill.
A few years ago I had been ill, and it was not until 9 mos. later when prepping for my taxes that I found they had denied coverage for a doctor I never saw (AFAIK) who diagnosed something the insurance company later said I did not have, but it was consistent with the diagnosis at that point.
I fought them and was reimbursed for that out-of-pocket, but it took a long time. I could never have done it while I was sick. And I barely figured it out from looking at the bills.
Obama is a stealth corporate operative.
I think it’s gonna be tough to get a dr to actually put his name to a denial of claim since they would loose their md license pronto
One example of how bad the insurance companies have become. My doctor now will ONLY bill Medicare. Other patients have to pay up front and then fight it out with their own insurance company. Thankfully, I will be going on Medicare with the next month. My doctor said that she simply is tired of dealing with the companies. Who can blame her?
me. Thrive not just survive!
OT..The latest from the Huckster:
link
Christy -
About time someone pointed out that any of the candidates’ plans that involve insurance are hopeless because even having insurance at best signs you up for a war with your insurer that you will lose more often than not. If you get your health insurance through employment, as most do, you are really screwed because the courts have held that your state law based bad faith claims are preempted by ERISA and ERISA provides no remedies at all. Single payer is the only answer.
OT, but somewhat important…
From Der Spiegel A Q&A with Bin Laden’s Second in Command
Christy’s post is excellent for two reasons:
1. A politician is making the case for better medical.
2. It is a step in the stairway to universal coverage:
Imagine all of the paperwork from all of the contested claims were supeonaed and stacked on the capital steps by a congressional committee headed by say…Rep Dennis Kucinnich (on NBC debate tonight) millions of yards of medical records even if just representing the existing files in medical offices and insurance companies all over the USA…huge evidence of all the contested SICKO non healthcare industry.
Faith based health care?
Oh, lordy, katymine . . . I am so sorry. I am SO sorry that this country has totally let you down. Crap. We have walked some of this with David, even when we bit the bullet and trekked to Mayo. And it’s a helluva bullet, let me tell you.
It is the insurance companies that are getting sued, not the doctors. The remedy against a doctor is typically a malpractice suit not a breach of insurance contract action.
A doctor that denies benefits without examining a patient is comparable to Bill Frist diagnosing Terry Schiavo via videotape as far as I am concerned and should be subject to discipline, at the very least.
By the way MsAnn, my wife, my daughter and I will be visting your fair city next month. We are all very excited at the prospect. Our thoughts have been with the people of your city since a certain, particular ’surge’.
I once got a very quick turnaround on a claim denial because the insurance representative told me that there were cheaper ways to treat my daughter’s strep complications. I happily told the doctor’s office and they blistered the phone lines for me about practicing medicine without a license. But, then that was in the ancient time of 2001. It might not work in the modern world.
One of my wife’s doctors will only accept Aetna because he hates dealing with multiple companies (or any at all, really). My employer, thankfully, offers Aetna, but it is $130/wk more (yes, more) than any of the other plans that are offered. There is no difference in what is covered, except the doctors.
faith based health care-”Please God, don’t let me get sick!”
I pray to God I’m covered for this!
Unfortunately, as president he would have no ability to do that. But it’s a good thought. (Edwards supporter here.)
He would have the soapbox to keep it on the radar tho.
sounds very christian and very scientific in a cristian scientific sort of way
*g*
What we need is universal health care NOT “universal coverage.”
Coverage = Insurance. Now, tell me who’s responsible for the current mess?
Right — Insurance companies.
Care NOT Coverage!
The current system still isn’t broken enough to overcome the years of “brain washing” of the evils of “socialized” medicine. The evolving economic “shit storm” (depression?) could change to public debate. Without torches and pitch forks by a very large majority of the public, single payer isn’t going to happen.
But if we have socialized medicine, I’ll have to wait for months to get my nose job.
