# Health care horror story #13848732 **URL:** \ **Category:** The BBQ Pit\ **Created:** [December 26, 2009, 8:01am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612 "2009-12-26T08:01:41Z")\ **Posts on this page:** 20\ **Page:** 12
**Author:** ![vivalostwages](https://avatars.discourse-cdn.com/v4/letter/v/d07c76/32.png) [@vivalostwages](https://boards.straightdope.com/u/vivalostwages)\ **Post date:** [December 29, 2009, 6:51pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/221 "2009-12-29T18:51:08Z")
## from **curlcoat** : We already have Medicaid for those people who simply don’t have the money to get insurance or health care on their own. Then we have all of these people, usually dubbed the working poor, who have made their own choices on what to buy that doesn’t include insurance. So we are supposed to create this new government money hole to provide cheap insurance to people who have already chosen not to pay for it at full price because they wanted to buy other things. How do you know that all of the working poor are choosing to buy things other than insurance? How do you know that their income allows them to buy anything beyond rent, utilities, phone, and clothes? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [December 29, 2009, 7:28pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/222 "2009-12-29T19:28:01Z")
> [@Mr\_Smashy](#): > > I’m afraid Wiki doesn’t agree with you > > [http://en.wikipedia.org/wiki/Health\_care\_in\_the\_United\_States](http://en.wikipedia.org/wiki/Health_care_in_the_United_States) Nice try, but no points. Health care dollars spent are not the same as health insurance premiums paid. Your cite is health care dollars paid after after premiums, so the 30% overhead still stands. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [December 29, 2009, 8:56pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/223 "2009-12-29T20:56:33Z")
> [@otternell](#): > > Ok, back to the hypothetical. Its 2009, the fetus is 6 months along and is expected to be born in 2010. Based on medical diagnoses of a genetic disorder, they doctors agree (multiple opinions) that this child (when born) will need $1mm in surgery/therapy to have a 50/50 chance of survival to the age of 5. The baby is born in 2009, as a preemie, and there are not enough funds in the GDP UHC bucket to cover even the first treatment, only the birth (and regular preemie care (not sure what its properly termed). (even assuming **gonzomax** is right and costs have gone down across the board.) Its not an election year. If you put the child on a waiting list, it will (for sure) die. If you start the procedures, the first one will run about $500k (heart surgery) and if the other procedures don’t start very quickly thereafter, the child will die (due to liver failure, kidney failure). (I guess technically I am assuming a GDP UHC budget year to run Jan-Dec, shift the months as appropriate, but don’t dodge the question!) > > **Does the child get the care?** > > This is the tough question that gets drowned out in all the noise. Yes its hypothetical, but I would find it hard to believe that there aren’t medical treatments and cases like this. To be fair, I am not really a “proponent”, I am actually a waffler: I was against it for a while, but I see that the people for it also have good points, now I just want it done so everyone will STHU. I just don’t want this true ethical dilemma (which will become a real life ethical dilemma) lost in all the noise. As a preliminary issue, you talk about the cost of a treatment; that may even make sense in the way the UK system works currently - they’re forever experimenting with idea for creating markets - but other UHC systems wouldn’t price the work. Instead, they provide what service they can with the resources provided - we’re talking about committed staff who believe in the system and are dedicated. They make things work when, if they were corporate employees, they might go home. Btw, having hugely committed staff is by far the most undervalued aspect of UHC - I mean committed to the idea. I can’t tell you how important that is. Next, the kind of bureaucracy you associate with the treatment doesn’t exist to my knowledge; once diagnosed you go through the process from one appointment to the next consultation to the next treatment. That’s it - no one at that level is concerned with budgets, it is just a process in which you move between appointments, etc (if budgets stagnate or worse, I suppose the gap between appointments would increase, unless it was urgent). As a general point, I’m sure you understand medical professionals make life and death decisions routinely. What I would say is if someone does not get appropriate \*and timely \*treatment, as in any other area of business, the hospital is exposed to legal action. In the end, stuff that needs to be done gets done - sometimes because the staff have gone beyond their duty - but it generally works, hence the decent life expectancy, child mortality, etc, rates. ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [December 29, 2009, 9:10pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/224 "2009-12-29T21:10:33Z")
> [@otternell](#): > > No offense to **kaylasdad** but I am going to see if I can take this argument over to Great Debates. I am little tired of hearing about **curlcoat** and all that crap. None taken. I think I’ll pop on over to that thread and snoop around, see if I can learn something. Google wasn’t all that helpful wrt how the Yurpeens handle that. ---
