Oh, I remember when my spouse worked at a company with Aetna as an insurer. One of his co-workers, who had breast cancer, could not get chemotherapy approved until her doctor filled out forms certifying that the chemo was not an "elective procedure".

Nothing makes me happier about having gone to law school than realizing that I'll be dealing with insurance companies.

My girlfriend actually just had this surgery @ 28 she was diagnosed at 24. Best of Luck with everything. There is a few support groups out there. Really are 1 in a Million. (Which are the odds of having this) Apply for disability also.

@mythago: Insurance companies almost make me want to go to law school. Please feel free to give them an extra punitive kick in the nuts for me, next time you get a chance.

Consumers need to take note. If you get a serious disease, media strategy may be a necessary component, depending on your insurance company.

Boy am I glad we don't have any of that socialized medicine! [/sarcasm]

Let's hear it for free market heath care!!!

@se7a7n7: I might be wrong and probably depends on the country, but I was under the impression there are a variety of treatments that aren't covered by socialized health care/NHS type system. That are covered here in the US. I'll have to look it up.

Damn. Glad to hear this had a happy ending and best of luck to the woman.

I wonder if this govener is up for re-election or if he would do this for anybody, anytime? You never can tell a politcians real motive. You just have to assume they are all motivated by the wrong things.

It's time we have universal health coverage. Vote Nader!

Clearly it's the patient's fault due to a pre-existing condition. She had a brain, after all.
Good thing this didn't happen in Europe. They don't even have governors!

I wonder how many calls he will recieve now from people who's health insurance is denying their claim. I wonder if he will help all of them, or just the ones that make him look like a hero with the media.

I'm a pessimist I know, but for me to assume a politician did anything out of the goodness of his heart is pretty much not possible for me.

You know insurance companies are out of control when Christ has to intervene just to get them to cover stuff.

The power of god compels you....to pay for this surgery!

I wonder if this govener is up for re-election

Crist is supposedly on McCain's short-list as a veep. He was inaugurated January 2007, so he's not up for a little while, yet. He just recently announced his engagement to Carole Rome, a "Halloween business" heiress. One of the things her company makes is beards.

@ConsumptionJunkie: Voting Nader is one of the best ways to ensure that we don't get universal health coverage anytime soon.

@ConsumptionJunkie: Please lets not try to recruit votes on the consumerist. It WILL lead to a nasty discussion, especially when your telling people to vote for Nader...

@johnva: A vote for Nader, is a vote for McSame.

They need to establish some sort of punitive damages or fines against insurance companies who pull this crap. They also need to make insurance policies pass a government review before they can be sold. Insurance companies purposely make things vague and don't spell many things out so they can cover and deny at will. No other industry could get away with selling such a vague service.

Two options. Crack down on the insurance industry and put some black and white laws on what they do, or finally institute national health insurance. I just want them to pick one.

That is just downright wrong. They call themselves an insurance company?

To all those arguing about which "type" of health care system we have, that point is kind of irrelevant. The point here is, if you pay for an insurance policy, that policy is supposed to cover the costs when something happens.

You pay for your car insurance, so when you wreck your car, the insurance company buys you a new one. Likewise, you pay for your medical insurance, so when you need an operation, the insurance company should pay for it.

I still can't figure out how an insurance company isn't going to win the Golden Shit.

@snoop-blog: Different situation obviously but I was having a real problem involving USCIS and the National Visa Center regarding some adoption stuff. After contacting both places a couple times and each time them blaming the other for the issue I contacted my governer's (Johnny Isaakson) office, it was resolved in 3 days. So hopefully the only reason the governor did this was because his job is to look out for his citizens.

Charlie Christ rules. TeraGram, I see what you did there, but honestly, I'd vote for McCain/Christ ticket in a second.

@Trai_Dep:
HAHAHAHAHAHAAAAA!

(You're joking, right?)

@dezeinstein:
Hmmm that was meant for Consumption Junkie's Nader comment.

@bohemian:

Screw punitive damages, and screw going after them at a corporate level. Make it a felony for a claims adjuster to deny medically neccesary benefits. Obviously these people aren't the cause of the problem, but I doubt many would be willing to go to jail for their jobs. That would scare the insurance companies straight I'm sure.

Where's all these hooray privatization and free market assholes now?

Hmmm, If we do go to a similar system as Canada, I wonder if all the foreign doctors would move back overseas or just stop coming over here?

