Hmm... Do the crooks in health insurance see the writing on the wall? I won my appeal!!!!

[PA Democrat]

Here's the background:

I recently had some problems which may have been a warning sign of colon cancer. I saw my doctor immediately. I am under the age of 50, fit none of the risk factors for colon cancer, and have no colon cancer in my family. Still, she recommended I have a colonoscopy as a "precaution".

I had the colonoscopy and they found 2 polyps, one was cancerous, the other precancerous. Both were removed during that procedure. My prognosis is very good and I need no further treatment other than annual screenings.

Then my health insurance company, Assurant Health (a subsidiary of Time Insurance formerly known as Fortis) started digging through my medical history, apparently looking for a reason to deny payment. They bombarded me and every doctor I have seen in the past 5 years for information. After more than 3 months of of what basically amounts to harassment, they denied my claim stating that it was a "preexisting condition".

I was furious. I had never had any symptoms and or treatment for anything that could have been connected to colon cancer. I did some research on this company and found out that they routinely deny payment for any type of cancer treatment or other catastrophic illness. Very little had been written in the press about this company's track record of malfeasance, but I did find some damning information, mostly thanks to the Attorney General of the state of Connecticut.

Some background here:

http://insurancetransparencyproject.com/wp-content/uploads/2007/04/blumenthalrelease.pdf

I filed an appeal with Assurant regarding my $4,300 in unpaid medical bills. I let them know that I was aware of the fact that they had been successfully sued in the state of South Carolina ($15 million verdict against them), and that they had been cited for unethical business practices (mainly non-payment based upon false claims that the insured had a "preexisting condition") in 12 other states. I told them I would be in contact with my state's Insurance Department to file a complaint (I have since done this).

And then a miracle occurred! After more than THREE MONTHS looking for rationale to deny paying my claim, it took them less than TWO WEEKS to determine that they had made a mistake and that they would be paying my claims after all.

The filthy greedy pigs. They knew that they were cheating me out of paying my medical bills, but thought they'd try to get away with it.

[lynnertic]

1. congratulations!

[PA Democrat]

2. Thanks. I'm not done with those bastards yet, though.

I will do everything I can to expose them for the thieves that they are. I have been writing letters and calling legislators as well as my state's Insurance Department about this issue. It's time to start punishing corrupt insurance companies.

[puebloknot]

22. Glad to hear you're not going to let this drop, even though...

...it takes your personal time and energy to pursue it. In the greater scheme of things, a $4,000 bill is peanuts. You could have a bill for $50,000 if you had had to have a more extensive surgery.

The "pre-existing condition" rube is a crime against our humanity.

Your little pebble in the pond will hopefully have effects that will radiate out for the benefit of a lot of other people.

[PA Democrat]

24. Yes. I know how fortunate I was to have caught this so early when it was easily

and much less expensively treated. But what's crazy is that this whole "preexisting condition" bullshit probably discourages some people from seeking earlier treatment for conditions that can be much more expensive (not to mention life-threatening) if not caught early.

[puebloknot]

37. Your problem is that you're logical. This kind of thinking could...

...bring down the insurance establishment!

Years ago, as one of my attempts to find something I could do to make a living, and have control over my own schedule, I sold insurance for a time -- whole life and health insurance. I was given to understand by the company I was working for that they didn't make money off of their health insurance policies. They were offered as sort of a gift to the public because, really, they made their money off of their life insurance sales.

At that time, another single-mother agent for that company and I got friendly, and she opened my eyes to something. She was from Israel, and she commented that it was insane that a country as wealthy as the U.S. could not organize itself to make healthcare available to all its citizens. It is, she explained, first, a human right, and second, the practical thing to do.

That was the first time that the idea of healthcare as a *right* actually entered my febrile, indoctrinated little American brain (and I'm no dummy).

We've been brainwashed into feeling that an insurance company is doing us a big favor to cover our pre-existing conditions. It's like having appendicitis is a moral breach!

The whole idea of health insurance started with Blue Cross (in Texas, I seem to recall), and that first group came together to implement the idea of shared risk (in kinder terms, giving a sh*t about each other). The idea was that, statistically, if 100 people paid into a "kitty," and then had their medical bills paid if they got sick, the fund would be able to meet those expectatins because only a certain percentage of the people would have to call on the group fund for payment of their bills. You *could* pay into it forever and never need it, but...

That whole ideas has been disorted into a for-profit scheme in which the main objective is to collect money and pay out as little as possible.

I haven't seen Sicko yet, but will asap. I want to work to promote the idea to the guilty American masses that it's not a sin to be ill, and it's not a sin to accept help when its needed -- and deserved.

