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RANT A Certain Medical Insurance Company

post #1 of 14
Thread Starter 
This is a rant against a certain popular insurance company.

Because of them, the husband of a dear friend is going to die of cancer.

They discovered a tumor in the abdomen of my friend's hubby almost a year ago. Well, this certain insurance company only just approved the surgery to remove the tumor. Tests were inconclusive as to if it was cancer or not. When they opened him up yesterday, they discovered that it was indeed cancer and was beyond help. They could not even remove the tumor, so they just closed him up and will be sending him home. He has at the most 2 months to live. If the insurance company had approved the surgery when it was first discovered, then they might have been able to remove it and he would have had a good chance to survive. Insurance companies don't care about people's health, they only are out for the almighty dollar.
post #2 of 14
Quote:
Originally Posted by Catkiki
This is a rant against a certain popular insurance company.

Because of them, the husband of a dear friend is going to die of cancer.

They discovered a tumor in the abdomen of my friend's hubby almost a year ago. Well, this certain insurance company only just approved the surgery to remove the tumor. Tests were inconclusive as to if it was cancer or not. When they opened him up yesterday, they discovered that it was indeed cancer and was beyond help. They could not even remove the tumor, so they just closed him up and will be sending him home. He has at the most 2 months to live. If the insurance company had approved the surgery when it was first discovered, then they might have been able to remove it and he would have had a good chance to survive. Insurance companies don't care about people's health, they only are out for the almighty dollar.
I don't want to seem unfeeling here, but if the tumor was discovered a year ago, why would he not have had the surgery then? He could have applied for the insurance after the fact. I know if I had a tumor I wouldn't be waiting a year to hear whether my insurance company would cover it or not - I'd be taking out a loan, re-mortgaging my house or whatever it took to get the surgery done and worry about getting the insurance money afterwards.

I feel bad for your friend but I don't understand how the insurance company can be blamed because your friend didn't get the surgery done when he was diagnosed.
post #3 of 14
That's really too bad.

Is there any way he can appeal for cancer treatment? Or he too far along for any type of treatments?
post #4 of 14
Thread Starter 
Quote:
Originally Posted by Yosemite
I don't want to seem unfeeling here, but if the tumor was discovered a year ago, why would he not have had the surgery then? He could have applied for the insurance after the fact. I know if I had a tumor I wouldn't be waiting a year to hear whether my insurance company would cover it or not - I'd be taking out a loan, re-mortgaging my house or whatever it took to get the surgery done and worry about getting the insurance money afterwards.

I feel bad for your friend but I don't understand how the insurance company can be blamed because your friend didn't get the surgery done when he was diagnosed.
They could not afford to get the funds on thier own. The insurance company dragged their feet about getting this approved. I know my company would have appoved it within a couple of weeks. This company has been notorous about things like this.

Quote:
Originally Posted by Lunasmom
Is there any way he can appeal for cancer treatment? Or he too far along for any type of treatments?
It is my understanding that it was too far along for any type of treatment. I haven't actually talked to her but I am getting all this secondhand.
post #5 of 14
Quote:
Originally Posted by Catkiki
This is a rant against a certain popular insurance company.

Because of them, the husband of a dear friend is going to die of cancer.

They discovered a tumor in the abdomen of my friend's hubby almost a year ago. Well, this certain insurance company only just approved the surgery to remove the tumor. Tests were inconclusive as to if it was cancer or not. When they opened him up yesterday, they discovered that it was indeed cancer and was beyond help. They could not even remove the tumor, so they just closed him up and will be sending him home. He has at the most 2 months to live. If the insurance company had approved the surgery when it was first discovered, then they might have been able to remove it and he would have had a good chance to survive. Insurance companies don't care about people's health, they only are out for the almighty dollar.
That is very sad. I have had recent dealings with an insurance company too (for my fiancee) and finally won, but had to jump up and down first. http://www.thecatsite.com/forums/sho...t=claim+denied
Are you saying that they wouldn't approve treatment without proof that it was cancer, but then approved it too late? Thats just terrible.

Quote:
Originally Posted by Yosemite
I don't want to seem unfeeling here, but if the tumor was discovered a year ago, why would he not have had the surgery then? He could have applied for the insurance after the fact. I know if I had a tumor I wouldn't be waiting a year to hear whether my insurance company would cover it or not - I'd be taking out a loan, re-mortgaging my house or whatever it took to get the surgery done and worry about getting the insurance money afterwards.

I feel bad for your friend but I don't understand how the insurance company can be blamed because your friend didn't get the surgery done when he was diagnosed.
The patient wasn't diagnosed with cancer immediately from how I understand the post. He was diagnosed with possibly having cancer.
We don't know if they attempted to get the money. Some people don't qualify for loans and don't have a home to mortgage. I know that after my divorce years ago and starting over, I would be hard pressed to come up with the kind of money required for surgery.
Twice I have fought an insurance company for other people and won both times. I am convinced that it is common practice for claims be denied before they are approved. Imagine how much money the insurance company saves just by insureds accepting the denial? I don't disagree with you very often, but in this case it sounds like the insurance company could have prevented this.
post #6 of 14
Quote:
Originally Posted by Rockcat
That is very sad. I have had recent dealings with an insurance company too (for my fiancee) and finally won, but had to jump up and down first. http://www.thecatsite.com/forums/sho...t=claim+denied
Are you saying that they wouldn't approve treatment without proof that it was cancer, but then approved it too late? Thats just terrible.

