Is been in labor for 3 days, failure to progress and my blood pressure skyrocketed almost out of control. I had it done at 1:30 in the morning in a Saturday.

Two months later I received a letter from United rejecting payment because I didn't schedule the c section in advance.

What a bunch of bullshit!

After what happened today, I don't think I'd want to be an employee of a health insurance company.

I lost. At the time they were getting away with denying claims left and right.

It took a few years but I paid it off.

and so much stress, as well as additional expense, when you'd just had a baby.

This shit has to change.

who jumped in to perform the emergency c-section (baby was literally stuck). They argued they would only pay for the delivery doctor - that the surgeon ($25K fee) was not covered. My husband happens to be an attorney & was in the delivery room. They did call in a capable surgeon to deal with the situation and save both of us. In the end UH paid. But I would expect it's much more difficult for families who aren't trained in the law - we had no problem threatening to sue them.

Apparently the IV had slipped out of my vein. I wasn't in much pain, but I felt like I needed to cut a nuclear fart. Woozily, I mentioned this to the people shoving things into me. (Got a nice view on a TV screen of a place I'd never seen before.) The comment caused some alarm, and corrective measures were taken.

He says there’s a contingent insisting his wife paid for this.

somehow women will always be blamed.

a spouse will be looked at and for spouses to kill spouses isn't unusual. Maybe the employees know something about their relationship. Maybe not.

in this case, given victim's profession, it wouldn't be the first place I'd look.

with those bullet casing having the words inscribed on the them which happen to come from the title of a book about insurance companies denying claims. I also read that he and his wife have lived apart for some time so that may be where the employee speculation arose.

Sure is an interesting case.

and that explains the rumor. I hadn't read that yet, but I haven't been seeking the stories out (read enough yesterday!).

A comment from her said he was a wonderful father but nothing about "and husband", so I wondered. She also mentioned he'd been receiving threats and something about "lack of coverage".

justifying the misdeed. If caught and tried, it causes me to wonder if they'll be able to find a jury that will indict the shooter.

And, if any good emerges, perhaps it will prompt insurance companies to wake up to how despised they are. (I would add most ALL insurance, not just health, is a scam.)

Last edited Thu Dec 5, 2024, 06:26 AM - Edit history (1)

happen to a health insurance CEO and not a politician.

Frankly, I would 100% expect this to continue to happen until the health care system changes to one without a profit motive or the system/country collapses (and at this point, I know which one I'm betting on).

...how long until some open carry red state husband with a wife in labor crisis doesn't insist on her getting the care she needs.

I vaguely recall a version of this being a movie plot a lot time ago -- but a father and son?

We are the only 1st world nation that doesn't have universal healthcare.
Single payer or whatever form of universal healthcare is less expensive
in every way. The congress is responsible for the fix we are in.

No one believes this is fair, no one.

gunning down people in the street.

I do predict, however, that if the killer is found and starts a GoFundMe for his defense, the amount received will dwarf the GDP of most countries.

Driving the point home that denying claims will not be allowed.

.... becomes alert and fully awake during brain surgery,... and is screaming in bloody pain.

The insurance company goes oh well,... we are after all entitled to a reasonable level of returns on our investments and profits. We owe that to our investors.

Boo-boos are supposed to be painful.
Now go pound sand.

It reminds me of a Mad Magazine cartoon back in the late '50s or early '60s. The docs are all gathered around the patient's bed, and the poor guy has a horrible look of pain on his face. In his hands is the bill for the services rendered. The caption of the cartoon was "The Presenting of the Bill."

I LOVED all the illustrations, even the little bitty ones on the outside corners of the pages. Just blew my mind.

Going by your description, I thought of the fold-ins.

I had a subscription to MAD in the 1970s and I always looked forward to receiving each issue.

and the insurance company refuses to pay them.

Seriously. Ain't that some stuff? I guess the brain doesn't feel anything and the patient gets a local in the scalp.

Anyway, this is is flat out insane. Only the doctors can stop this shit.

I used to work in surgery decades ago, and there are no pain receptors in the brain. Patients were awake and in no discomfort. it is often necessary to assess if the surgeon is in the correct area.

Ponder that.

This is horrifying. I guess “drive-thru mastectomies” and “drive-thru births” just didn’t give their shareholders enough warm fuzzies.

hahahahahahaha, I crack myself up.

When someone covered by Medicare goes into the hospital, Medicare will pay a set rate for the diagnosis, even if care takes several days more than expected. The hospital either absorbs it or files an appeal documenting the set rate was not enough because of complications, etc.


Besides-- Medicare and others are headed toward these payment models--

Medicare's bundled payment model, also known as episode-based payment (EBP), groups all costs associated with a patient's care into a single payment. This includes the fees for surgeons and anesthesiologists, as well as staff, supply, and facility costs. The goal of bundled payments is to improve the quality of care and patient experience while reducing costs.

They probably did that after years of getting bilked by hospital administrations. This must also be why the hospital is so eager to kick the patient out.

quickly that wasn't going to work because docs, hospitals and others caught on quickly that if they keep increasing their charges they'd get paid more.

In late 1970s and 1980s, Medicare reimbursement policies were changed to prevent the obvious greed. Medicaid and private insurers did the same.

Once payment was guaranteed, universities raised tuitions and salaries.

It is a way to force surgeons to refuse to take complicated cases.
They just tell the patient there is nothing that can be done.

Because they know they won't get paid if they take too long.

