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Medical Forum / General / Alternative / January 2008Medical Insurance Company Bad Faith
Unbelievable, how an insurance company could refuse to pay for a treatment that could have saved a person's life. This makes me sick. For the lackey that refused the treatment, how can they live with themselves the rest of their life?? This is the very reason we need not only health care reform in this country, but insurance company reform as well. ttp://fayetteville.injuryboard.com/insurance-bad-faith/mark-geragos-is-wasting-his-time-only-the-united-states-congress-can-correct-the-injustice.php?googleid=14339 Unbelievable, how an insurance company could refuse to pay for a treatment that could have saved a person's life. << They've been doing variations of this forever .. It is just a matter of .. money. When money gets involved and you get people MAKING money .. then you have a situation RIPE for .. crime. People lose paperwork .. "didn't apply in time" .. When there is an **incentive** then expect to get screwed. There are just too many fkdinthehead people .. and THOSE are the people who get .. hired .. because .. ? .. they ARE nuts and they FIT RIGHT IN that .. position .. they fit the job qualifications. "Someone who will screw you without thinking twice about it" Sooo .. the ONLY way out of that situation is .. no **incentive** .. Universal healthcare .. EVERYONE treated the same .. no **special** consideration. Imho .. Who loves ya. Tom Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com Man Is A Herbivore! http://tinyurl.com/a3cc3 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > sick. For the lackey that refused the treatment, how can they live > with themselves the rest of their life?? This is the very reason we > need not only health care reform in this country, but insurance > company reform as well. > > ttp://fayetteville.injuryboard.com/insurance-bad-faith/mark-geragos-is-wasting-his-time-only-the-united-states-congress-can-correct-the-injustice.php?googleid=14339 > When there is an **incentive** then expect to get screwed. > [quoted text clipped - 3 lines] > > "Someone who will screw you without thinking twice about it" People think that education and grades choose the doctor. In reality, those that are chosen are those who have been exposed to the system, i.e. children of doctors, or those who can be indoctrinated and brainwashed into "screwing you without thinking twice about it." The medical monopoly has been built upon this principle of hiring. DrCee > Unbelievable, how an insurance company could refuse to pay for a > treatment that could have saved a person's life. This makes me > sick. For the lackey that refused the treatment, how can they live > with themselves the rest of their life?? This is the very reason we > need not only health care reform in this country, but insurance > company reform as well. playing devil's advocate here for a minute firstly...one' s insurance coverage always has a lifetime limit (of money they will pay).......this girl had already had a bone marrow transplant...one of the most expensive treatments there is ...the bone marrow transplant was to "treat" her leukemia...she never did well afterwards..in fact was in the ICU and considered vegetative... then her liver..probably other organs..started failing... so the issue of liver transplant came up...possibly a transplant WOULD have replaced her failing liver...but certainly not necessarily the rest of her failing organs...and NO a liver transplant would NOT have cured her if the leukemia had not responded to the bone marrow transplant not to mention that the data and statistics supplied gave her a 65% chance of surviving THREE months(this is not a cure btw) one thing most of us forget is that our health insurance...like our car or home insurance has a LIMIT as to how much they have to pay out... she likely had already reached or passed that limit.... as a nurse my joking comment as always been "don't ever go without health insurance" because you might need a liver transplant...in the past the policies we got thru employer coverage usually had a $1 million dollar LIFETIME limit...which sounds like there would be never be a "lifetime" in which one of us could exceed that limit...recently my policy was switched (due to employer shopping) to a different company...one night I read the booklet of benefits cover to cover...guess what..now I only have $200,000 LIFETIME limits on coverage!!! just for arguments sake..a liver transplant can easily cost about $300,000...which does not include the lifetime of very expensive anti rejection drugs... as for the case involved......they didn't HAVE a liver to give her anyway... and sorry to say...shouldn't scarce organs go to those who DO have a chance of a much longer life..even a cure....not to