If there were a national healthcare plan that put strong emphasis on education and preventive care, a lot less would have to be spent on after-the-illness-strikes costs. All of us are maybe a little guilty of not eating a pristine diet, not exercising enough. Some of the population is just out of control in that respect. But punishment is not the answer. Encouragement to do better, knowing that we all have the dignity of an insurance plan in effect if we should need it, is a higher calling!

In the same way that the younger generation now is aware of the harmful effects of smoking, we need a strong national campaign, in consonance with a national healthcare plan, to educate and lure people away from destructive dietary habits.

And above all, to use my favorite phrase: "Moderation, even in moderation." You catch more flies with honey that with vinegar!

Fun talking with you. Glad you got your problem taken care of early!

[SeattleGirl]

3. Good on you for fighting back, and hitting them over the head with facts!

:thumbsup:

[bluethruandthru]

4. Good for you!

Stories like this warm my heart.
Please go see "Sicko" and tell everyone you know to see it too!
We need to start a revolution when it comes to health care in this country.

[porphyrian]

5. No, they won't see it. They're still saving money.

I pretty much guarantee that your court winnings were all factored in at least a year ago when their accountants decided it was cheaper to pay you and the few others who take them to court than to simply cover every policy holder as promised.

[PA Democrat]

8. Yes. My medical expenses were relatively minor.

If my bills were larger, they more than likely would have given me more of a hassle. That's why I will still pursue this with legislators and regulators. I want these cretins put out of business because if they tried to screw me over a relatively SMALL medical bill, you know they're really cheating people with catastrophic illnesses.

What is so maddening to me, is that I KNOW that there was NOTHING in my medical records that they could have pointed to as proof that the cancer was a preexisting condition. I have been to the doctor maybe 2 or 3 times in the past 5 years for anything other than a routine exam. And those few times it was for minor things like a sinus infection and strep throat.

During the course of the lawsuit they lost, it was revealed that their computer system automatically kicks out claims for things like cancer and AIDS.
Connecticut Attorney General said this about Assurant Health:

“Assurant added insult to illness – compounding consumers’ struggles
with grave illnesses, cancer and other devastating diseases, with fears of losing
their homes and possessions to pay for life-saving treatment that Assurant
promised, but failed to pay. My office will continue to fight relentlessly for
consumers to ensure their promised benefits are paid – and Assurant held
accountable for the gross harm it imposed.”

http://insurancetransparencyproject.com/wp-content/uploads/2007/04/blumenthalrelease.pdf

[porphyrian]

18. We need to take insurance out of the equation entirely.

Insurance is the reason health care is so expensive, making it practically mandatory. And then they don't want to pay anything anyway, and will tie shit up in court until you're dead. Insurance has no place deciding who lives and dies.

[PA Democrat]

19. I agree. That's why I am so disappointed that Kucinich is the ONLY candidate talking about

single payer health care. The end consumer isn't the only person being screwed by the insurance companies. Doctors and other health care providers need an army of people to deal with the various insurance companies crappy procedures. Pharmacist spend a good portion of their day dealing with prescriptions for drugs that various insurance companies won't or no longer cover.

I wish the corporate media would spend some time dealing with the corruption of the current for-profit system instead of the latest blond celebrity story. I guess they don't want to lose all the ad revenues they currently get from the insurance industry.

[porphyrian]

38. The corporate media needs to be eliminated from providing news.

Entertainment's fine, until they intentionally blur the line, which is all they do any more.

[blondie58]

40. when I was younger, I had a friend whose husband died from colon cancer

I was in my early twenties, so I think that were in their thirties. It was really sad, they were trying to have a baby- then Terry came down with colon cancer and died.

[LSK]

6. send your story to Michael Moore

Im sure hes still taking story requests.

[MiniMe]

7. Did you ever read Rainmaker, but John Grisham?

At least I think it was Rainmaker. This guy had a client that was having problems getting insurance to pay for their son who had leukemia. Long story short, the lawyer found a missing chapter from the employee manual that said to throw every bill in the trash when it comes in. If it is appealed, then they pay the lower amounts. But the basic premise was that they kept denying until they got sued, because not many people sued, and it was cheaper for them to lose in court and pay the lawsuit out than to pay all the claims.

[PA Democrat]

9. Here's what really bothers me. The insurance industry is SUPPOSED to be regulated. Every state has

an insurance department that is supposed to help consumers who are getting cheated by insurers, but yet the companies CONTINUE to pull the same crap, cheating people out of coverage, because there very little disincentive for them to play fair. Why is this company I dealt with still in business? Why aren't the medical directors and corporate executives who KNOWINGLY and INTENTIONALLY routinely deny people benefits to which they are entitled, in jail?

