Insurer revoked HIV patients' coverage

[ddt]

Maybe they don't talk about it?

Or it's the other way around?
"Honey, had a good day at the office? I really want that weekend to Acapulco. Oh, and I saw some great Prada shoes today."

 

[BenBurch]

I know somebody who got cervical cancer.

Coverage denied.

Why?

Being female was a pre-existing condition.

She was a good friend.

I've missed her.

 

[JoeTheJuggler]

I know somebody who got cervical cancer.

Coverage denied.

Why?

Being female was a pre-existing condition.

She was a good friend.

I've missed her.

The one I recall from Sicko was about like that. IIRC, a woman with some sort of women's reproductive system disease (may have been cervical cancer) had her policy rescinded because she failed to mention that she'd once had a yeast infection that was in her medical records from many years prior. (I thought having an occasional yeast infection was tantamount to being female.)

 

[quixotecoyote]

The one I recall from Sicko was about like that. IIRC, a woman with some sort of women's reproductive system disease (may have been cervical cancer) had her policy rescinded because she failed to mention that she'd once had a yeast infection that was in her medical records from many years prior. (I thought having an occasional yeast infection was tantamount to being female.)

I'm pretty sure that's what Ben is talking about. You couldn't discriminate against women, but you could sure use any previous condition that most women had.

 

[JoeTheJuggler]

Maybe they don't talk about it?

Or, more likely, they use very impersonal language (speaking about accounts and various businessy-financial terms) rather than anything that sounds like they're having terrible negative impact on real people's lives. I suspect even doing the job is that way. A person can probably do that kind of work day in and day out without often having to be reminded of the consequences of their actions.

 

[Yalius]

I guess someone at least should give a positive anecdote about health insurance. My insurance carrier voluntarily backdated coverage for my wife and newborn daughter by over a year to cover almost all of our bills.

We missed the "life-change" deadline on my insurance, and were supposed to have to wait for the normal open enrollment to add both of them to my policy. When I filed the paperwork to add them on about 5 months after our daughter was born, the woman who handled our paperwork let us backdate the entire policy to the beginning of my wife's pregnancy. My wife is a bit older and diabetic, so the bills for all of her appointments, ultrasounds, and special care was pretty significant-- over $14,000. When my insurance company backdated it, I think the final bill that we ended not being reimbursed for was about $600.

 

[Achán hiNidráne]

This was systemic, deliberate, and apparently intended to wear down a seriously ill customer so that he died or gave up before they had to pay any money. How many other people did the strategy work with?

I've read tons of similar stories, and they send a chill down my spine. I don't understand how all the US posters who seem so happy with their great coverage can be sure something like this could never happen to them.

And the teabaggers have the gall to create conspiracy theories about "death panels" and "death books" deciding who will live and die to save on costs while there is actual proof that their precious "free market" providers do just that.

Disgusting.

 

[Achán hiNidráne]

A guy who ran his own business, paid his taxes, created jobs, and did everything right, will have one serious illness ruin his family's life.

He's just lookin' for a handout like all liberal commies!

(Warning, you better have a strong stomach before watching this.)

 

[Rolfe]

I guess someone at least should give a positive anecdote about health insurance. My insurance carrier voluntarily backdated coverage for my wife and newborn daughter by over a year to cover almost all of our bills.

We missed the "life-change" deadline on my insurance, and were supposed to have to wait for the normal open enrollment to add both of them to my policy. When I filed the paperwork to add them on about 5 months after our daughter was born, the woman who handled our paperwork let us backdate the entire policy to the beginning of my wife's pregnancy. My wife is a bit older and diabetic, so the bills for all of her appointments, ultrasounds, and special care was pretty significant-- over $14,000. When my insurance company backdated it, I think the final bill that we ended not being reimbursed for was about $600.

That's a great story. If these companies were more focussed on giving good service to their customers instead of gold-plated cutlery, executive bonuses and private jets, maybe they'd even do more business.

I heard a similar one about fire insurance, from the 19th century. A grocer called John Sainsbury was expanding. He already had two or three shops, and he was opening another one. Unfortunately, with all the things to remember when outfitting the new shop, he forgot about fire insurance, and when the shop had only been open a couple of days, there was a serious fire.

It could have bankrupted the business. However, his insurance company said, well, we realise you forgot, but if you'd remembered, you would have insured that building with us, just like your other shops, wouldn't you? Mr. Sainsbury said yes, that had been his intention. So the insurance company said, OK then, we'll assume you did that - and paid for the damage to the new shop. (I'm assuming Mr. Sainsbury paid the premium retrospectively!)

Last I heard of it (though this may be out of date) J Sainsbury plc still used the same insurance company for its enormous chain of supermarkets.

Rolfe.

 

[Rolfe]

He's just lookin' for a handout like all liberal commies!