someone who MAY get an extra few months of life?? lastly...anyone foolish enuf to think that this situation would not become very common in a single payer system...is dreaming...if anything..payments would be more stringent..and denials much more common... not to mention...we have a huge disparity in need for organs to transplant..and patients who die waiting for them.... investigate ANY nation with "nationalized" health care....and read up on their "limits on coverage"... we are a nation that DEMANDS Mercedes medicine...but is only willing to pay for "Honda" medicine...a direct quote from a doctor I once worked for as he explained to a patient WHY her "honda" policy would not cover whatever it was she was demanding.. my h.o. opinion only > ttp://fayetteville.injuryboard.com/insurance-bad-faith/mark-geragos-is-wasting-his-time-only-the-united-states-congress-can-correct-the-injustice.php?googleid=14339 I never read that her other organs were failing and if they were was it because her liver had failed? the bone > marrow transplant was to "treat" her leukemia...she never did well > afterwards The bone marrow transplant was successful, but she did develop complications, most likely the drugs that were used for the bone marrow transplant. > not to mention that the data and statistics supplied gave her a 65% chance > of surviving THREE months(this is not a cure btw) wrong, it was six months. > one thing most of us forget is that our health insurance...like our car or > home insurance has a LIMIT as to how much they have to pay out Apparently you have never been in the position. And another thing, We are talking about a persons child NOT a damn car! > as for the case involved......they didn't HAVE a liver to give her anyway Yes, they had a LIVER for the girl, It became available 4 days after the request from her doctors. On Jan 17, 2:31 pm, <Hawk...@sbcglobal.net> wrote: > > Unbelievable, how an insurance company could refuse to pay for a > > treatment that could have saved a person's life. This makes me [quoted text clipped - 63 lines] > > - Show quoted text - I never read that her other organs were failing and if they were was it because her liver had failed? perhaps you need to get your facts straight then before engaging your mouth I live in LA..and read the daily LA Times to answer your above statement...if her other organs were not failing...can you explain why her brother...who donated bone marrow in Nove...also gave her a kidney (she was in kidney failure ...likely from the chemo) the bone > marrow transplant was to "treat" her leukemia...she never did well > afterwards Kevysmom: The bone marrow transplant was successful, but she did develop complications, most likely the drugs that were used for the bone marrow transplant. truth: the bone marrow transplant was NOT successful...her complications developed directly after her dual transplants in Nov (ie...she was desperately ill FROM her cancer and its treatment) also...she was comatose and in ICU directly before and after the bone marrow/kidney transplants...her condition NEVER got better..in fact...she was on life support and vegetative her liver shut down after chemo to treat her recurrence of leukemia due to a blood clotting complications ( > not to mention that the data and statistics supplied gave her a 65% chance > of surviving THREE months(this is not a cure btw) Kevy's mom" wrong, it was six months. truth: sorry...six months not to be confused with a cure for EITHER her cancer or with THREE transplants....how long do you think she would live?? answer...not long > one thing most of us forget is that our health insurance...like our car or > home insurance has a LIMIT as to how much they have to pay out Kevy's mom" Apparently you have never been in the position. And another thing, We are talking about a persons child NOT a damn car! sorry.....yes I have...but that is not the issue...I have spent my prof career in dialysis and transplant...so I have a lot of experience and yep...we are not talking about a car or a house...what my point was was that her dad's employer health insurance DID have a lifetime limit......the limits are chosen by the employer... not to mention....to give this comatose cancer stricken girl maybe 6 months of life...would mean depriving someone else a liver AND resources that perhaps would give them decades of life...you make the choice..and not out of emotions... > as for the case involved......they didn't HAVE a liver to give her anyway Yes, they had a LIVER for the girl, It became available 4 days after the request from her doctors. livers must be transplanted within a very few hours... quotes from other sources" "the young cancer pt was too sick for the surgery to have likelihood of success ...ie ...she likely would have died in the OR...with a healthy liver" "the poor girl was in such bad