And is the insurance company on solid ground with this “technicality?” It might be a good idea for this couple to consult with an attorney, possibly with state regulatory officials. I understand that recission is not a good way to make yourself terribly popular, lately, if you’re an insurance company.
OK, you hire a lawyer. They’ve already got lawyers. Lawyers who likely do nothing but this sort of work, and can be expected to have some serious expertise that your attorney probably does not have. Odds are at least decent that even if they lose, they’ll just have to pony up what they should have in the first place.
It’s also not a bad way to save a buck or two. Assume they have a 50% chance of prevailing in a civil action; their potential exposure is a 20% penalty, interest, and the original cost of care*; their potential gain is not having to pay the claim, plus recovery from the family mentioned by the OP of their costs and attorney’s fees.
It’s not like they have to worry about their credit rating getting ruined, or anything; meanwhile, Joe and Jane Policyholder do, since the patient is ultimately responsible for payment.
*That is, assuming they’re using language present in the insurance contract to fuck over their policyholders; if they’re just fucking them over, their potential exposure is significantly greater.
Well, it doesn’t really work that way. Insurers do not generally have access to better attorneys than plaintiffs. However, they are certainly likely to be better at hiring them than plaintiffs.
What is wrong with those people? The doctor says your baby is sick and has to be transferred to better hospital for a series of operations to save his life, and their first response should have been to sit down and check their coverage ?If they weren’t covered, their kid didn’t need the operation.
Aaah, civilization. Toiling together since the dawn of history, sharing strengths, harshing a living out of a cruel and uncaring world and making life easier and better for everyone, so that libertarians could be born and say “fuck all of y’all, me and mine !”.
Isn’t it ironic ? Don’t you think ?
Can’t you fuckers just pool all your piggy banks together and buy an island somewhere remote, to live out your [del]Lord of the Flies[/del] ideals in harmony ? And, if possible, cut off from all communications with us whatsoever ? A refuge from having to deal with us peons and chumps who don’t really feel like shitting on our neighbours even when we can, that sort of thing ?
I think I recall brother elucidator’s been working on a list of people to be put against the wall come the Revolution. He should know. 
Well, that and the knowledge that the law shields them from punitive damages.
Then there’s altruists like this.
Assuming the child was actually covered under the policy and all of that, the insurance company wanted your friend to provide to them the information they didn’t have so they would understand why the baby needed the extra care. Or do you just assume that the big company insurance is evil but the big company hospital couldn’t possibly have made a mistake in billing?
Because its a baybee. Birthin’ babies is the only thing you can do that you can get everyone else to pay for with little to no complaint. No matter who you are, whether or not you can pay for it, whether you would be a decent parent, whether you have serious genetic illnesses and/or have produced previous babies with them. You don’t even have to stop drinking, taking drugs and/or abusing your previous kids! Everybody has a right to have babies that the rest of us have to pay for! :smack:
Seriously tho, I just don’t understand why it is that society thinks it’s ok to force everyone to pay for extraordinary care on the one in 1000 chance that this baby would have a decent life. Such as Juliana Wetmore (“the girl without a face”) - millions of dollars in surgery so far, paid for by taxpayers. She was born because her parents don’t believe in abortion - fine, but why force me to pay for your choices?
Far too many people assume that because they have insurance, that policy will pay for everything, no matter how expensive or unreasonable. We don’t have many details in this story, but one thing that would cause a denial would be if the parents went out of network to get the best care, but they actually could get adequate care in network. It’s their choice if they want to pay for the best care, but it shouldn’t also be that we all have to help them pay for it too.
[Jean Shepard]curlcoat wove a tapestry of inane corporate apologetics that to this day is hanging in space somewhere over the Newport Beach Back Bay.[/Jean Shepard]
Those are interesting points. However my rant was about the fact that, on top of all the stress this couple is currently going through (both are taking time off of work, she may have to quit her job to raise the child, her health being at risk, their child’s health being at risk) they also have to deal with an insurance company looking for a technicality to avoid paying. That is kicking someone when they are down. 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.
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. Its the ultimate slap in the face IMO to do this at such a sensitive time.
My rant was about that, kicking people when they are down and the fundamental structural flaws of our current health system.
However to address your points, what is unreasonable about neonatal care (this is not world class care as far as I know)? My understanding is that because he works in health care his insurance only covers care to providers related to his work (something like that). And again, my impression is that they felt insurance would cover the cost at first, but once the bills started rolling in the company found a way to avoid paying. Had they refused to pay up front I don’t think this would bother me as much. It would still bother me, but not as much because it makes me think that they agreed to pay, then found a clause somewhere in the health insurance paperwork that gets them off the hook. 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.
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.
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. The events in my life that have made me more compassionate and wiser were events that destroyed my social status and short term emotional gratification. What would I be without them?
