Anthem BCBS Decides Boy Who Can’t Sit Up On His Own Doesn’t Need A Wheelchair

There’s a 2-year-old in New Jersey whose cerebral palsy makes it impossible for him to walk or even sit up without support. But according to the computers at Anthem Blue Cross Blue Shield, he should give a cane a try before Anthem forks over the cash for a wheelchair.

The boy’s parents have had to carry him around the house and wherever they go, but when he grew heavier than 30 pounds, doctors prescribed a specialized wheelchair at the cost of around $5,000.

Thankfully this is what health insurance is meant to cover!

Oh… wait.

“I don’t think anybody could really comprehend why it was denied,” the boy’s mom tells Philadelphia’s KYW-TV.

Well, according to Anthem — a subsidiary of insurance titan and perennial Worst Company In America candidate WellPoint, a wheelchair is not medically necessary for the boy.

Because doctors apparently just love to write bogus wheelchair prescriptions for small children, Anthem said needed more proof that the boy couldn’t just get by with a cane or walker.

The parents’ attempts to talk sense into Anthem didn’t work, so they turned to KYW.

Amazingly, once the reporter called Anthem, it had a change of heart and approved the wheelchair.

However, the insurance company swears that it’s just a coincidence it overturned its initial decision the morning after being contacted by KYW.

Back in September, WellPoint announced it was “hiring” Watson, the IBM supercomputer that had competed on Jeopardy, to help it make better treatment decisions for policyholders.

Maybe the boy’s doctors should have worded the prescription in the form of a question.

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  1. Mike says:

    Private health insurance companies will be looked back on as one of the worst and most disgusting inventions in human history. Private insurance is great for insuring your merchant ship crossing the Atlantic, but for healthcare it is just sick to have an intermediary with a profit motive between patients and care.

    • Nigerian prince looking for business partner says:

      How is durable medical equipment usually handled in countries with nationalized health care? I don’t have the slightest idea.

      • Mike says:

        From my experience living in Canada, which is single payer (think Medicare for all), as opposed to the UK which is more of a Nationalized, you simply get a Dr.’s prescription for the medical equipment, then go and get it.

        • Nigerian prince looking for business partner says:

          That’s interesting, thanks! For some reason, I was under the impression that Canadians often had supplemental insurance for those types of things (like prescriptions).

          • justhypatia says:

            Many Canadians do have supplemental insurance for medications (usually provided through work) but at the same time provincial governments step in to the market to keep prices reasonable. They cut deals with major pharmaceutical companies, encourage the distribution of cheaper generics etc.

            In my province the health care system will generally pay 75% of the initial cost of an assistive device that meets an individual’s basic need for mobility. So if your doctor states you need a walker the province will not pay 75% for a new power scooter.

            In the particular case presented in this story, the child would probably be eligible for the children with severe disabilities program and would therefore have 100% of his assistive devices paid for.

            That said, many will use private insurance to cover the gaps; the remaining 25%, maintenance costs and repairs that occur with the use of these products.

    • UCLAri: Allergy Sufferer says:

      Private insurance, in and of itself, isn’t awful. The French and Japanese have managed to create wonderfully functional hybrid public/private health regimes.

      Medicine needs some kind of reimbursement scheme, but what we have is just stupid.

      • Mike says:

        To be fair, Japan is essentially single payer health care, with private supplementary insurance like Aflac. France is hardly much of a hybrid either, with a similar system to Japan in some ways, where private insurance simply helps reduce people’s co-pay into the national system.

        If we had either of those systems I would take it in a heartbeat.

        • UCLAri: Allergy Sufferer says:

          Right, but it’s not fully socialized, and is to some degree both public and private: hence the “hybrid” systems, where the single-payer insurance covers most of the most important costs, and you use private insurance to cover other costs.

          I’m all in favor of single-payer systems, but private insurance, even in health, can be a good thing if it’s not what we have.

          • Mike says:

            I think the world would be better off without private insurance in the health care business. I didn’t have to deal with it in Canada at all, oh man that felt good. But if you like private insurance, be my guest.

            • UCLAri: Allergy Sufferer says:

              Well, I like it for the supplemental insurance like I had in Japan. It really paid off for me when I screwed up a ligament in my foot.

              I think the point is, public insurance should have some reasonable coverage limits, and private supplementary insurance makes sense. As far as I can tell, the Japanese and French systems make a lot of sense both from a health care perspective and from a financial perspective.

              I mean, we have to pay for medicine somehow. It’s just a question of how.

    • Torchwood says:

      Hmmm… I would prefer the private industry over a government agency that would have the efficiency of the DMV and the compassion of the IRS because of no competition.

      • PunditGuy says:

        Confronted with a real private-industry screw-up, you point out that a hypothetical government system would be worse? Based on a completely unrelated service they provide? That’s convincing.

