Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!

Some may know – especially those who have been following my most recent blogs related to a return of Prostate Cancer that I’ve been dealing with – but today was a Red Letter day when it comes to Health Insurance, Health Insurance Companies and how they ethically (oops unethically) deal with their customers.  I am not sure how we got here, but where we are when it comes to our health and how that is paid for is so broken it’s quite unbelievable.

WHAT’S THE SCOOP?

healthcareToday was a follow up visit with my local doctor.  Nothing special and almost a waste of time, but the appointment was scheduled and kept.  Routine visit – weight, blood pressure, temperature, and nothing unusual.  Today I was to receive the results of my bone scan and CT scan, but since I got a CD with the data ready to send to the Mayo Clinic (which of course I read – not that I’m a doctor, but I can read, and a report that says nothing was found was exactly what I was expecting), which I sent, I knew the outcome before the visit.

Doctor enters the room with a pleasant smile asking me how I am.  Now that was a loaded question since I am full of frustration over the way Health Insurance companies deal with their customers (namely me).  Of course since I am the one that wants treatment, I personalize their actions.  Yes, I know better, but to me it is personal since it is my health.  So…I proceed to vent to the doctor.

“Doc, I don’t know how you deal with these insurance companies day in and day out!  They are a pain in the ass.”

“You don’t know the half of it,” he responded, “and it’s only getting worse!”

For a few minutes he openly allowed me to vent, then looked at me, removing his glasses and said, “Let me vent a bit.”

AMAZING STORY!

Of course with no identifying information shared, my doctor shared with me the most amazing story I’ve heard (and I suspect that this is nothing in comparison to many many more stories like this out there).

“So I have a patient with advanced lung cancer.  He’s been a smoker most of his life, so as you can imagine his lungs are pretty damaged.  Likewise, he has cancerous lymph nodes in his chest.  So I suggested a form of radiation treatment that is more localized to his tumor so that I can spare what little lung he has left.  If I use traditional radiation the tissue damage will create substantial problems for this man who needs to salvage as much of his lung as possible.

I submitted my request to his health insurance company.  Their reply:  DENIED.  They wanted me to use the conventional treatment!

I told the person on the phone, because by now I was personally involved, that if it were their lung or even their father in a similar situation, they would want the better treatment.  The treatment that would salvage what lung he has left.

They then suggested that I resubmit the request showing the two treatments: (1) more effective treatment and (2) conventional tissue destroying treatment.  We did that.

Got the response today:  DENIED!

I was incensed and called again for a peer to peer discussion.  Not more than 30 minutes ago I was told that the conventional treatment was all that was needed, even though I know that the damage from that will substantially diminish his quality of life and could create more medical costs down the road.

Chuck, they just don’t care!”

HOW DID WE GET HERE?

How did we get to the point that a person checking off a checklist is the determining factor into the kind of health care we receive in the United States of American?  Are we really OK with care provided at the lowest common denominator?  We we can receive quality treatment but the insurance company will only pay for adequate treatment, is that OK?

SHARE YOUR STORY

You don’t have to name names, but feel free to share your story.  Maybe if enough of us get our stories told…SOMEONE WILL LISTEN.

FEEL FREE TO SHARE YOUR STORY OR YOUR COMMENTS.

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20 Responses to Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!

  1. […] Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!. […]

  2. […] Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!. […]

  3. I hate hate hate the insurance companies. Reason 1: My mother needed a liver transplant. Statistically, the insurance company knew she’d die the longer they waited. So, they proceeded to do everything in their power to delay the transplant. How do I know? THEY TOLD US. They have no shame. None. Reason 2: Along the way, my mother had to spend a few months in a nursing home, which should have been covered by her insurance company — especially as they had forced her into it by refusing to pay for hospitalization when she fell into comas while waiting for liver. Bill submitted… denied. Over and over again. Eventually paid because we didn’t give up, but nursing home told us most people do give up and they think that’s why insurance companies do it. Sick and dying people don’t have the strength to fight with insurance companies. (My mother was relatively young and had four persistent (and college-educated) children which is only way we got it paid. Reason 3: I paid for my entire staff to have high-quality health insurance for 20 years. TWENTY YEARS. Then I developed a mystery allergy that puts me into anaphalactic shock. (Something that can happen to anyone, no fault of my own.) They doubled the premiums on everyone. So, our first thought was to switch to a lower-level policy and we submitted all the applications online. Amazingly, they received and processed ALL BUT MINE. Despite the fact that they were all submitted in the same batch and despite the fact that we could document the submission, they refused to reissue my insurance (which was illegal)– and no one else would cover me. I fought them for 8 months and would probably still be fighting them, but Obamacare opened a Pre Existing Condition Plan a few years ago to handle transition years. I gave up fight and signed up for that because I just couldn’t handle stress of being uninsured. Meanwhile, still cutting checks to EVIL insurance company for others. I laugh when people rant about Obamacare bringing us death panels. We already have death panels… they’re called insurance companies.

  4. dazzaw35 says:

    Coming from the UK I’ve never understood the US health care system, if it can be called a system.

    In the UK you work for a living and pay your taxes, those taxes go towards the roads, housing, education, social securtity etc and probably the most important “A health care system” which is available to everyone and includes hospital treatment, visits to a local doctor, physio the list could be endless.

  5. […] Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!. […]

  6. X says:

    Very sad story…health care is jacked all around us

  7. tumorwarrior says:

    I have fought with insurance companies a number of times. The only good thing that I can say is that it give you an outlet for the anger of getting a disease that isn’t your fault.

  8. Wow, What a story. Unfortunately, I think it will become worse with government standardization with the Affordable Health Care Act.

  9. mrenergyczar says:

    Profit over the people. That’s the side effect of Capitalism… no wonder one party is so against Obamacare….

  10. […] Yesterday was a red-letter day when it comes to getting the run-around from all sources.  Even the great Mayo Clinic contributed (but we’ll get to that later).  Since this is in two parts – the first part was posted yesterday and can be seen here:  https://chuckgallagher.wordpress.com/2013/11/26/health-insurance-companies-and-the-ethics-of-health-c… […]

  11. […] Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!. […]

  12. Gary Brewer says:

    Doctors get paid by who they see, Hospitals get paid by who they they admit. The Health Care industry is the biggest scam on the planet and unfortunately so many people fall for it. The system is built on managed sickness not managed wellness and as soon as people figure that our and stop feeding it by listening to phony diagnosis and prescription medicine the quicker we can get out of the strong arm they have on the public’s wallet.. Go to http://www.naturalfooddiet.org and watch some of the videos to learn more.

  13. […] Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!. […]

  14. Reblogged this on Greatpoetrymhf's Weblog and commented:
    appreciate your courage in sharing the Journey and building awareness of the things that need fixing the the health insurance world

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