Insurance Insider Tells How To Appeal Coverage Denial

We’ve heard plenty of horror stories about people’s coverage being denied for situations where they’re darn sure that they were covered, and now, an insurance industry insider has come forward with some tips on how best to make an appeal.

These steps assume that you have gotten treatment and are certain that your policy covered your doctor, service, and diagnosis.

“1. Call the insurance company to get a clear explanation of the denial.

2. If they do not believe it is an error, ask if there is any way that a 1 time “pay and educate” exception can be made to cover it. For many small dollar situations, large companies will make a one time exception without having to proceed further.

3. For denied claims, ask the insurance company the exact reason for denial.

3a. If it is a policy exclusion, they should be able to reference what the exact exclusion is in your policy. If it is truly excluded, the company may have no right to actually pay the claim. Polices represent contracts and paying an exclusion for you can potentially get the insurance company in trouble with the department of insurance.

3b. If the denial is due to the provider not participating with your policy/insurance company, ask if there has been a change in the provider recently. For situations where that has not happened, be sure to include why you believed the doctor to be in your network in your appeal.

3c. If a denial is due to a medical guideline, check with you doctor. You should be able to get guidelines on the exact medical criteria from the insurance carrier, sometimes just from the website. By consulting your doctor’s office, you may be able to provide information to show that you do meet whatever criteria led to the denial.

4. Finally, if the above does not work, be sure to follow the appeal process that is outlined in your policy document. In the appeal, make sure to explain exactly what happened and why you felt the process you followed was correct. In the appeal letter, try to explain your case to show that you understand the process/coverage now and that you would have followed the guidelines if you had known before the service.

5. If your appeal is turned down, follow the steps to continue to the next level appeals process, but make sure to respond to the denial letter with more information rather than just resending the same letter again.

If you follow these guidelines, this should provide what you need for getting a fair shake with the appeals team.”

Thanks, Deep Ears, Nose, and Throat! Have any of you readers been in a situation where the insurance company denied coverage when you thought it was covered? How did you deal with it?

(Photo: Getty)

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  1. Fujikopez says:

    My insurance-biller-SIL once advised me when they wouldn’t pay up (even though they previously assured us we were covered for the services we needed-midwife) to send them a certified letter (with the bill) stating that if they don’t pay within the month that we would be reporting them to the insurance commission (or whatever the gov’t insurance agency is called). She said that they are required by law to pay within a month. This is in Oregon, BTW.

  2. aujahlisa says:

    3 denied claims
    The liver biopsy that diagnosed my cancer 7 years ago (Doc said cured!) because it wasn’t pre-approved. Of course it wasn’t. The doc doing my upper GI endoscopy ordered a STAT biopsy – I was barely out of the anesthetic for that when I was had the biopsy.
    I appealed and failed.

    Installing my med-port – it was pre-approved, but some insurance co. clerk coded the procedure wrong.
    I appealed and I’m pretty sure that the insurance company paid it (I had a few other things on my mind…).

    Blood Transfusion after my last chemo treatment – it was done as an outpatient procedure in the hospital’s ambulatory clinic. The word “clinic” was why the claim was bounced. The insurance company told me to have the hospital re-bill it and remove the word clinic, and then they’d pay it. The hospital didn’t.
    Fail.
    What REALLY bit about that one was that it was a directed donation from my mother. Not at all relevant to the billing issue, but definitely the crowning cherry on the whole pile of s—.

  3. ageekymom says:

    Our son was scheduled to have open heart surgery in March. The day before the surgery, during the presurgical testing and lab work, they decided that, due to a rash that he had on his chest, they couldn’t perform the surgery. The cardiologist billed the tests as a consultation instead of a presurgical consultation and the tests were not covered. What a load of BS.

  4. HIV 2 Elway says:

    How to appeal denied coverage…
    Be less of a liability.

  5. Archteryx says:

    @HIV 2 Elway:

    Sure, just don’t get sick, and if you are unfortunate enough to get seriously or chronically ill, just go off somewhere and die to help contribute to Aetna CEO’s second yacht payment.

    FOAD, please.

  6. HIV 2 Elway says:

    @Archteryx: Hard to have any sympathy when a smoker or alcoholic gets denied coverage. Not sure if you realized this, insurance companies are in business to make money, not lose it.

  7. KIbbit says:

    former insurance csr….be nice … and ask the rep for “their help”, we usually got $250 we could play around with each claim, not so much when the customer outright asked for the claim to be paid, go figure.

  8. johnva says:

    @HIV 2 Elway: Sadly, this is true. Insurance companies nowadays are making profits by selling expensive insurance to people who least need insurance. It’s become a huge scam, on everyone. People who need to use their insurance can’t get their company to pay out, and people who don’t get overcharged to pay for massive corporate profits.

  9. johnva says:

    @HIV 2 Elway: Those people are a vast minority of the people being denied claims.

