lealdragon

I'll be sure to tell that to my clients who had cancer or heart attacks and ran up a huge hospital bill, and later called to thank me for selling them health insurance, since they got by with only about $5000 total instead of going bankrupt.

Opie ofMaybery2

"Everyone has done "something" wrong. It's a question of whether what you've "done wrong" justifies the penalty someone else wants to impose (for their benefit, of course.) It would be like an insurance company refusing to reimburse you for your car being stolen because you didn't tell them you'd been cited for making an illegal U-turn. Their excuse for not paying you money they owe you isn't justified by what you "did wrong."

You gotta learn to smell a fishy story, Opie. "

No Kluge, I understand what you're saying But.... I have trouble when the "innocent victim" is a willing particpant in the fraud. Maybe I'd feel differently if I knew the entire situation that person was in...but everyday I see people make poor choices with money and it's applications. I see many people who make choices that when disaster strikes moan why me???
Which is funny because in many cases they had ample opportunity to protect themselves.

Do you know more about this person's finances? What if she was making good money? would you still feel the same way? or would she be similar to a corporate exec stealing little?

Believe me, I hold in great contempt our white collar criminals out there, but often feel alone. We'd rather incarcerate a dope smoker for a decade than put a guy in the box for taking kickbacks from a plan advisor to carry their products and "steal" a chunk of all the employees retirements.

The fishyness of this story is the lady... she's a victim because she got caught in a lie. Had she told the truth, she would have paid more, but she'd have coverage.

I'm sorry I just disagree with the concept of lying on a contract and then claiming victimhood. It doesn't mean I support "Bonuses" or the like. But I do support honesty. It's just me... sorry. I wasn't lying about losing 50k a year because I was unwilling to kickback 5 years ago... It was illegal for my license, it was an illegal activity in my state, and with the IRS. It took the guy all of 24 hours to find somebody who would... accounts transferred, god help those employees..because if they only knew the real reasons for change...

I refuse to send executives on trips, buy expensive gifts when dealing with employee benefits.. because their is supposed to be some sort of fudicary responsibility going on, instead depending on the size of your company, the decision maker gets showered with gifts... and makes decisions based on what's best for them, rather than the employees. ..

Sorry for disagreeing, maybe I'm just a little bitter, but I hold little empathy for system gamers when they get caught..

You see this lady as a victim, I see her differently. that's all. Maybe if we knew more about her situation, our opinions might switch and be on the same side. But for now respectfully, we disagree...

lealdragon

Well said, Opie.

Every day people turn away our offers of insurance. Just last night a couple living in a $1million home with 2 expensive vehicles in the driveway turned away my offer to insure their family of 5 for $500-700/month (depending on which options they wanted). The man said he'd 'take his chances.' They were in their late 30s.

About a month ago, another man told me to call him back in 2 weeks, because he was 'too busy.' When I called him, he was on the way to the hospital for triple bypass surgery. True story! He was kicking himself.

Every day I get calls from people practically begging me to sell them health insurance. I can always tell, when they seem so eager, that they've just been diagnosed with diabetes or cancer. Now, suddenly, they want the insurance company to pay their bills for them.

Folks, that's not the purpose of insurance. Insurance companies are not obligated to pay YOUR medical bills! You don't go get insurance when you know you already have an illness. That makes no sense. Why is it THEIR job to pay YOUR bills?

Rather, the purpose of insurance is to SHARE THE RISK.

If you ALREADY have an illness, it's no longer a question of risk, but of CERTAINTY. You already HAVE the illness, so it's no longer a RISK that you MIGHT get the illness.

Insurance companies need to know your past medical history so they can calculate YOUR particular risk factors. Certain lifestyle practices, like smoking, and certain physical characteristics, like obesity and high blood pressure, are known to increase risk. So those folks will pay more than someone who is lean, fit, and has low cholesterol and normal blood pressure.

Why should the fit person pay as much as the fat person? That wouldn't be fair. That would be like expecting someone with a clean driving record to pay more for car insurance, to make up for the person with lots of tickets and accidents.

Sure, sometimes illnesses and accidents strike with no warning, but generally a LOT of the illnesses could be minimized or even avoided if people would change their mentality about health; quit being victims and start eating better and exercising. There are a lot of things people can do to decrease their risk of illness. And, get a good, basic health insurance policy with a reputable company (one who won't drop you or raise your rates after you get an illness) when you are HEALTHY. Get the insurance when you are healthy, when the cost is lower, so you don't end up on risk pool later if you get sick.

bookworm

teriwtt,

I can't tell you to not feel anger. As my earlier post stated, insurance companies asked for names of all my MDs and did research. If that woman had a serious bout of depression, and had taken medication, it would be included in the history. What if this woman was hospitalized for depression? At the current rate of $1000-2000/diem, she would end up paying a lot.

rds248

Wow, is that hypocritical thinking or what?

let me get this straight... Patients should have the "right" to pursue any therapy they want, whether proven, unproven or harmful, just because somebody out there says that a particular snake oil they concocted is effective. Just wondering if you think that their health insurance should pay for it as well?