Why doesn't the corporate media cover these crimes? Could it be that they like the politicians are in the pockets of the insurance industry? How much money is spent by the health insurance industry every year to lobby politicians, how much money paid in the form of advertising to silence the media?

It's all about money and greed. And people are dying as a result.

[CoffeeCat]

28. Then litigants should be able to also sue...

...for pain, suffering and emotional damages.

If these pig insurance companies want to play dirty--then they should pay a price
for dragging people through hell.

I'd sue for the time it took me to gather records, research and get the insurance
company to pay. Then, I'd sue for the stress that it caused me.

This really is sick. I've never been sick before, so I am pretty much oblivious
when it comes to how these insurance companies operate. I'm glad that Moore made
Sicko--which I will definitely see. There are many people who have not experienced
the stress of dealing with these insurance companies--and exposing a larger audience
to the truth will only help facilitate change in the medical/insurance industries.

[canetoad]

31. Sicko brought this book and movie back to mind

Read and saw it back in 90's when first released and found the attitude of insurers almost unbelievably callous.

With the release of Sicko, it's a good time to revisit 'The Rainmaker', just to keep the anger alive.

[PA Democrat]

32. That was a great book and movie.

And since the release of both the book and the movie, the insurance industry has only become more blatant in their corrupt ways.

[canetoad]

35. and heartfelt congratulations

for having the temerity to insist on your rights.

I wish more people would keep a level head, get everything in writing, retain documentation and employ a terrier-like attitude; grab it and don't let go.

[HCE SuiGeneris]

10. Well done, and congrats.

I hope this story finds greater exposure. How many instances of this kind of abuse go unreported?

[Rosemary2205]

11. "Delay, deny and hope they die"

Probably hidden in the mouse type of your policy. :mad:

[PA Democrat]

15. Yep. It seems to be standard operating procedure.

It should be a crime.

[OzarkDem]

12. Medical Mutual in Ohio does the same thing

They make up some bogus claim about pre-existing conditions, etc. and stall for as long as possible assuming patients will give in and pay out of pocket.

I suspect many of those in charge of state departments of insurance, who are supposed to oversee these problems, are looking the other way. In Ohio, the GOP was heavily funded by insurance companies and allowed this practice. Hopefully, our new leadership will change that.

[PA Democrat]

13. What I have been told is that many of the heads of the states' insurance departments

are former insurance company executives. They look after their own and screw the poor slobs who are desperate to be treated fairly by the greedy profiteers in the insurance industry.

[OzarkDem]

14. It was true in Ohio

many of the heads of health related departments, including Dept. of Medicaid & Medicare, were executives "on loan" from insurance companies.

[LiberalHeart]

16. When I had a problem with my HMO, the Ohio Insurance Commisson...

...stepped in and got the problem solved overnight. I sent flowers to the woman who went to bat for me, but I still don't know what she did. She was very close-lipped about it, but when I laid out the problem for her, I could tell that she thought I was being treated shabbily. I'd tried for months on my own to take care of the problem, but got nowhere. I was shocked at how easy it was for the woman from the commission.

[PA Democrat]

17. I'm glad to hear that she helped you.

I'm just appalled at how blatant and widespread the abuse seems to be. I think they need to start sending some people to jail for cheating people out of coverage. It seems that all the companies get are slaps on the wrist, and even when there are financial penalties, it comes out of the companies' profits. The companies don't lose their licenses to operate; the individuals making unethical business decisions seem to walk away unscathed.

It's so sad that when you have serious health problems that you have the additional worry of wondering whether your insurance company is going to pay.

[Heathen57]

30. My mother had an HMO

that she paid into for years. When she went in for a breathing problem, they only paid for part of the bills. After not getting anywhere with them, she changed to another company. That was when the trouble began.

They were informed via phone, fax and registered letter that she had discontinued their company's coverage, but they continued to withdraw money from her checking account every month.

After 4 months of letters and phone calls (which I logged with the name and number of the CSR) I wrote a long letter to the Ins. Commission of our state (including copies of all the correspondence).

It wasn't more than a couple of days until I heard from the Commission that they were investigating. Two days after that, my mom got a call from the HMO apologizing and assuring her that a refund check was in the mail.

It took another call to the Commission to get them to finally send the check, but we did get a full refund.

The insurance companies routinely rip off the elderly since they figure that they won't 'rock the boat'. And I find that really appalling.