(Warning, you better have a strong stomach before watching this.)

"You looking for a handout? Nothing for free here! You gotta work for everything you get! No more handouts!"

How do people get into a mindset like that? And this being America, I assume many of them call themselves Christians? Don't they do Matthew chapter 25 in their bible study groups?

Rolfe.

 

[Achán hiNidráne]

How do people get into a mindset like that? And this being America, I assume many of them call themselves Christians? Don't they do Matthew chapter 25 in their bible study groups?
.

A couple of reasons, off the top of my sleep deprived head:

1. The cultural impact of the so-called "protestant work ethic" that states that the only we one legitimately receives anything is through hard work.
2. Lingering paranoia against anything that vaguely resembles "socialism/communism."

Seeing that once-upon-a-time I would have agreed with them, I'm not willing to throw the word "greed" at the teabaggers. Most of them are not '"rich" and they truly and honestly believe that because of it's ideology of "personal freedom" that laissez faire capitalism not only works, but is the only economic system out there.

They're wrong, but they are at least honest in that they have no other ulterior motive.

 

[ARubberChickenWithAPulley]

I guess someone at least should give a positive anecdote about health insurance. My insurance carrier voluntarily backdated coverage for my wife and newborn daughter by over a year to cover almost all of our bills.

We missed the "life-change" deadline on my insurance, and were supposed to have to wait for the normal open enrollment to add both of them to my policy. When I filed the paperwork to add them on about 5 months after our daughter was born, the woman who handled our paperwork let us backdate the entire policy to the beginning of my wife's pregnancy. My wife is a bit older and diabetic, so the bills for all of her appointments, ultrasounds, and special care was pretty significant-- over $14,000. When my insurance company backdated it, I think the final bill that we ended not being reimbursed for was about $600.

I haven't had any major issues with insurance companies either. We had some minor complications with the birth of our daughter, and my wife had to spend 3 extra days at the hospital and get blood transfusions, and we had no issues whatsoever. My father has had several very expensive surgeries and has also had no major issues (his employer has been a bigger pain in the neck than the insurance company).

Here is an interesting story about someone whose husband had cancer, and the cost of care, and some of the deeper issues around health care costs and so forth. Doesn't really have to do with rescission, but it is interesting in that the author is actually concerned about whether the insurance company paid too much in the end, and whether they hung on too long. It's a well thought-out article.

Pretty much, if you have even halfway decent benefits, you'll typically get quite good care. And there are companies that at least say that they don't do rescissions,and don't make efforts to deny coverage, and so forth, so there's always a danger in painting an entire industry with too broad of a brush. The system itself is the bigger issue -- there are just too many cracks (i.e. losing one's job, having to buy individual or small group insurance, etc.) in the system that screw people.

 

[Rolfe]

The one I recall from Sicko was about like that. IIRC, a woman with some sort of women's reproductive system disease (may have been cervical cancer) had her policy rescinded because she failed to mention that she'd once had a yeast infection that was in her medical records from many years prior. (I thought having an occasional yeast infection was tantamount to being female.)

It wasn't quite that simple, if I'm remembering this right. All she had was a yeast infection right enough. However at the time, didn't some medic make a note on her records that it might be "pre-cancerous"? It wasn't, of course, so naturally she didn't mention anything about that when she took out the insurance. It's quite likely the doctor never said anything to her about any suspicion of a pre-cancerous condition, it that turned out to be a false alarm.

Doctors do this all the time. They have to make notes about what they're thinking, in case they get run over by a bus and another doctor has to take over the case. That includes the "differential diagnosis" list - the short list of things you're considering, as you narrow it down. You might think it's only an outside chance, but the next guy needs to know that's why you did the test, for when the result comes back.

Insurance companies seem to be looking at these differential diagnosis lists, and asserting that any mention of a condition in such a list is evidence of a "history" of a condition, even if the patient was proved not to have it. The patient probably never knew the idea even crossed the doctor's mind, and even if the doctor was consulted when making the insurance application, that would not, in the doctor's assessment, count as a "history" of that condition anyway.

The other thing they do is to penalise patients for having something they really do have, but they didn't know about. Something incidental, or asymptomatic, that the doctor thought wasn't worth worrying them about. One guy got his policy rescinded because he had an asymptomatic aortic aneurism, that the doctor hadn't told him about. There's no doubt that was a genuine risk - if it progressed, he'd need surgery for it, and no doubt the doctor was keeping an eye on it.

But he didn't know!! He couldn't know. The doctor had decided not to stress him with the knowledge.

Should patients be asking their doctors to fill in the insurance applications for them? How much would that cost, and how much would it add to healthcare costs as doctors were tied up for hours every week on the job? Would doctors do it, anyway, if they were liable to be sued by a rescinded patient for something they wrote in good faith? What would that do to professional liability insurance premiums?