And then, if they get sick and they want conventional therapy to make them well, which is available, yet so expensive that only a select few could afford to pay for it without insurance, health insurance has no obligation to insure them? Here in the United States of America, the wealthiest country in the world?

Healthcare in this country should be a basic right. It should be available to everyone. I'm not saying it should be free... it should not be. But those who are able to pay for insurance should pay, and those who can't should be covered by other programs. Every person should be insured. No person should be denied care or coverage, and just as every person who can afford insurance should be FORCED to buy it, insurance companies should NEVER be allowed to deny coverage to anyone based on "pre existing conditions". If they want to do that they should be forced OUT of the health insurance business. Let them sell auto insurance... then it's OK to deny coverage if someone has had 20 accidents. If our system operated on those basic tenets, we would be in a lot better shape than we are now. The idea that insurers should be allowed to micro evaluate risk and cherry pick all the healthy patients results in a system like what we have, where many, many people fall through the cracks.
By the way, what the insurance companies are doing by turning away higher risk patients is to transfer the cost to us.. the public. These patients end up getting their care, either through programs like Medicaid, or charity care which is paid for by taxes and higher costs for everyone else. This is so McGuire can walk away with his $100 million dollars.. money he stole from taxpayers, patients, and physicians.

Face the facts.... the large Insurance companies have singlehandedly destroyed our health care system, with the assistance of the government, who basically turned their backs and let them do whatever they wanted.
What we have now is a system where both patients and Physicians are dissatisfied, while insurance companies reap millions in profits (money that used to go pay for actual health care).
Until this is changed we will face continued increases in premiums, more health care rationing and denial of care, and more uninsured.

And by the way, the stuff in Sicko is also bogus. It does portray the problems in the US system, but if you think Cuban medicine is better... that's a total joke. It might be better for a society where Medicine is practiced at a third world level, but if you need a CAT scan, MRI, or a complicated operation, I wouldn't recommend going to Cuba. What Michael Moore neglected to mention in his film is that the technology there is about where we were in the early 70's. I don't know how many CAT scanners they have in Cuba, but in Canada, another socialized system, the wait is 6 weeks for a CAT scan!! My patients get mad if they have to wait more than 2 days.

lealdragon

Even though I currently sell health insurance (because, like it or not, at this point of time people do need it and they are often grateful to get it), if we end up with UHC I would happily find another career. I am certainly not attached to my current occupation. I would want whatever is for the highest good to be available for everyone.

No, not because someone said it was effective, but because they should have the right to decide for themselves. And your use of the term 'snake oil' is offensive. You are implying that all the anecdotal evidence and even scientific research into alternative supplements, treatments, etc. are bogus.

At worst, some supplements do no harm. Unlike drugs, which almost always have side effect.

At best, some remedies are quite effective. And many HAVE been proven effective by scientific research:

Life Extension Foundation: Research


Nope. I would not expect health insurance companies to pay for modalities outside their paradigm. However, there are some new companies that offer coverage for some alternative treatments. And, the company I work for, a conventional provider, now offers a lump sum payment option (in addition to covering the medical bills) which can be used to offset lost wages while recovering, alternative treatments, whatever. A person diagnosed with cancer could choose to use that $10k or $20k to pursue alternative treatment, if so desired. This is a wonderful idea.

Are you implying that someone would get sick FROM alternative treatments? and THEN choose conventional treatment?

Ha, quite the opposite is usually the case. In the vast majority of cases, people with serious illnesses got frustrated with conventional treatment, drug side-effects, and, often, were even given up on by allopathic medicine, and THEN they tried alternative treatments in desperation, and they turned their lives around! I've personally met people who were literally on their deathbeds, with hours to live, and they decided to try alternative treatments, and not only didn't die, but recovered their health and were vibrant many years later.

I have a personal story of my own - it's how I got into wholistic healing - I was told my ONLY option was surgery, I opted for natural methods instead, and not only did the symptoms disappear but my overall health improved dramatically.

Respectfully, sir, it is arrogant to think that conventional allopathic medicine is the only path to healing.

