# 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:** 7
**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 27, 2009, 9:46pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/121 "2009-12-27T21:46:48Z")
> [@Batfish](#): > > Would you mind listing what you do consider “rights”? The right to scrabble tooth and nail for every scrap of life necessities you see. The right to hold on to whatever you manage to acquire, using deadly force if necessary. The right to starve to death if you fail to secure sufficient nutrients through your own actions (including exploiting the altruism of the weak-minded and easily manipulated). The right to die of exposure if you fail to secure adequate shelter through your own actions (including exploiting the altruism of the weak-minded and easily manipulated). Basically, the right to suffer the full range of potential consequences for your failure to secure any desirable thing through your own actions (including exploiting the altruism of the weak-minded and easily manipulated). Aw, darn, I went and answered for him, didn’t I? Well, I’d hate to have him think of me as weak-minded and easilly manipulated. **C\_M** , please PM me and we can discuss an equitable plan for you to pay for my services. 😛 ---
**Author:** ![casdave](https://avatars.discourse-cdn.com/v4/letter/c/c6cbf5/32.png) [@casdave](https://boards.straightdope.com/u/casdave)\ **Post date:** [December 27, 2009, 9:59pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/122 "2009-12-27T21:59:21Z")
If that were true, then why are employees so opposed to having higher wages and the insurance taken out of their pay then? Lots of Americans are so short sighted they can’t see the obvious, if it is not on the deductions on their pay sheet then it is not a cost to them. Lets have proper free market, lets see what middle class America thinks about that. You see America does not want UHC for other people, and does not want to pay healthcare insurance directly, they want it both ways, not to pay for others and not to pay for themselves and its what the scaremongers exploit. All libertarians, right until the moment they have to actually bear their own costs, then its unfair to them. Why is is that Americans are happy to have companies pay their healthcare insurance, and get it for free, but do not want others to get it for free? Nothing is free of course, nothing at all, ‘I’m alright jack’ is the attitude of middle America, problem is that they are simply cutting their own noses off to spite theIr own faces. I am happy for American healthcare costs continue to rise at double and triple the rate of inflation, because it is the only way you will all learn, it is the only way you will realise what a crock your own politicians are selling, maybe the old scare monger tactics of threats to you and uyours will eventually cease to work. So keep going, keep watching your costs go up, its a drain on your economy and it allows other countries to have a huge fiscal advantage. Your labour markets will become less and less flexible, you could end up with the Douglas Adams ’ Shoe Event Horizon’ but instead of shoes, it will be healthcare, where every resourc you have goes into paying for healthcare insurance, the same insurance that routinely denies claims. [http://www.csua.berkeley.edu/~dxu/econ/shoe.html](http://www.csua.berkeley.edu/~dxu/econ/shoe.html) ---
**Author:** ![Polycarp](https://avatars.discourse-cdn.com/v4/letter/p/82dd89/32.png) [@Polycarp](https://boards.straightdope.com/u/Polycarp)\ **Post date:** [December 27, 2009, 10:48pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/123 "2009-12-27T22:48:01Z")
> [@Johnny\_L.A](#): > > You have to understand that I lurk at a gun forum. People there shout about how immoral Society is, and how much better the country would be if only everyone were as moral as they. > > And then they post about how much they’d like to shoot illegal immigrants. Or there will be some instance of a crime and the perpetrator is Black and they sarcastically post ‘Well, surprise, surprise!’ And then say how the perp should be killed quickly, and often tortuously. Or they’ll read about a rape and seemingly have a contest to see who can come up with the most gruesome execution. Or they imply that they’re just waiting for someone to do them wrong so they can kill them. > > They talk about how righteous they are, yet are completely opposed to the whole ‘Love they neighbour’ thing and helping the poor as Jesus did. Or even justice. It doesn’t have to be ‘love thy neighbor’ (though I certainly think it’s usually a good idea!) to insist that the accused receive a far trial in which the prosecution has to prove beyond reasonable doubt he committed the crime. The Old West cliché of “He deserves a fair trial and a first class hangin’” isn’t entirely without merit – the evidence may point to his probable guilt, but dammit, prove it first! ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [December 27, 2009, 10:48pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/124 "2009-12-27T22:48:21Z")