health that there was "no chance" that a liver transplant at a huge cost to "someone" would have had a positive outcome" "there is scant clinical evidence that a liver transplant would have benefited this patient" from the Wall Street Journal: "a study of liver transplants in the UK and the US showed NO pt in the UK that was in ICU (let alone had recently received a bone marrow and kidney transplant ,,was comatose and vegatative)...compared to over 19% of US liver receipients that were in ICU...suggesting that VERY sick patients in the UK were transplanted..where the gov't funds the healthcare....this is called rationing bottom line...tho this poor girl was deathly ill...decisions will always be made based upon a risk/benefit paradigm Americans tend to believe that the fairy God mother will always be around to pay the piper...if we have the technology...why not use it?? good theory...but now we are replacing organs,,joints and doing open heart repair on 90 year olds...who have a life span of...oh yes...they have outlived it.. On Jan 17, 2:31 pm, <Hawk...@sbcglobal.net> wrote: > "Debbee" <Butterflies2...@yahoo.com> wrote in message > [quoted text clipped - 74 lines] > > - Show quoted text - UCLA is the TOP hospital on the west coast, It is the 3rd best hospital the the USA. With the top physicians in the world. These doctors gave this girl a 65% chance of survival if she would have had a liver transplant. I don't know about you, But 65% chance that my child would survive a transplant against the alternative of zero percent chance of survival without one is something I would fight for. UCLA also has their own criteria for Liver Transplants.... There's nothing in the MELD model to indicate that a patient has gone too far to justify transplantation. No one wants to be unsympathetic to a dying patient, or to tell his family that he can't be transplanted because he's likely to die anyway. But at the end of the day, using the MELD model leads to transplanting the sickest patients, while the UCLA model attempts to select those patients who will make the most use of the organ. If predicted survival based on the UCLA model is less than 70% in one year, if it falls below threshold criteria, we shouldn't transplant. If one-year survival probability is at least 80% to 90%, it's okay to transplant. http://www.medscape.com/viewarticle/444523 This was written 5 years ago....The criteria could have been dropped to 65%...Or the doctors didn't have the heart to tell the parents their daughter was too sick to survive a transplant,(We are talking about UCLA not some little hilly billy hospital in Kentucky) Or the doctors knew the insurance company would refuse.(Doubtful, this is the case) Maybe the UCLA doctors had real hope that they could save this girls life and that's why they went ahead and pushed to have a liver transplant. I do blame the insurance company for not doing what they are paid to do, and that is to provide health-care for sick people. That's why they get paid big money from ALL of us. Remeber UCLA is the TOP Hospital in the world fro Liver Transplants, I trust her doctors when they gave the parents hope only to be rejected by the insurance company. If it was YOUR child that was given a 65% chance of survival with a liver transplant or the alternative of zero chance, which would you choose? When should the cut off be? This child was in a similar situation... RELATED DONOR LIVER TRANSPLANT FOR VENO-OCCLUSIVE DISEASE FOLLOWING T- DEPLETED UNRELATED DONOR BONE MARROW TRANSPLANTATION. Brief Communications Transplantation. 61(4):664-666, February 27, 1996. Bunin, Nancy 1,2; Leahey, Ann 1; Dunn, Stephen 3 Abstract: Veno-occlusive disease (VOD) is the third leading cause of mortality after bone marrow transplant. Management consists of supportive care, with restricted fluids and diuretics. Most patients will recover, but approximately 25% may develop severe life threatening VOD with subsequent respiratory compromise and multiorgan failure. Orthotopic liver transplant has been attempted for a few patients with intractable VOD, but this approach is limited by availability of a cadaveric organ. We report a child who underwent a T-depleted unrelated donor bone marrow transplant for severe aplastic anemia as a manifestation of Swachman-Diamond syndrome who developed severe VOD. She had evidence of engraftment when liver transplant was considered, and had no evidence of major organ dysfunction. The left lateral segment of her mother's liver was transplanted at day +33 following bone marrow transplantation. The child remains well ten months post- BMT and nine months after liver transplant. A related donor liver transplant may be a justifiable approach in a patient with severe VOD post-BMT. http://www.transplantjournal.com/pt/re/transplantation/abstract.00007890-1996022 70-00028.htm;jsessionid=HP1b282dh13ky2ZTqH4QhclzrzyQgW2Y93tpLrWF9wtJfF9vx229!607 026366!181195629!8091!