Unless you can find a very gifted surgeon who can do the complicated surgery
quickly you are out of luck.

Health insurance is not insurance. It is a casino where you provide the money that the house uses. All they are doing is making bets.

And Republicans keep voting for people who want to take their money but deny them healthcare. Nice racket when you can easily get away with it.

The US has a profit making system which produces as much profit as possible while producing as little health care as possible as a byproduct.

Probably never knew what hit him. The patients to whom he denied care were not so lucky.

...now that the circus is coming to town.

Send in the Clowns...

It didn't even deal with people who were uninsured. Only those who actually had health insurance. The level of cruelty exposed in the health care industry was scary.

harboring great animus towards scumbag CEOs and their ilk when I was a young man, as I watched manufacturing disappear and prices rose. Never acted on it, of course.

Her doctor came in, examined her, and said, "Well, when I check on you tomorrow, if you are still recovering at this rate, I may just release you tomorrow."
He walked out, and ten minutes later he walked back in, looking embarrassed.
"Your insurance company said you're ready to go home today."

We only exist for the benefit of their profit margins.

Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
NOW!

Anthem Blue Cross and Blue Shield are separate companies.

Anthem is a for profit company within that federation. Anthem has such a shitty reputation that they changed their name to Elevance Health 2 years ago.

Co-pays and deductibles go up every year. When will US get our act together? Not under newly elected admin that's for damn sure.

not a good sign though especially with the incoming administration

And I live in Missouri. If I have to face surgery, I will have questions for the doctors.

— Ron

MO policy but my surgery I discuss below was done over the state line in KS.

The rich get richer at the cost of lives and quality of lives.

Rank and file medical professionals are worn to a nub.

As a teenager I had a car accident that shattered my pelvis and crushed my ribs.
I was in surgery for 16 hours. God bless the surgeons, nurses, and everyone else.
But if this was in place at my worst when I needed grace the most, my parents would have been bankrupt!

I can't imagine going through injuries like that. You're lucky to be alive. Crushed ribs = can't breath.

I had Anthem when I went in for a simple out patient removal of an ovarian cyst. The first incision made them realize immediately that it was bigger than they thought and it was cancer. Once they converted from a lapro to a fully open abdominal surgery is when they saw cancer also on the other ovary and in my uterus. They also discovered possibly decades of undiagnosed endometriosis all over the abdominal wall, kidneys,colon, and a vein. While scraping the endo they nicked a vein and I began to hemorrhage, needing several units of blood.

I'm telling this because my surgery went over by several hours. According to this policy I could be denied any more anesthesia after what was initially predicted to be no more than 40 minutes in and out. Can anyone imagine going through what I did without anesthesia?

People will die under this policy.

That could be the first of many if decisions like this are allowed to stand. What an awful company.

Gee, I wonder what they will do.

But deleted it.

What will happen is doctors will refuse to accept that crappy insurance.

I would also expect those states governments are going to say hell no and this will go to court.

the anesthesiologist didn't keep me under for the whole procedure. (I'm not saying it was this but I'm just relaying what it is like to come to while a procedure is still taking place.) So the person doing the colonoscopy needed to snip some polyps to send for examination. That all took place with me being under enough to not be able to scream, open my eyes or move but I was conscious enough to feel every bit of it.

I think YES.

its was always fun to get an additional bill. I required an active monitoring for any surgery due to a low heart rate, in including colonoscopy. I'd make the bells and other alarms go off. After my recent death and rebirth the gave me a defibrillator pacemaker and raised my heart rate.

A substantial number of anesthesiologists are out-of-network even when the hospital in which you are having surgery is in-network, so this may be a way of trying to rein in costs associated with the higher costs of care by an anesthesiologist.

When I was 5 months pregnant I had an emergency appendectomy. Insurance completely denied the claim by the anesthesiologist because they were out of network. They were eventually required to cover the costs - because the closest in-network anesthesiologist was 50 miles away. Not a good look to require a 5-month pregnant woman needing emergency surgery to research and find the only in-network anesthesiologist (and then to drive 50 miles to have surgery. (The anesthesia was complex, since they tried to operate with only an epidural to save my daughter from in-utero exposure to anesthesia. Unfortunately, they had to switch to anesthesia since there was too much pain associated with the surgery.)

I'm sure I'm not the only one who has successfully argued to get out-of-network anesthesia covered as in-network care, since most people are completely unaware that anesthesiologists are often not employed by the hospitals in which they work.

I'm not suggesting it is appropriate - just that there are reasons unique to anesthesiologists for special rules - and to some extent these rules are similar to the time limits insurance imposes, at least indirectly, on regular office visits (where payment is based on the time each kind of visit is allotted - and if the visit runs over (or the doctor chooses to schedule longer visits) there is no additional payment.

Trump's win has given all the corrupt players in industry and politics permission to do whatever they want.

Yes, I know this doesn't result in anesthesiologists setting a timer, it just triggered an unfortunate memory.

better luck next time.

blue cross SUCKS

This may not be limited to just Anthem.

Some of the BCBS across state lines have similar, if not identical, policies.

For example, in 2021, I was undergoing lymphoma treatment.
The drug was denied due to 'eligible for stem cell transplant'
It was successfully appealed.

I did some research on the internet and found out this reasoning was also used in another Blue Cross & Blue Shield.

so insurance companies want us to feel the pain. Meanwhile their stocks and profits are doing great.

A stiff drink? Does Anthem Blue Cross Blue Shield have any helpful hints?????

$100 for the next five minutes."