> [@Mr\_Smashy](#): > > […They will lose approx 20-30 seats in the House, the Senate probably 4-5 seats. It will be even worse in 2012 and 2014, when the Dems will have to defend far more seats than in 2010. Well, let’s see here. The Dems have about 255 seats, Pubbies 178 in the House. Dems lose 30, Pubbies gain 20, 255 take away thirty, carry the two…hmmm. Dems have 60 in the Senate, Pubbies 40, Dems lose 5 that means they only have a majority of 55 to 45. Yep, that spells doom fer sure. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2009, 10:48pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/125 "2009-12-27T22:48:38Z")
> [@ntucker](#): > > United HealthCare. “Our records indicate you have primary insurance coverage from another provider.” This is a routine tactic for United HC. I moved our company’s health insurance away from them because of their attempts to reject valid claims. The above reason was given to many of our employees, including me several times. ---
**Author:** ![I\_Love\_Me\_Vol.I](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/i_love_me_vol.i/32/521_2.png) [@I\_Love\_Me\_Vol.I](https://boards.straightdope.com/u/I_Love_Me_Vol.I)\ **Post date:** [December 27, 2009, 10:51pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/126 "2009-12-27T22:51:17Z")
> [@elucidator](#): > > So, you want him to magically come back and tell us there is no such thing as magic? Hey–why not? Makes about as much sense as anything else in Christianity. ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [December 27, 2009, 10:53pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/127 "2009-12-27T22:53:22Z")
> [@elucidator](#): > > Dems have 60 in the Senate, Pubbies 40, Dems lose 5 that means they only have a majority of 55 to 45. > > Yep, that spells doom fer sure. Well, it does mean they would not be able to stop a Republican fillibuster. If the Democrats had a 55-45 majority now, the health care bill would not have passed the Senate. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 27, 2009, 11:01pm UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/128 "2009-12-27T23:01:04Z")
The Repubs vote in a bloc. They don’t have dissenters. They know who they work for. ---
**Author:** ![jayjay](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jayjay/32/6765_2.png) [@jayjay](https://boards.straightdope.com/u/jayjay)\ **Post date:** [December 28, 2009, 12:20am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/129 "2009-12-28T00:20:09Z")
> [@gonzomax](#): > > The Repubs vote in a bloc. They don’t have dissenters. They know who they work for. So do the Democrats, unfortunately. Especially since it’s the same employer. The Senate HCR bill was political kabuki, a carefully scripted, carefully choreographed diversion. The Republicans wore the black hats, overtly opposing ANY reform. Most of the Democrats wore the white hats, trying to push reform through. JUST enough of the Democrats wore gray hats, finding enough nitpickety moral objections to what WAS in the bill to water it down to the very bare bones that might possibly help more people be allowed (sorry, FORCED) to buy insurance with their own money. What did the insurance industry get out of this? Thirty million new customers, customers who will either have to buy insurance out of pocket, or pay a fine to the government. I know government is the art of compromise (though you wouldn’t know it by watching the Republicans), but that compromise is supposed to be between congressmen and senators with differing views of how to help the citizenry, not a compromise between the political elite and the captains of industry. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [December 28, 2009, 1:42am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/130 "2009-12-28T01:42:36Z")
Clintonistas. Three-legged centrist “business friendly” _menshevik_ Liebermonkees. ---
**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 28, 2009, 2:37am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/131 "2009-12-28T02:37:06Z")
> [@elucidator](#): > > Well, let’s see here. The Dems have about 255 seats, Pubbies 178 in the House. Dems lose 30, Pubbies gain 20, 255 take away thirty, carry the two…hmmm. > > Dems have 60 in the Senate, Pubbies 40, Dems lose 5 that means they only have a majority of 55 to 45. > > Yep, that spells doom fer sure. OK let me try to dumb it down for you. No offense. The House would have ~225 Dems, the GOP ~200. The previous bill passed 220-215 > **[House passes health care reform bill - CNN.com](https://www.cnn.com/2009/POLITICS/11/07/health.care/index.html)** > > The House of Representatives on Saturday night passed a sweeping health care bill by a vote of 220-215. The Senate bill was 60-40 of course. Get the picture? This opportunity to pass something this sweeping and massive only will happen this year. Then it’s done, maybe for 15-20 years. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [December 28, 2009, 3:15am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/132 "2009-12-28T03:15:25Z")
