Health care horror stories – Part IISeptember 15, 2009Jon Brooks 1 Comment »
Amid the posturing, politicking, and general confusion of the health care debate, it’s easy to lose sight of the situation on the ground and the reasons that reform made it to the top of the agenda in the first place. The growing number of uninsured is one major factor, and the sense of powerlessness among many who have been forced to negotiate and plead with their insurance companies is another. In a series of posts this week we present health care horror stories gleaned from consumer sites online. Keeping in mind that a license to complain is issued with every keyboard nowadays, the sheer breadth and scope of these Kafkaesque encounters, coupled with the frequent tone of weariness and desperation in their recounting, serve as a powerful indictment of the present system.These extracts have been edited for spelling, grammar, and length. A list of sites from which they were taken can be found at the end of the text. Part I in this series here.
On January 20, the local hospital called to say they had a kidney ready for my wife’s transplant, but we couldn’t have it done because the insurance hadn’t approved it. Now, the company tells us they will not approve a transplant in Tulsa; it has to be done at Baylor University in Texas. Baylor told my wife that she has to fill out a bunch of forms and wait again for a kidney. It’s going to be expensive for us to spend time in Texas. Meanwhile, my wife’s company is again up for sale. If they cut back on employment, move to a different region, cancel insurance or change insurance companies, she will again be unable to get the transplant. Please complain to your congressmen and other politicians. This kind of thing must stop.
My first run-in with managed care was when I went to the HMO emergency room for severe pain in my back right where the kidneys are. After a 4-hour wait they took a urine sample. Since that came up normal, they sent me away with instructions to make an appointment with my primary care physician (PCP).
I did that, figuring I could bear the pain for that long. Two weeks later I went to see the PCP, only to be told that I needed to reschedule. I saw her two weeks later; she ordered some blood tests and a urinalysis, and referred me to a urologist.
Four more weeks went by before I could see the urologist. He ordered another urinalysis – the one ordered by my PCP had been thrown out because a PCP is not authorized to order a urinalysis! Two more weeks of pain, and I went back, only to find that there were no clear results and I should have yet another test.
It took 6 more weeks to get that test scheduled. When I showed up, I was told that the machine that develops the X-ray films was not working, and I would have to reschedule. Four more weeks. The total elapsed time is now about 6 months. If this had been an unusual kidney infection I would have long since been dead. Apparently the HMO wished I was.
When I was working for a small company, they purchased individual policies for us. These policies all had a $2000 pre-existing condition limitation for the first year. There were three of us who exceeded the $2000. One broke her foot six months after starting work. This was denied as a “pre-existing condition.” No amount of additional information or appeals or grievances would change that. Eventually, what did change it (15 months later) was that she had a secondary insurer through her husband’s employer, and they paid it. The secondary insurer then sent to the insurance company a letter saying essentially “we have as many lawyers as you do, and will not only win this case but get punitive damages from it.”
It has come to my attention through denied emergency room insurance claims that several Southland emergency rooms are no longer negotiating physician contracts with my insurance company. The company is denying ER claims, deeming them “out of network.” However, it continues to sell corporate and individual policies stating emergency room coverage is included after a one hundred dollar deductible is paid. This fraudulent activity is not only a gross misrepresentation of coverage, it is a blatant lie…and clearly insurance fraud. One doctor told me he receives daily calls from shocked patients who are being billed, in addition to the one hundred dollar co-pay, for ER visits.
My sister Bonnie had MS. Her sudden death at age 49 of coronary arrest was attributable to the pain she struggled with and the lack of treatment she received. She had an MRI done one year prior to her death, which revealed spinal disc damage that directly contributed to increasing pain, depression, and lack of sleep. Her insurance company-appointed case mgr denied there was any pain and also did not refer Bonnie for evaluation for possible relief. Instead they cancelled her physical therapy treatments and acupuncture. They insisted that she could not be helped, even when the doctor who was managing her treatment resigned over differences in her therapy. Bonnie’s death was a cumulative effect of constant pain, depression, and neglect. Calls to her plan physicians following her death were never answered.
Bonnie was a Senior deputy in the Los Angeles City Council. She managed Business Revitalization projects in the downtown area as well as special programs for disabled and homeless citizens. She was a special liaison to the LAPD and was very involved in their morale development and continuing education as well as budgetary and planning issues. With all she was able to do, she could still not get the Cigna HMO process to help her in the slightest bit.
Our managed care organization was using automatic debit to deduct our premiums from the wrong checking account, and they terminated our memberships because of their mistake. I submitted a written appeal, as required, to their FAX. When I called to ask whether the fax had been recieved, I was told “It takes six days for fax communication to be delivered.” So, I called after six days and asked, “What’s the status? When can I expect a decision?” I was told, “You’ll recieve a call and a letter by Friday.” I did not get either. I called on the following Monday, and was put off again – “It’s in committee being reviewed.”
On Friday, I contact Direct Pay Customer Service, and they tell me it takes at least a month for the review process to complete.
“So, what’re we supposed to do for insulin, asthma medication, and so forth in the mean time?” I ask.
“Sir, you’re not the only member whose appeal is being considered,” she says.
“I don’t see how that answers my question. When will I get an answer?”
“Look,” she says, “We’re doing you a favor by even considering this.”
Today I got the letter that says, “We regret to inform you that we must deny your appeal.”
I want a written record of their deliberations including an explanation of the reasons. Like, is it because we’re too old, and both need medications that are fairly expensive, and they’ve got the long-term fear of carrying a cancer survivor with asthma and diabetes who’s become disabled and they’re foreseeing a lot more potential expense? Or is it because after nearly beggaring myself to keep their coverage, I’m a bad payment risk?