boutons_deux
03-07-2014, 03:29 PM
Worse Than the Mob: The Insurance Industry Is Organized Crime
http://truth-out.org/opinion/item/22279-william-rivers-pitt-worse-than-the-mob-the-insurance-industry-is-organized-crime
It's long, but the comments he received are even better
"S.L.: As someone who worked for a big, local health insurance company, I can tell you that this sort of thing happens a LOT. And it's one of the reasons I didn't last too long, at that job. I felt like the biggest piece of poo, for having to follow "company guidelines" that royally screwed people over. I'd rather scrub toilets than to ever work in the health insurance field again.
J.R.: I have rheumatoid arthritis and have had nothing but hassles with BCBS denying coverage for blood work and medicines. In fact, I was on the Arkansas Risk Pool because I have a "pre-existing condition" and no other health insurance company would take me. But now that very same Risk Pool is not going to pay my office visits and labs from last year because...(wait for it) I have a pre-existing condition! Fuck all of them. I am sick of being punished for my chronic condition.
R.M.: As a mental health professional I'm convinced insurance companies will do ANYTHING to delay or avoid payment. Michael Moore understood that years back, providers bang heads against walls and get scared shitless we'll be caught up in the outcomes of reckless disregard for what patients desperately need, and it's the love of profit, pure and simple. The history of "insurance" in its many forms is book-worthy, from the black and poor families who used to save every penny for when the insurance man came around, often just so they'd get buried without ruining their families, to the people who literally sit and go over dental x-rays and challenge whether you really need that more expensive treatment when they've never laid eyes on you, to the many people who have been in your wife's situation.
T.R.: Similar thing happening here with my lead-poisoned kiddo - waiting 4 months - sick 11 year old misses 9 weeks of school - waiting to see a specialist because he "isn't in enough pain to expedite" and he can't eat or breathe without pain - we finally get in to specialist on Wednesday (Pediatric GI) and she said - and I quote " I don't even need to examine him really - I've reviewed all the paperwork" WTF - sending us away with a referral to a pain clinic! Fuck - an 11 year old needs to be in debilitating pain for four months so he can see an idiot who refers him to a pain clinic !!!
G.S.: Our insurance company did the same thing with my migraine medicine, zomig. Told me I could only have 6 pills a month- which is awesome when your migraines come in clusters, multiple times a day, weeks on end. We ended up having to pay hundreds of dollars to get them. Doctor even called in an override to no avail.
K.B.: I have stories, many of them from my husband's last 6 months of life in hospitals, or the ten years before as he slowly became more ill each year. What killed him? Mostly incompetence or willful disregard. Steve had been in the hospital since April 5 for a surgery to remove an aneurism that had been allowed to grow to nearly 23% of his body mass. A man that was 6'4" and right at
225 pounds. On his birthday (June 10th) he was about 145 lbs unable to walk at all without two people holding him.
T.S.: Once, when the firm changed plans, I found that my insulin pens were covered by the new one, but the syringe tops were not. The pens are sitting there full of medicine, but you must tap the pen with a syringe top to get at it, obviously. These needle are fairly expensive, and as an item that must be changed for every shot, I could go through 6-10 a day. Of course I spent weeks on this, and ultimately someone approved my claim, seeing the obvious problem. But I always thought it was a deliberate bottom-line choice to begin with, and that I was lucky to get a fix at all.
A.S.: I had a wrangle with United Health Care last year over a denied claim. I had had an echocardiogram to determine if high blood pressure was causing damage to my heart, a procedure covered for that purpose. However, the code submitted by the provider's office indicated that the echo was done to DIAGNOSE high blood pressure, for which it is not covered.
M.S.: You'll never hear me say a good word about any health insurance company, not after the one I had in 2001 decided that the only kind of chemo they would pay for is one that gave me congestive heart failure seven years later.
L.S.: I got out of the hospital yesterday and did the pharmacy drive thru for my pain control script on the way home. Had to pay for it out of my own pocket because of some screw up at the insurance company. It is fucking Sat. morning and I have just been released after a few days in the hospital trying to stop an internal bleed someplace around my spleen. Trust me when I say pain control was not an optional thing. I paid the man for those drugs and cussed while I did it.
K.F.: Humana screwed me over by first denying coverage for emergency surgery (because I had not asked Mother May I & instead relied on a doctor telling me I needed surgery--silly me), then covering the expenses after I made a ruckus, then a YEAR LATER, deciding on their own that they didn't have to pay after all, resulting in me getting calls from a collection agency threatening all kinds of nasty stuff.
L.D.K.: I had Aetna tell me they wouldn't pay for an anti-fungal prescription for my toenail fungus......after multiple appeals and proof (biopsy results) that only this certain (expensive) medication would be affective in curing it.....but that they WOULD PAY to have all my toenails SURGICALLY REMOVED!
I.B.: Harvard Pilgrim Healthcare canceled my prescription for Provigil when I lost my job. They said that since I no longer "do productive work," I no longer needed a medication that prevented me from sleeping all day. My doctor had to write them a letter explaining that without the medication, I wouldn't be able to SEEK productive work, let alone ever HAVE productive work. We eventually got them to reinstate the prescription, but it took a couple months.
S.C.: My health insurance company tried to refuse to cover the brand of ADHD medication I need and force me to use one that contains a dye I'm allergic to.
A.W.: My dad's been a doctor for 40+ years. From talking with him, the growing bureaucracy and endless paperwork that has come to typify interactions with the insurance companies makes actually doing the job of caring for the sick increasingly difficult. He also knows a few doctors who were charged with insurance fraud, for lying to the insurers in order to get patients the treatment they needed.