Maybe, but only if this is a strictly partisan question, which it isn’t. Health care reform is an issue bubbling from the ground up, for decades. No one thing is going to stop it, or resolve it, its huge. Its not a controllable issue, you can’t sling it out like raw meat to the base, like the Forces of Darkness are wont to do, and keep the returns directed as you might wish. It ain’t gay marriage. Said it before (here, let me smarten that up for you, no offense): used to be, hardly anyone knew someone who had been bent over a barrel and royally buggered by an insurance company. Now, a lot of us do, and a whole lot more are going to. And they are doing it for money, harming our fellow citizens for no other purpose but their own comfort. Now, if the insurance companies are capable of straightening up and flying right: ok, no problem. If they can provide reliable health insurance without bullshit, make a modest but sustainable profit while performing a genuine service…well, then, groovy. Go for it. Now, clearly that means some sort of mechanism to enroll many healthy people into the system. There’s where I start feeling itchy. I don’t trust these people any better than a rattlesnake, if they take what they are given and start getting up to the same old shit all over again…then I want the full power of the Federal government to come down on them from a great height. You had your chance, you fucked up, adios, melonfarmer. And if any of them don’t pull any shit, if any of them show us they can behave like the insurance companies on the calenders…well, fine and dandy, give _them_ the business we take away from the crooks. Otherwise, to hell with them. So let it be written, so let it be done. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [December 28, 2009, 3:53am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/133 "2009-12-28T03:53:25Z")
> [@Wesley\_Clark](#): > > they also have to deal with an insurance company looking for a technicality to avoid paying. That is kicking someone when they are down. You are expecting a multi billion dollar industry to care that this couple had a baby that was born sick? You are expecting them to ignore their stockholders and policyholder and pay out hundreds of thousands of dollars on a baby that may not be covered? > [@](#): > > Not only that, but what else can they do? These are people who did everything right. They waited until they were financially secure and ready to have a child together. They both have good jobs with benefits as well as advanced educations. Neither did any risky behavior. Actually, we don’t know that, since we have the story third hand. I did note that this is a couple that may have been married 20 years, so it is entirely possible that the mother is older and of an age where birth defects are not uncommon. The baby may have been conceived using IVF, which also ups the chance of birth defects. Heck, that could even be why the insurance isn’t paying - I haven’t seen such a policy, but it could be that any IVF baby born sick isn’t covered. > [@](#): > > If I am mugged, the police are not going to look for a technicality to avoid investigating the crime. They are going to go out and find the guy who did it so he cannot do it again, and so he gets justice for what was done to me. Uh, actually, unless you live in a small town, it is highly likely that the police are not going to go forth and find your mugger for you. And that also has nothing to do with kicking you while you are down, it is just the reality of life that the police generally cannot spend a lot of time on minor crimes. > [@](#): > > However to address your points, what is unreasonable about neonatal care (this is not world class care as far as I know)? I have no idea, but what you or I think is unreasonable isn’t important. It depends on what the insurance company thinks is unreasonable, based on their policy. > [@](#): > > Had they refused to pay up front I don’t think this would bother me as much. My impression was that the insurance company wasn’t given the option to refuse up front. > [@](#): > > They found a way to say ‘we are not going to pay anymore bills starting January 1st 2010’. So all care in December of 2009 will be covered, but everything after that is YOYO (You’re On Your Own). It happens all the time. In fact I believe health insurance companies use computer programs which automatically start looking for justifications to rescind or deny coverage after an expensive illness crops up. That is what I remember from a congressional hearing on health care. Uh, I wouldn’t believe everything