Nova10

People in healthcare consider supplements to be drugs. FDA doesn't recognize them as drugs for political reasons. Everyone else does. They do meet the definition of drug. They can interact and impact other drugs. St. John's Wort is one of the worst offenders.
NIH has done a number of studies on alternative medicine. They have an entire department on it. Their studies and others have shown very little positive data about supplements. They see, in general, a lot of placebo effect. An issue with supplements is the variance in purity. However, all supplement manufacturers are now required to obey to the botanical Good Manufacturers Policy. Hopefully, that will help to standardize things.
It is actually cheaper for an insurance company to insure 100 people than 1 person. With the bigger group, you can look at the statistics. An individual can be an anomally, but the group is not.

Bay

Patsy Bates, the Health Net "victim," is a hair-dresser. Health Net says it would not have written her policy if it had known her true weight/heart condition. We don't know whether she might have found coverage elsewhere had she been truthful, but perhaps the experts on this thread would know: Does your insurance company offer policies to applicants who are 35 pounds overweight and have taken fen-phen in the past?

lealdragon

My company would insure someone 35 lbs overweight, no problem (if you mean 35 lbs over optimum weight). That's not even considered very overweight, but is right on the border of standard. Over the limit of the upper range, the person would be rated up (pay a higher premium) for being very overweight, up to another ceiling, and if they are over that, they pay yet a higher price, and then if they are above the top tier of overweight, they are considered obese and not insurable.

Example: An average height woman weighing 150 would be considered normal weight. 200 would be considered a rateup. 220 might be a higher rateup. 300 would be uninsurable.

As for fen-phen, that's not a question I'm required to ask, so if they've taken it and didn't have problems with it, we'd probably never know or care. otoh, if they got an adverse reaction and ended up in the doc's office or emergency room, it would show up in the medical records and would be evaluated during the underwriting process, just like everything else.

We are also required to ask the person to tell us 'ANY OTHER' medical conditions in the last x # of years. An adverse reaction would definitely be classified as such, and they would be obligated to tell us about it. If they didn't, that's a material misrepresentation and grounds for fraud.

lealdragon

Of course. That's because they are trying to treat supplements like drugs - in isolation! They don't understand that wholistic medicine is WHOLISTIC - supplements are but one piece in a giant jigsaw puzzle - the wholistic paradigm utilizes all these factors TOGETHER to effect healing.

Nevertheless, your statement is still inaccurate. There is a wealth of data on some supplements - like CoEnzyme Q10 and heart disease, for example. Look it up and you will find LOTS of data on that supplement.

Yet, how many docs bother to tell their heart patients about CoQ10? (as an adjunct to other treatments if necessary) The data is in their very own medical journals! and many docs don't even know about it!

rds248

just to correct a misinterpretation of my statement.. when I read it over it was not clear.

I did not mean to suggest that patients necessarily get sick from alternative therapy (although some do), and then seek conventional treatment. My point was that you were supporting alternative therapy, and I assumed (wrongly as it turns out) that you would want insurance companies to cover such therapies. At the same time you were proposing that it's OK for insurance companies to turn down conventional therapy for patients or refuse them insurance completely if they have some risk factors in their history. So we are in agreement that insurance companies should not cover unproven alternative therapies. On the other hand we completely disagree on what the requirements should be for insurance companies that sell health insurance.

As far as harmful effects of alternative therapy, I have seen deaths because patients were told to give up their normal treatment and take alternative ones. I am a GI doc, and an expert in Ulcerative Colitis. I had one patient who was told by a "naturopath" to stop all her meds and drink aloe juice.
She ended up with an emergency total colectomy (removal of the entire colon) and an ileostomy (bag). That was a direct effect of stopping treatment abruptly. Others have been luckier and just had flare ups and eventually realized that natural treatment for this disease doesn't work at all. Oh by the way, she didn't sue him because he's not a licensed practitioner and there was no insurance, so no money to be had. So don't tell me there is "no harm" done by those that promote these treatments. It is totally unregulated. I have also seen fulminant hepatitis (the most severe and sometimes fatal form) secondary to use of unregulated supplements, and many milder cases which get better when the drugs are stopped.
I have been practicing for 20 years, and I have never seen a cancer patient that was "cured" when they sought alternative treatment. Every one died.
So that's my experience, and I honestly believe that there is virtually no value to any alternative therapy. If an alternative therapy is helpful, and shows benefit in a clinical study over placebo, it is adopted as an accepted treatment fairly rapidly. Most lay people do not understand how strong the placebo effect is, and this accounts for most of the reports of beneficial effects from alternative therapy. In the old days (you couldn't do this now) we used to give hospital patients who we thought were trying to get narcotics a placebo for their complaints of pain and most of the time it worked. We used to write an order on the chart for Obecalp (placebo backwards), 1 capsule as needed for pain, and the pharmacy would give them a pill with some lactose in it. They would report it wasn't quite as strong as Demerol but still worked pretty well!!