  10. johnva says:

    @HIV 2 Elway: Also, getting sick is not a moral failing. Stop viewing it that way.

  11. BigElectricCat says:

    @HIV 2 Elway: “Not sure if you realized this, insurance companies are in business to make money, not lose it.”

    Not sure if you realized this, but there’s no guarantee that an insurance company will actually make money. And if a given insurance company’s business plan relies on denying coverage in order to make their nut, then perhaps that company deserves to go out of business.

  12. HIV 2 Elway says:

    @johnva: No, but being unemployed is. It’s not hard for any educated person to find employment that provides insurance.

    @johnva: My insurance costs me less than $600 a year, granted some of that is subsidized by my employer. I guess that’s one of the perks of taking control of ones life, educating yourself and find ample employment.

  13. HIV 2 Elway says:

    @BigElectricCat: Minimizing risk has to be a part of their business plan.

  14. gotroot801 says:

    I once had a procedure done by an in-network doctor at an in-network hospital that got rejected by my insurance company because they claimed it was out of network.

    It took a lot of angry phone calls and letters between me, the insurance company, and the hospital, but after six months, the insurance company paid up.

  15. miran says:

    I’m actually apposed to health insurance being a profit making enterprise. Property insurance, ok make a profit (if you can with hurricanes, tornados and the like) but not for health care.

    @johnva: I agree: Getting sick is not a moral failing, but making money of someones misery is.

  16. SkokieGuy says:

    @HIV 2 Elway: The complaint isn’t people don’t get denied coverage – people get denied benefits.

    Your screen name, HIV2, hmmn. Should people who contract HIV through unsafe sex be denied benefits, because they should have known better, like smokers and alcoholics?

    Yes insurance companies need to make money. They also need to fufill their contractual obligations to customers that they have provided coverage for. So what exactly is your point?

  17. Tyr_Anasazi says:

    @HIV 2 Elway:

    Your naivete is refreshing!

  18. chrisjames says:

    @HIV 2 Elway: What’s your point? Don’t get sick or don’t get insurance?

    The point here is that the insurance companies, while working well within their rights to minimize their risks and maximize their profits, are twisting their system to deny claims.

    How to appeal denied coverage…
    Untwist the system.

  19. johnva says:

    @miran: I agree with you. This sort of behavior is the natural end result of for-profit insurance. They have a direct economic incentive to pay as little in claims in possible. For-profit insurance doesn’t work well for healthcare. I don’t blame the profit-hungry companies so much as I blame our government for failing to regulate or outlaw their industry.

    I’m getting really tired of people implying that if someone doesn’t have the good healthcare coverage they do that they must not have worked as hard, or been a smoker, alcoholic, etc. The worse your health is, the harder it is to get affordable coverage (sometimes, it’s hard to even get a job then because employers don’t want the cost of a chronically ill person). And many serious health conditions are just the result of bad luck.

  20. HIV 2 Elway says:

    @SkokieGuy: I wouldn’t want to underwrite someone with the hi five.

  21. HIV 2 Elway says:

    @SkokieGuy: Just reread the post, didn’t realize we were dealing with people who had procedures performed only to have coverage denied. That is bogus. I was referring to people applying for new insurance coverage and being denied. If someone is an obvious liability, no insurer should have to insure them.

  22. SkokieGuy says:

    Then you are not endorsing insurance companies who provide coverage, then deny benefits. You simply suggest that insurance companies should refuse to insure people who are sick, or have a high potential of becoming sick. How Charming.

    And to others, it’s not just insurance, our entire healthcare model, drugs, hospitals, doctors and insurance being for-profit is logical, ethically and morally wrong. It obviously pits the profits against the amount of care provided.

    This is also why natural treatments (herbs, minerals, lifestyle changes like meditation, massage and accupuncture) are not well investigated, reported or supported, because these are not patentable ideas that would lead to a monopoly on sales and profits.

  23. johnva says:

    @HIV 2 Elway: “If someone is an obvious liability”? Who should insure them then (especially if it’s something detectable but not their fault, like a genetic disease)? The government? If you allow private insurance but dump the “high risk” people on the government, what you’re doing is privatizing the profits of healthcare and socializing the costs. Why should the taxpayers have to pay for people who have genetic diseases and such just so that private insurers can make a profit on healthier people? Isn’t that an indirect subsidy of private insurers from the government? Or are you suggesting that anyone with any preexisting condition should just be allowed to die (regardless of whether it’s their fault)?

  24. johnva says:

    @SkokieGuy: I was with you until your last paragraph. “Natural” treatments like you mentioned ARE well investigated. And in many cases derivatives of them CAN be patented…for example, plants have been a huge source of new compounds for pharmaceuticals. And there is still a market for pharmaceuticals and such that isn’t a monopoly situation…after all, there are generic drug makers.