you see on Fox News… :dubious: > [@](#): > > Also, why do you feel that society has agreed everyone has a right to abuse and poison their kids? Knowingly doing that is a felony. What I said was that society has agreed that everyone has a right to have a baby, even if they are abusing the kids they already have. > [@](#): > > Your post starts to delve into issues of medical ethics too. I once read somewhere that over half of women would abort a fetus if that fetus was genetically prone to morbid obesity. However, what kind of society are we creating where all we care about is social status and short term emotional gratification (ie, avoiding babies that will cause emotional pain or have lower social status)? A deformed baby will cause short term emotional trauma, and the baby will have lower social status. However, who knows what the long term consequences will be, or what the longer term consequences will be of that. None of that has anything to do with medical ethics. If you chose to not abort a fetus genetically prone to some disease, that is fine. Just don’t expect anyone else to pay to help you raise it, and do not throw it out on society at 18 because it is now an adult and you are “no longer responsible”. If _you_ chose to have a kid that will have ongoing issues, _you_ are morally responsible for that kid for the rest of your life. Unfortunately, you are not legally responsible, which is why the taxpayers end up paying for all of these people whose parents cannot be bothered. > [@ntucker](#): > > And if anyone has any doubts as to our health care system’s efficiency, the childbirth cost nearly $20k, every single penny of which was denied by the insurance company. My favorite charge was one night’s worth of “routine infant care” for the low low price of $4126. That’s some pricey babysitting. Yup! Having a perfectly healthy baby thru easy routine childbirth is expensive as hell, yet you all have no problem expecting me, or an insurance company, to pay for your choice. And birthing it is only the beginning of the expense. But to address your point, yes healthcare all around is expensive, but creating a multi-billion dollar government money hole isn’t going to change that one bit. > [@](#): > > United HealthCare. “Our records indicate you have primary insurance coverage from another provider.” It is completely wrong, and they readily admit that. Almost every time I speak to one of their representatives on the phone they acknowledge that this is in error and claim they are fixing it. Then they continue denying claims for the same reason. My daughter is now 4 months old and they have denied 24 out of 24 claims for her basic health care. My wife recently fell and broke one ankle and the other foot and had to have surgery, and UHC has started playing the same game with her coverage. Unfortunately, I have little recourse other than to file a complaint with my state insurance commissioner (which I will be doing). Which should take care of it and should have been your first move four months ago when you were unable to get the first bill paid. You now have 24 claims unpaid and more to come and you haven’t done anything but call United Healthcare? That said, UH is a huge pile of steaming shit, and unfortunately since they are running about buying up smaller companies, they are becoming more and more common as a choice for employer sponsored plans. Meaning we have far fewer choices, kind of like what would happen if we had government insurance. Why you all expect that the government could handle all of this even as well as UH does continues to amaze me. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [December 28, 2009, 4:31am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/134 "2009-12-28T04:31:00Z")
> [@Broomstick](#): > > Why do you assume the insurance company _isn’t_ trying to get out of paying the bills? The insurance company is the only party here with a motivation to deny care, and in this case it’s a big motivation with lots of dollar signs attached. > > Why are you assuming these bills are being denied due to a _lack_ of information? An insurance company cannot deny a claim without cause, and that cause is specified in insurance law. Even our current government insurance plans will deny a claim if they don’t have the information they need. Which is actually only one of the reasons a claim can be denied. We don’t even know that the baby is covered, the care is covered, or anything else about the policy these folks have. You seem to be assuming that because these folks have insurance, everything must be covered. > [@](#): > > Except that the parents in the OP _are not_ irresponsible and did nothing to trigger this problem. The purpose of insurance is (or at least it used to be) to cover you for unforeseen/unanticipated disasters. This is certainly one. One again, you completely fail to understand the purpose of