Monday, September 21, 2009

Health Insurance Denied


One difficult part about being a doctor is that I am part of a horrible, greedy, uncaring industry that I cannot influence. Ah, such strong words for American medicine, you say? Well, I have encountered yet another patient who is denied health insurance for underwriting reasons that are just plain unfair.

Maryanne has run out of COBRA, the temporary continuation of health insurance that is guaranteed when a person loses their job. It only lasts 18 months and, in case you didn't know it...we are in a hell of a recession and there are a lot of people who are unemployed.

Maryanne, age 41, was turned down by Blue Shield of California after submitting all of her health records because she (and I quote) "did not meet the underwriting acceptance criteria:
  • Migraines treated with Imitrex, Aleve, seen in emergency department once 2009
  • Thyroid adenoma treated with Synthroid
  • Deaf "
This is pretty outrageous. One migraine headache that required an over- the- counter pain killer and a recognized pill that works for migraine is hardly a rare health condition. Some 30 million Americans have migraine headaches.

She is deaf since childhood and functions completely normally by lip reading. Of course, being profoundly deaf does affect her ability to get just any old job in this economy, doesn't it?

She does have a thyroid enlargement that will likely need further investigation. These are easy to work up but, without insurance, the cost can be exorbitant and probably more than an unemployed person can comfortably pay.

Another one has joined the 47 million uninsured. There is no safety net for Maryanne or millions of others who are living with the anxiety of being uninsured.

17 comments:

Anonymous said...

What recourse does she have if any?
That could happen to any one of us.

Arun said...
This comment has been removed by a blog administrator.
Cary said...

Yep. Big Insurance strikes again. Hate them.

Denied and Dropped said...

Dr. Brayer

This story sounds like so many others that seem to be floating around in the healthcare debate. We need change, but we all know that political change doesn't happen unless there is either A) a lot of money driving legislation, or B) a lot of people (voters) organizing and trying to make their collective voice heard.

Toward that end, we have started this blog site: http://denieddropped.blogspot.com/ to try and gather those stories and voices in the hopes of bringing together a collective voice that is loud enough to make a real difference.

I feel very sorry for this woman and her frustrating situation, but maybe we don't have to be powerless.

KM said...

There is an American Disability Act that can help people with disabilities not be discriminated against as far as employment but it has a clause that exempts
health ins. from discriminating. So Health Insurance can do it as much as they want and there aren't laws to protect patients from this. So it is extremely unfair and unfortunate to be born deaf like she is.

broker Lorne said...

Well said. This is pretty sad. I mean, what the hell is going on? Today you can insure weather, any event, basically anything. BUT there are so many people with no basic insurance of their health. It needs to change.

Lorne

CountryMidwife said...

Thought you might enjoy this.

http://www.funnyordie.com/videos/041b5acaf5/protect-insurance-companies-psa

Kellie said...

I learned that after the 18 months of COBRA is over there is another option that by law has to be provided without asking any medical health questions and can't be denied. It is called CalCobra and is offered in
California for 18 additional months if a person can't get health ins. from another job and has exhausted the original COBRA.

http://www.hmohelp.ca.gov/library/reports/news/ccfaq.pdf

antioxydant said...

I finally decided to write a comment on your blog. Its interesting.

Anonymous said...

I am in the same situation, and being the one that brings "the beacon" home, in a family with 4 kids, it scares the hell out of me. I live in the US, and in June my employer terminated the health insurance benefits, with three days of warning. In the last 19 years I have seen the monthly premium going from $350 to $1200 for a family of 6, and now with 3 days of warning I was with no insurance and a spouse and 4 kids at home. Immediately I started to shop around for a private health insurance, in the meanwhile, on June 15th I was in a car accident, I was not at fault, the other guy lost control, "jumped the lane" across a rural hwy, and hit my car, sending us into a multiple rollover, destroying the car, and injuring me and 5 kids. I was insured for 19 years, uninsured for 14 days, and this happens. In the ER, as soon as they found out I was uninsured, they "stabilized" me, pumped me up with heavy-duty pain killer, and released me the same afternoon. After a few days of agonizing pain, I went to see a doctor. After MRI and CT Scan, turns out, I had three broken vertebrae in my neck. Odd ,since CT scan were done in the hospital too, and seemingly none noticed that... I wonder... To make it short, urgent surgery was needed to avoid being paralyzed for good.... $65,000 dollars later, I am at home, partially healed, in debt for $50K ( friends and family pitched in and loaned me the $$, since at the neurologists opinion was that surgery could not be postponed. Auto insurance will come into play, but it could be up to two years before they pay, and even then it will not be for the full amount. The other guy had minimal insurance, and my insurance added up does not cover the total amount I spent, so far in excess of $65K. I will probably have to hire an attorney for the legal fight, and that alone will cost me about 40% of anything that will be recovered from the insurance. In the meantime I have been making calls to finally acquire health insurance, but all the company I called so far, either refused to insure me or priced me out of the policy, because of the injuries in the car accident. So, now I am still uninsured, not of my own will, still somewhat hurt, $55k in debt, spent $10k of my cash reserve, and mad as hell. Originally I am from Europe, one of those "socialistic countries" as they are called here, that have universal health care. Yes, those systems have their own share of issues, and there is often a genuine attempt to fix them. They do, however, produce a *good* quality health service product, to a *wider* segment of the population, and at a *lower* cost than we have in the US.
(follows)

Anonymous said...

(follows)
I had to go to the ER overseas, and it's a whole different experience. As it happened to me in Texas, in Europe, no one asks for your American Express before they stop the bleeding from your son's head (Memorial Hospital, The Woodlands, TX, 2003 ) America deserves better, and should rise up and DEMAND better from their leaders, all of them. The people of the US of A, should know that there *are* better alternatives, they should *pretend* from our *expensive* elected officials, to come up with a good health care product, free of bipartisanship, not injected with lobby-special interest money, at a fair and affordable price, free at the point of delivery, especially caring for the young and elderly. It has been done elsewhere, why not here ? We have/are one of the wealthiest nation, we have brains, talent, and technology. We OUGHT to do it. And just to add another small point: the so called "death panels" that we are told "exist" in Europe .. they DO NOT. I lived there for the first 30 years of my life, I lived in 3 European countries, my parents and many other relatives live there, and there is no such a thing. ON the contrary. I have seen some of the healthiest, more active elderly population in Europe than I have in the US. Italy, France and UK have a higher life expectancy than the US, by far. We are been fed a truckload of bull. BTW, health care rationing: it looks to me that it already is rationed: *IF you can get health insurance* *By who your health insurance is. *By how much money you can afford to pay for it. *By what your health insurance decides you can have, as procedures and medications.

charlesdowney said...

What you Need with Medical Insurance - You might come across many companies that provide good coverage, but you don't know if you're paying too much. You may be charged a little more on certain coverage's, but you need to make sure the higher charges are justified. Coverage for X rays or MRI scans for example, are an important consideration and you need to make sure the policy covers these.

Anonymous said...

Conscious accidents: The trick vehicle will take its place in front of the victim automobile in traffic and all of a sudden hit the brakes when there's no way to avoid collision. This typically causes rear-end accidents, with the con driver receiving auto damage coverage cash and sometimes medical cost coverage also. Further damage: The trick driver leaves the accident site, whether deliberate or not, and causes further damage to the automobile to claim that it was caused in the accident and raise car insurance rate in their favor.

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