    The real reason these things aren’t used more often here in the U.S. is that many of them do not work or have not been proven to work. I have no desire to throw my money at something that there is no evidence will help, and insurers likewise do not pay for treatments for which there is no evidence of medical necessity.

  25. HIV 2 Elway says:

    @SkokieGuy: Yet what country attracts the most doctors and provides the most medical breakthroughs? Is this because there is some socialist, everyone gets a hand job, universal health care system in place or because there are financial incentives to develop such breakthroughs?

    Mother econ wins every time. She’s undefeated in the history of the world. Attempt to remove the incentives to from the medical industry and watch the quality of services rendered diminish overnight. Profits are good, greed is good.

  26. HIV 2 Elway says:

    @johnva: Natural selection, worked for Darwin, works for me.

  27. johnva says:

    @HIV 2 Elway: Does not “work for me”, sorry. The profit motive “works” for the people with the power in the system, but it doesn’t “work” if your goal is taking care of individual people. I believe the health of all our citizens is far more important than corporate profits.

    Also, most “medical breakthroughs” discovered in the U.S. have little to do with profit and a lot to do with government funding of research. You didn’t think the high cost of drugs and medicine was because of all the money they were plunging into R&D, did you?

  28. Parting says:

    @HIV 2 Elway: Then why the insurance company authorized coverage in the first place? Either they tell the truth and don’t take your money; or they are lying and stealing from you.

  29. Parting says:

    @HIV 2 Elway: Define ”liability”. You seem as liability, let’s deny you coverage? How are you going to evaluate who’s liability and who’s not? Once you’re retired and lose your employer’s coverage, I suppose you being old is a liability for any insurance company.

  30. SkokieGuy says:

    @HIV 2 Elway: The same could be accomplished by the goverment and (non-profit, taxpayer supported) universities doing the research.

    It would be far more economical and reduce healthcare costs by eliminating the marketing, advertising, bloated salaries and lobbyist expenses involved in developing and selling a drug through current private corporate channels.

    @johnva: Natural treatments are NOT well investigated, as most “peer reviewed journals” and other ways of publicizing research are controlled by the medical establishment that is more interested in protecting their own than in the health of the public.

    As an example, it’s been found that St. John’s Wart is as or more effective than many prescription anti-depressants. Exactly who is economically motivated to champion this and do even more wide-scale testing and research? And yes, many medications come from plants and such, but only when the active ingredients can be synthesized and patented. Asthma? Relieved by increased hydration. Who’s gonna fund that research?

    The medical industry has no incentive to maintain or restore wellnes. That would eliminate their market. The medical industry exist to treat and manage illness.

  31. Parting says:

    @HIV 2 Elway: As for research, it has nothing to do with health insurance, NOTHING. Also, wait few years and observe how the research is gradually getting outsources by PHARMACEUTICALS companies.

    Pharmaceuticals often finance a variety of researches in universities, in exchange for rights on whatever is discovered.

  32. @SkokieGuy: Please stop making so much sense all the time, I can’t stop swooning.

  33. AidelMaidel says:

    I *work* for an insurance agent that sells group health insurance and I had an evil time with Oxford/UHC. My five year old developed tremors in her hands, arms and legs, and none of her doctors could figure out what was causing it. Her neurologist thought that possibly she had a fatal genetic degenerative brain disorder and suggested a special blood test that is only done by three labs in the country – none of which are in network with Oxford/UHC.

    Oxford/UHC has a special line for high selling brokers to help them with customer service. Prior to the test, I called several times to this line and spoke with them regarding this issue and was told that because they didn’t have a lab that performed the test, I could do it out of network, it didn’t require pre-authorization, and that they would pay it as if it was in-network.

    This was my kid and time was of the essence so I laid out the money for the test and to have the blood overnighted to Kennedy-Kreiger’s Lab. I submitted it to Oxford and was denied several times – because it was out of network, because there was no provider listed who ordered it (there was, her neuro is in network), there was no pre-authorization, etc.

    We did that test in July 2007. It took three customer service reps in my office, two customer service people on the special broker line, seven months, two appeals through Oxford, a threat to appeal to the state, and finally, we asked for a favor from our Oxford salesperson.

    What finally did it? The salesperson had them pull an override. Why? Because it looked very bad for her if one of her biggest brokers got upset about how Oxford treated one of the *broker’s* employees.

    The kicker? The test only cost $165. That’s chump change for Oxford.

    And no, thank g-d, she the test was negative. She doesn’t have a fatal degenerative brain disease.

  34. johnva says:

    @Victo: Like I said earlier, our system right now is privatized profits, socialized costs. We allow private for-profit insurance companies to profit by cherry-picking the healthiest people to be their customers. This minimizes the possibility that they will actually have to pay out a lot in benefits. Then we have the taxpayers pay for the people who cost a lot (like the elderly through Medicare, the poorest of the poor (who tend to have more health problems) through Medicaid, and the medically uninsurable (through state high-risk pools)). This raises the average cost per patient of the government programs, because they naturally have the people who can’t get private insurance. So basically we are bankrupting our government to allow for-profit insurers to make huge profits.