insurance. Hardly. Insurance is for paying for those things that are covered, generally for things that happen thru little or no fault of the insured. Childbirth and babies are _very_ expensive conditions that people choose to go thru, and it is entirely possible that this policy was written to try to save the policyholder from paying out hundreds of thousands of dollars on a baby that may or may not live for any length of time. Just as there are restrictions and caps on what insurance will pay for cancer treatment, there may also (finally) be on childbirth and neonatal. > [@](#): > > Since we don’t know, specifically, what is wrong with the child in question there is no way to know what the odds are of a “decent life”. It says right in the OP “child is severely deformed and might die (the doctors say there will be tons of surgeries over the next few years). Now she has to quit her job to stay at home to raise the kid since it’ll be special needs.” The odds are not on this kid’s side, yet you see nothing wrong with expecting someone other than the parents to pay for those “very expensive operations” on the off chance the kid will grow up to lead a normal life. You accuse me of imagining the worst case scenario, yet you are doing the opposite - imagining sunshine and bunnies if that evil insurance company will only pony up. > [@](#): > > Why do you force the taxpayers to pay for your monthly disability check? That’s what always amazes me - so are so quick to condemn people on any kind of public benefit, or even those who cost a private insurance company money, yet every month you accept a government check without batting an eyelash. You are one amazing hypocrite. Repeating this stupidity will not make it become true. Especially when it has nothing to do with the subject. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [December 28, 2009, 4:37am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/135 "2009-12-28T04:37:59Z")
> [@casdave](#): > > It seems strange to have a bunch of insured people, who do not actually pay for it, complain about some other people who don’t have insurance getting it for nothing. What makes you think that insured people are not actually paying for their insurance? ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [December 28, 2009, 5:05am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/136 "2009-12-28T05:05:34Z")
First of all, this couple didn’t purchase health care, they purchased health care insurance. I wish we could get out of thinking of it as insurance. Insurance companies have one goal, and that is protection of assets. Not your assets. Their assets. So first of all, the health care decision made here can be appealed, and should be. If they both work in health care, they should know this. These things can be appealed and reappealed. A little publicity never hurts. Second, they’ve already received significant health care benefits. You don’t find out that your child has severe problems while it’s still in utero unless you have really good health care to begin with. What they’re doing for their child is extreme measures. When I was a kid, I don’t think there was any such thing as a neonatal intensive care unit. And this is the very reason people should have health insurance–for the extreme case. I know of people like this, too. A couple–ten years ago they owned two houses, lived in one, rented the other, took great vacations. Then he developed heart problems at a relatively young age (and if it had happened in the 60s or 70s he probably would have just died right then), meanwhile she was diagnosed with a brain tumor. The result now is that they had to sell one house and they’re hanging on with their fingertips to the other one, having remortgaged it (it was not mortgaged, it was paid off, but they remortgaged to get money for health care expenses). They had insurance, too. Now neither one of them has a job–he can work, but nobody’s hiring, she can’t go back to her old profession and can’t use a computer without lots of modifications, and since they now have ultra pre-existing conditions, they’re paying a criminal amount for their health insurance. But, in the case of my friends, they’re dead broke now because they had excellent health care. If they hadn’t had excellent health care, they’d be dead. Your money or your life. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 28, 2009, 5:21am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/137 "2009-12-28T05:21:59Z")
Saying they can not deny coverage without cause misses the point. They determine if it is cause. Then you have to fight long, hard and expensively . Of course you are sick and have other things on your mind. My fav is a pre-existing condition. Quit your job for a better opportunity. Should be no problem. But you have to work 90 days before you are covered. If your wife is pregnant , they declare it a pre-existing condition. That means you have to spend a ton . If you have complications, you could go bankrupt. Nice system. ---
