Meet 19-year-old Caitlin Jackson. Caitlin was recently diagnosed with Chiari Malformation, a potentially fatal brain disorder that interferes with motor control and memory. Immediate brain surgery is Caitlin’s only treatment option, but her insurance company, Aetna, took its sweet time approving her operation, and then reversed itself claiming her benefits had expired.
Thankfully, Caitlin’s story ends well. After Florida Governor Charlie Christ’s office read about Caitlin and had a nice quiet chat with Aetna, the insurer quickly to agree to pay the full cost of Caitlin’s $113,000 operation.
The moral of the story: if your heartless insurance company changes its mind about a life-saving operation, call the media and the governor.
Why was a brain surgery patient turned away? [News 10]
Governor Crist hears Tampa Bay’s 10 story, and takes action! [News 10]
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All right, I didn’t cheat and look at the other comments yet – but I’m saying “Thank God we don’t have socialized medicine like in da Europe” was one of the first three. It’s right up there with “This is why I don’t fly”, “Slow news day?” and “I make my own pizza!” as a sure thing on this site.
Let’s see if I’m right here…
Dammit! Fourth post. MsClear, please try to be 6 minutes faster next time
I’d be fine with some type of government health care as long as we could deny benefits to smokers, alcoholics, obese people, motorycycle riders, skateboarders, and people that drive without seat belts.
I’m with Aetna HMO. My doctor prescribed a cholesterol drug at 80mg. I went to Wal-Mart to fill the scrip. The pharmacist told that the 40 mg dose was generic at $24 for three months but the 80mg dose was $326 a month (What??????)
The pharmacist had my doctor write two scrips. Aetna refused to pay saying I didn’t need two pills. It was explained to them why we were doing this but they refused to budge. I paid for the scrip myself; $24 for 3 months supply as opposed to the $978 that Aetna would have had to pay. I know that I should have let Aetna eat the4 higher bill but I just shook my head and called it a day.
What kind of person do you have to be to evaluate someone like that and decide “nah, we’d rather just let you die”?
God that makes me sick.
@Bobg: That’s another advantage of the health systems in other countries – lower incentives for people to screw you on price. Each prescription in the UK would cost you £7.10 (around $14). Most pharmacies will sell you a lower priced over-the-counter alternative if one is available rather than fill the prescription. There’s also exemptions from even this charge for children, the elderly, the poor and the unemployed. Drugs can be even cheaper in other countries – I pay roughly half for the gout medicine I take in Spain than I did in the UK and I can get it without a prescription if needed.
@A few others in this thread who thanked me. Erm, wow thanks, glad to know my comments are appreciated. Just to clarify for anyone else, I’ll repeat – I don’t think that completely socialised medicine is the way to go in the US, nor is it perfectly implemented elsewhere. However, it’s sad to see people on an international forum claiming “communism” and pointing to myths and/or exaggerations as to why a system that favours profits over human life (as per the article) is favourable.
I live in Canada, and I love our system. Although it does has some problems that need to be addressed (as if anything out there doesn’t) it is much better than the alternative. Every time a serious injury/illness has occurred in either friends or family the health care system was there.
We don’t pay 60% taxes (a blatant lie, actually ~35%), we don’t wait long times for life saving treatment, we don’t have to deal with HMOs, insurance companies, it is not communism, and it raises the quality of life of everyone in Canada, and as a result we live in one of the top countries in the world, even with the room for improvement. I think the reason it works in Canada is we don’t have a duopoly of governing parties in our political system. There are currently four parties vying for votes (with a fifth moving up) and it makes for a more balanced approach where the average American doesn’t get. I can see with the current administration why they would not have trust in government to run health care.
@BluesFan:
Unless you can’t afford a large legal team, or can’t get the media interested in your story. Then your insurance gets “straightened out” shortly after you’ve lost your home… or your son. The hospital will NOT perform the procedure until you’ve provided proof that you can pay.
That’s just a fact of a for-profit health care system. The hospital can’t provide free non-emergency care because they’d be out of business in no time flat. Of course, the waters are a little muddier when you realise that an insurance company likely owns your hospital.