**Author:** ![spinky](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@spinky](https://boards.straightdope.com/u/spinky)\ **Post date:** [December 29, 2009, 10:30pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/225 "2009-12-29T22:30:02Z")
> [@curlcoat](#): > > It’s party B’s fault when all B does is whine about something that happened without taking some responsibility for the issue. Well aren’t you the little dipshit. I’ve done more than complain (you say whine, I say complain), and I’ve done more than call UHC about it. I went to a higher authority: the people who pay **them** on my behalf (you should appreciate the entirely capitalistic tactic, which, by the way, works). Maybe you think I would have gotten better results going to the insurance commissioner right off the bat, and maybe you’re even right, but implying I’ve somehow failed to “take responsibility” is idiotic. It’s just more of your favorite pastime of blaming people for anything unfortunate that comes their way. Cause if I was _responsible_ I’d be able to pay my mortgage (I can) and make my car payments (don’t have any) and I’d have acquired health coverage (I did) and I’d only have babies I could afford (I can) and that whose births were covered by my insurance plan (they are), and even considering all that, it’s still my fault that UHC decided to try to play games and deny claims that they are obligated to pay, because I’m not diligent enough to have the insurance commissioner on speed dial. Right? > [@](#): > > what will you do then when the government denies your claims? I hear filing a complaint with the government works like magic. I appreciate your opening my eyes to this. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [December 30, 2009, 12:17am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/226 "2009-12-30T00:17:01Z")
> [@Fear\_Itself](#): > > Nice try, but no points. Health care dollars spent are not the same as health insurance premiums paid. Your cite is health care dollars paid after after premiums, so the 30% overhead still stands. Ahem. Where does it say that those are health care dollars after premiums? Let’s read the entire paragraph together, shall we? > [@](#): > > Health care spending > > U.S. healthcare costs exceed those of other countries, relative to the size of the economy or GDP.Current estimates put U.S. health care spending at approximately 16% of GDP, second only to East Timor (Timor-Leste) among all United Nations member nations.[7] The health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017.[32][33] Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories (diagnostic laboratory services, pharmacies, medical device manufacturers, etc.[28] Unfortunately the reference provided goes to a pdf that doesn’t exist (#28 if you want to try yourself), so I can’t find any source data. But at least I’ve shown something to bolster my point. The Forbes article further does. Still awaiting your cites proving that 30% is admin costs, wasted money that will not also have to be spent for UHC. Still waiting… still… If you can prove that, I’ll concede your point. Again, prove it please. No Kos/HuffPo/Pravda/etc. 30% is wasted dollars, right? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [December 30, 2009, 2:56am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/227 "2009-12-30T02:56:29Z")
> [@curlcoat](#): > > Am I? According to [this](http://www.consumersunion.org/conv/conversions_101/nonprofit_health_sector_history_and_trends/index.html), the BX’s of California have been for profit since 1996, and that started “a domino effect on other Blue Cross and Blue Shield plans”. Perhaps it is only the private coverage part of BX/BS that is still mostly non-profit? Wellpoint of California was, indeed, the first for-profit Blue company. When I started working for BCBS there were something like 120 primary licenses. When I was laid off in 2007 it was down to 39. Basically, the for-profits started buying each other, until only two remained in 2007. They still operate under state names - so, for example, BCBS of Indiana, Ohio, and several other states are all owned by the same primary licensee, but are known still as “XXX of Ohio” and “XXX of Indiana” and so forth. This gives the appearance of more for-profits than actually exist. Only two primary licensees are for-profit. The vast majority are still not-for-profit, whether you believe it or not. And that is as far as I’m going to with this hijack of yours. I do not want to side track this thread any further with a history of the Blue Cross Blue Shield empire. > [@](#): > > I’d say that I hope you don’t really mean that, but since you have said so many ridiculous things, I fear you really do think this would be a good idea. For the whole country to be without insurance, with the majority unable to pay for health care for however many years it would take to get something up and going to replace the loss of those insurance companies. Shall we start now, with you, with the expenses you have coming up? Are you willing to wait for a couple of years for medical care? I see you don’t understand that universal, single payer health care is NOT an absence of