**Author:** ![Clothahump](https://avatars.discourse-cdn.com/v4/letter/c/51bf81/32.png) [@Clothahump](https://boards.straightdope.com/u/Clothahump)\ **Post date:** [December 28, 2009, 5:34am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/138 "2009-12-28T05:34:02Z")
> [@Wesley\_Clark](#): > > So the mother had a pregnancy, and the child has a variety of organ deformities which were spotted around 6 months. One does have to ask: why wasn’t there an abortion performed when these deformities were discovered? That would have been the logical thing to do. ---
**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 28, 2009, 6:48am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/139 "2009-12-28T06:48:21Z")
> [@curlcoat](#): > > You are expecting a multi billion dollar industry to care that this couple had a baby that was born sick? You are expecting them to ignore their stockholders and policyholder and pay out hundreds of thousands of dollars on a baby that may not be covered? Yes, I do expect that, because of the type of industry this company is in. And, this may blow your mind, but not every health insurance company is publicly traded, they don’t all have stockholders. This sort of crap is why I think health insurance should be a strictly not-for-profit enterprise as it is the for-profits that are the worst offenders. > [@](#): > > Actually, we don’t know that, since we have the story third hand. I did note that this is a couple that may have been married 20 years, so it is entirely possible that the mother is older and of an age where birth defects are not uncommon. The baby may have been conceived using IVF, which also ups the chance of birth defects. Heck, that could even be why the insurance isn’t paying - I haven’t seen such a policy, but it could be that any IVF baby born sick isn’t covered. Once again, you are manufacturing assumptions out of your own fantasies. We have no idea of how this child was conceived. Women have naturally conceived children into their fifties - it’s rare, but it does occur. Also - I have _never_ heard of a policy that excludes medical coverage for people conceived via IVF. And, if I recall, I have been more recently employed in the health insurance industry than you have. Prior attempts to exclude coverage for birth defects (as pre-existing conditions, usually) have wound up in the courts and were decided in the patient’s favor. Many states mandate coverage for all brith defects. > [@](#): > > I have no idea, but what you or I think is unreasonable isn’t important. It depends on what the insurance company thinks is unreasonable, based on their policy. It also depends on what the company thinks it can get away with not paying. > [@](#): > > What I said was that society has agreed that everyone has a right to have a baby, even if they are abusing the kids they already have. Actually… that is not true. Back when I worked in social services we had several women who were barred from having custody of children. One of them continued to produce babies, but they were, by court order, invariably were taken into state custody at birth, she wasn’t even permitted to see them. So, once again, we find your assumptions to be untrue. > [@](#): > > None of that has anything to do with medical ethics. If you chose to not abort a fetus genetically prone to some disease, that is fine. We have no information on the cause of the deformities mentioned in the OP. Only about 1/4 of birth defects have a clear, genetic cause. In other words, it is most likely (barring further information) that this is NOT a genetic disorder and could not be foreseen in any way. > [@](#): > > Just don’t expect anyone else to pay to help you raise it, and do not throw it out on society at 18 because it is now an adult and you are “no longer responsible”. Once again, we have someone dehumanizing a disabled person, in this case a child, by referring to the person as an “it”. **curlcoat** , why don’t you just admit you view the disabled as sub-human - except for yourself, of course. You’re disabled, but apparently we’re supposed to give you equal status to the rest of us. Just like you expect the rest of us to meekly comply with handing over our Federal tax money every month for your check. In other words, you’re still a hypocrite. > [@](#): > > If _you_ chose to have a kid that will have ongoing issues, _you_ are morally responsible for that kid for the rest of your life. And when the parents pass away? Should we just let the disabled starve, homeless on a sidewalk? Is that what you’re saying? Oh, wait - _you’re_ disabled, but we’re supposed to hand you a monthly check. Why should you receive government money but not someone else? > [@](#): > > Unfortunately, you are not legally responsible, which is why the taxpayers end up paying for all of these people whose parents cannot be bothered. Since you’re not a tax payer but rather a government money collector why do you care? > [@](#): > > Yup! Having a perfectly healthy baby thru easy routine childbirth is expensive as hell, yet you all have no problem expecting me, or an insurance company, to pay for your choice. You’re on the government benefit rolls - you don’t pay for anything. > [@](#): > > But to address your point, yes healthcare all around is expensive, but creating a multi-billion dollar government money hole isn’t going to change that one bit. Why do you object to government aid when you collect a check from the government every month? Don’t you have Medicare - you know, the _government health system?