How Crafty Health Insurers Are Denying Care

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Thanks for digging into the areas of this health care problem that does not seem to get the publicity and scrutiny it should. These greedy practices by the insurers needs to be controlled.

Ken of MN 11:23AM September 16, 2009

i cannot begin to describe how horrifying aetna treated me. they denied a surgery that was very specifically covered in their literature. i eventually got the surgery 2 1/2 years later, but now i am unable to ever work again because they took too long. when all is said and done, it took 2 1/2 years and the insurance company paid out about 40K in claims to prove i needed a 5K surgery. the appeals board took less than 10 minutes to decide in my favor. my work had to scrap a four month project because i was off and on short term disability for 2 1/2 years. that probably cost the insurance company at least 200K (i made a lot of money) as they were paying my std wages instead of my employer. my employer did not get this excellent new product out. the coworkers were too busy covering for me, so they didn't get anything done. and now, i am on permanent disability to the tune of almost 100K a year. 100K spending on nothing, no vacations, no trips, nothing because i am in too much pain constantly as i die slowly.
even if you have the world's best private insurance, you are still screwed. the only solution is to completely dismantle private insurance companies and socialize it. as for the fools who actually believe about these death squads, they already exist -- they are called "insurance adjusters". they cost me my life, but not quick and painless like euthanasia.

not ms. nicer at aetna of FL 2:56PM August 15, 2009

It is true that more people need to die in the United States. It IS true that more people in the United States need to become comfortable with death.
It IS ridiculous to spend tens of thousands of dollars on heart bypass surgeries for people over 80 years of age (this was done for my father). We need to stop spending most of the money that is spent on the average person in this country for medical care, in the last--what is it?--2 years of life. It's ridiculous.
We need to pull the plug on people in vegetative states rather than keeping them in comas for months & years.
In short, we need to shift the financial burden from health insurance companies to life insurance companies. Pay up, Prudential!

tramky of CA 1:44AM June 01, 2009

A lot of these health 'insurers' are really just financial scams designed to extract as much money as possible from as many people as possible, then denying coerage to as many people as possible. This is their game.
We want the executives of these companies to be IN JAIL. In STATE PRISON. For many YEARS!
Either that or drag them out of their offices, tar & feather them, and ride them out of town on a rail. These people think they have the right to make decisions that effect the physical being of patients--we should start making some decisions about the physical being of these clowns. Drag 'em out by their heels!

tramky of CA 1:31AM June 01, 2009

It was enlightening to read that most states can review insurance company denials. Over the last several weeks, several providers have call United to get authorization for coverage. United staff have told them that the particular treatment isn't covered under my plan, so of course this ends the providers' requests. United then lists the requests as withdrawn or rescinded, rather than denied, so I cannot even get a letter of denial and appeal. This has got to stop.

Stephan McCaffery of AZ 12:48PM January 15, 2009

"Nor do insurers provide much detail about the professionals making decisions. Who are they? What's their experience? Are they moonlighters denying care from New Delhi? (Yes, many large insurers are now outsourcing claims adjudication to India.)"
I worked at a well-known health insurer, known for its "quietude" (ahem). Now, we all have a mental image of a doctor sitting in an office, carefully studying medical records, to come to some kind of balanced, yet cost-effective decision about our care (well, maybe not). As a new employee, I was stunned to overhear a fellow employee making these life and death decisions...the person making the decisions was a nurse. Nurses are well-educated, hard-working people, but I do not want them making these sorts of decisions. It was grossly inappropriate and cheap. Oversight on the decision-making process is urgently needed. Good grief!

Shocked, Just Shocked of OR 4:07PM January 07, 2009

What I really want to know is how to help the Attorney General go after these guys as I have plenty of evidence to supply. Just tell me where to send them!

jp of CA 9:31PM December 05, 2008

Doctors and Dentist have a monopoloy on the charges that are passed along to you are your insurance company. There is no cost analysis to see if the charges are honest are even applicable to your treatment. Dentist seem to have a set cost for certain treatments. The Dental cost is the same from one Dentist to another.
It like the oil companies all selling gas for the same price.
If these costs are questioned by your insurance company. The story is the told the insurance company is the villian.
The story of the cancer drugs is another. If you take these drugs to extend a life from 1 year to 1.87 years and it cost $190,000 as long as someone else is paying it O.K. However, would you have the same answer if it would take all your saving and leave your family broke after you die.

Oscar of GA 6:52PM October 18, 2008

So you believe that the insurance companies can deny anyone medical coverage regardless of the validity of the denile because they want to save a little cash? Thats ridiculous, the people that get denied are paying customers that are refused what they are buying because of trivial reasons. that is the same as buying a brand new computer on Ebay and getting an empty box, and then having someone say that you wont recieve the computer because you fogot to fill out a form correctly but they are going to keep your money anyway. These insurance companies are corrupt and have caused many people to die because of denied medical care.

Some student of OR 7:28PM October 15, 2008

You claim that if we "take the profit motive out of healthcare, it eliminates a whole host of evils and people get much better care". What is your basis of evidence here? The fact is, for-profit healthcare institutions have consistently better outcomes and lower costs than non-profits. In addition, we live in a free market economy, and making a profit (or at least breakeven) is necessary to sustain any operation.
Finally, no physician should be under any obligation to see any patient (outside of the ED), regardless of their health insurance. You can call is unpatriotic until the cows come home, but individuals running a business should continue to have every right to refuse service to anyone they want.

MHA/MBA Grad of NE 2:21PM October 14, 2008