The patient wasn't diagnosed with cancer immediately from how I understand the post. He was diagnosed with possibly having cancer.
We don't know if they attempted to get the money. Some people don't qualify for loans and don't have a home to mortgage. I know that after my divorce years ago and starting over, I would be hard pressed to come up with the kind of money required for surgery.
Twice I have fought an insurance company for other people and won both times. I am convinced that it is common practice for claims be denied before they are approved. Imagine how much money the insurance company saves just by insureds accepting the denial? I don't disagree with you very often, but in this case it sounds like the insurance company could have prevented this.
I have to backpaddle here a bit. It is disgusting that the insurance company would not give a decision much sooner and you are right in that we may not all be in a position to come up with the required money even for necessary surgery. I was being too quick to judge/opine before thinking it through and I apologize. It is terrible that this has happened to this gentleman (and his family as it affects them as well).

As a Canadian who has no worries about health coverage and medical needs, I forget sometimes that others don't have that luxury and I should count my blessings.

I think most insurance companies will go to many lengths to get out of paying claims and that is why it is so important to do the research before choosing one to give your hard-earned money to.

I apologize for my quick and unthinking reply and my prayers and thoughts go to your friend and her family.
post #7 of 14
My sympathies as well....

I can't imagine being in this situation with my back against the wall.
This is why I am glad to be Canadian.
post #8 of 14
Quote:
Originally Posted by Yosemite

As a Canadian who has no worries about health coverage and medical needs, I forget sometimes that others don't have that luxury and I should count my blessings.

I very much admire the Canadian government when it comes to medical needs. The USA is soooooooo lacking in this.
post #9 of 14
I wish more people knew that they can apply for medicaid and social security when faced with grave illness. They may turn you down several times, but most people are able to get covered and they do cover retroactively.
post #10 of 14
Medicaid coverage, maybe. If their income was low enough and they met their state's other eligibility requirements, maybe.
Social Security disability insurance, maybe not. If the illness is treatable and the person is expected to recover enough to be able to work within a year, they will not qualify for Social Security. And you have to have been disabled for two full years before Medicare will kick in.

Canadians, you are SOOO lucky!!


HOWEVER....
If someone is terminally ill, their disability case will be put on high priority and approved as soon as possible. In many cases, retroactive payments can be made beginning with the initial onset date of the illness.
So tell your friend to get down to the SSA office and make an application for her husband, and tell her that if he was working up to the time he got sick, to set his onset date as the first day the doctor said "it's probably cancer."
(My job is to determine disability cases for SSA, so this isn't just hearsay.)

I am so sorry for your friend. That is terrible. Insurance companies are so scummy.
I think she should sue to insurance company. I am not pro-lawsuit, but this is a case where it's warranted.
post #11 of 14
I used to actually use my social work degree and was able to get every one of my clients on medicaid and social security. They all had HIV/AIDS. I can't imagine things have changed that much in the past three years. The problem is you have to be persistant, and unless you have someone advocating for you (ie social worker, case manager) it's very hard for a seriously ill person to stick it through. I had one client who was using a walker, weighed less than me (I was 112 at the time, those were the days!), and had viral loads off the chart and a cd4 of less than 12. They kept denying this person, but eventually after about a month we were able to get them aid. It took a lot of paper work and many hours, but really most people can get that help.
post #12 of 14
I'm not normally a litigious type, but I'd be suing the behinds off that insurance company.
post #13 of 14
Insurance in the United States is a joke, unless you work for a rare good company, or can afford to pay 500.00 a month for coverage. Nobody should ever be denied medical treatment, for the sake of the all mighty dollar.

I just woke up, and haven't put my thoughts together. This is one of my big peeves. I had a situation happen to me, where I got really sick, and had to go to the hospital for tests . My insurance only paid 80 dollars of a 5,000 bill. Yes, it's real and I am still paying monthly for it. I had to cancel my insurance to pay my monthly medical bill. Thats a slap in the face.....

It is a crime when you die because you don't have enough money to pay for the health costs in this country. Canada and other countries take much better care of their citizens than the United States!!! I pay taxes, lots of taxes for what???

Every person in the United States should have equal medical coverage no matter what walk of life they come from!!!!
post #14 of 14
I really cannot WAIT until the day that the U.S. decides to take over the medical situation.

My boyfriend served in the army and now is under VA. When I take him there, its absolutely fabulous. In a sense its a little like an HMO. You go to see one doctor and they make the recommendation if you need to see a specialist or not. When went in a couple of weeks ago, he came out with a bunch of Rx and being the Urgent Care and seeing an Ear Nose and Throat the next day. For everything, he probably will pay $60.

The only thing I do see though as the hold up is the fact that doctors rates would be at a cap. They wouldn't make the $100K+/- they do now with their own practice. They would still be paid well, but things like charging $1000 per eye for lasik would actually be lowered. Plus the 1400% that pharmacies make on the precriptions, wouldn't be seen anymore. Then in the end, Rx drug developers/companies would be either put out of business or be forced to be govenment regulated. Doing a huge change like this might actually hurt our economy since medical insurance companies would be put out of business, doctors would have a cap, so they wouldn't make as much money, thus unable to spend as much and drug companies would hurt as a result.
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