Medicare Cancels coverage on a mother with cancer - 1 week before life saving operation

Attorney · Raleigh, NC · Member since 2008 · 4k+ posts · 1k+ votes

"If they don't allow her to have this transplant coming up right now next week, they're in effect signing her death warrant"

http://cbs4.com/health/Diana.Smith.Woman.2.1623788.html

I've been told this happens a lot more often than this isolated incident. This is the compassionate government run healthcare system at work.

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Mark N.A

Real Estate Investor · North Carolina · Member since 2008 · 1k+ posts · 483 votes

16y

The problem is with the CHOICES people make: new truck payments, big screen TV, pit bull, cell phone, and so many other toys much more fun than health care premiums.

I evict a fair number of these people because they choose some toy over their rent.

I don't know what the answer is, but I don't think it's penalizing those who make responsible choices.

Which, unfortunately, leaves the option of penalizing those who make irresponsible choices.

Darwin had some thoughts on the subject.

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Ali Samana
Real Estate Investor · Frisco, TX, TX · Member since 2010 · 388 posts · 138 votes
16y
this story is sad. I am glad at least she will be able to have her surgery anyway.
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J ScottPro Member
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Investor · Sarasota, FL · Member since 2008 · 17k+ posts · 17k+ votes
16y
Originally posted by Tim Wieneke:
This is the compassionate government run healthcare system at work.

If you think one person dying from lack of health care is bad, I have to imagine you're appalled by the fact that 44,000 people per year die from lack of health care:
http://namesofthedead.com/

So, from this post, I take it you're all for ensuring that every person in this country has health care, whatever it takes?
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Mike McKinzie
Investor · Westminster, CO · Member since 2009 · 1k+ posts · 1k+ votes
16y
Health Care is a SERVICE that anyone should be able to BUY. Just like Lawn Care, House Care, Babysitter, etc.... Why should Health Care be any different?
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Mark N.A
Real Estate Investor · North Carolina · Member since 2008 · 1k+ posts · 483 votes
16y
The problem is with the CHOICES people make: new truck payments, big screen TV, pit bull, cell phone, and so many other toys much more fun than health care premiums.

I evict a fair number of these people because they choose some toy over their rent.

I don't know what the answer is, but I don't think it's penalizing those who make responsible choices.

Which, unfortunately, leaves the option of penalizing those who make irresponsible choices.

Darwin had some thoughts on the subject.
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J ScottPro Member
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Investor · Sarasota, FL · Member since 2008 · 17k+ posts · 17k+ votes
16y
Originally posted by Mike M:
Health Care is a SERVICE that anyone should be able to BUY. Just like Lawn Care, House Care, Babysitter, etc.... Why should Health Care be any different?

Perhaps you should be asking Tim that, as he was the one who started this thread. He seemed to be very upset that this woman was denied government-paid health care services that she needed to save her life.
Tim - Your thoughts? Why should this woman's surgery be any different than any other services she has to buy?

My personal opinion is that the provision of health services is protected by The Declaration of Independence ("life, liberty, and the pursuit of happiness"). I can't imagine anything that has a bigger impact on "life" than preventative and emergency health care.

I don't know if Tim's rationale is the same as mine, but clearly we both agree that this woman should have gotten the health services she needed free of charge if she couldn't afford to pay for them.
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Timothy W.
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Attorney · Raleigh, NC · Member since 2008 · 4k+ posts · 1k+ votes
16y
You missed the point completely. "Coverage" is just a promise on paper that's only as good as the name behind it. It doesn't mean a thing until the actual life saving operation is done and paid for. The government has made it clear that they have no good name to back up their "coverage" so we're all on the way to having wonderful pieces of paper that don't mean anything. (Geeze, sounds like government fiat currency....)
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J ScottPro Member
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Investor · Sarasota, FL · Member since 2008 · 17k+ posts · 17k+ votes
16y
Originally posted by Tim Wieneke:
The government has made it clear that they have no good name to back up their "coverage" so we're all on the way to having wonderful pieces of paper that don't mean anything.

And you think private health insurance companies are better!?!?

They're much, much worse...