-1 On Jan 17, 7:46 pm, <Hawk...@sbcglobal.net> wrote: > I never read that her other organs were failing and if they were was > it because her liver had failed? [quoted text clipped - 183 lines] > > - Show quoted text - UCLA is the TOP hospital on the west coast, It is the 3rd best hospital the the USA. With the top physicians in the world. These doctors gave this girl a 65% chance of survival if she would have had a liver transplant. please do not lecture me .....again...that was a 65% survival of surviving 6 months....you seem to forget she ALSO had a cancer...plus a kidney transplant that indicates her kidneys were shot a liver transplant is the toughest transplant to survive from...add in the above pre existing conditions and the stats go down and down...the 65% number BTW is "survival from the liver transplant"....not from her general very grave condition...ie leukemia.. not to mention that the life saving anti rejection drugs totally make it difficult to fight off infection..so likely her leukemia would have returned (if the bone marrow transplant had worked to put her back in remission that is)....anti rejection drugs and chemo do NOT mix ...the patient would have literally NO immune system I don't know about you, But 65% chance that my child would survive a transplant against the alternative of zero percent chance of survival without one is something I would fight for answer:... funny how you continue to ignore the "other" problems this kid had..ie cancer and renal failure.... UCLA also has their own criteria for Liver Transplants.... There's nothing in the MELD model to indicate that a patient has gone too far to justify transplantation. No one wants to be unsympathetic to a dying patient, or to tell his family that he can't be transplanted because he's likely to die anyway. But at the end of the day, using the MELD model leads to transplanting the sickest patients, while the UCLA model attempts to select those patients who will make the most use of the organ. If predicted survival based on the UCLA model is less than 70% in one year, if it falls below threshold criteria, we shouldn't transplant. If one-year survival probability is at least 80% to 90%, it's okay to transplant. reply: you just contraindicted yourself...first you say she had a 65% chance of survival for 6 months...now you say if it is less than the survival threshold criteria of 70% don't transplant (again...assuming that a liver transplant is the ONLY problem...not cancer that requires chemo etc)...and a potential reciepient that is comatose and vegatative... choose which data you choose to quote and stick with it http://www.medscape.com/viewarticle/444523 This was written 5 years ago....The criteria could have been dropped to 65%...Or the doctors didn't have the heart to tell the parents their daughter was too sick to survive a transplant,(We are talking about UCLA not some little hilly billy hospital in Kentucky) Or the doctors knew the insurance company would refuse.(Doubtful, this is the case) Maybe the UCLA doctors had real hope that they could save this girls life and that's why they went ahead and pushed to have a liver transplant. I do blame the insurance company for not doing what they are paid to do, and that is to provide health-care for sick people. That's why they get paid big money from ALL of us. Remeber UCLA is the TOP Hospital in the world fro Liver Transplants, I trust her doctors when they gave the parents hope only to be rejected by the insurance company. reply: not sure where you got that data...the best liver center is in Pittsburgh Pa....not that UCLA is not top notch..it is... one article "wondered" why the great UCLA didn't go ahead and do it anyway...pro bono... If it was YOUR child that was given a 65% chance of survival with a liver transplant or the alternative of zero chance, which would you choose? When should the cut off be? reply:...after 40+ years in medicine..I do not think death is the worst thing that can happen....life without quality is... I suppose you also thought Terry Shivavo...after 10 years vegetative...should have been kept alive?? I am not for "assisted suicide"...too Catholic...but in my years of dialysis we frequently stopped treatment (with family and patient consent of course)...when quality of life was nil....I did my master's thesis on the topic...so it is a hot button This child was in a similar situation... reply: this is ONE case... we do not make decisions based upon one situation....this child had NO other organ malfunction...she also got a living donation from her mother...so her chances of recovery were excellent.. again...you are not in a position to evaluate such data and make medical comparisions RELATED DONOR LIVER TRANSPLANT FOR VENO-OCCLUSIVE DISEASE FOLLOWING T- DEPLETED UNRELATED DONOR BONE MARROW TRANSPLANTATION. Brief Communications Transplantation. 