@failurate:
He is. People spout that crap constantly, but no canucks I know have ever validated it. I spent 6-7 hours in an emergency room with chest pains here. Told one of them about it, and his response was “But don’t you guys have to pay for your health care?”
Hey,
I live in Canuckistan and I have *no* problem at all paying higher taxes knowing they go to healthcare and education and infrastructure….. and not murdering foreigners so old white men can continue to bank away blood money for their children.
@FoneMonkeh: Compare your experience with the UK NHS to that in the U.S. – if you seek out treatment for ailments like you did, you become ineligible to get individual health insurance except for a very expensive high-risk policy.
@Frank_Castle:
I blame the consumer a lot… because the consumer is frequently wrong.
I often write posts stating that the consumer should probably DIAF because, well, they’ve done something stupid.
But your post there, I don’t think I’ve ever before encountered such a hate-filled pile of BS on this site. You’re saying that she should die because her insurance company refused to cover a procedure that they were supposed to cover? You’re saying that people should die because they’re not super-rich and can’t afford life-saving medical treatments that cost six figures or more?
—–
Isn’t there supposed to be a Report button somewhere?
@varro:
Speaking of high-risk, my parents recently had to cancel my mother’s health insurance entirely in favor of a HSA. Insurance for her was topping $500/mo.
All because she was infected with Hep-C from a bad blood transfusion after I was born. So the medical system ROYALLY screwed up and nearly killed her – but she’s somehow considered responsible for it, and now has to pay for it the rest of her life.
I will say ONE good thing about the medical industry – the antivirals she was on were provided at a discount through the pharmaceutical company. I still think that they’re (when they’re for-profit corporations) largely hucksters and cheats, but they don’t do EVERYTHING wrong.
ok, I understand the disdain for insurance companies, but I do believe they are often attacked in the media without fair cause. there was a case in my state that was reported all over the news: employee of a company needed a transplant, company new this and STILL switched insurance providers *knowing* that this provider required a 6 month wait period for all transplants after joining their coverage (something about not wanting people just to switch when they needed something). so the employer made this decision knowingly but the insurance agency gets turned into “the big bad insurer won’t pay to help him!” shouldn’t the media also be looking at the type of options companies offer their employees? sometimes it seems they are equally to blame in offering limited policies to their employees….
@heyo:
If the transplant was covered and had been vetted PRIOR to the switchover, the original insurance provider should be held responsible for the procedure.
They wouldn’t be, of course, because they don’t actually care about what you’ve paid them for over time, they only care about what you’re paying them for at this minute. The irony, of course, being that they can decline coverage for past (covered) events, even after you’ve cancelled your (future) coverage, though you can’t request payment for past (covered) events when you’re no longer covered by them.
The crux of the story’s fairness to the insurer would be when the switchover was made, did they cover that?
@ RvLeshrac: Hmm…this was about a year ago so I am not sure… or at least I don’t remember reading about the past insurer in the news. The reports on it were just totally sensationalized. Yes, our health care system is seriously messed up and needs revamping. Way too many people don’t receive the treatments they need on a regular basis (due to insurance or lack of etc etc) but I am also tired of reading about all these situations where we don’t have all the details (like, as you said, when was the switchover made? did she need a transplant before?)
I am sure that a lot of times the customer is in the right, but I also think that there are other times when the insurers just cave to keep the press positive, regardless of their policy. after all, you can’t simply say to a reporter “well, our policy that the sick person or their employer signed says xyz, so we aren’t responsible” when someone is about to lose a family member/friend. you know?
@heyo:
The problem is precisely the number of stories you DON’T hear about on the news. The number of “unfair” cases hasn’t even placed a dent in the insurers’ bottom lines, so I’m perfectly fine with the “unfair” cases being processed if it means they’ll take more care with what they do and don’t cover.
A dozen “unfair” stories about the insurance company doesn’t justify even a single death due to the inability to obtain a necessary medical prodcedure. I understand what you’re saying, but the penalties for the insurers are infinitely lower than those for the insured.
@emilayohead: You’ve never been to an ER in the US, have you? Having been in a California ER several times, I’d KILL for a three-hour wait for a non-life-threatening problem (which, let’s face it, your son’s cut chin is). Average wait in my area is closer to 4-6 hours.