This is one hell of a mess.

Rolfe.

 

[ZirconBlue]

"You looking for a handout? Nothing for free here! You gotta work for everything you get! No more handouts!"

How do people get into a mindset like that? And this being America, I assume many of them call themselves Christians? Don't they do Matthew chapter 25 in their bible study groups?

Rolfe.

It's the American Dream, don't ya know. Pull yourself up by your bootstraps and all that. You can be anything you want, if you just work hard enough.

Work hard in life boy,
there's paradise in the end.
Year after year we struggle to gain
the happiness our parents never claimed.
They told us all we had to do
was do what we're told, buy what was sold,
Invest in gold, and never get old.

 

[Rolfe]

Here is an interesting story about someone whose husband had cancer, and the cost of care, and some of the deeper issues around health care costs and so forth. Doesn't really have to do with rescission, but it is interesting in that the author is actually concerned about whether the insurance company paid too much in the end, and whether they hung on too long. It's a well thought-out article.

I had a good read at it, and indeed it's interesting and thoughtful. It almost sounds, though, as if she's arguing in favour of the "death panels". Is $620,000 too much to prolong a cancer patient's life for eight years, mostly happy? Absolutely not, I'd say. And I think any universal healthcare system would agree. That's paid for by maybe a dozen contributors who had a sudden stroke or something and took very little out of the system.

And then again, they apparently didn't pay $620,000, but only about $230,000, because the insurance company screwed a very good deal out of the providers.

(Where does that one sit in Beerina's perennial rant about the USA paying the full price to allow medical relearch to continue?)

That's only about £140,000. It's practically small change. Of course it wouldn't add up if everyone had expenses of that nature, but this stuff only happens to a small percentage of people. If we want to chip into a pool so that we'll be treated if it happens to us, I don't see the problem. The argument really seems to be about whether this should be an individual decision, or one mandated by society, and in the former case, what do you do about the people who didn't chip in, for whatever reason.

The writer didn't really highlight how much of the cost was incurred in the last few weeks, but I think that's maybe the bigger issue. However, they had genuine hope of getting the cancer into remission again, so I wouldn't say it was unjustified at all. Also, it's only by making that extra effort with the poor-prognosis cases that the new treatments can be refined and turned into something that's really worth having.

I'm not sure Terence, in that story, had anything he wouldn't have received without any heart-searching in a univeral healthcare system. I'm not sure about the very new drugs at the end, but since he seems to have been in a clinical trial, then again yes. I think it's actually a shame that the family had to think of all this in monetary terms, even if they weren't paying most of the bills.

At one point, the relative usefulness of spending that money on Terence rather than on vaccines for children in Africa was questioned. My reply to that is, if you're going to make that comparison, then there are a lot of things we should give up in order to vaccinate these African children, before we take medical treatment away from cancer patients.

Rolfe.

 

[BenBurch]

I'm pretty sure that's what Ben is talking about. You couldn't discriminate against women, but you could sure use any previous condition that most women had.

No. They called "being female" her pre-existing condition.

Disgusting.

 

[Rolfe]

No. They called "being female" her pre-existing condition.

Disgusting.

Aw, come on! I need fuller and better details of that, at the very least.

Rolfe.

 

[JoeTheJuggler]

No. They called "being female" her pre-existing condition.

Disgusting.

Hmmm. . maybe it was a policy that didn't cover reproductive health services or something, and they lumped cervical cancer in with pregnancy and such. In other words, the conditions covered by the policy were maybe the same for a man and a woman, and anything unique to women wasn't covered. It wouldn't be so much that "being female" was a pre-existing condition, but rather that conditions unique to women weren't covered?

Just a guess. But as I said, the story in Sicko was tantamount to saying being female was a pre-existing condition.

And again, my initial reaction to Sicko was doubt that the anecdotes weren't spun or misrepresentative, until I read the House Energy documents investigating rescission. They found cases where a patient in need of expensive medical treatment had their policy rescinded because a relative made a mistake on their forms (medical history, usually), or there were mistakes or non-disclosures of pre-existing conditions that had no connection to the claim. They have rescinded policies when the mistake wasn't even the fault of the insured (for example, a mistake by the insurance agent). And so on. They're clearly looking for an excuse--not to ferret out fraud--not to pay off for expensive medical treatment.

People buy insurance specifically to feel secure that if something really bad should happen, they'd be covered.

 

[BenBurch]

Aw, come on! I need fuller and better details of that, at the very least.

Rolfe.

Best I can do. She died quite some time ago, and I certainly don't have her records, just what she told me.

 

[Rolfe]

It just sounds so unlikely. They'd be able to deny all claims for things like breast and cervival cancer, and they don't seem to do that. Even one insurer doing that seems an awful stretch.

Rolfe.