coverage but rather an extension of coverage to everyone in the country. It wouldn’t take years to effect this change if the country actually wanted to make the change. > [@](#): > > Which means it is likely you have not seen as many different policies as someone who has worked for several large national companies. Your statement is utterly and completely ridiculous. BCBS covers 1/3 of the US. You are stupid enough to think all those policies are identical to each other? You’re grasping at straws rather than admit you were flat-out wrong. > [@](#): > > Just as I earned the SS from paying into it for those 35+ years. I might concede you earned your RETIREMENT SS - you DID NOT earn the money you get for being disabled prior to retirement age. That is above and beyond the usual benefit. > [@](#): > > You consider all money that comes from the Federal government welfare? All retirees are on welfare? Yes. It is a government benefit paid for by taxes. It is a form of welfare. Unlike you, however, I don’t find the word “welfare” inherently evil. > [@](#): > > Huh. Sounds like the programs we already have in place! Oh, unless you don’t have kids, then society will let you die. Right. I don’t have kids. I’m screwed in regards to welfare in many ways. > [@](#): > > But it is typical of you to say that we should seriously lower our quality of life in order to support people who haven’t been bothered to be responsible for themselves. Again - you assume anyone receiving any form of government assistance must have been irresponsible rather than unfortunate. Except for yourself, of course - you’re the special exception snowflake. > [@](#): > > Wow. Just…wow. Five years of payments on something that isn’t at all necessary, and you don’t consider that very expensive? No. People spend 20-30 years paying off a house - now THAT is expensive. > [@](#): > > The cheapest Ford SUV according to their site starts at $20K and over five years it’s a bunch more. It’s at least $400 a month, which is just under a quarter of our monthly bills, including mortgage. That must be an example of how so many people get themselves into financial trouble. Can’t afford it? Buy it on time. Yes, we allow people to take out loans to enable to obtains items they can’t pay for all at once. Provided the loans are paid back why is this a problem? Don’t take on more debt than you can afford to pay back. Or are you seriously saying no one should buy anything except by paying for it entirely up front? If that’s the case… why do you have a mortgage? > [@](#): > > No, I don’t. I have been very clear that I am talking about those people who expect to get cheap medical insurance from the taxpayer when they could have afforded it themselves if they hadn’t purchased those SUVs that you think are so easy to afford, or had those 2-3 kids, or bought a house they couldn’t afford, or or or. I have no trouble with extending Medicaid to those who cannot qualify for insurance or who have been maxed out. I am just tired of paying so that the irresponsible can have their kids, houses and SUVs. Oh, so now the middle class are irresponsible? Why don’t you just admit you hate everyone? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [December 30, 2009, 5:06am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/228 "2009-12-30T05:06:35Z")
> [@legalsnugs](#): > > Curlcoat, you blow my mind! You disdain the government for “making” you pay into SS, but if it hadn’t, you wouldn’t be getting any disability benefits now or retirement benefits at 66. You should be thanking the government each and every month for thinking ahead so you could be taken care of! If the government hadn’t taken that money from me, I could have put it in a proper retirement fund, rather than having them piss it away as they have, so that I have to listen to people in here whining that they are paying my SSDI. > [@](#): > > You do realize that you will, if you live your actuarial lifespan, receive far more in benefits than you personally ever paid in. I imagine that is true of most everyone who gets social security benefits. There are many people who get them without having paid in at all. > [@](#): > > How about some gratitude? Snort. I didn’t demand gratitude from the folks that were on SS while I was working, if for no other reason than that is a ridiculous thing to expect. > [@](#): > > What happens if (God forbid) your husband loses his job? The same exact thing that happened when he was laid off in early 2008. We paid COBRA for nine months, until he got another job. We’ll get Medicare when we have to, but not one minute earlier. I am not even accepting the free Part A that they automatically signed me up for. > [@](#): > > Your pro-insurance company arguments have been all about healthcare vs. money, ala why should the healthy pay for the care of a child who will probably die soon? Not at all, it is the young folks that don’t think they should pay into insurance until they get sick. My stance is that I am tired of paying for other people’s choices. People have sick babies all the time, so why is it a surprise when another one is born? And then why is it the responsibility of people other than the parents to pay for it/see that it gets paid for? Having a healthy baby is expensive enough and we already have way too many people having babies they can’t afford, so having to