Posted on 10/15/2009 12:43:13 PM PDT by pabianice
In the state of New York, insurers are legally prohibited from discriminating against individuals who submit large claims. So when Guardian, a major insurance company, was faced with the high-cost claims of 37 year-old muscular dystrophy patient Ian Pearl, it decided to cancel its entire line of coverage in the state of New York rather than pay for Pearl’s claims. In an e-mail obtained by The Washington Times, it was revealed that one executive at the company refers to patients like Pearl as “dogs” that the company can simply “get rid of”:
Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl’s. In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl “dogs” that the company could “get rid of.”
A federal court quickly ruled that the company’s actions were legal, so on Dec. 1, barring an order by the federal Department of Health and Human Services, Mr. Pearl will lose his benefits.
The cost of Pearl’s annual treatment is approximately $1 million a year. The Pearl family is unable to receive the quality health care that Ian needs. “One-on-one skilled nursing is essential,” Mrs. Pearl said.
Something is fishy about this whole story.
Have you heard the news?
The dogs are dead!
You better stay home
And do as you’re told
Get out of the road
If you want to grow old
The devil as always is in the details. However DU seldom lets accuracy get in the way of a good indignation fest.
That's just so brilliant it's beyond conception.
So the company offered a policy for unlimited home nursing - but when that became too expensive for them, the company backed away. I guess words mean whatever a corporation, a Congresscritter, or a judge decides them to mean any longer.
http://www.kineticconsulting.co.uk/healthcare-it/healthcare-robots.pdf
Apparently it was a contract to the point where the individual policy could not be voided, hence the need to eliminate coverage in the entire state.
It’s standard to have this kind of “out” stipulated in any health care policy. I have seen these clauses before and wondered what kind of situation would bring it to pass. I envisioned situations where fewer and fewer were buying the policy or it was slowly running out of money. I never thought of pulling the rug out from under an entire state to shake off one “dog.” (I wonder if it was only one “dog” or a whole kennel of them?)
Anyone with a double digit IQ (or better) can see the logic flaw here. There are people like Mr. Pearl in every state. Something must be different about New York to make insurance companies drop coverage there for everyone.
There are a few things that I don’t understand about the situation. My son was born very ill. One of the first things they wanted to do was put him on permanent disability/medicare. How come Mr. Pearl wasn’t put on disability/medicare to begin with? Why was he counting on private insurance anyway? If someone knows, please explain.
Yes, we as consumers do have some recourse when dealing with insurance companies and it is in every state....State Insurance Departments. Insurance companies do NOT want any insurer to file a compaint with this department. Just mention the State Insurance Dept when dealing with any insurance company on a claim and see how high they jump.
Not saying this company did the right thing, but I know there has got to be more to this story.
Yea, right. And there are whack jobs out there that actually believe this crap.
I can see $1000/day for 24 hours of full-time nurses if they get benefits. Plus the home care agency’s overhead and profit.
I have a homecare patient who gets 24/7 care, mostly skilled nursing, but at most one of the nurses gets benefits. My patient has a lawsuit settlement for lifetime care, but no one is at fault for a case of MS, as in the article.
Sadly, sometimes finances dictate a nursing home rather than homecare.
I don't know what you mean by "specialized product line" but how do Group Health, Blue Cross and others manage to make a go of things here in the northwest? I'm not aware of any great drama with respect to their businesses. Premiums are going up about 10% or so but that's it.
Anyone who believes this sh** needs their head examined.
OR and WA have pretty high state mandates (compared to the rest of the country) that require insurance companies to cover more voluntary and cosmetic procedures(read elective, and for things like acupuncture, I shit you not) that makes it harder to price basic medical care in a range that can reach those types of employees. The average $8-$15 temp or cleaning lady at a hotel can't afford the full package major med plans, and most companies that employ alot of folks like that can't afford to contribute enough to pay for it for them. Hence, true basic healthcare and most importantly AFFORDABLE insurance programs can't be sold. It's more of an all or nothing strategy in those states. You either work for an employer that can pay and provide enough benefits to cover you on a full major med, or you get nothing.
Again, those 5 states just make it the hardest for competition to occur or to provide a service to a demographic that needs it. I get several calls a week from small to medium companies that just try desperately to offer some type of health insurance to their low wage employees but have no option but to go broke providing them and not offer anything at all but AFLAC and other supplemental plans that aren't even health insurance. Don't get me wrong, those products are great for what they are designed to do: help replace some out of pocket expenses. But health insurance they are not.
Just a question that strikes me - If you have a son with muscular distrophy, very ill, why does he live in NY and you live in FL? Wouldn't a parent want to be involved somewhat in his care and his life?
Well, my own WA State policy doesn’t cover acupuncture, which at one point was a bit of an issue since I’d had it in the past and it was beneficial for that particular malady. One could only get it covered by having it prescribed and then getting the health plan to approve it in advance. But I agree the state mandates are relatively demanding with respect to pre-existing conditions and other things like mental health treatment. However, I was checking out premiums from Group Health a while back and was surprised they were as low as they were (for me, mid-50s, I could get a fairly high deductible policy for under $300/month).
For HDHP’s, that’s not too bad. Our PPO plan here in SC, runs me around $600 a month for family.
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