You only provided one government example, but statistically, if you're in the top 1% of patients who require private health insurance funds for procedures, there is about a 50/50 chance that your private health insurance company will find a reason to drop you...

You want to entrust your life to a flip of the coin?

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Rich Weese
Real Estate Investor · the villages, FL · Member since 2008 · 5k+ posts · 3k+ votes
16y
Choices- I like that point NC. I actually know a lady that received a NEW HOME absolutely free from a source in So. TX(weslaco). I went to visit her in a religious calling. Big gigantic brand new TV in the LR. That sunday she came to church and asked for enough money ($ 450) for a warrant on ticket. The ticket was $65 and she didn't pay until warrant was issued for her arrest in amount of $450. Choices should have some rewards or penalties, imo. No one much accepts responsibility for their actions anymore. Rich
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Timothy W.
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Attorney · Raleigh, NC · Member since 2008 · 4k+ posts · 1k+ votes
16y
Originally posted by J Scott:
And you think private health insurance companies are better!?!?......They're much, much worse...You want to entrust your life to a flip of the coin?

By percentage, no one denies more claims and cancels more coverage than the government run Medicare.

But aside from that. The private insurance industry is so much better because what Medicare did here, you can not do in the private insurance industry. It is illegal. In the private insurance industry when you promise coverage and then later remove it, it is called estoppel. In the system we have the contract between insured (individual) and insurer (private insurance company) is regulated by the government via state departments of insurance. IF a private insurance company were to ever try pulling a stunt like this, they would be faced with a lawsuit where the impartial state DOI and the court system would referee and in a case like this that is such clear estoppel, would inevitably rule in favor of the insured person. In addition to whatever the individual insured person would recoup in court winnings, the insurance company would be paying fines that start at one million dollars. This is what keeps private insurance companies in line and keeps them from committing crimes like this case of estoppel here.

This is what keeps the individual protected from the financial influence and power of large corporations - they are both private entities where disputes are refereed by the government. But guess what? When government owns the insurance entity and the means by which disputes are refereed the protection for the individual is gone. Have a ball suing the government for coverage of your impending life saving operation. You'll die in continuances. Have a ball getting coverage again once you've sued your insurer. In the private industry you have the option of finding someone else. Not so with a single-payer system.
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J ScottPro Member
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Investor · Sarasota, FL · Member since 2008 · 17k+ posts · 17k+ votes
16y
Originally posted by Tim Wieneke:

By percentage, no one denies more claims and cancels more coverage than the government run Medicare.

I didn't know that...can you provide some actual data for my reference?

As you'll see below, I always substantiate the claims I make...

The private insurance industry is so much better because what Medicare did here, you can not do in the private insurance industry. It is illegal.

You're wrong here, Tim. The government used a ******** excuse to deny a claim, and insurance companies do the same exact thing all the time.

You're correct that insurance companies don't use this same excuse (as it wouldn't make sense for a private insurer to deny a claim based on earnings), but private insurance companies deny claims all the time based on rationales far, far worse than that.

Some common tactics and examples:

- A very common tactic among insurance companies is to deny a procedure to a very sick person until they are pretty much dead.

For example, Nataline Sarkisyan died when Cigna refused her liver transplant, claiming it was "too experimental". Her doctors claimed that the surgery wasn't at all experimental, and protested the insurance company. As did thousands of other people. The insurance company finally agreed to the surgery hours before the girl died.

Here is a reference: http://en.wikipedia.org/wiki/Nataline_Sarkisyan

- Another common tactic is "recission" (taking away of coverage for some reason). Often the reason is completely frivolous, and often the insurance companies wait until you have an expensive procedure request before they do it.

For example, Robin Beaton got approved for a double mastectomy for her breast cancer treatment, and then days before her surgery the insurance company rescinded her coverage. They claimed that a dermatologist once wrote something on her chart that indicated she had a pre-cancer and she didn't disclose it. The dermatologist never said that she had anything but acne (and never said that she had anything pre-cancerous).

Didn't matter what the doctors said, the insurance company played judge, jury and (almost) executioner.