pay for a sick one that doesn’t appear to be viable is just too much. > [@](#): > > Okay, why should my tax money go to someone who’s disabled? If we just stop providing for them, maybe they’d die sooner and stop using up money that could go to someone who’s not disabled who can really enjoy their earned retirement benefits. Puh-leeze. :rolleyes: You are advocating starving disabled people to death? Disabled people are unable to enjoy their earned retirement benefits? Way to be a bigot. > [@](#): > > We can see clearly who you care about and your attitude is just sad. My attitude is that we have created a society of people who think they can have whatever they want as soon as they want it, and when their house of cards falls down they expect someone else to take care of it. We cannot afford to continue to do that for much longer, unless your idea of a perfect society is everyone as the same level of poverty. > [@](#): > > My feeling is that if all those CINOs out there really behaved like Christians ought - according to the words of Jesus - healthcare reform would never have become necessary. Good lord, you guys will try to inject Jesus into everything, won’t you? > [@Nava](#): > > No other reason has been given. I seem to remember quite a few wondering why they would continue the pregnancy knowing that the baby would be born with severe problems and most likely not have anything approaching a normal life. It’s a moot question anyway since it has become impossible for people to avoid giving birth to suffering after a certain period of time. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [December 30, 2009, 6:22am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/229 "2009-12-30T06:22:25Z")
> [@Sateryn76](#): > > So no one has an answer for me? Is it too hard of a question? > > \*\*curlcoat \*\*- shut up until I get my answer! You make it too easy for people to avoid the real questions! It has nothing to do with me. Almost all of the people that scream for a UH in the US either don’t know or chose to ignore the fact that government funded health care will still be working with a finite amount of money. > [@kaylasdad99](#): > > I have a hunch, and it is no more than a hunch, and it is based solely on my impression that **curlcoat** has some self-interested reason for being so pro-health-insurance-industry, that this is not likely to occur unless single-payer comes to pass, and the industry stops existing. I have no idea what you are talking about, but I will say I am not “pro-health-insurance-industry”. Which you would know if you paid attention to what I post, not what folks like **Broomstick** pretend I say. > [@vivalostwages](#): > > How do you know that all of the working poor are choosing to buy things other than insurance? > How do you know that their income allows them to buy anything beyond rent, utilities, phone, and clothes? I didn’t say anything about “all” of the working poor. Aside from that, every last example here and all of my own personal experiences have supported my belief that there is a large, growing section of our population that go forth and do whatever they want with little concern as to what they will do should they have some sort of emergency. There are two families of these folks living right across the street from me even. All they need is to lose one wage earner, or have one of the five or six kids get some severe health problem, and they will lose the house they couldn’t afford, the SUVs they had to have and everything else. ---
**Author:** ![spinky](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@spinky](https://boards.straightdope.com/u/spinky)\ **Post date:** [December 30, 2009, 8:34am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/230 "2009-12-30T08:34:38Z")
> [@curlcoat](#): > > **every last example here** and all of my own personal experiences have supported my belief that there is a large, growing section of our population that go forth and do whatever they want with little concern as to what they will do should they have some sort of emergency. (emphasis mine) Really? In what way has my example supported this belief? ---
**Author:** ![auRa](https://avatars.discourse-cdn.com/v4/letter/a/c4cdca/32.png) [@auRa](https://boards.straightdope.com/u/auRa)\ **Post date:** [December 30, 2009, 11:57am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/231 "2009-12-30T11:57:48Z")
> [@Johnny\_L.A](#): > > One of our UK Dopers reported that his or her 90-year-old grandmother received expensive surgery (possibly a transplant?) even though she was near the end of her life. That poster reported that the grandmother’s age was not a factor in whether or not she would receive treatment. She needed treatment, and she got it. > > Just a data point. Yeah, a few more data points for you. This is in socialist hellhole Finland, by the way. - my 89-year-old fully demented grandmother died last spring when they decided to take her off life support. DEATH PANEL! Of course, said death panel was composed of my father and three aunts who negotiated long and hard with the doctors, who informed them that they would keep my grandmother alive for as long as possible if that’s what they wanted. They decided it wasn’t. - my 84-year-old grandfather died about a week later on the operating table. His body never really fully recovered from a bad bout of influenza he had had about a year earlier, and his systems gave out when they were trying to remove a bowel obstruction. 