Amid the posturing, politicking, and general confusion of the health care debate, it’s easy to lose sight of the situation on the ground and the reasons that reform made it to the top of the agenda in the first place. The growing number of uninsured is one major factor, and the sense of powerlessness among many who have been forced to negotiate and plead with their insurance companies is another. In a series of posts this week we present some health care horror stories gleaned from consumer sites online. Keeping in mind that a license to complain is issued with every keyboard nowadays, the sheer breadth and scope of these Kafkaesque encounters, coupled with the frequent tone of weariness and desperation, serve as a powerful indictment of the present system.

The extracts in these posts are edited for spelling and grammar. A list of sites from which they were taken can be found at the end of the text.

My 16 yr. old son was taken by helicopter to the nearest trauma center due to a motorcycle crash. My PPO will not pay the E.R. bill, stating it was an out of network hospital. I had no choice which hospital he was taken to–state law says in a life and limb situation he must be taken to the nearest trauma center. He had lacerated his pancreas–cost for 8 day stay is $78,900, only for room and board. Insurance company has a special circumstance clause they are not following….What to do. Denied appeal.

I was sold an insurance plan labeled as $2500/$5000 and told that it meant that my wife and I each had a $2500 deductible. I had a bike accident in June and spent an afternoon in the hospital. The bills are almost to $5000. The insurance company is telling me that I have a $5000 “family” deductible and that my agent should have explained it better. Even my agent thinks that I should have a $2500 deductible, but the company is definitely trying to screw me. Health insurance in this country is a corrupt racket. This is criminal.

I have been in the ER of my local hospital with horrible abdominal pain, swelling, constipation and nausea several times this week. Earlier today, I noticed a large amount of dark black blood in my stools, accompanied by a low grade fever, lightheadedness and yet more abdominal pain. I reported once again to the Emergency Room. The doctors said they wanted to call in a gastroenterologist for an endoscopy. After several hours and some blood work, they stated that they were discharging me…They said my blood pressure and hemoglobin were fine, and that my HMO would not authorize an endoscopy unless I had lost “a lot of blood” or my hemoglobin was low… I voiced (my) concern to the ER staff, only to hear “well you really need to follow up with this referral we are giving you.” My HMO doesn’t recognize referrals from the ER, only from my primary care physician, who I have phoned many times only to hear that he is not available to see me for several weeks. I can’t see anyone else because my HMO won’t cover them. I can’t even explain how horrible this is, to know something is horribly wrong with my body and to be hung out to dry like some menial financial liability.

Last winter I was doing some work around my apartment and accidentally drank some paint thinner that I thought was water. I had put the paint thinner in a drinking glass because it made it easier to clean the brushes. My roommate rushed me to the emergency room and dropped me off because she had to go to work. I awoke 3 hours later in a pool of my own vomit in a hallway of the hospital. They gave me a charcoal treatment and I stayed there for a day and a half for observation. Now my insurance company not only has refused to pay for the visit ($3800), they dropped me from my PPO plan on the grounds that I had a substance abuse problem that I did not disclose. They accused me of drinking the paint thinner on purpose to get high.

I feel like I am being railroaded down a railroad that is going into the desert of financial and emotional ruin..and you know what? I’m thirty in this desert, and the only thing to drink is paint thinner…paint thinner served by my insurance company.

I live in South Texas and my Mother is going blind in her left eye. She got Photodynamic Therapy to slow the process. The first time the insurance company paid for it like they’re supposed to, but after the second treatment they said that it was experimental and that they would not pay. Well she had to have another treatment and those bastards are telling us that now we have to come up with $7,000.00 on our own and that we’re just out of luck. If you know of a lawyer who can help us, please send me a line, I just know that we can’t possibly be the only people this has happened to.

My twins were born via C-section. The anesthesiologists at my local hospital, which was on the “approved” list, had banded together and decided that they would no longer be included “in the network.” Luckily for me, I had out of network coverage as well, so even when the doctor’s office sent a letter and $1000 bill, I figured I was okay.

Fast forward to over a year, at least 6 attempts to file and about 12 phone calls to the insurance company later. The company has decided that it won’t pay bills to out of network doctors, so they just kept rejecting the claims (alternating reasons of wrong claim code and invalid dosing code). At this point they are also routinely rejecting claims from my out of network bloodwork lab and an out of network pathologist.

Enter MY HERO: North Carolina Dept of Insurance. I read about them in a article about consumer complaints against the plan. They have a handy-dandy online complaint form, and within just 2 weeks of sending in all of my supporting rejection notices, the plan coughed up the money. Of course, they weaseled out by saying that it was their Pennsylvania office (total untruth), but at least they finally paid up.

My father had a stroke 14 years ago and they put him on preventative meds, then about 6 months ago he had another one. It has put him in a permanant disability situation. The insurance company is trying to cancel the policy plus not honor the long-term and permanent disability clause. They are calling it a pre-existing condition. There have been 3 doctors to state that it…is NOT a pre-existing condition. I need to find a website or sample letter of dispute to file to the insurance company. If anyone has any information, please email me.

More stories tomorrow…

Sites:

• http://www.bluecrosssucks.com/consumer.htm
• http://www.kaiserthrive.org/kaiser-permanente-horror-stories/
• http://cigna.pissedconsumer.com/
• http://www.consumeraffairs.com/insurance/cigna_health.html
• http://www.consumeraffairs.com/insurance/aetna_health.html
• http://aetna.pissedconsumer.com/
• http://consumerist.com/

Posted on September 14, 2009 at 12:26 pm
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