61(4):664-666, February 27, 1996. Bunin, Nancy 1,2; Leahey, Ann 1; Dunn, Stephen 3 Abstract: Veno-occlusive disease (VOD) is the third leading cause of mortality after bone marrow transplant. Management consists of supportive care, with restricted fluids and diuretics. Most patients will recover, but approximately 25% may develop severe life threatening VOD with subsequent respiratory compromise and multiorgan failure. Orthotopic liver transplant has been attempted for a few patients with intractable VOD, but this approach is limited by availability of a cadaveric organ. We report a child who underwent a T-depleted unrelated donor bone marrow transplant for severe aplastic anemia as a manifestation of Swachman-Diamond syndrome who developed severe VOD. She had evidence of engraftment when liver transplant was considered, and had no evidence of major organ dysfunction. The left lateral segment of her mother's liver was transplanted at day +33 following bone marrow transplantation. The child remains well ten months post- BMT and nine months after liver transplant. A related donor liver transplant may be a justifiable approach in a patient with severe VOD post-BMT. http://www.transplantjournal.com/pt/re/transplantation/abstract.00007890-1996022 70-00028.htm;jsessionid=HP1b282dh13ky2ZTqH4QhclzrzyQgW2Y93tpLrWF9wtJfF9vx229!607 026366!181195629!8091!-1 On Jan 17, 7:46 pm, <Hawk...@sbcglobal.net> wrote: > "Kevysmom" <bluebun...@gmail.com> wrote in message > [quoted text clipped - 214 lines] > > - Show quoted text - > Unbelievable, how an insurance company could refuse to pay for a > treatment that could have saved a person's life. This makes me [quoted text clipped - 4 lines] > > ttp://fayetteville.injuryboard.com/insurance-bad-faith/mark-geragos-is-wasting-his-time-only-the-united-states-congress-can-correct-the-injustice.php?googleid=14339 Agreed. The B L O G article mentions how ERISA has been distorted by the courts. It reminds me of how the American With Disabilities Act has been chopped up by the courts. BTW, I thought you said you do not do blogs when I referred you to the Neurodiversity blog? ow the American With Disabilities Act has been > chopped up by the courts. > > BTW, I thought you said you do not do blogs when I referred you to the > Neurodiversity blog? I normally don't do them--but this one made me a little on the sick side to think that insurance companies would be so disgusting, as to not pay for a treatment right away that could have possibly saved someone's life. Unbelievable, I'm sure some 3rd party claim expert vetoed it in the first place---and public outcry is what forced the insurance company into shame....a case of too little too late... for those of you who do not know the whole story here this was actually an issue of a self insured employer ....the insurance company was ONLY managing the claims....it may well be that the girls dad's employer had a say in the decision..ie...the cost of the transplant would have come directly out of the pocket of the employer.... which also negates all the naysayers who want to blame a "rich" insurance company with ceo's with million dollar bonuses read the info.... again...we are a medical society with the technology to extend life nearly indefinitely....at an immense cost every family thinks "their case" is special and that "their" family member deserves the million dollar treatment... it is really not fair to blame an entire industry for considering each very expensive treatment choice individually....it is not a matter of "denying a claim that could save a life".... in this case it was using a judgement call....this girl was gravely and likely terminally ill....her liver failure was only a part of her problems...even if she had received a liver transplant...the odds are great that she would have survived a very short time... again...your health insurance HAS a limit of $$ they must pay out...do not think that it is a bottomless pit of money when it comes to your needs... I also think that this case emotionalized the situation.... On Jan 17, 9:02 pm, Mark Probert <markprob...@lumbercartel.com> wrote: ow the American With Disabilities Act has been > chopped up by the courts. > > BTW, I thought you said you do not do blogs when I referred you to the > Neurodiversity blog? I normally don't do them--but this one made me a little on the sick side to think that insurance companies would be so disgusting, as to not pay for a treatment right away that could have possibly saved someone's life. Unbelievable, I'm sure some 3rd party claim expert vetoed it in the first place---and public outcry is what forced the insurance company into shame....a case of too little too late... |
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