[LynneSin]

20. Well it is pre-existing.....

I mean, you've always had a Colon. I'm guessing that was their logic

:grr:

[PA Democrat]

21. They are creative little buggers, aren't they?

I'm trying to get a copy of the South Carolina court decision in which this same company got a $15 million penalty assessed against them for wrongly denying payment for a customer's AIDS treatment. The court described Assurant's (formerly known as Fortis) actions as "highly reprehensible."

I think that the people making decisions to cheat people out of health care coverage should charged with a crime and have their names and photos on the news and on the front pages of every newspaper in the country.

[puebloknot]

23. Spot on!!!! nt

[FloridaJudy]

25. I hear you

Something similar happened to a former co-worker of mine. This was a healthy young woman who didn't smoke or drink and wasn't overweight. In fact, she rarely took a sick day during the five years she worked with me.

Then she started being plagued with a number of bizarre symptoms - blurred vision that would clear up in hours, odd muscle twitches, and an intermittent limp. She wrote them off to stress, until the day she tried to get out of bed, her legs collapsed under her, and she could not stand up. Her frightened husband drove her to the emergency room. Within a week she was diagnosed with multiple sclerosis.

Guess what her insurance company said? Yup. "Pre-existing condition". No way are we gonna pick up the bills for your devastating and expensive disease.

She fought like hell, submitting all her previous medical records and her employee records of exemplary attendance. She finally got her coverage, but not before being put through twenty kinds of hell in addition to learning she had a chronic, catastrophic illness.

Health insurance companies need to be put out of business by a universal single-payer system. Their record of pulling this kind of crap deserves a death sentence. Greed and dishonesty is their pre-existing condition.

Do you know what the difference is between a vulture and a private health insurance company?
One's a cruel scavenger that preys on the sick, frightened and dying.
The other's a bird.

[blondie58]

39. that was my first thought- M.S,

which to be diagnosed with, you must have at least two episodes of different symptoms- even if your MRI shows a clear lesion on your brain.

And stress is definitely not good for it- the stress that the insurance company caused probably exacerbated her symptoms.

I hope that she is doing better now. M.S. can be a life altering disease, not necesarily a catastrophic illness.

[PA Democrat]

41. I like your health insurance company joke.

What is becoming increasingly apparent, is that these heartbreaking stories like the one about your former co-worker are not all that rare. That's why I am still OUTRAGED about what happened to me. This company had been caught, fined, successfully sued, time and time again, for cheating people out of coverage, and yet they STILL CONTINUE TO DO IT.

I agree with you, that single-payer is the only solution.

[formercia]

26. Congratulations

I had 2 polyps removed but they were ok. My bills came to over $10K. Lucky for me, my wife's work has good coverage.

This is why we need a national single-payer program.

[midnight]

27. Congrats on getting your health care benefits.

I have WPS in Wisconsin. The insurance Co. has been requesting info. for over ten months and then denying coverage. I'm in another wait for them to receive more information so they can deny again. I wrote the Insurance commissioner and received a letter indicating that they cannot make WPS provide insurance, and that it was the employees responsibility to make sure that this is covered. Employer said it was between doc and insurance co. It has been very amazing to see how much money they will spend denying the need for health care treatment.

[PA Democrat]

29. I'm sorry to hear about your problems.

I know that in my case there were probably well over a hundred letters sent out by this insurance company plus dozens of letters from my current doctors and previous doctors to provide information about my past medical care. The expense of all of that correspondence and paper pushing is pure waste. It is money that is being diverted away from actual health care.

Have you tried talking to your state legislators? Maybe they can help exert some pressure on the Insurance Commissioner. You have to be exasperated dealing with this problem as long as you have. I know that I was ready to track down the home addresses of the executives of my former insurance company and stage protests outside their homes.

:hug:

[raccoon]

33. Glad to hear it, PA Dem! Good for you. nt

[TexasThoughtCriminal]

34. I'm glad you had the strength to fight it. But what of those who don't?

The most infuriating thing is that this kind of shit happens to people who are literally fighting just to stay alive. They and their families don't have the time or emotional energy to fight their insurance companies too.
:mad:
All my best wishes for a polyp-free future.

[PA Democrat]

36. I know. That's why I am still pursuing the complaint with my state's Insurance Department and

have been talking to my state rep. The whole system is corrupt. I would like to see a single payer system, but in the meantime, I'd settle for super hefty fines for any company involved in these sort of corrupt practices. Put the fines collected into a fund to be used for providing health care for the uninsured.

[jpgray]

42. You are fucking awesome.

[PA Democrat]

43. No, I'm just one of the lucky ones.

My health is good enough that I have the ability to fight the bastards. A lot of the people they do this to are fighting for their lives. It's a crime that their fight is not just against a deadly disease but also against the thieves sitting in the corporate offices of these corrupt health insurance companies.