Up to 50% of Americans claiming insurance for major medical problems may find their claim denied

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Up to 50% of Americans claiming insurance for major medical problems may find their claim denied

Yet another sign of the ethics free and moral free American Health care system, where profits are placed above peoples health.

If you are in real need of help, with a huge bill, that anyone could encounter each day they step outside, you might only have a 50/50 chance of getting it paid. American health care is great, unless you actually need it.

"Rescission" is the action of denying medical claims by the insurance companies.

From the article linked below...
... Quote:
An individual adult insurance plan is roughly $7,000 (varies dramatically by age and somewhat by sex and location).

It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesn’t make a lot of sense for the insurance company to take the nuclear option of blowing up the policy. $11,487 in claims is less than two years’ premium; less than one if the individual has family coverage in the $12,000 price range.

But that top one percent, the folks responsible for more than $35,000 of costs – sometimes far, far more – well there, ladies and gentlemen, is where the money comes in. Once an insurance company knows that Sally has breast cancer, it has already seen the goat; it knows it wants nothing to do with Sally.

If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population).

If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population.

If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

And people shout that they don't want change.

By netchicken: posted on 6-8-2009

I thought this was appropriate....


This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the US department of energy. I then took a shower in the clean water provided by the municipal water utility.

After that, I turned on the TV to one of the FCC regulated channels to see what the national weather service of the national oceanographic and atmospheric administration determined the weather was going to be like using satellites designed, built, and launched by the national aeronautics and space administration.

I watched this while eating my breakfast of US department of agriculture inspected food and taking the drugs which have been determined as safe by the food and drug administration.

At the appropriate time as regulated by the US congress and kept accurate by the national institute of standards and technology and the US naval observatory, I get into my national highway traffic safety administration approved automobile and set out to work on the roads build by the local, state, and federal departments of transportation, possibly stopping to purchase additional fuel of a quality level determined by the environmental protection agency, using legal tender issued by the federal reserve bank.

On the way out the door I deposit any mail I have to be sent out via the US postal service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the department of labor and the occupational safety and health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all it's valuables thanks to the local police department.

I then log on to the internet which was developed by the defense advanced research projects administration and post on freerepublic.com and fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right.

By netchicken: posted on 10-8-2009

The brutal truth about America’s healthcare

The LA Forum in Inglewood, California, hosted dental and medical examinations, for thousands of people thanks to the charity Remote Area Medical.

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.

In the week that Britain's National Health Service was held aloft by Republicans as an "evil and Orwellian" example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.

The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed – for eight days only – into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.

... Quote:
You'd think, with the money in this country, that we'd be able to look after people's health properly," she said. "But the truth is that the rich, and the insurance firms, just don't realise what we are going through, or simply don't care. Look around this room and tell me that America's healthcare don't need fixing.
Read the rest of the article on the disturbing lack of health care not found in other western countries.

Stats below from link above.

Health spending as a share of GDP
US 16%
UK 8.4%

Public spending on healthcare (% of total spending on healthcare)
US 45%
UK 82%

Health spending per head
US $7,290
UK $2,992

Practising physicians (per 1,000 people)
US 2.4
UK 2.5

Nurses (per 1,000 people)
US 10.6
UK 10.0

Acute care hospital beds (per 1,000 people)
US 2.7
UK 2.6

Life expectancy:
US 78
UK 80

Infant mortality (per 1,000 live births)
US 6.7
UK 4.8

Source: WHO/OECD Health Data 2009
By netchicken: posted on 16-8-2009

Here are the anti health care protesters, tightly organized paid employees of America’s Health Insurance Plans. The parasites fight back.

A spokesman for America’s Health Insurance Plans, the industry’s trade group, admitted in an article published Monday that as many as 50,000 industry employees are involved in an effort to fight back against aggressive health care reform.

The admission, published in the last sentence of a Wall Street Journal article, highlights the stakes of potential healthcare reform for the private health insurance industry. Insurers and investors alike are terrified at the prospect of a so-called “public option,” which would create a government-run health insurance program to compete with private insurers. Because the government plan wouldn’t have to earn a profit, the plan would be able to undercut the premiums of private firms, pressuring profit margins.

... Quote:
The health-insurance industry is sending thousands of its employees to town-hall meetings and other forums during Congress’s August recess to try to counter a tide of criticism directed at the insurers and remain a player — and not an outsider — in the debate over the future of the health-care system,
the Journal’s Vanessa Fuhrmans and Avery Johnson wrote Monday.

