"Yes, copious amounts of blood flowing from your nipples is really something you want to wait out."

Well sure, one could be nursing a baby vampire.

*headdesk*

Not surprised to hear this from BCBS - wondering what levels of appeals the woman went through before she contacted the news... sad, but usually just need to appeal and it's approved.

BCBS is also the insurer that approved my first & last days in a 5 day hospital stay, but not the days in between, when I could have had "home health care" during that time. Appealed & approved, but sorry to hear their definition of an emergency is seriously flawed.

Even if she knew it was "just" a benign tumor, I think copious bleeding from one's breast is an emergency, and therefore justifies an emergency room visit.

But that's assuming she knew it was a benign tumor, which she definitely did not, nor would any reasonable, non-medically-trained person.

@hillsrovey: Oops - I see now that she had 1 appeal upheld... so she gave BCBS a chance to correct this and they stood their ground. Would be nice if insurers were monitored by a neutral 3rd party and punished when they pull crap like this. They really do count on most people not appealing... and they make it really difficult and time consuming for those of us that do.

@TCama:
In the original article, you can see that even the doctors assumed it was breast cancer until a biopsy revealed it was a benign tumor.So even a doctor couldn't tell it was "just" a benign tumor just by looking at it.

Even if they could instantly tell, it still seems like something you wouldn't just leave be. Blood loss is not a good thing.I can never see the following happening:

"Ma'am you appear to be bleeding, you should really go to the hospital."
"Its okay. I'm a doctor. Its just a benign tumor causing me to bleed from my breast. I'll get it taken care of tomorrow when I'm at work"

I just don't understand it: with health care reform looming, you think the insurance companies would be doing their best to behave and keep stories like this from happening - at least until the health care reform push is over.

Goodness..how the heck can anyone say that the government could do worse than THIS?

@buymecandy: Deathpanelbirthcertificatemustardmuslinsocialist

@jrizos: Governmentbureaucratseeeeeevulsocialisms...

@l951b951: Actually, insurers would gain more business under Pres. Obama's reform

@drizzt380: Very true. You can't tell if a tumor is benign unless it's examined by a pathologist, which usually means a biopsy or other means of collecting a cell sample.

@buymecandy: THat really is the bottom line in all of this debate, isn't it?

Sure, the government screws up almost everything that it touches, but can it REALLY be worse than this???

@Homerjay is utterly alone.: You would think that if nothing else the government has an embedded interest in keeping its citizens healthy. You can only tax a dead person so far.

I remember when I used to have BCBS. They would deny coverage for bloodwork as a part of a physical every single time because the lab didn't bill the location of BCBS in the "correct state" for the work. Never even needed to do a formal appeal to get it fixed, but it was still a ridiculous waste of time for something that they barely even pay out any money for.

@buymecandy: I'll let you know when I get through this line at the DMV.

@Homerjay is utterly alone.: Unfortunately, it could, because at least this woman has the opportunity to appeal, and sue, a private organization. She also has the option to switch insurance plans by moving to another state, or getting another job. When it comes to corporations committing evil, or government committing evil, I'll always choose the evil group that DOESN'T have the guns and the IRS on their side.

@Blackfished: I haven't had a problem with lines at the DMV for a long time. Though I've been going to the DMV's that have a somewhat modern queueing system that really helps move things along.

"Walk it off."

At least we don't ration health care here. Right?

@buymecandy: Sure it can. Ref: Iraq and the War on Terror.

Unfortunately all it takes is an incompetent/bad faith administration to tweak the policy so that it starts looking incredibly bad. Especially when that government's motto is: "Government screws everything up."

Which is funny, because if I was interviewing for being a programmer, and I told the interview panel: "Programmers are losers and they screw everything up. If you hire me as a programmer, I will just outsource the job offshore. Of course, I still expect you to pay me the premium rate, in addition to the cost of the outsourced programmer." I would never get that job.

@Blackfished: If the lines at DMV are bothering you, find out if you can renew your license at AAA.

In many states, you can get simple license renewals at AAA offices instead of going to DMV. Clean, friendly, takes 5 minutes, no line. $2 surcharge if you're not a AAA member. I love using this service.

Of course you still have to go to DMV for driving tests, registration, or plate changes, etc. But going for license renewal at AAA makes my day easier, and makes the line shorter for someone at DMV. Win-win.

@kaceetheconsumer: *takes away kacee's Twilight*

The problem is really doctor availability and ER costs. She probably didn't think she was bleeding to death, and could have waited for an appointment later in the day; alternatively, the ER could have offered similarly priced care as a scheduled appointment. But doctors need to pack their schedules so that they can have high salaries, and ERs need to charge more for "convenience"...

@Blackfished: Last time I went to the DMV there was NO line AND they admired my baby. And I was like, "Bring on the public option, bitches!"

@Snakeophelia: In fact, she's probably tied into mandatory binding arbitration and NO rights against a corporation except those delineated by contract, whereas when it's the government running things, you have constitutional rights (most notably due process rights) when you fight their bad decisions AND you have the right to run for office yourself if you don't like the way things are run. AFAIK, I can't run for "CEO of BC/BS"

I'm both puzzled and saddened by this "them vs. us" attitude towards the government. YOU ARE THE FREAKING GOVERNMENT.