    If, instead, we just put everyone in a single risk pool, the average cost per patient would go down because the healthier people would then be bringing the cost down for everyone. Our hybrid public/private system is incredibly wasteful AND a massive corporate-welfare scam on the taxpayers, healthcare providers, and patients.

  35. HIV 2 Elway says:

    @SkokieGuy: A lot fo the reseaerch is done by universitys and then the technology is then puchased by drug comapanies.

    If you want to blame one faction in particular, blame the FDA.

  36. HIV 2 Elway says:

    @HIV 2 Elway: Nice sentence, asshole.

  37. SkokieGuy says:

    @alphafemale: Thank you for recognizing my latent brilliance. There are now two of us who agree.

    40 years ago I was diagnosed as ADD (Now ADHD). My mother fought the doctors who wanted to drug me up. Now, 40 years later, we have school teachers and guidance counselors determining that if little Johnny isn’t medicated into submission, he will not be allowed back in school. 40 f’ing years and we cannot manage what used to be called childhood. (Wow, kids have short attention spans, can be unpredictable and some times act inappropriately. Why in the new millenium, does this continue to suprise people and require drug usage to ameliorate)

    So as a child, we have public schools demanding we drug children, (too young to give consent). Once those children grow up, if they want to smoke a joint (their own choice to self-medicate) we throw them in jail.

    I generally have little patience for people who defend the status quo. There are very few things in life where we should accept and be satisfied with the status quo.

    This does not apply to Ben & Jerry’s ice cream, however.

  38. johnva says:

    @SkokieGuy: Look. My big thing is that I think these things need to be scientifically validated. I don’t go for “belief-based” alternative medicine. If the effectiveness and safety is scientifically validated, great. But I do not believe there is any such worldwide conspiracy to keep “natural” (I’m not sure you’re defining that in a valid way…everything is “natural”) treatments out of peer-reviewed scientific journals. And I don’t believe some things, like homeopathy, are even worth wasting research dollars on. Herbs and acupuncture, yes (though my understanding is that the pseudo-scientific theory behind acupuncture has been mostly disproven now…meaning it’s a purely physical effect). Homeopathy, no.

    And I feel you’re ignorant of the vast amount of research that in fact is being done on various “alternative” treatments. As I said earlier, most research is actually done by universities and such, not private industry. So if the government will fund the research, it will be done, regardless of the profit motives or economic model behind it. It just might not get done at a private company…but then, these companies are doing less and less of their own R&D anyway. If you want this stuff to be researched, ask the government to fund it and vote for people that want to fund scientific research. No profit motive is needed then.

  39. johnva says:

    @SkokieGuy: There is nothing wrong with “challenging the status quo”. That’s what I do here and elsewhere in every one of these health insurance threads. But do it in a way that is grounded in reality and evidence. We need scientific guidance to do the best medicine. The profit motive actually distorts the scientific process in many ways. You touched on one way, and another is that for-profit enterprises generally don’t like to fund expensive research with a long time horizon or a high risk of failure.

  40. SkokieGuy says:

    @johnva: I too believe in scientific and unbiased evaluation.

    Our government has many documented cases of squelching or supressing science (many scientists in the FDA, Centers for Disease Control, EPA have all come out and acknowledged that have been pressured to change or modify data).

    As one example, a recent widely publicized study discounted the efficacy of vitamin C. The study gave the entire dose at once time, which is a waste, because vitamin C is excreted in the urine. If the same daily quantity had been given, but spread out over the course of the day, the results would have been vastly different. Despite this obvious study design flaw, this study has been widely disseminated by maintstream media and mainstream healthcare. Why – because it tends to discredit the alternate health crowd, and tends to support the prescription health industry.

    I could go on and I (I won’t), but in addition, we have consolidated mainstream media, what, like about 6 companies? The healthcare industry, drug companies, insurance companies and such are a huge source of advertising revenue.

    Just as there is little economic benefit to researching non-patentable health treatments, there is little economic benefit to reporting on succeses in this area or debunking mainstream health.

    Computers have been used in the business world for what, like 20 – 30 years? Most doctors still hand-write prescriptions and exam notes in patient records. How on earth can this be justified? My local Jiffy Lube uses a higher standard of computer verification and bar coding. Talk about low-hanging fruit for cost reduction and reduction in medical errors (and lawsuits and deaths).

    The healthcare community has gotten a pass for far to long from the mainstream media. Investigate journalism is dead, unless you want to know about the latest backstage scandal on American Idol.

    The whole alternate health community knows about the criminal scandal involving the approval of Aspartame – Nutrasweet, yet only bits an pieces have every been reported in mainstream media.

