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Old 06-24-2009, 12:48 PM
 
52 posts, read 233,482 times
Reputation: 43

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I was having a little bout of insomnia last night and flipping through channels I settled on one of the C-Span ones and after seeing what I saw I have to say I was having even more trouble sleeping...

Has anyone heard of this happenning?

You have an Individual Insurance Policy and as usual when you sign up you fill out the questionnaire and are are honest as your memory serves...and pay your monthly premiums...so far so good...after a few years, heaven forbid, you find out you have a costly illness...like cancer. You start a treatment and all of a sudden get a call from your insurance company...sorry your insurance has been cancelled and rescinded...BACK to the day your coverage started...so...whatever they have not paid yet they are not paying and what's more you have no coverage now for whatever treatment you need. They say they looked back at your file and saw a red flag...and investigated and apparently because you never mentioned you had gall stones you are considered a fraud and that's why it's being cancelled. Meanwhile your doc did that cat scan 3 years ago to check out something else in your body and never even told you have gall stones nor were you ever treated for them...so you never knew.

They had 3 witnesses in front of the Congressional Committee at this hearing and this is one of the stories...Blue Cross/Blue Shield was one of the insurance companies in 2 of the cases and the other one I don't know I could not make it out when they pronounced it. One of the witnesses was a cancer patient and she said her church friend works for Blue Cross?Blue Shield and that when they see one customer has too many visits to the doctor or starts a costly treatment they go back and try to look at anything they possibly can to then try and claim there was some fraud at sign up just to cancel insurance plans that were costing them too much money!

I know this is lenghty but I thought it was worth bringing up...who knows if anyone knows someone affected..and people think they have no recourse...and just wait to die at home...apparently you can contact your state's Attorney General's office and/or your Congressman/woman and they will take up your cause with the insurance company...they have been successful in helping some people have their coverage reinstated. I hope no one knows anyone in this position but if you do...please pass this on!

A HEALTHY and happy one to all!
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Old 06-24-2009, 02:43 PM
 
Location: Portland, Oregon
7,084 posts, read 12,022,410 times
Reputation: 4125
That is complete bull, I'm a big proponent for private health insurance but this trend needs to die. I think there needs to be risk management, but this is the outright wrong way to do it (UHC is even worse about it then BCBS). If there is fraud it's different, but in many cases there is none.
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Old 06-24-2009, 04:23 PM
 
Location: home state of Myrtle Beach!
6,889 posts, read 22,449,317 times
Reputation: 4559
I am left wondering why we insist on increasing life expectancy at such a huge cost to this country.
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Old 06-24-2009, 05:11 PM
 
Location: Central Ohio
10,808 posts, read 14,875,742 times
Reputation: 16471
Quote:
Originally Posted by arabella22 View Post
I was having a little bout of insomnia last night and flipping through channels I settled on one of the C-Span ones and after seeing what I saw I have to say I was having even more trouble sleeping...

Has anyone heard of this happenning?
Happens all the time but you don't notice it until it happens to you or someone you love.

To put it in perspective with automobile insurance.

You must have auto insurance to drive.

Never having had a speeding ticket or accident your auto insurance is relatively cheap running $400 per month.

But one day you are caught traveling 72 mph down the interstate where it is marked 65 mph.

You are obviously a poor driver and risk. The next month you receive notice your auto insurance is going to be put into a pool of equal risk drivers and your new premium rate will be $750 per month.

You go to other insurance companies and they quote rates equally high, as if they fixed prices which you know they wouldn't do because that would be illegal, or they decline to insure you for any price.

But bad luck is at your door. Dodging to miss a stray dog in the road you sideswipe a car causing $5,000 in damage. Your insurance company pays the claim but the next month you are notified you're in the super duper club and your insurance rates are now set at $1,250 a month. You also know, through the experience of others, this rate will never go down regardless of how good a driver you become or your future ticket history. $1,250 a month for the rest of your life.

Or so you thought.

The next year you are notified the premium will be $1,725 per month. You shop only to find everyone declines to offer your a policy at any price. You can not purchase any other policy.

Another year goes by and your policy premium is bumped again to $2.660 per month. You have difficulty paying, it is really strapping your style and one month you are one day late getting the premium in the mail.

Like a flash you get notice the only policy you can purchase is cancelled for non-payment.

You shop and shop and shop. Every company you approach laughs, clucks their tongue and tells you no, you can not purchase an auto policy from them at any price. Any price, are you serious? You offer $20,000 for one month of coverage and they decline, they are serious.

If you're in good health, young and with personal policy it works pretty good, pretty cheap and all. But God help you should you develop skin cancer, Crohn's disease, diabetes or any of hundreds of other diseases because while you are covered now your rates are about to go to the stratosphere.

Knew a guy in the late 80's that owned a bicycle shop. His wife developed cancer and he he paid premiums until they got to $2,600 a month at which time his premiums were more than he could make at the bicycle shop.

He went naked, went bankrupt, his wife went toe emergency room for which the taxpayer paid and finally she died.