Here is a reference: http://www.youtube.com/watch?v=dT_2GjSkzHE

- Another example is Oddo Raddatz, who was diagnosed with stage four non-Hodgkin's type lymphoma. In the midst of his chemotherapy treatment, his coverage was canceled and he was not able to receive the stem cell transplant needed to save his life.

He was told that his coverage was canceled because he failed to disclose that a doctor had once noted in his file that a CT scan showed a small aneurysm and some insignificant gallstones. The problem was, he was never told about these finding, so there was no way he could disclose them.

He died because the insurance company dropped him for reasons beyond his control, because they wanted to save money.

Here is a reference: http://www.npr.org/templates/story/story.php?storyId=105680875

- Wittney Horton is another example of the above. She was dropped when the insurance company found a note from a doctor in her file that she never saw. Of course, she was only dropped *after* she got sick.

Here is a reference: http://www.youtube.com/watch?v=LCYPC2BMmB8

- Here is an example of an insurance company that dropped an entire line of coverage most likely to avoid paying for the coverage of a single member...that member will now likely die:

http://www.washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/

- Okay, getting tired of all the typing, so I'll just include another link to another example here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/07/AR2009090702455.html

Now, you've provided one example, and I've provided a half-dozen or so examples. And the examples I've provided you claim don't happen because it's "illegal"...

This is what keeps private insurance companies in line and keeps them from committing crimes like this case of estoppel here.

Then how do you explain the examples above?

In many of the cases above, the insurance company was sued, and in many of the cases, they lost.

But, the actuaries at the insurance companies were smart enough to know that the payouts for the lawsuits would be less than paying for the denied treatments.

Therefore, the insurance companies are happy to get sued and lose, as they save money that way. They don't seem to care much for the people who die in the meantime.

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Timothy W.
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Attorney · Raleigh, NC · Member since 2008 · 4k+ posts · 1k+ votes
16y
"I didn't know that...can you provide some actual data for my reference?"

http://www.patientpowernow.org/2009/10/12/medicare-denies-most-claims/
http://www.statehousecall.org/which-insurer-denies-the-most-claims
http://www.mrswing.com/articles/How_Do_We_Keep_Gov_t_Honest_Medicare_Denies_More_I.html
http://www.independent.org/blog/?p=4459
http://biggovernment.com/ptuohe/2009/10/05/ama-endorses-largest-denier-of-health-care-claims/

"I always substantiate the claims I make..."

Then substantiate this one: "statistically, if you're in the top 1% of patients who require private health insurance funds for procedures, there is about a 50/50 chance that your private health insurance company will find a reason to drop you"

"But, the actuaries at the insurance companies were smart enough to know that the payouts for the lawsuits would be less than paying for the denied treatments. "

Good lord you don't even know what an actuary's for do you?

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J ScottPro Member
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Investor · Sarasota, FL · Member since 2008 · 17k+ posts · 17k+ votes
16y
Originally posted by Tim Wieneke:

Then substantiate this one: "statistically, if you're in the top 1% of patients who require private health insurance funds for procedures, there is about a 50/50 chance that your private health insurance company will find a reason to drop you"

I guess you forgot that about 10 minutes before you wrote this, you claimed in another thread that you weren't going to acknowledge me anymore...

I'm actually impressed that you lasted 10 minutes at that effort...

Here's the analysis:

http://tauntermedia.com/2009/07/28/unconscionable-math/

I realize that you'll probably just ignore this and call the author a geek for his use of math that is more advanced than what you learn in the 8th grade, but it's a good read nonetheless...

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Ali Samana
Real Estate Investor · Frisco, TX, TX · Member since 2010 · 388 posts · 138 votes
16y
Originally posted by Mike M:
Health Care is a SERVICE that anyone should be able to BUY. Just like Lawn Care, House Care, Babysitter, etc.... Why should Health Care be any different?

I agree with the notion that people that make bad choices should suffer the consequences. Culturally, we have very few people that are on the path to financial prosperity. It is their choices like stated above that puts them on the path to ruin.
I don't however, agree with denying someone access to medical care because they made some bad choices. Even inmates have access to basic health care, and thus, so should regular Americans.
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