Actually Fox News contacted Charlie Crist's office and that's how he found out. Fox carried this story first...

And if we adopt universal healthcare, where will the canadians who want good healthcare go?

It doesn't surprise me to see support for government intervention in the comments here, but an all-out assault on capitalism, and support for socialism... that is a new low here.

I understand that you want to be anti-corporation, but check your Communist views at the door please.

@hypochondriac: Yes and no. In the UK, there are certain types of procedure (largely cosmetic, elective and/or experimental) and drugs that are either not covered at all by the NHS or which have a long, low priority waiting list. However, it's possible to buy private health insurance that covers these.

Whenever people bring up socialised medicine in these kinds of threads it's to point out the simple fact that with a socialised system, nobody will get refused a life-saving operation regardless of cost, insurance status or patient income. There are problems, but the risk associated with a socialised system pales in comparison to this story. Yeah, this particular person managed to get a win in the end but that's not going to happen for everyone. I'd be extremely concerned to think that when I need a vital operation, some paper-pusher is going to be paid to look for a way out of providing it.

Oh and vote for Nader, please, if it weren't for him we would have a that fat alcoholic al-Gore in the White House.

@JeffDrummer: What about the other 99.9% of Canadians who are happy with the health service there and don't go across the border? It doesn't surprise me that Fox would come up with such an idiotic "talking point" though.

Why are Americans so scared of a system where it's only incompetence that screws up their healthcare? Are you really happier when it's corporate greed that's killing people?

My son was approved for an overnight stay in the hospital by our insurance company.

He was only going in to have a minor procedure done.

Getting a new pulmonary artery and valve is minor, right?

That said, I've seen enough to know that the last thing I want for him is socialized or single payer medicine.

At least when he needs something here, he gets it. And insurance can get straightened out later.

geez everytime something about insurance is brought up everybody pulls the "we need national healthcare" I mean I'm glad this girls operation got approved, but this is one case we heard about. Has anybody looked into Aetnas record to see how many surgeries are requested versus how many are denied?
As far as private health care, my health care rocks. I've had 12 surgeries over the last 2 years and my insurance company has been awesome, I'll stick with private insurance thanks.

Oh, what a terribly meaningful moral you glean from this story. Twerps.

@aphexbr: And the thing about comparing competing systems is you avoid the anecdotal, instead focusing on reliable statistics.
Compare Europe vs US health stats on any measure, and we're at the bottom of the list among Industrialized nations. Period. Except, perhaps, optional cosmetic surgery.

If "socialized" medicine were so bad, we'd pay less and get more. Since the opposite is true, any rational person would recognize we don't have a workable system.

Of course, all you irrational commentators, I don't expect you to see this...

That's cool and all, but if you don't fine them 10 times what the claim is worth they have no incentive to do the right thing the next time.

Wow, insurance companies are the spawn of satan. Everytime I hear one is getting sued for the big bucks it makes my day. And don't give me that bs that our rates will go up either.

Moral of the story: Private insurance companies will gladly and openly kill you unless you contract some muscle- political or otherwise.

What a way to run a civil society.

Ok... Let me offer this and you can all yell...

My family is insured by Aetna QPOS and have found it to be really good. And we should know... Three years ago my wife needed cancer treatment/surgery that required a few days of inpatient care and a LOT of outpatient visits. We paid all the co-pays ($15 per visit and I think $50 at the hospital - maybe $300-$400 out of pocket) and received great service from doctors we chose and who were part of the Aetna system. So a few weeks go by and no bill.... I figured that the other shoe had been delayed in its dropping so I called Aetna.

Story was...

It was all taken care of. Period. All the surgery, hospital bills, specialists, consults, etc. ALL paid for when we paid the co-pay. There was no hassle, no fights, no ethical lapses, no lengthy mumbo jumbo bills/explanations.... just good service.

Sorry to tell a positive story, but we find Aetna QPOS to be great, especially after years of Care First/BCBS (Ugh!) home of the "THIS IS NOT A BILL". Now QPOS is not ALL of Aetna, but it is worth noting, isn't it?

@timsgm1418: Thanks for your comment, Senator!

a few years back aetna axed its benefits package for retirees. retired employees used to have benefits for life, but now they're left out in the cold. not really anything new in this market, except they not only axed benefits for those that retired after the change, they made the changes retroactive! [hr.blr.com]

kind of funny when even the insurance company can't afford their own insurance anymore, isn't it?

big surprise. Watch sicko.