By netchicken: posted on 25-8-2009

Back to the original topic of this thread, is more on the people who manipulate your opinions and tell you what to think.

Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.

“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.

Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.

By netchicken: posted on 28-8-2009

Here in terms and stick figures anyone can understand is the primary reason you need public health care. Watch it.

By netchicken: posted on 28-8-2009

Twenty one percent of all claims for medical care denied in California.

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released today by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care - 21 percent of all claims.
... Quote:
With all the dishonest claims made by some politicians about alleged 'death panels' in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation's biggest and wealthiest insurance companies simply because they don't want to pay for it,
said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

PacifiCare denied 40 percent of all California claims in the first six months of 2009.
Cigna is rejecting one-third of all claims for the first half of 2009.
... Quote:
Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,
said Burger.

California Blues rejected 28 percent of claims in the first half of 2009.

Kaiser Permanente, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later."

Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.
... Quote:
The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about.

Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.

The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation.
she said.

By netchicken: posted on 6-9-2009

What the hell happened to this thread?

I finally get some time to come back and it's gone?
By Venus: posted on 12-9-2009

Venus- I tidied it up.

Yet more examples of the wonderful Private health system. The same people who take your money, don't pony up when you need help.

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

"This is probably the most egregious of examples of health insurers using their power and their resources to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous activity on the part of the insurers."

Much of that process was a condition of settlements with state overseers, who fined Blue Cross $11 million over the past two years and required it, and all other major insurers in California, to restore canceled policies. Insurers still face court challenges, including a class-action suit targeting Blue Cross on behalf of 6,000 canceled policyholders.

"These cases are very, very good in front of a jury," said Bill Shernoff, whose Claremont law firm has settled 90 cases and has 130 cases pending. "I wish I could tell you the amount of money they throw at us just to make it go away and keep quiet."

In the only case to go to trial in California, an arbitration judge awarded $9 million to a beautician who had to stop chemotherapy for her breast cancer after Health Net dropped her policy. Company officials declined to comment.

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. Blue Shield officials said they would not comment on a pending case.

Officials from three insurance companies told a House Energy and Commerce subcommittee this summer they had saved $300 million by canceling about 20,000 policies over five years.

Critics charge that companies, rather than vetting applicants, wait until a claim is filed. "It only happens if you create this bill. Then they go back into your application," said Dev GnanaDev, president of the California Medical Association, which lobbied Democratic House leaders to include restrictions on cancellations in their legislation. "Costco doesn't let me take something back after 90 days," he said. "If they want to investigate, let them do it within 90 days."

Regulators say many omissions appear to be honest mistakes on forms that are needlessly complex. Others result from ambiguous conversations between patient and doctor.

Yvette Thomassian of Glendale, Calif., lost her Blue Cross policy because she did not declare a deviated septum. She questioned why a common misalignment of the nostrils would disqualify anyone but emphasized that her doctor never clearly indicated she had the condition. They spoke Armenian in the exam room, she said, where the physician's words were "You have a bone in your nose."

"It's been three years of hell," said Thomassian, whose suit over the $31,000 in bills is scheduled for trial in January. Blue Cross officials said they would not discuss specific cases.

For Teresa Dietrich, it was fibroids. The Northern California real estate agent was left to pay $19,000 after Blue Cross said she did not disclose a diagnosis of the benign uterine tumors. But Dietrich said the doctor who had written "fibroids" on her medical record never mentioned his suspicions to her. The bills destroyed her credit and cost her her home -- and, in a comically cruel twist, the surgery proved the doctor was wrong.

"They said I had a condition I didn't even have," Dietrich said. "And they canceled me."

If federal health-care reform bars companies from screening for preexisting conditions, insurers note that cancellations will no longer be an issue. But Melinda Beeuwkes Buntin, an economist at the Rand Corp., said that unless for-profit companies are compensated for taking higher-risk patients, the firms will continue to look for ways to unload them.

"They wouldn't be able to overtly kick you out, but that doesn't mean that they might not put, for example, more onerous preauthorization requirements on services that people who are at risk might need, and that might discourage you from re-enrolling next year," Buntin said.

She said one solution would be for Washington to subsidize insurers that take on higher-risk patients. The government does such "risk adjustment" for the private insurance provided through Medicare Advantage -- though Obama has called for ending those subsidies to finance reform.

"You can ban rescission," Buntin said, "but what we really want is a system under which insurers' incentives are aligned with treating all of their patients well, whether they're sick or healthy."

By netchicken: posted on 24-9-2009

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