Posted on 09/18/2006 10:39:10 AM PDT by Hydroshock
When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.
Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.
ADVERTISEMENT"We're in big trouble," Leslie said.
Shortly after Selah's medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively, refusing to pay for treatment, including surgery the insurer had authorized in advance.
The company accused the Shaeffers of failing to disclose in their coverage application an undiagnosed bump on Selah's chin and physician visits for croup. Had that been disclosed, the company said in a letter, it would not have insured Selah.
(Excerpt) Read more at latimes.com ...
I hate to say it, but they'd be better off if the parents quit their jobs or took lesser paying ones, went on assistance and let the government pay for their medical bills.
we're doing it for the mexicans I sure as heck would rather see some of my tax money going to help out regular U.S. citizens in a time of serious need.
and I don't care what anyone says against welfare. The way it is now sucks but the fact is I would rather STOP sending money to other countries, STOP giving freebies to non citizens and use THAT money to help U.S. citizens in critical need.
If you read into the article they are sueing the insurer. I wish them the best in that and the girls health.
Monty Python had a skit about an insurance agent. He examined a claim and then said "Aha! I see that you're covered under our 'No Payment Plan'. That means that whatever happens to you, we don't have to pay you anything. Have a nice day!"
That's just bull. The insurance companies/medical establishment enjoy information sharing that the Kremlin would have envied! The only one to blame for the non-disclosure is Blue Cross, they didn't exercise due diligence in researching the family. Once again, the Blues screw!!
Blue Cross screwed up badly in this decision, and they will probably have to pay out a lot more than they saved by screwing the family out of their insurance.
CRISIS: Blue Cross excluded Selah Shaeffer from coverage as she was being treated for a facial tumor, leaving large bills unpaid. (Don Bartletti / LAT) Jul 20, 2006
The claim that it was pre-existing is absurd. That's what they pay for health insurance for.
My doctor gave me 6 months to live, but I told him I couldn't pay the bill in that amount of time, so he gave me another 10 years.
Yep the bad publicity alone is going to burn them.
Ping
Has anyone been subjected to the medical information questions on your dentist's form. Have you experienced your dental office taking your blood pressure and asking what medications you are taking? Have you been required to sign off on the above? HIPPA has given access to all areas of "medical" information and every single time you fill out a form and it is repeatedly updated by "you need to fill out this form again" you better be consistent as you can be assured it will be compared if necessary.
Yep it will.
What has happened is that people are rushing to the doctor for sniffles, itches, and dandruff. These people think because they have insurance, it's free.
Well, that abuse has led to this kind of denial of coverage.
If you have gone to the doctor for something that was self limiting and could have been treated at home.....then look in the mirror.
actually , I agree with you.
I never go to the doctors unless absolutely necessary and neither does my family.
If there is a home remedy, I use it.
Even when I have insurance I almost NEVER USE IT!
The only time I think I used it was when I gave birth.
What a great sytem.
You want to work for yourself or your company stops paying for medical.
You apply, go though the insurance company's scrutiny and tests then if you are lucky (and they don't disqualify you for acne (it happended to my daughter) , you are approved and pay your huge premiums.
Then if you really get sick and need it, they find anything in your application or records to cancel you, even if it has nothing to do with your illness or as the article claims they accuse you of having medical conditions that you don't even have.
You spend more money to sue them which comes out in favor of the company 90% of the time.
Or you can sit on your butt, apply for goverment help and have everything paid for whether you're a citizen or not.
Most children are covered at birth if their parents have policies. This says that the parents applied just before the tumor was found. Could be bad luck. And sometimes insurers act like slime, just as insureds do.
If they indeed did not report ANY physician visits the company has grounds for cancellation. The applications are crystal clear on this. And the companies know, as they cooperate in maintaining a central repository for claims information and can go back and look up 10 year old claims histories.
The moral: if you are applying for a policy tell them everything and get health insurance before you have any possibility of being ill.
That used to be called Hospitalization Insurance
Catastrophic is entirely another thing and you can purchase that coverage over and above 'health insurance' the same as you can purchase long-term care.
What has happened is that people are rushing to the doctor for sniffles, itches, and dandruff. These people think because they have insurance, it's free.
I think this came with major medical lowering thresholds on deductibles to be met by individual or family.
Well, that abuse has led to this kind of denial of coverage.
When will they go after the 911 taxi cabs? That irritates me in the biggest way. 911 is for life saving procedures and all others should be made pay the tab. I would be happy to see insurors start denying payment for the taxi service.
If you have gone to the doctor for something that was self limiting and could have been treated at home.....then look in the mirror.
In my opinion all office visits should fit in this category. Why should any insurance cover the doctor visit at all? There would be fewer crowded doctor offices if it didn't as people would think twice before shelling out the $50 to $100 per visit for a cold. I suspect the entitlement to paid office calls came after and because when a catastrophic illness met the major medical threshold the doctor visit was picked up by the insurance.
You & ex-texan must be one hell of an unhappy couple.
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