@Eyebrows McGee (now with more baby!): The people at my local DMV (NJ) are friendly and efficient. Even when there are many people waiting it only takes 15 min to get a license renewed. I spend more time waiting on hold to get my computer fixed.

@morlo: Um... If you wake up and your bleeding and your not sure why I think you should be forced to go to the hospital.

What's ironic about the whole thing is that if she waited and passed out from blood loss in the meanwhile, the blood loss would have been because of "a preexisting unreported condition" (her tumor) so it would have been denied anyway.

"The money will come in especially handy for her family: Miran-Ramirez is being laid off as part of city budget cuts."

Well at least she doesn't have to worry about BCBS anymore - she won't have insurance.

@Blackfished: Yeah, the line at the DMV is quicker even here in LA than hm, the BANK or the grocery store.

@Snakeophelia: This is ridiculous: "She also has the option to switch insurance plans by moving to another state or getting another job."

If those are my only options (and for many those are not options at all), then bring on reform and a public option.

@morlo: The article didn't say, but it could have occurred on a weekend day. In my experience, most of my medical emergencies have happened on weekends and holidays -- when everything's closed.

@morlo: In many ways, doctors need those high salaries. They have to pay insane malpractice insurance premiums.

@morlo: Are you kidding?
If you woke up, randomly bleeding would you think, "well, I'll just call and see if I can get an appointment later today."?
The only people that would NOT seek out immediate treatment for something like that are people with NO INSURANCE.
This woman pays for insurance, surely its not unreasonable to think she should be able to visit the ER when she wakes up bleeding.

Wow, another anti-insurer post on a Gawker blog. Who'd have thunk it?

@Eyebrows McGee (now with more baby!): Some places in CA the DMV is a reasonable place to visit. Some places, even making an appointment doesn't save you having to waste the better part of a day being herded like sheep through the place. There are lots of things I like about CA, but govt services here do not fall into that category.

(There are other DMV's you can find that are very easy and you can get in and out. And I use AAA for as much as humanly possible!)

@TCama: I'd say that copious bleeding from ANYWHERE is an emergency.

@Eyebrows McGee (now with more baby!): This.

I agree with you completely on each point. My claims all go to arbitration if I'm not happy with the resolution, and my previous few policies have been the same.

But it does bring up the interesting question of what is the contingency if we get a government plan and there is a denial of claim which we want to contest?

I'm sure this has been addressed, but I haven't read it. Anyone?

I'm sure the CEO and executives of Blue Shield of California would have patiently waited for a scheduled appointment with a physician if they woke up soaked in blood.

Don't you?

Don't you think Bruce Bodaken, the CEO, would tell his wife "Honey, you're profusely bleeding from your breast? It's probably just a benign tumor! Calm down, girl!"

@darkwing: Wait, when did Consumerist get sold back to Gawker? Get back in your cage.

@darkwing: So you fully support such a claim being denied? I hope your insurer displays just as much sense and logic when it's your turn.

@buymecandy:
Easy. The detractors are preying on the ignorance of Americans. Personally, I'd love to have public health insurance, but that's just me, I guess.

Health insurance is an industry that deserves to die.

Sounds mildly familiar. Empire BCBS (emphasis on BS) was my insurer at the time... I suddenly started having horrific grinding pain out of nowhere in the vicinity of my wisdom teeth.

Go to see an oral surgeon, he finds masses under the impacted teeth that appear tumorous. Gets approval from my health insurance to pay to remove the teeth (and tumors underneath as medically necessary (As opposed to my crappy dental insurance). Which of course means he turned around and jacked up the price, added a bunch of extra things to the surgery.

Sends the suspect tissue out to the lab, it comes back benign. Suddenly... The insurer denies paying the claim. I don't even at this point recall what their excuse was, but I got left holding the bag.

@twophrasebark: Sure - he's the CEO so he should know best. He wouldn't want to waste company money and, no doubt, appreciates that he needs to be a good role model.

@Blackfished: In Iowa, if you wait more than 30 minutes at the DMV, it's free (you don't get a pizza though).

I work for an insurance company and can no way condone the actions taken here. If someone is bleeding, it should be a no-brainer.

That said, incidents like this represent only a fraction of all claims paid and by no means is the norm (yet people think it is because only the negative stories get air time.)

Every industry has bad apples, but the majority are good (especially here in MN).

@TCama: Agreed. That's the flaw in BCBS's logic. They're starting from "benign tumor" and arriving at "not an emergency". What they need to do is start from "HOLY &^%@! I'M BLEEDING FROM MY NIPPLES!" and arrive at "GET ME TO THE ER NOW!!!"

@buymecandy: They always find a way.

@John Gage:

If you buy a bad apple, you get a bad taste in your mouth.

If you buy bad health insurance, you get financially ruined or you die.

@morlo: I had a similar situation last year. I was experiencing extremely heavy menstrual bleeding that just wouldn't stop. It wasn't a "must go to the ER this instant" emergency, but I couldn't find a doctor who would see me - the soonest I could get an appointment was 6 weeks, even after I explained it was an emergency. The after hours clinics wouldn't deal with gyn issues. I ended up in the ER, although I called my insurance company and they told me to go ahead. But it was frustrating - I didn't really need an ER, but there seemed to be no middle ground between going to the ER or waiting 6 weeks.

@kaceetheconsumer: incidentally, The CW has greenlighted "Nursing a Baby Vampire" as a midseason replacement show, set to air in January