If we have some sort of national system everyone has to pay, everyone has to be insured and as we are a huge group nobody can ever be declined for a pre-existing condition if you were covered for that condition when you came down with it.
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Old 06-25-2009, 05:56 PM
 
947 posts, read 3,131,968 times
Reputation: 736
Sounds like something out of a John Grisham novel. Then again, if you can think it, it can happen.

It doesn't surprise me in the least that insurance companies do this or would do this. I think everything is about profit now.

I wonder if that is where the term "managed care" or "Health Management Organization" comes from.
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Old 06-25-2009, 06:41 PM
 
Location: Indianapolis, IN
914 posts, read 4,435,675 times
Reputation: 854
I saw this happen a few times when I was a medical biller. It is very sad. Especially because the insurance companies like to play the innocent game. They will tell you it is everyone's fault but theirs. Very frustrating. None of the cases I saw turned out positively in the end, either.

I also wanted to add to the recommendation of the OP to contact the Attorney General or a Congressmen . . . another good state resource can be the state's Insurance Commissioner. Not all states have one, or have a very good one, but some states have an excellent Insurance Commissioner's offices. They can be a good resource for information on your rights (they vary state to state) and might even be able to help you with your case. This is also an office that tracks things like repeat offenders. Montana, for instance, has a great Insurance Commissioner. I used his office as a resource a few times when I was a medical biller in that state, and they were always fantastic!
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Old 06-25-2009, 10:06 PM
'M'
 
Location: Glendale Country Club
1,954 posts, read 3,180,930 times
Reputation: 2813
Now I understand why insurance companies ask for medical records five years previous...isn't it interesting that docs don't seem to be proactive and take advantage to interpret an entire CT scan or MRI...whatever...to look at the BIG picture for a patient's health? And... when the insurance co. gets the medical records, instead of reviewing all of them to see if they see anything that could present a future health concern....they stay mum until their client gets really sick...then, after it may be too late, they review the medical records in order to deny treatment to their client? Bottom line: Does anyone else think this is unethical, or at the very least, lazy?
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Old 06-25-2009, 11:07 PM
 
Location: home state of Myrtle Beach!
6,889 posts, read 22,449,317 times
Reputation: 4559
Quote:
Originally Posted by 'M' View Post
Now I understand why insurance companies ask for medical records five years previous...isn't it interesting that docs don't seem to be proactive and take advantage to interpret an entire CT scan or MRI...whatever...to look at the BIG picture for a patient's health? And... when the insurance co. gets the medical records, instead of reviewing all of them to see if they see anything that could present a future health concern....they stay mum until their client gets really sick...then, after it may be too late, they review the medical records in order to deny treatment to their client? Bottom line: Does anyone else think this is unethical, or at the very least, lazy?
lazy, no, unethical, definitely. I will be unemployed as of next Wednesday and any cuts I make are going to hit my insurance companies first because I can't possibly keep up with the high cost and keep the same level of coverage in the coming years.
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Old 06-25-2009, 11:19 PM
 
52 posts, read 233,482 times
Reputation: 43
Default Thanks for the add!

Quote:
Originally Posted by Jillaceae View Post
I saw this happen a few times when I was a medical biller. It is very sad. Especially because the insurance companies like to play the innocent game. They will tell you it is everyone's fault but theirs. Very frustrating. None of the cases I saw turned out positively in the end, either.

I also wanted to add to the recommendation of the OP to contact the Attorney General or a Congressmen . . . another good state resource can be the state's Insurance Commissioner. Not all states have one, or have a very good one, but some states have an excellent Insurance Commissioner's offices. They can be a good resource for information on your rights (they vary state to state) and might even be able to help you with your case. This is also an office that tracks things like repeat offenders. Montana, for instance, has a great Insurance Commissioner. I used his office as a resource a few times when I was a medical biller in that state, and they were always fantastic!
It's great that there are states that have the added recourse options!
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Old 06-25-2009, 11:22 PM
 
52 posts, read 233,482 times
Reputation: 43
Default Tottaly Unethical!

Quote:
Originally Posted by 'M' View Post
Now I understand why insurance companies ask for medical records five years previous...isn't it interesting that docs don't seem to be proactive and take advantage to interpret an entire CT scan or MRI...whatever...to look at the BIG picture for a patient's health? And... when the insurance co. gets the medical records, instead of reviewing all of them to see if they see anything that could present a future health concern....they stay mum until their client gets really sick...then, after it may be too late, they review the medical records in order to deny treatment to their client? Bottom line: Does anyone else think this is unethical, or at the very least, lazy?
Unethical! Immoral! Irresponsible...and the list goes on and on...to me this is "legal murder" until they change the laws to control this kind of thing. The bottom line is...it's all about the money...they'd rather let you die and do a quick autopsy to determine cause of death then treat you for something to help you live a normal life...

At the end of the day...it's beaurocrats that make the decisions for "Managed Health Care" not doctors.
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