I could share a hundred more similar stories. The pattern is self-evident."
http://truth-out.org/opinion/item/22279-william-rivers-pitt-worse-than-the-mob-the-insurance-industry-is-organized-crime
It's long, but the comments he received are even better
"S.L.: As someone who worked for a big, local health insurance company, I can tell you that this sort of thing happens a LOT. And it's one of the reasons I didn't last too long, at that job. I felt like the biggest piece of poo, for having to follow "company guidelines" that royally screwed people over. I'd rather scrub toilets than to ever work in the health insurance field again.
J.R.: I have rheumatoid arthritis and have had nothing but hassles with BCBS denying coverage for blood work and medicines. In fact, I was on the Arkansas Risk Pool because I have a "pre-existing condition" and no other health insurance company would take me. But now that very same Risk Pool is not going to pay my office visits and labs from last year because...(wait for it) I have a pre-existing condition! Fuck all of them. I am sick of being punished for my chronic condition.
R.M.: As a mental health professional I'm convinced insurance companies will do ANYTHING to delay or avoid payment. Michael Moore understood that years back, providers bang heads against walls and get scared shitless we'll be caught up in the outcomes of reckless disregard for what patients desperately need, and it's the love of profit, pure and simple. The history of "insurance" in its many forms is book-worthy, from the black and poor families who used to save every penny for when the insurance man came around, often just so they'd get buried without ruining their families, to the people who literally sit and go over dental x-rays and challenge whether you really need that more expensive treatment when they've never laid eyes on you, to the many people who have been in your wife's situation.
T.R.: Similar thing happening here with my lead-poisoned kiddo - waiting 4 months - sick 11 year old misses 9 weeks of school - waiting to see a specialist because he "isn't in enough pain to expedite" and he can't eat or breathe without pain - we finally get in to specialist on Wednesday (Pediatric GI) and she said - and I quote " I don't even need to examine him really - I've reviewed all the paperwork" WTF - sending us away with a referral to a pain clinic! Fuck - an 11 year old needs to be in debilitating pain for four months so he can see an idiot who refers him to a pain clinic !!!
G.S.: Our insurance company did the same thing with my migraine medicine, zomig. Told me I could only have 6 pills a month- which is awesome when your migraines come in clusters, multiple times a day, weeks on end. We ended up having to pay hundreds of dollars to get them. Doctor even called in an override to no avail.
K.B.: I have stories, many of them from my husband's last 6 months of life in hospitals, or the ten years before as he slowly became more ill each year. What killed him? Mostly incompetence or willful disregard. Steve had been in the hospital since April 5 for a surgery to remove an aneurism that had been allowed to grow to nearly 23% of his body mass. A man that was 6'4" and right at
225 pounds. On his birthday (June 10th) he was about 145 lbs unable to walk at all without two people holding him.
T.S.: Once, when the firm changed plans, I found that my insulin pens were covered by the new one, but the syringe tops were not. The pens are sitting there full of medicine, but you must tap the pen with a syringe top to get at it, obviously. These needle are fairly expensive, and as an item that must be changed for every shot, I could go through 6-10 a day. Of course I spent weeks on this, and ultimately someone approved my claim, seeing the obvious problem. But I always thought it was a deliberate bottom-line choice to begin with, and that I was lucky to get a fix at all.
A.S.: I had a wrangle with United Health Care last year over a denied claim. I had had an echocardiogram to determine if high blood pressure was causing damage to my heart, a procedure covered for that purpose. However, the code submitted by the provider's office indicated that the echo was done to DIAGNOSE high blood pressure, for which it is not covered.
M.S.: You'll never hear me say a good word about any health insurance company, not after the one I had in 2001 decided that the only kind of chemo they would pay for is one that gave me congestive heart failure seven years later.
L.S.: I got out of the hospital yesterday and did the pharmacy drive thru for my pain control script on the way home. Had to pay for it out of my own pocket because of some screw up at the insurance company. It is fucking Sat. morning and I have just been released after a few days in the hospital trying to stop an internal bleed someplace around my spleen. Trust me when I say pain control was not an optional thing. I paid the man for those drugs and cussed while I did it.
K.F.: Humana screwed me over by first denying coverage for emergency surgery (because I had not asked Mother May I & instead relied on a doctor telling me I needed surgery--silly me), then covering the expenses after I made a ruckus, then a YEAR LATER, deciding on their own that they didn't have to pay after all, resulting in me getting calls from a collection agency threatening all kinds of nasty stuff.
L.D.K.: I had Aetna tell me they wouldn't pay for an anti-fungal prescription for my toenail fungus......after multiple appeals and proof (biopsy results) that only this certain (expensive) medication would be affective in curing it.....but that they WOULD PAY to have all my toenails SURGICALLY REMOVED!
I.B.: Harvard Pilgrim Healthcare canceled my prescription for Provigil when I lost my job. They said that since I no longer "do productive work," I no longer needed a medication that prevented me from sleeping all day. My doctor had to write them a letter explaining that without the medication, I wouldn't be able to SEEK productive work, let alone ever HAVE productive work. We eventually got them to reinstate the prescription, but it took a couple months.
S.C.: My health insurance company tried to refuse to cover the brand of ADHD medication I need and force me to use one that contains a dye I'm allergic to.
A.W.: My dad's been a doctor for 40+ years. From talking with him, the growing bureaucracy and endless paperwork that has come to typify interactions with the insurance companies makes actually doing the job of caring for the sick increasingly difficult. He also knows a few doctors who were charged with insurance fraud, for lying to the insurers in order to get patients the treatment they needed.
I could share a hundred more similar stories. The pattern is self-evident."