_ > [@](#): > > Which should take care of it and should have been your first move four months ago when you were unable to get the first bill paid. You now have 24 claims unpaid and more to come and you haven’t done anything but call United Healthcare? Oh, please - my last two years with Blue Cross I had the same shit. Every time a claim was submitted they pulled that same dodge: “Our records indicate you may another primary insurer”. I’d sign a stack of forms swearing I didn’t (because I didn’t), they’d pay one claim, then issue the same damn denial excuse for the next claim. It’s just a way for the health insurance companies to delay payment. They’re hoping you’ll miss something and wind up paying for something _they_ should be paying for. Why? Because it saves the company money. It’s that simple. Health insurers have a strong incentive to make it difficult for you to collect on your policy no matter how much in the right you are. > [@curlcoat](#): > > An insurance company cannot deny a claim without cause, and that cause is specified in insurance law. Oh, please - no one ever breaks the law? Get real. > [@](#): > > We don’t even know that the baby is covered, the care is covered, or anything else about the policy these folks have. You seem to be assuming that because these folks have insurance, everything must be covered. Not everything, but life-saving treatment is almost always covered. If the mother was covered by insurance prior to pregnancy I can’t imagine - based on working in the health care industry - that the baby isn’t covered, too. THAT battle was fought back in the early 1990’s and the result was that the insurers had to cover babies on a covered pregnancy. Yes, there are probably things not covered but there are past cases of health insurance companies trying to get out of paying out on a covered patient that suddenly got expensive. Legal or not. > [@](#): > > Hardly. Insurance is for paying for those things that are covered, generally for things that happen thru little or no fault of the insured. Childbirth and babies are _very_ expensive conditions that people choose to go thru, and it is entirely possible that this policy was written to try to save the policyholder from paying out hundreds of thousands of dollars on a baby that may or may not live for any length of time. Just as there are restrictions and caps on what insurance will pay for cancer treatment, there may also (finally) be on childbirth and neonatal. It sounds like the parents were more than adequately covered for a _normal_ pregancy and child, but not for this _completely unexpected_ catastrophic condition. Normal childbrith costs money, but it’s a leap to say it’s _very_ expensive. The average new SUV costs more than a _normal_ childbirth. If the child is covered the health insurance company really is obligated to spend the “hundreds of thousands of dollars” on the child’s care. Regardless of prognosis. And can we clear something up? It’s NOT the “policyholder” that will be paying out, it’s the _insurance company_. If an insurance company tries to avoid a payout it has NOTHING to do with safeguarding the “policyholder”, it has to do with safeguarding the insurance company. You claim to have worked in the industry yet you don’t know that? What did you do? Work in the mailroom? Empty the trash? You’d have to be pretty low down on the totem pole not to be cognizant that the insurance company really has only its own interests at heart. > [@](#): > > It says right in the OP “child is severely deformed and might die (the doctors say there will be tons of surgeries over the next few years). Now she has to quit her job to stay at home to raise the kid since it’ll be special needs.” The odds are not on this kid’s side, yet you see nothing wrong with expecting someone other than the parents to pay for those “very expensive operations” on the off chance the kid will grow up to lead a normal life. You accuse me of imagining the worst case scenario, yet you are doing the opposite - imagining sunshine and bunnies if that evil insurance company will only pony up. Yes. The insurance company sold a policy promising to cover health care. Failing