  41. johnva says:

    @SkokieGuy: Your post reads more like an indictment of the government and the media than of the scientific community to me. I still do not believe that scientists are conspiring to suppress research into alternative medicine. If anything, alternative medicine is getting more funding than it merits.

    I think you’re looking at things selectively in a way that reinforces your bias here. The media reports on unproven alternative health woo all the time, so I really doubt your claim that they are suppressing the evidence in order to benefit the for-profit pharma industry or whatever.

    As for computerization, yes, in some places it’s pretty bad. The government is partly to blame for this, because it’s often regulations and such that make computerization difficult. For example, HIPPA has extremely vague and complex data privacy rules that make it expensive and difficult for a doctor or hospital to go paperless.

  42. SkokieGuy says:

    @johnva: Scientific funding costs money. Most funding sources are either the government (owned by corporate lobbyists), or private drug companies.

    No lawyer has a witness on the stand whom the laywer is not absolutely certain of what the testimony will be.

    Who is a funding source for scientists to uncover the truth, no matter what it may be?

  43. SkokieGuy says:

    In Africa, they are treating AIDS with an extract made from the Oleander plant, a flowering plant that you might have in your garden. In small clinical trials, success rates are approaching 100%.

    Have you, has anyone reading this thread heard of this? Seems to me, ought to be newsworthy.

    A diagnosis of AIDS is a lifetime annuity for the drug companies. The NY Times reports $32,000 ANNUALLY to treat one AIDS patient. Where is the economic motiviation for a cure?

    (Simply google oleander + AIDS)

  44. johnva says:

    @SkokieGuy: Prove to me that alternative health is not getting research funding. It is, and you’re wrong if you think it isn’t. Even without patents and such, it’s still incredibly profitable, BTW. Look at how many people are willing to pay through the nose for various “alternative” treatments even with no evidence that they work or are safe.

    There is always going to be some influence over researchers from the funding sources. But it’s less than you might think, especially in academia.

  45. johnva says:

    @SkokieGuy: Stop obsessing about the “economic motivation”. The government is putting tons of funding into AIDS research. They are not suppressing some miracle cure because it threatens big pharma interests. Do you realize how paranoid that statement sounds?

  46. bleh says:

    Don’t feed the trolls, folks.

  47. SkokieGuy says:

    @johnva:

    One tiny example: Cancer, 7,080 clinical trials, 123 into alternate modalities, 1.7% of total.
    [www.naturalnews.com]

    Prove to me that alternative medicine IS getting research funding!

    And my last comment on this thread, because you and I could debate alternate vs. conventional medicine all day and night.

    How about we agree that an industry that has life or death prescriptions hand written is in need of a wee bit of change?

    How about we agree that the FDA that only requires drug companies to submit studies with positive results and does not require them to publish or supply other studies with negative results, and an FDA that employees top people from the drug industry – is in need of a wee bit of change?

  48. SkokieGuy says:

    @worksintheory: Your contribution was so valuable. Thank you.

  49. johnva says:

    @SkokieGuy: I never said the industry and the regulatory apparatus are not in need of change. It obviously is. I’m just against introducing nonscientific treatment as part of that. If “alternative” medicine can provide scientific support for their theories, great. Just don’t push stuff that is based on pseudoscientific woo as an equal to scientific medicine.

    Alternative health should not get the same level of research funding as more scientific stuff, because there is less reason to believe that most of those things will work. I support research into alternative treatments that have a plausible theory behind their possible effect. I don’t support it into things that are based on discredited or made up belief-based theories of medicine (which is what a lot of alternative health is). And you can’t just compare numbers of studies like that. You have to look at whether the particular things being studied MERIT being funded.

  50. SkokieGuy says:

    @johnva: We actually agree, we both support the scientific study of new treatments and cures. I also don’t like to see anecdotal based claims being used to justify (usually alternate) treatments either.

    Where we disagree is whether an appropriate amount of funding is being provided to alternate health strategies.
    And I disagree tht traditional medicine is somehow more “scientific”. Surely the profit motive to manipulate data, the impact of lobbyist, the corrupt FDA, etc. has an impact on how the studies are designed, interpreted and reported.

    If science were truly pure and unbiased, I suspect we’d have a lot less blockbuster drugs being introduced and a lot less being withdrawn a few years later.

    Really, need to do some actual work, but thank for (and others) for an interesting thread.

  51. johnva says:

    @SkokieGuy: You’re welcome. I’ve got to get back to work too.

  52. BigElectricCat says:

    @HIV 2 Elway: “Minimizing risk has to be a part of their business plan.”

    That’s quite irrelevant if the risk in question is covered by the terms of the insurance product in question. By your standard, Toyota could increase my monthly payment on my new car if their profits went down last quarter.

  53. calvinneal says:

    @HIV 2 Elway / You are an ass!