Eleanor Roosevelt was ugly, and FDR had polio which paralyzed him. However she helped write the Universal Declaration of Human Rights and after becoming president he signed a law outlawing child labor in 1938. Would we be better off as a society if they had been aborted by their parents because genetic tests had shown she would grow up to be ugly and he would grow up to be disabled?
That kind of defects aren’t found out early enough for a legal termination.
Not quite it, Wes. Raising a severely handicapped child is a major challenge, and not everyone is up to it. I will not sit in judgment of someone who looks into themselves and does not find the strength. Such an brutally honest self-assessment is necessary, this is no time for pious vanity, for pretending you can do something you can’t do, simply because you think you are supposed to be able to. You can’t give what you ain’t got.
Right, there would not have been a Universal Declaration of Human Rights but for the contribution of the former and children would still be down the mines today but for the latter. Utterly provincial nonsense.
Just for clarification: What gave you that impression? It sounds like a policy (which is common) where out-of-network expenses are not covered unless emergency or pre-approved. This helps to keep costs down, and most people would agree it’s reasonable, so long as pre-approvals are not unreasonably withheld.
Are you assuming this or do you know? I ask because what you describe sounds like we’re missing something.
And I know some people (I’m not suggesting you) believe implicitly that we all have the right to all medical options available, cost be damned, but that is simply not a sustainable model. I say that acknowledging that, like most human beings, I would want the same for my loved ones as well. But it’s not realistic. So, it seems distasteful to us, but it is reasonable to ask how effective a treatment will be, how likely it will produce a good effect, relative to its cost; policies attempt to mirror those value judgments. And they must, because we cannot all of us, everyone, have access to every possible treatment. I couldn’t afford the policy that provides that coverage, and I make a decent living.
Funny you should make this claim, as I am currently going through the hell that is getting my insurance company to actually step up and willingly pay for my wholly-routine childbirth which was done in an In-Network hospital and by In-Network doctors.
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.
ntucker, on what basis did they deny the claim? Who is the insurer?
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).
I guess I could take the capitalist approach and vote with my dollars by buying my own insurance instead of taking the limited options my employer gives me (or hey I could find a new job! Yeah, what a sensible thing to have tied to healthcare). But that is of course very expensive due to the inherently non-free-market nature of healthcare that the libertarian zealots like to ignore.
That may be true at his workplace but not because he works in health care.
I work in health care and typically the way my medical center offers plans is that we get a choice of one insurance company’s different coverage types - EPO (pays lots at the medical center you work at, pays less elsewhere), or PPO (pays an even amount everywhere, except for locations that don’t take that insurance company at all). Those types of plans don’t require referrals when you’re seeing specialists; you can opt to go to one at your discretion. Naturally, there are also HMO plans that require referrals. All of these require pre-approvals/approvals for surgery and hospital admissions, etc.
I worked in a hospital before this that didn’t have an EPO option - we had a HMO versus two varieties of PPO.
My wild guess is that he has an EPO that favors his workplace. It might be the only thing his workplace offers, or maybe he figured it would cover the most in the way of charges and thought they’d be best off with that. If you work at a major hospital like I do, that’s a pretty awesome plan. If you work at a smaller place or suddenly run into one of those uncommon situations where your workplace can’t handle the complicated situation, then you end up paying more than you would otherwise.
One thing the liberals all forget, rather conveniently I feel.
Lack of universal heatlhcare reduces market flexibility, workers cannot move from one employer to another without careful consideration of the total package.
It means that talent cannot move across the labour market as easily as it might.
If you suspect you have any reason to believe another insurer might not cover you as a new policy holder, you will stay where you are, unless you are forced out.
Imagine the other version, it does not matter which employer you work for, you do not have to worry about healthcare plans, you can move, and employers have less difficulty in attracting talent. More flexible labour markets means more choice for employers.
Since it is felxible employment that keep an economy dynamic and wealth producing, it make no sense whatsoever to shackle the wealth producers in this way - the only benefit gained is to the insurance industry - whcih in itself does not create wealth, nor does it innovate in any meaningful way.
All insurance does is provide some sort of security - but not in the case of medical insurance - which actually reduces personal security - it certainly does not create basic wealth, it services and feeds off production, and in this case it also shackles labour.
As far as the debate about aborting this baby, which would have been too late term for that legally, no one has thought of the third and best option? Let the baby be born normally and receive normal care. Now if it dies because of problems you have not run up all these bills, and you also have not aborted anything.
If God wants the baby to live you have given that opportunity, there is the best answer to this whole debate over the baby, and no one thought about that? No one need feel bad about whatever happens, no one is broke or needing lawyers, and no one has an abortion either, which is also an added cost. It would all be done at that covered hospital, and there is the elegant solution to this.