My daughter had a biking accident during a p.e. class last spring. She was knocked unconscious and taken to the local emergency room. She was there for five hours. The bill was $25,000.00. The school paid for all of it but $4,000. The $4,000 that she had to pay would have paid for her first semester in nursing school. Of course, she had to borrow the money from one of the “privatized” school loan companies.
We live our lives looping through the bowels of corporate America until we have been fully digested.
CaliCat: I didn’t make myself very clear. My question was about the insurnace company being able to cover for the people on their review boards (nurses and doctors)that are responsible for the review and denial of claims. Not the physician that filed the claim.
And yes, the Bill Frist fiasco should be taken to court by all means.
I don’t mean to sound cranky, I just don’t have the refined communication skills as the rest of the fine FDL crew.
Faith based health care?
Nope - just your basic constitutionally-mandated theocracy.
there’s the thing though and that’s exactly why it’s NOT “socailized medicine”
social medicine implies the competitive market is not at work however the private sector can still compete and therefore this is NOT socialism
in addition, elective surgery would obvioulsy need private funding not public funding
Where only the ‘good’ is allowed insurance.
PJ
You can make a premium account for yourself say in T-Bills that pay interest. When you have a medical event you have some bucks to cover. Some medical offices and hospitals require insurance…don’t know how that will work for them. Anyone know why we can’t pay in cash?
Chronically ill people who have been reamed by the system have no cash or coverage.
It appears that on Feb. 5, I’ll have to choose between Obama and Clinton, even thought I prefer Edwards. I don’t particularly like either of them, Obama for his right-leaning domestic policies and rhetoric and Hillary for her right-leaning foreign-policy stances. Hillary seems influenced by the neocons and Obama by the paleocons.
OT
Lieberman left a robocall
for McCain on the answering machine of dKos diarist Brainwrap, who lives in Michigan.
My son broke his foot at school in May of ‘06. The bill for xrays and doctor care was $12 and I paid an extra $75 to have a waterproof cast.
He broke his foot again at school in August of ‘06. This time, the bill was again $12 but they sent us to an orthopedic specialist who decided not to cast it. No charge for the specialist.
We had high taxes, but still made more than most in our lower-income rural area. We lived quite comfortably (well, except for the fact that the houses aren’t heated in winter, but then there is long underwear!). We also knew that none of our neighbors, many of whom were very low-income, would be denied basic care.
No, not in America, but in New Zealand.
Survivors: Mr. Gnome and my mother.
Faith based health care: Thank God I live in Canada? (Which I don’t but I did once and delivered a baby emergency c-section and had the best care I ever got in a hospital, but that was 26 years ago.)
To the best of my knowledge any and all medical professionals will accept cash at the time of treatment. There are some who now deal strictly in cash, as filling out the paperwork required by the insurance companies has become too onerous.
…and Prairie’s Mr. Sunshine…
Christy, thank you for this post! The healthcare industry has driven many people to work, not for the income net on a paycheck, but the healthcare benefit…which too often they have to fight for. And more too often still don’t receive.
Again, the once-hads are finding how much has been taken from them.
I didn’t hear any reference to healthcare - I think he wants some kind of amendment re the sanctity of human life.
IOW, a dog-whistle to fundies that he’d ban abortions nation-wide - Roe v. Wade would be history, and that states would not be allowed to make any choice as to how they would treat the question. A federal preemption of abortion rights.
I just wish everyone would see “Sicko”. It was eye-opening for me. I did not realize that we are the only advanced nation that does not provide healthcare for its citizens.
Sorry I misunderstood. Many of the claim denials are not made by doctors or nurses on review boards. My point was that the denials made by non-licensed physicians may be the unauthorized practice of medicine, which I believe is a felony in most jurisdictions.
There are a lot of things we don’t do for our citizens that other advanced nations do. If the Rethugs had their way we would do a lot less. They seem to want to make us a third world country with a ruling elite and poor masses and not much inbetween.