  54. HIV 2 Elway says:

    @BigElectricCat: We’re not comparing the same things. You’re talking about not honoring coverage already extended to a customer. That’s bogus. I’m talking about not insuring a high risk customer in the first place. If a policy is granted, it needs to be honored. However, it’s unrealistic to think that insurers should have to insure anyone who applies.

  55. Thain says:

    Just as an aside about the cost of health insurance, not everyone can get a good job that provides good benefits, regardless of their education level, unless they are willing to relocate (and even then it can be a challenge).

    The company I work for toyed with providing health care for its employees for less than a year. If we wanted insurance for just ourselves, it cost us $25 per month, or about $300 per year. If we had the audacity to request coverage for our spouses, this suddenly increased an additional $200 per month, for a total of $2,700 per year (incidentally, this was nearly 15% of our gross income). One of our employees had three children. He tried to get coverage for them and ended up losing over half of his NET paycheck every month.

    I developed epididymitis while we had insurance, and was fortunately covered for ALMOST everything (I had to pay $100 for the emergency room visit, and another $100 for an ultrasound – I never got a good explanation for why I was denied coverage on the ultrasound, since it was an important part of actually diagnosing me).

    That was a random tangent, but something to consider is this: what is the point of HAVING insurance if they are simply going to deny you coverage (either outright or when you develop a severe enough condition) when you become a liability? I thought the whole point of health insurance was making sure that you could afford these inflated health-care prices that insurance companies helped create? Suddenly, I see that the REAL point of health insurance is to pad the pockets of large conglomerates, while still forcing you to pay the same ridiculous health-care prices. I guess I’ve learned my something new for the day.

    And you wonder why conservatives and liberals alike shudder at the thought of Hillary’s mandatory health insurance plan. I don’t want to be forced to pay someone money to tell me that I can’t be covered!.

  56. Thain says:

    Specifically @ HIV 2 Elway:

    Stop and think for a moment, though: Who needs insurance more? The healthy person who might end up in a bad accident, or the person genetically pre-disposed to cancer who will very likely cost the insurer tens- to hundreds-of-thousands of dollars later on (or immediately)?

    Does the person pre-disposed to (or currently suffering from) a serious illness have any less of a RIGHT to healthcare coverage?

    Honestly, denying treatment coverage to an existing customer or flat-out denying coverage to an applicant who would certainly be a liability is no different. Either way, you’re cutting your liabilities. It might be good business, but that’s why insurance needs to be less about business and more about people.

  57. JustThatGuy3 says:

    @SkokieGuy:

    Small clinical trials? I googled, as you said, and saw no evidence of clinical trials, but just a couple emails from someone who sells the stuff saying, in effect “I’ve been giving it to people, and they’re totally getting better. Really.”

    A clinical trial has a control group, and is preferably double-blind. No evidence of anything of the sort. If there is, please be more specific.

  58. HIV 2 Elway says:

    @Thain: Show me where it is stated that we have a RIGHT to healthcare. I’ve read the Bill of Rights, didn’t see it in there. People simply aren’t entitled to health care.

  59. SkokieGuy says:

    @JustThatGuy3: Truncated from one article: … supplement designed by South African HIV and cancer crusader and researcher Marc Swanepoel had been virtually 100% successful in stabilizing and reversing HIV symptoms and over 90% successful against a broad range of cancers. As a result of this success with several hundred people over the past almost four years…….Mr. Swanepoel devised and helped conduct a small scale clinical trial….. against HIV at a well known Johannesburg AIDS clinic. The clinical trial has just concluded with results as impressive as the previous reports: All of the HIV patients improved significantly whereas all of the placebo group continued to decline. In the trial, a double blind, placebo controlled study, the 20 participants were patients attending the AIDS clinic……….

    Link to article: [www.naturalnews.com]

    So they are using the classic scientific standard, but (I am guessing due to a miniscule budget) did the test on an extremely small sample size. Regardless, this certainly seems like promising data worthy of further research. As far as I’m aware, it’s not even getting (mainstream) media play, let alone any funding or research from traditional medicine sources (drug companies, government or universities).

  60. frari489 says:

    Wow, a little late to this, but let me just add my 2 cents

    “Scientific funding costs money. Most funding sources are either the government (owned by corporate lobbyists), or private drug companies.”

    I work at the NIH as a scientist and I know for a fact that corporate lobbyists have ZERO say in what we research. And while we’re on the point of conspiracy theories,

    “The U.S. public spent an estimated $36 billion to $47 billion on complementary and alternative medicine (CAM) therapies in 1997.” (from nccam.nih.gov). That’s a lot of money. CAM is big business, and is a worry when much of it was not been shown to offer any real benefit other than as a placebo. In fact I could link you many studies showing negative effects of CAM:
    [www.maj.com]“> hepatotoxicity_of_herbal_remedies.pdf

    “Prove to me that alternative medicine IS getting research funding!”