84 years old. Extremely weak. Bowel obstruction. They still attempted to save his life. - I’ve brought up my brother in other threads. Born with a full bilateral cleft lip and palate, gone through 7 operations so far, the last one just before Christmas of this year. Also, he regularly sees a psychologist, speech therapist, physiotherapist and specialized orthodontist. This 12 years of care so far has cost my parents 30€ per hospital night. Everything else is paid for. - the preemie situation mentioned in this thread: in Finland, the cut-off age for treatment of micropreemies is, I think, 22 weeks. Anything further along than that gets treated to the full capability of the staff, _depending on the situation and discussions with the parents_. Mikko Hallman, a professor at Oulu University Teaching Hospital, says: > [@](#): > > "We shouldn’t think of this in a fatalistic way, as ‘nature’s will’. We should treat premature births, or rather the process that leads to a premature birth, as some sort of disease or condition for which we could attempt to find a cure. > > If we imagine society to be so hard and cold that only the tough survive, then of course we can say that only the “useful” population should get treated. But of course, that’s not the case in our Western society. > > In a situation like this, no doctor or outsider can say what is the best solution for the family. In this case, the parents have the choice, but there has to be frank discussion spanning all the options." [translated from here: [http://yle.fi/akuutti/arkisto2003/140102\_c.htm](http://yle.fi/akuutti/arkisto2003/140102_c.htm)] - in the GD thread, someone mentioned dentistry (in a sort of “hur hur Brits have bad teeth” way). I had braces for four years because my canine teeth came in before the milk teeth had a chance to fall out and they grew in all wonky. This was covered fully by the government since I was a school kid. Had I gotten braces as an adult, I could have gotten them at a private practice and the Social Insurance Institution of Finland (KELA) would have reimbursed me. So, there’s a few insights onto how health care is in Finland. Did you know, our men have a life expectancy 7 years lower than women? Women in Finland are expected to live 82 years, the men only 75. We drink a lot of alcohol as a people, we eat quite unhealthy foods, people get drunk and stab each other. And then they get taken to the hospital and treated. And then, maybe, they leave the hospital and go get drunk again and get stabbed and brought back and treated again. And yes, it’s frustrating. But we do it, because they’re people, and that’s what you do with people in a civilized society. That’s the general point of view here. Our health care spending per capita in 2006 was US$ 4,031, by the way. Y’all’s was US$7,439 according to the Office of the Actuary. We treat everybody. _shrug_ ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 30, 2009, 4:44pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/232 "2009-12-30T16:44:28Z")
> [@auRa](#): > > Yeah, a few more data points for you. This is in socialist hellhole Finland, by the way. > > - my 89-year-old fully demented grandmother died last spring when they decided to take her off life support. DEATH PANEL! Of course, said death panel was composed of my father and three aunts who negotiated long and hard with the doctors, who informed them that they would keep my grandmother alive for as long as possible if that’s what they wanted. They decided it wasn’t. > > - my 84-year-old grandfather died about a week later on the operating table. His body never really fully recovered from a bad bout of influenza he had had about a year earlier, and his systems gave out when they were trying to remove a bowel obstruction. 84 years old. Extremely weak. Bowel obstruction. They still attempted to save his life. > > - I’ve brought up my brother in other threads. Born with a full bilateral cleft lip and palate, gone through 7 operations so far, the last one just before Christmas of this year. Also, he regularly sees a psychologist, speech therapist, physiotherapist and specialized orthodontist. This 12 years of care so far has cost my parents 30€ per hospital night. Everything else is paid for. > > - the preemie situation mentioned in this thread: in Finland, the cut-off age for treatment of micropreemies is, I think, 22 weeks. Anything further along than that gets treated to the full capability of the staff, _depending on the situation and discussions with the parents_. Mikko Hallman, a professor at Oulu University Teaching Hospital, says: > [translated from here: [http://yle.fi/akuutti/arkisto2003/140102\_c.htm](http://yle.fi/akuutti/arkisto2003/140102_c.htm)] > > - in the GD thread, someone mentioned dentistry (in a sort of “hur hur Brits have bad teeth” way). I had braces for four years because my canine teeth came in before the milk teeth had a chance to fall out and they grew in all wonky. This was covered fully by the government since I was a school kid. Had I gotten braces as an adult, I could have gotten them at a private practice and the Social Insurance Institution of Finland (KELA) would have reimbursed me. > > So, there’s a few insights onto how health care is in