So you can save yourself a lot of money on alternative medicines and just have someone give you Lactose pills (of course you have to believe that they will work) and that will have the same effect.

lealdragon

Glad we got that cleared up. I would love to see insurance companies accept everyone equally, but that is not financially feasible at this time. As I said, I am completely open to solutions to the healthcare crisis. I'm in sales. I can sell anything (as long as it's a good product) so it won't bother me if we get UHC. It's probably true that the CEOs of the ins. companies make a disproportionately high income, just like the CEOs of oil companies, and those in many other industries.

Key word here is 'abruptly.' That was completely irresponsible. All the alternative therapists I've known have always stressed that the patient should NOT abruptly quit conventional treatment.

Then you must not be looking for them, because they most definitely are out there. Go to any health food store and you will find countless books telling their very moving stories. I'm not even a practitioner, but because I have been involved in the natural foods industry, I've met several dozen personally! (Who did NOT write books! Just told me their stories)

I've always found this viewpoint hilarious. You will accept that people can cure themselves with only their minds, but you cannot accept that physical substances have any effect?

Placebo effect does not account for some supplements not working and then others worked. I have personal experience with searching many different supplements, each time believing it would work, and it didn't until I found the right one.

Again, respectfully, sir, you don't seem very up on the research in your own medical journals about the natural substances that HAVE been studied - like CoQ10 for heart ailments, blue-green algae activating the killer cells in the immune system, extracts of blue-green algae activating adult stem cells, graviola killing abnormal cells in vitro, etc. Not to mention the healing of various colon disorders by very specific forms of, yes, aloe vera. (I guess the poor guy's practitioner was misinformed - again, irresponsible. But that does not negate the very real evidence as to the efficacy of certain types of aloe vera in CERTAIN types of cases.)

Anyway, thank you for your concern about me saving $$, but I've already saved a bundle by choosing natural therapies over an expensive, invasive surgery.

Sorry, but you cannot take my experiences away from me. I invite you to consider that your mind is quite closed.

As for alternative treatments being useless, millions of people who have improved their lives would say you are, quite simply, wrong.

You can't take their experiences away from them, either.

mini

"Rather, the purpose of insurance is to SHARE THE RISK.

If you ALREADY have an illness, it's no longer a question of risk, but of CERTAINTY. You already HAVE the illness, so it's no longer a RISK that you MIGHT get the illness."

And that is precisely the problem with private insurance - we are sharing the "risk" rather than sharing the cost, and the deck is stacked. The result is that sick folks can't get insurance. Actually, healthy folks (like my wife, recently cured of breast cancer) can't get insurance. It means great loss of productivity to the nation - I can't change jobs to somewhere where I might be more productive because no one will ever underwrite my wife.

"Glad we got that cleared up. I would love to see insurance companies accept everyone equally, but that is not financially feasible at this time."

Absolutely true. Which is why we need to do away with health insurance companies. Republican CEOs of health insurance companies, for example, unanimously support the bipartisan expansion of SCHIP because it means a guaranteed transfer of public dollars into their pockets. The expansion of SCHIP could be accomplished FOR FREE - and I really mean FREE (we have crunched the numbers in our state) if the state could self-insure for SCHIP (as they do for my own single-payor health insurance.)

(With my previous insurance, doctors were paid - literally - for not referring folks to needed specialists. The hope was that the "consumer" who needs specialists would switch insurance at the next opportunity, hence saving them the cost. I did. But I am one of the lucky ones.)

emeraldkity4

I just got letter today saying my car ins won't be renewed and the reason given is that my liscence wasn't validated.
???
While the ins agent did apparently intially input it incorrectly, it has been corrected,so ***?
My husband freaked me out by saying that maybe my liscense expired( i just had a birthday), but I double checked and it is good till 2010 whew!

overseas

How did we get into this situation where our lives are so ruled by insurance companies? Will it ever be possible to extricate ourselves? Car? Let's see get rid of cars by developing better modes of public transport and housing scenarios. Health? Some form of "state insurance" (like where I live). Floods? Prevent homes being built in flood plains. But then earthquakes? I guess we all take risks. Insurance tries to assuage our fears about our future calamities. I guess in the old days, we all lived with them. In the old days, there probably wasn't a lot of court action going on as well. Maybe a little sharp shooter action.

I have had good and bad luck with insurance companies but recently they have come through when the chips were down. With medical insurance, I have a mixture of medical insurance and state benefit, so for my breast cancer treatment, follow-up doctor visits and further pills that I will be taking for a long while, I pay nothing. That's pretty darn good and I feel blessed. I worry about my son who will most probably make his life in the States. The best advice I can give: prepare for eventualities because they do come in various packages. They hit us all unless we get hit by a car first.