to do that is a breach of contract and might even be fraudulent. If the insurance company isn’t willing to do what it promised to do then it would have been better for the parents to put their money elsewhere to guard against future catastrophe. You also seem miffed someone might staying home to take care of the kid. What alternative do you expect? Just chuck the kid to the curb? Is that how you think the disabled should be treated? In which case - how do you excuse the fact you yourself collect a government check every month due to your own disability? How do you justify sucking down government dollars on a regular basis? Why shoudl we pay for you and not someone else, such as this baby? The baby didn’t do anything to get into this situation while - well, we don’t know what sort of lifestyle you had, whether or not you took care of yourself, whether or not you did drugs and how much of them you took, or whether you drank or smoke. Maybe if you’d taken better care of yourself you wouldn’t be on disability, right? Isn’t that what you throw out for everyone else with a problem? > [@](#): > > Repeating this stupidity will not make it become true. Especially when it has nothing to do with the subject. It’s not “stupidity”, it’s a fact you handed to us. You collect a disability check every month from the government - yet you’re opposed to the government, or anyone else, helping anyone else. That’s called hypocrisy. I pay Federal taxes and it makes me furious that even a tiny fraction of them are going to support you. Why are you forcing me to pay for you? I could use that money for my own family. > [@Clothahump](#): > > One does have to ask: why wasn’t there an abortion performed when these deformities were discovered? That would have been the logical thing to do. We covered this already. The condition wasn’t discovered until 6 months into the pregnancy. Up until this year there were only 3 doctors in the entire US that would perform an abortion that late in a pregnancy. We now have only 2, because one of them was murdered in cold blood while attending church because he performed abortions. Getting an abortion that late in a pregnancy is no small feat and may well have been infeasible for a variety of reasons, one of the chief ones being that there are so few people performing them that late. ---
**Author:** ![spinky](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@spinky](https://boards.straightdope.com/u/spinky)\ **Post date:** [December 28, 2009, 7:34am UTC](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612/140 "2009-12-28T07:34:15Z")
> [@curlcoat](#): > > Yup! Having a perfectly healthy baby thru easy routine childbirth is expensive as hell, yet you all have no problem expecting me, or an insurance company, to pay for your choice. Actually, I don’t expect you to pay for it, but yes, you’re damned right I expect my insurance company to pay for it because they’ve contracted to do so. And the fact that it is so absurdly expensive is part of the problem. You see, if there weren’t so many uninsured people, there wouldn’t be so many people failing to pay their medical bills, and the hospitals wouldn’t have to inflate the prices of routine care to outrageous levels to compensate. > [@](#): > > [Reporting the issue to the insurance commissioner] should take care of it and should have been your first move four months ago when you were unable to get the first bill paid. You now have 24 claims unpaid and more to come and you haven’t done anything but call United Healthcare? Sure, because when party A fails to uphold their end of the contract, it is party B’s fault for failing to report it to the proper agencies. Thanks, Dick. I might add that having a newborn baby and a wife with two nonfunctional feet leaves one with slightly higher priorities than wading through bureaucracy and will you please forgive me if I express dismay at the state of affairs when the insurance company’s default position is to screw me until I force them to fulfill their obligation. PS: Fuck you. Besides this, I don’t have 24 unpaid claims. I currently have 2 unpaid claims. They were all denied, but most of the eventually get paid after a shitload of followup on my part and a few threatening invoices from the doctors and labs who rightfully want to be paid. I am starting to get the impression that UHC’s business model is making money on the float they enjoy by delaying payment for as long as possible, with a side benefit for their employees of making a sport out of trying to raise my blood pressure. If there were actually a free market, this sort of behavior on their part would hurt their bottom line because customers would be abandoning them for insanely shitty service. [Previous page](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612.md?page=6) [Next page](https://boards.straightdope.com/t/health-care-horror-story-13848732/522612.md?page=8)