    The fact is that CAM is getting funding, just check out [nccam.nih.gov]“>NCCAM

    But you’re obvoisily a CAM true believer so there’s nothing I can really say that would influcence you and your conspiracy theories. Sure there are some things wrong with the FDA at the moment, but nothing even close to what you’re ranting about.

  61. BigElectricCat says:

    @HIV 2 Elway: “We’re not comparing the same things.”

    That would be your problem, not mine.

    @HIV 2 Elway: “You’re talking about not honoring coverage already extended to a customer.”

    Yes, I am. I’m pleased that you caught that.

    @HIV 2 Elway: “That’s bogus.”

    Yes, it is. I’m pleased that you agree.

    @HIV 2 Elway: “I’m talking about not insuring a high risk customer in the first place.”

    I wasn’t *responding* to that. If a company doesn’t feel like extending coverage, that’s their lookout. But that’s not the point of this thread and it certainly isn’t what I was talking about.

    @HIV 2 Elway: “If a policy is granted, it needs to be honored.”

    Yes, it does. I’m pleased that we agree on that point.

    @HIV 2 Elway: “However, it’s unrealistic to think that insurers should have to insure anyone who applies.”

    Yes, it would be. And of course you noticed that I made no comment about that, right?

  62. frari489 says:

    Wow, a little late to this, but let me just add my 2 cents

    @SkokieGuy: “Scientific funding costs money. Most funding sources are either the government (owned by corporate lobbyists), or private drug companies.”

    I work at the NIH as a scientist and I know for a fact that corporate lobbyists have ZERO say in what we research. And while we’re on the point of conspiracy theories,

    “The U.S. public spent an estimated $36 billion to $47 billion on complementary and alternative medicine (CAM) therapies in 1997.” (from the national center for complementary and alterative medicine) and this figure is bound to have grown by quite a lot since then. That’s a lot of money, so much it’s becoming a little tiring hearing how CAM is the little guy fighting against the big money.

    CAM is big business, and it’s a worry when much of it was not been shown to offer any real benefit other than as a placebo. In fact I could link you many studies showing negative effects of CAM:
    [www.maj.com]“> hepatotoxicity_of_herbal_remedies.pdf
    But then I guess these studies are from corporate stooges (rolls eyes).

    @SkokieGuy: “Prove to me that alternative medicine IS getting research funding!”

    The fact is that CAM is getting funding, just check out [nccam.nih.gov]“>NCCAM

    But you’re obviously a CAM true believer so there’s nothing I can really say that would influence you and your conspiracy theories. Sure, I think there are some things wrong with the FDA at the moment, but nothing even close to what you’re ranting about.

  63. BigElectricCat says:

    @HIV 2 Elway: “Show me where it is stated that we have a RIGHT to healthcare. I’ve read the Bill of Rights, didn’t see it in there.”

    While I am in no way asserting a right to health care, you clearly missed the Ninth Amendment:

    “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”

    [en.wikipedia.org]

    Given that, perhaps you could show me where in the Constitution businesses are guaranteed a profit.

    @HIV 2 Elway: “People simply aren’t entitled to health care.”

    Nor are businesses entitled to profit.

  64. frari489 says:

    Wow, a little late to this, but let me just add my 2 cents

    @SkokieGuy: “Scientific funding costs money. Most funding sources are either the government (owned by corporate lobbyists), or private drug companies.”

    I work at the NIH as a scientist and I know for a fact that corporate lobbyists have ZERO say in what we research. And while we’re on the point of conspiracy theories:

    “The U.S. public spent an estimated $36 billion to $47 billion on complementary and alternative medicine (CAM) therapies in 1997.” (from the national center for complementary and alterative medicine) and this figure is bound to have grown by quite a lot since then.

    That’s quite a lot of money, so much it’s becoming quite tiring hearing how CAM is the little guy fighting against the big money.

    CAM is big business, and it’s a worry when much of it was not been shown to offer any real benefit other than as a placebo. In fact I could link you many studies showing negative effects of CAM: hepatotoxicity_of_herbal_remedies.pdf
    But then I guess these studies are all from corporate stooges (rolls eyes).

    @SkokieGuy: “Prove to me that alternative medicine IS getting research funding!”

    The fact is that CAM is getting funding, just check out NCCAM.
    But you’re obviously a CAM true believer so there’s nothing I can really say that would influence you and your conspiracy theories. Sure, I think there are some things wrong with the FDA at the moment, but nothing even close to what you’re ranting about.

  65. HIV 2 Elway says:

    @BigElectricCat: No one has suggested the companies are entitiled to profit. Rather, what is being suggested, is that companies be free to opporate how they choose in a manner that allows them to maximize their interests.