Finland. Did you know, our men have a life expectancy 7 years lower than women? Women in Finland are expected to live 82 years, the men only 75. We drink a lot of alcohol as a people, we eat quite unhealthy foods, people get drunk and stab each other. And then they get taken to the hospital and treated. And then, maybe, they leave the hospital and go get drunk again and get stabbed and brought back and treated again. And yes, it’s frustrating. But we do it, because they’re people, and that’s what you do with people in a civilized society. That’s the general point of view here. > > Our health care spending per capita in 2006 was US$ 4,031, by the way. Y’all’s was US$7,439 according to the Office of the Actuary. We treat everybody. _shrug_ In America, many feel the poor do not deserve health care. They are poor because they are just not as good a person as the wealthy. If they had gone to the right schools, picked the right profession and saved properly, they would not be such a drain on public monies. Errors start when you choose to be born poor. It is a bad choice and you should pay for it. We have many educated, professionals losing their jobs. They just did not choose wisely. Our insurance companies are spending mega-millions of insurance revenue in fighting health care reform. They are fighting their customers over coverage and denying care. But they can afford to spend 1.5 million dollars a day lobbying the senators and congressmen. ---
**Author:** ![Richie\_Incognito](https://avatars.discourse-cdn.com/v4/letter/r/e36b37/32.png) [@Richie\_Incognito](https://boards.straightdope.com/u/Richie_Incognito)\ **Post date:** [December 30, 2009, 5:25pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/233 "2009-12-30T17:25:44Z")
I think there is something funny about this story. I know insurance companies do some evil things, but I have never heard of a case of an insurance company giving express approval for something and then turning around and not covering it. In my opinion, there are two likely scenarious which occurred here: 1. The hospital is out of state. Many insurance plans require you to only see doctors in your home state unless you have to go to the emergency room. Perhaps this couple could not get the needed care in their own state and believe that as a result, the insurance company should cover out of state care. This argument makes sense but an insurance company is unlikely to go along with it. Those are not the terms it agreed to. 2. The couple assumed this care was covered. Perhaps the insurers coverage manual made it sound like this care would be covered. Coverage manuals tend to contradict themselves constantly and are almost impossible to read. What’s odd about this story is that, in my experience, the insurance holder is not the last stop in determining whether something is covered. One of the first things which occur when you attend a hospital is the hospital gets ahold of your insurance card. They are going to know immediately what is covered and not covered. If there is a question, they get to the bottom of it. They want to be paid. The idea that this couple was told that they could attend this specialty hospital and it would be covered by insurance only to later be told that none of it would be covered does not add up. -R. Incognito ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 30, 2009, 5:36pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/234 "2009-12-30T17:36:22Z")
Adds up fine to me. I called my insurer last year to ask if (essentially routine) testing for sexually transmitted diseases would be covered. The helpful person on the other end asked which specific diseases, so I threw out HIV/AIDS, hepatitis, herpes, gonorrhea, chlamidya, and hepatitis. She did not know, and referred me to the coverage manual. Having already reviewed said publication, I told her that it did not appear to offer the answers I sought. She expressed dismay and said she was unable to provide further assistance. So, I asked to be transferred to somebody who could. She sent me to a supervisor, who gave me the same answer. I asked if _he_ could transfer me to somebody who knew. He said no, but “[they]'ll call you back”. They called back. They asked if I knew the billing codes for these procedures. I obtained same from my physician, and called back. They _still_ didn’t know. Their advice was, essentially, “go have it done, and you’ll find out if it was covered when you get your statement”. I wish I was joking. It _was_ covered, and I’m clean as a whistle, in case you’re wondering. Anyway, the point is that any system so arcane that insurers cannot define or even offer the practical terms of \*their own policies \*is one in which any stupid shit can happen. It’s not like I was a prospective customer or something - I had been a policyholder for over two years at that point. ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [December 30, 2009, 5:47pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/235 "2009-12-30T17:47:56Z")
I used to get “prior authorization” from insurance companies for surgeries done by the doctors I used to work for. They make a VERY emphatic point of the disclaimer “Coverage is not a guarantee of benefits” and are very explicit in saying that even if they give you “prior authorization”, if something happens that is in anyway different than the exact scenario you give them when you call (because, of course, medicine/surgery is predictable and changes never happen during surgery), that they can still turn around and deny coverage. There ain’t no guarantees from an insurance company. None. ---