@Ubermunch: Yes, and I've had some fairly routine reimbursements from Blue Shield without having to call the governor to shake them down. That's the way it's allegedly supposed to work, and really not a defense of what these companies are really up to.

You don't get a gold star just for showing up - you get it for going above and beyond what is expected of you.

The rest of the industrialized countries manage to keep their citizenry healthy and happy with shared insurance risk - the USA is the *only* one that allows private corporate oligopolies to kill (or maim, or lessen the health of) its citizenry who were unfortunate enough to be born broke, or not be contract attorneys, or politically powerless, or have purchased "health" insurance from a company having too many "losses" the same quarter they develop brain cancer, or....

It's these stories that point out that single payer healthcare is the only direction to strive. The fact that many bills actually get paid in the current corrupt "managed care" system is hardly a reason to celebrate or defend it.

bohemian,

I don't think your statement of (they) "make things vague and don't spell many things out so they can cover and deny" is not the plan of the insurance companies. I think it's more of a lack of education on the customers part and the fact that insurance companies have lawyers who write these documents and don't take into account the education level of the readers.

Even so, I hate insurance companies!

@snoop-blog: A few months ago, my doctor confided in me that his business is being squeezed left and right by the managed care reimbursement rates and lag time, and wasn't sure if he could stay in business. Said that nearly the only viable option for doctors now is closing up shop and work for Kaiser or another group where he'll just be another employee of a bigger company, with corporate bureaucrats micromanaging his every move. He's spent many "vacations" volunteering his services down in latin america and other areas that are underserved for the most basic of needs, and he is just shocked by how bad medical care has been taken by HMOs.

Just got a letter last week that said he's leaving the practice.

@JeffDrummer: Instead of the skinnier alcoholic Bush?

Definitely we need some kind of government intervention, the system we have now is not working. Our politicians knew back in the early 90's it was not working and decided to ignore it as usual.

More likely rather than denying a surgery claim, you would go to the hospital and get hit by the old 80/20 and go broke trying to pay the 20% they would not cover.

@timsgm1418: Oh, well if you have had positive experiences with your private insurance company then there couldn't possibly be anything wrong with private medicine! This woman should just be more like you and then she won't have anything to worry about!

On a not-sarcastic, long story note: Aetna did a similar thing to me when I was in high school. They cashed my parents' checks every month for years, but when it became necessary for me to have surgery, they denied the claim because, while the procedure itself was covered in my plan, they decided that it was elective in my case. We appealed the decision, providing additional documentation from my doctors (current and former) that they considered the surgery medically necessary. About two weeks after sending off the appeal, we got two letters from Aetna: a letter of receipt of the appeal and a notification informing us that the entire family was being dropped because of delinquent payments. It took about two weeks of phone calls and paper shuffling convince them that not only had every payment been on-time and for the correct amount, but that they had cashed every check and even noted these payments in subsequent bills.

It could have been coincidental incompetence, but that doesn't sound much better to me. They spent another several months claiming that the appeal was "pending," but we wound up just giving in and dropping them, switching to a Blue Cross/Blue Shield provider available from my mother's job. The new insurer approved the surgery in about a week and I had the procedure about two weeks later: almost five months later than I should have.

It was actually a good thing that we ditched Aetna when we did, though: when I checked into the hospital for surgery I saw a sign that said that Aetna plans would no longer be accepted. According to a staff member, it was just too difficult to get them to pay for procedures that they had approved!

Thanks, Ubermunch, for the reality check that this discussion sorely needs. Not all insurance companies are evil, even though they are attempting to (gasp! heaven forbid!) make a profit. Clearly they were wrong on this one, but if this were the standard of care that insurance companies offer, then the market would have already dealt with this company. This is just one bad, bad decision.

I was in England last month visiting my parents, when my son cracked his chin on a seesaw and split it open. It looked bad enough for stitches, so we went to the ER. I was told that it didn't need stitches, just a butterfly bandage, which they would be happy to put on him for free in three hours. I left and put a band-aid on him myself.

Therein lies the flaw in the national health care fanboy's thinking. There is not a magical, endless supply of medical care. Currently, the medical care that is available is rationed out according to money. When money isn't a concern, it will be rationed out according to time. When everyone in the country is eligible for their life-saving procedures, the only people to get them will be the ones who can wait (read: last) the longest. Or the ones with private insurance who can cut to the front of the line. There will always be inequality in resource allocation, and just because we want everyone to have equal access doesn't mean that we can make it so.