  66. littlemoose says:

    No, there’s no “right” to health care, just as there’s no “right” to roads, or schools, or any of the other things that wouldn’t be accessible to poor people if we had a pure market system in every industry. Society has made a choice that these are desired public goods to which all people should have access. The insurance system provides perverse incentives, I agree. But let’s not drag the Constitution into this. It comes down to a difference in political beliefs. Some people think the government should have an expanded role; others, a contracted role. That’s all fine and good. What I implore you to remember is that our current system, as a commenter noted above, works to encourage care only for healthy people and to deny care for unhealthy people. I believe this is a serious problem. No, there’s no “right” to health care, but if society as a whole decides that it is a desirable good, government intervention is warranted, especially when the existing private market system is so clearly inadequate to meet people’s needs.

  67. BigElectricCat says:

    @HIV 2 Elway: “No one has suggested the companies are entitiled to profit. Rather, what is being suggested, is that companies be free to opporate how they choose in a manner that allows them to maximize their interests.”

    I took your snarky comment in re the right to healthcare as deserving of a snarky comment right back in re the right to profit.

    Perhaps you would show us where all these putative business freedoms to which you allude are enshrined in our precious Constitution?

  68. guevera says:

    @HIV 2 Elway: You just post to stir up a shit storm, right?

    “I guess that’s one of the perks of taking control of ones life, educating yourself and find ample employment.”

    Dude, should rewrite this to say “I guess that’s one of the perks of taking control of ones life, educating yourself and find ample employment, and never getting screwed over by the random viscitudes of life’s uncertanity inflicted on the average working stiff when living in a capitalist oligarchy.”

    There are a ton of big, tough questions about the right way to run a health care system. The bottom line is that if everyone is entitled to bleeding edge, mayo clinic style care, the country goes bankrupt, and quick, but trying to make a decision about who gets treated when the result is literally life and death take King Solomon’s wisdom to get right. But in all these really, really tough issues, one is really easy: the people in charge of making these life and death decisions shouldn’t have corporate profits as their ultimate duty. I mean, fuckin’ duh. Now that we’ve solved that, we can get rid of the private insurance companies and then start working all the hard bio-ethical issues of modern health care.

  69. guevera says:

    Forgot to mention step #6:
    Find the top five corporate officers of the insurance company (use the annual reports from http://www.edgar.sec.gov, you want the 10-k filing). Then start killing their families. Maybe start with their pets, if it’s a non-life threatening condition, otherwise, I’d start with their kids.

  70. frari489 says:

    Wow, a little late to this, but let me just add my 2 cents

    @SkokieGuy: “Scientific funding costs money. Most funding sources are either the government (owned by corporate lobbyists), or private drug companies.”

    I work at the NIH as a scientist and I know for a fact that corporate lobbyists have ZERO say in what we research. And while we’re on the point of conspiracy theories:

    “The U.S. public spent an estimated $36 billion to $47 billion on complementary and alternative medicine (CAM) therapies in 1997.” (from the national center for complementary and alterative medicine) and this figure is bound to have grown by quite a lot since then.

    That’s quite a lot, so much it’s becoming quite tiring hearing how CAM is the little guy fighting against the big money.

    CAM is big business, and it’s a worry when much of it was not been shown to offer any real benefit other than as a placebo. In fact I could link you many studies showing negative effects of CAM: hepatotoxicity_of_herbal_remedies.pdf
    But then I guess these studies are all from corporate stooges (rolls eyes).

    @SkokieGuy: “Prove to me that alternative medicine IS getting research funding!”

    The fact is that CAM is getting funding, just check out NCCAM.
    But you’re obviously a CAM true believer so there’s nothing I can really say that would influence you and your conspiracy theories. Sure, I think there are some things wrong with the FDA at the moment, but nothing even close to what you’re ranting about.

  71. mzs says:

    3b is what saved us. This was because of a scammy doctor that would apply to be a member of a particular insurance plan only to not complete the application. This would have him listed as a participating member for 30 days at a time. If only we had know to ask about recent changes in status for that doctor, that would have saved us more than a year of trouble. In the end the insurance paid because of this and they were supposed to sue him but we had to sign documents that we would not sue the insurance company, the doctor, the clinic, and/or the hospital.

  72. lyllydd says:

    Aetna seems to be taking lessons from United Healthcare on this front!
    They have tried claiming my primary is not in network, when she is in fact listed on their website as being in-network. They have tried denying my claims for physical therapy by stating that even though we were covered by their PPO and only needed to pay the co-payment, we were also liable for a $10 to $20 charge per visit. They claim that this is because they only pay 90 % of what is left after the co-pay. None of this is listed in the policy documentation. We’re still battling this and it may well end in small-claims court.
    Every time we need a doctor, be it for a routine office visit or an all-out emergency, Aetna has been trying to rip us off.
    It becomes much harder, because both my hubby and I are unemployed – we’re paying for Cobra. The moment one of us has a full-time job, we’re switching.