**Author:** ![Richie\_Incognito](https://avatars.discourse-cdn.com/v4/letter/r/e36b37/32.png) [@Richie\_Incognito](https://boards.straightdope.com/u/Richie_Incognito)\ **Post date:** [December 30, 2009, 6:01pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/236 "2009-12-30T18:01:56Z")
> [@Indyellen](#): > > I used to get “prior authorization” from insurance companies for surgeries done by the doctors I used to work for. They make a VERY emphatic point of the disclaimer “Coverage is not a guarantee of benefits” and are very explicit in saying that even if they give you “prior authorization”, if something happens that is in anyway different than the exact scenario you give them when you call (because, of course, medicine/surgery is predictable and changes never happen during surgery), that they can still turn around and deny coverage. > > There ain’t no guarantees from an insurance company. None. Shows what I know. I guess luckily I’ve had pretty good experiences. ---
**Author:** ![sinjin](https://avatars.discourse-cdn.com/v4/letter/s/ebca7d/32.png) [@sinjin](https://boards.straightdope.com/u/sinjin)\ **Post date:** [December 30, 2009, 6:10pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/237 "2009-12-30T18:10:00Z")
Another little data point about how the parents could have been given the idea they were covered: I was on vacation on Maui last winter and got an eye infection due to a chronic problem I have. Being the dutiful drone that I am I called the number on the back of my insurance card to get a local referral. I was given two names and numbers. The first was located on Molokai, I would have had to fly to get there. The second phone rang and rang and no one ever picked up (at 10 am on a weekday) and there was no message machine. I called back the insurance company, explained the situation and asked if I could get approval to go to local Dr. XYZ who was out of network but could see me in a timely manner. The insurance guy said he _could_ do that. So I go to Dr. XYZ, he fixes me up and I submit the insurance documents. Surprise, surprise the claim is denied. I call the insurance company back and politely (really) describe the situation and ask why the claim was denied. The woman puts me on hold for a long time to review the situation and comes back and tells me that yes, they have a record of my calling for permission and yes their guy said he _could_ approve my going out of network however he never said he _would_ approve it. Therefore, claim denied. Unfucking believable. The woman I was talking to seemed to think it was as big a load of bullshit as I did and suggested I file a request for review. Long story short, my secondary insurance company picked up almost the whole tab except for about $10 bucks above my co-payment so it wasn’t worth my time to fight the denial. I am totally in favor of UHC. Finally, I am embarrassed by many of my fellow Americans who so vehemently oppose UHC because they think so poorly of both our government and many of our fellow citizens. The ones who’s arguments seem to boil down to we can’t have UHC because the government will fuck it up and/or many Americans don’t deserve health care because they’ve made bad personal choices and/or many Americans will take advantage of the system. What a shitty country they live in. ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [December 30, 2009, 7:42pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/238 "2009-12-30T19:42:06Z")
**RNATB** , my brain hurts from even trying to think about dealing with bureaucracy like that just to have some simple tests done. Ouch. The idea of not wanting your fellow citizens to have healthcare because you don’t want to pay for it - some day, some way, everyone ends up needing healthcare. I’m paying for the healthcare of older, sicker people now, but someday I’ll become one of them. I guess it’s two different ways of looking at things. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 30, 2009, 8:25pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/239 "2009-12-30T20:25:36Z")
I am on Medicare. It serves quite well. I don’t use it much, just a 6 month checkup and renewal of prescriptions. Not all Medicare users are beating the system to death. They send me Emails telling me what preventative tests I qualify for. They know keeping me healthy longer will save them money. They can not just deny coverage. They have a financial interest in keeping me healthy. Insurance companies do not worry. They will deny enough customers coverage that they will guarantee great profits. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 30, 2009, 9:26pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/240 "2009-12-30T21:26:36Z")
> [@Cat\_Whisperer](#): > > **RNATB** , my brain hurts from even trying to think about dealing with bureaucracy like that just to have some simple tests done. Ouch. Not as ouch as if they’d denied coverage. The tests would have cost $1300. [Previous page](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612.md?page=11) [Next page](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612.md?page=13)