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Sorry for the depressing way to start your Friday morning, but CBS 5's Anna Werner has a pretty damn harrowing tale of an insurance company, Blue Shield of California, twice denying a claim to a patient's breast tumor. It seems Rosalinda Miran-Ramirez woke up one morning back in April to find her breast bleeding from her nipple. Rightfully concerned, she darted to the emergency room where doctors told her she had a tumor in her breast.
Doctors found a tumor and initially told her she had breast cancer. A biopsy later proved that assumption false; the tumor was benign.But Miran-Ramirez said the real shock came when her insurance company, Blue Shield of California HMO, which had initially approved the claim for the emergency room visit, reversed course and sent her a new bill three months later requiring her to pay the total charges for that visit: $2,791.00.
But wait, it gets worse. After appealing the reversal, she was denied again by the health insurance mammoth. Blue Shield, it seems, told her she wasn't in "any acute distress" and "reasonably should have known that an emergency did not exist."
Miran-Ramirez's coverage, we should point out, came via her job with the San Francisco Department of Public Health.
Anyway, after Werner's report, Blue Shield decided to review the case and pay up. But we have to wonder how many claims like Miran-Ramirez's, the ones that aren't touched by the golden hand of the media, have been so vulgarly denied.
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Why the hell would anyone want a public health insurance option? Obviously these caring and trustworthy insurance companies have everyone's best interests at heart.
+1!
Are you saying Sarah Palin, Glenn Beck, Bill O'Reilly, AND Rush Limbaugh could all be wrong?
Impossible!
Amen.
no apology necessary brock and thank you for sharing. we need more of this sobering dose of reality to wake up the stupid fucking masses in this tv zombie land of ours.
I used to do legal filings as a messenger, and maybe half of those were people fighting insurance companies
just go to the court website and search for Blue Shield and others...You'll see
Blue shield, defendant, defendant, defendant...100's of them..thousands, maybe
If you have problems with your health insurance, particularly HMOs, you can contact the Help Center at CA Dept of Managed Health Care. 1-888-466-2219, http://www.hmohelp.ca.gov/dmhc_consumer/pc/pc_default.aspx
There are dedicated folks there who will help you resolve your problems. You don't need to go to the media.
errrm -- going to the media rarely ever resolves any problems. the point of the media isn't to resolve problems.
that being said, sometimes bringing problems to light (through the media) can indirectly do more to help that class of people (in this case, those who are fucked over by health care companies) than each individual in that class going through some byzantine government agency.
The workers at the Help Center are truly there to help you. Most people don't know about the service that is available. I know it can be a hassle and going through the process is no fun, but it's worth a shot to get it fixed.
Of course, the insurance companies should just get it right in the first place.
i don't doubt they're there to help, but it's not like media exposure is useless either. in fact, it may be smart if the MHC Help Center had a media liaison, if you know what I mean.
The DMHC does have a media liason. Her name is Lynne Randolph.
http://dmhc.ca.gov/aboutthedmhc/itn/itn_media.aspx
The only surprise in this story is that they initially approved the payment.
The only thing I find surprising is that people are still surprised by such accounts. In the last 5 years I have seen:
1) Blue Cross (or maybe Shield, don't remember) posthumously deny the cost of my dad's chemotherapy because it was "experimental." No shit, there is no cure for cancer, all of it could be called "experimental." Similarly, though, they originally cleared it and only later said they would refuse to cover it. Exactly what my grieving mother and I wanted to deal with.
2) a friend of mine who had to have an emergency appendectomy. They refused to cover because she had not first cleared it with her primary physician. Doctors said she probably would have died in a few hours.
I think the problem is that the opponents of reform say, "well you get the health insurance you pay for. If you don't like your coverage, buy it somewhere else." Which would be a fair point but for the fact that you don't really find out what you truly are paying for (claim refusal, doctors offices are often wrong about what your insurance will cover, definitions of "experimental" and "medically necessary" become more slippery than you ever thought) until you are too sick or injured to fight.
Again, the DMHC can help you with both of these issues. There are specific laws regarding coverage of "experimental" procedures and whether something is an emergency.
Obviously, I've worked in the industry, and if I've learned anything it's that you have to fight for your rights. You do have rights, and there are people (like the DMHC) who will help you, but you have to fight for them.
i saw this yesterday. it broke my heart to see how hurt this woman felt.