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Tuesday, September 25, 2007

Murder by Spreadsheet, or the future under an "Everyone Must Buy Insurance from For-Profit Comapnies" health care plan
Posted by Jill | 4:37 PM
From Consumerist:

Now, on Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn't necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong!

On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, "We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it." WTF!!!??? I asked her, "Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o'clock in the morning?" It was then, I think it clicked in Jane's mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn't have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway?

Mind you we have had Blue Cross and Blue Shield of Kansas City for less than three months, they have denied every claim we have submitted to them. EVERYONE! Even though all claims are clearly covered under our policy, is this the going to be the norm dealing with BCBS? Any help would be very much appreciated!
-Tonya Gullino


Does anyone honestly believe that when everyone is FORCED to buy insurance from companies like BC/BS of Kansas City, anything will be different? Does anyone honestly believe that "competition" among insurance companies will bring costs down?

Insurance means nothing if when the time comes to have an illness or emergency covered, the company finds a way to deny the claim. The policy cited here has a high premium AND a $2000 deductible -- and still, they weasel the system by claiming that a miscarriage is an elective abortion.

Can you imagine miscarrying a wanted pregnancy and being told by a gum-chewer in an insurance company call center that because you had an elective abortion, your expenses aren't covered?

The ONLY answer to the healh care crisis in this country is a single-payer plan, and getting health care out of the for-profit model. Because as long as coverage of health care is tied to the need to show profit to shareholders, these companies will be in the business of denying care, not covering it. As early as 2003, almost 2/3 of Americans favored a single-payer plan. Yet ALL of the Democratic presidential candidates still give for-profit insurers a nice fat piece of health care pie. Why? They say that they favor legislation to prevent companies from cherry-picking those they insure and denying claims. But how do they plan to go about it when such legislation is going to have to get by Congressional legislators whose pockets are bulging with insurance industry campaign cash?

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