        Every other industrialized nation in the world called. I’d ask them what they want to talk to you about, but they’re laughing too damn hard.

      • Awesome McAwesomeness says:

        That’s a set-up b/c that isn’t necessarily the choice people would have to make. It’s almost a false dichotomy of sorts. You have no actual clue as to what government health care would be like b/c it hasn’t happened. It could be really good, especially if they used the Canadian or English model. Your biased view of the government doesn’t actually translate to reality.

      • jimbo831 says:

        I take it you have never dealt with the IRS. I owed them some money and they were quite pleasant and compassionate. They were infinitely better than dealing with any private company I owed money too and set up a great reasonable payment plan. People who are scared of the IRS are probably hiding something.

        As for this issue, someone is making decisions on your health (not your doctor). It can be a private company motivated by profits, or the government, not motivated by profits. Who do you think is more likely to have your best interest in mind. Or I suppose another option is a highly regulated non-profit private company, like France.

      • Kuri says:

        So basically it’d be less of a headache than it is now.

      • sparrowmint says:

        If you’re not trying to pull one over on the IRS, the IRS is just fine to deal with. They are actually very reasonable, and the people on the phone are almost always very kind, in my experience.

        • abruke says:

          My ex-accountant screwed up my tax return one year and the only way I found out is when the IRS sent me a letter telling me I was due an extra $1500 in my return because my preparer didn’t put me in for all the proper deductions, so yeah, I can’t complain about the IRS.

        • dobgold says:

          My ex-wife made a mistake in not declaring alimony one year. When the IRS sent me a notice, she immediately filed an amended return and paid the taxes due. It took my accountant an additional 1-1/ years to get the IRS to understand.
          The IRS is not always reasonable.

      • Cor Aquilonis says:

        Funny thing is, I’ve never had a bad experience at a DMV/BMV or with the IRS. I’ve dealt with DMV’s in IN, CA, and AR, and I prepare taxes for a living. Yet, I always hear them getting ragged on.

    • dolemite says:

      I agree. There are some things on the horizon:
      1. Equal rights for all citizens despite race, genetic sexual preference, gender, etc.
      2. Universal healthcare provided by tax payer dollars.
      3. US stepping down as world police.

      Why prolong any of those?

    • aerodawg says:

      It certainly is sick. Next damn thing you know there will be some profit seeking bloodsucker between food consumers and the farm, water drinkers and the wellhead, people who need housing and the house….oh wait….

      • WalterSinister2 says:

        All of those have the distinction that you get what you pay for at the time you pay or very shortly thereafter. Food and water have the upside of repeat business. If they provide bad food, most of their customers are going to be mad at them and they can’t afford to lose all the customers who would be mad at them.

        Insurance doesn’t work that way. Most people don’t need much from their insurance companies and the few people that do need a lot are people the insurance companies can afford to lose as customers. “Pay off a legitimate million dollar claim or lose a few thousand a year from the claimant switching to another company” isn’t much of a threat. The lack of an ability to switch to another carrier when your current one screws you over is the reason why insurance companies can be sued for punitive damages in a breach of contract case.

    • Difdi says:

      The problem is that public health insurance isn’t all that great ether.

      Private will deny claims promptly. Public will deny claims four years after you die of your affliction.

  2. Coffee says:

    Status: DENIED
    Reason: LAZINESS

    • Marlin says:

      APPEAL

      Status: DENIED
      Reason: Reason?…REASON!?!?! F__k you, is that reason enough.

      • Coffee says:

        Thank you for applying for new insurance coverage with Blue Cross/Blue Shield, and we appreciate your interest in our basic plan! Unfortunately, we are unable to extend coverage to you at this time because of the following reasons:

        PRE-EXISTING CONDITION: Contrariness
        PRE-EXISTING CONDITION: Argumentative…uh…ness. Agrumentativeness.

    • BorkBorkBork says:

      BOOTSTRAPS!!!

    • aerodawg says:

      It’s called step therapy. The system is designed to find the cheapest option that will work for the patient. In this case the system is geared towards the fact that most people who need wheel chairs are not nearly as severely disabled as this child is and could possibly be ok with a cane or walker. It’s a simple consequence of the fact you can’t process every single claim by hand.

      But really, WTF would I know as the guy who submits claims for my wife’s practice….

  3. Sean says:

    God bless this boys parents.I know how difficult it is taking care of a child with special needs. Too often we have to fight with doctors, insurance companies, teachers, school bureaucrats to get what our children need.

    • Verucalise (Est.February2008) says:

      Same here. We’ve been lucky to have a school system & a wonderful group of specialists who love our daughter and always gives us what we feel she needs, but many are not as lucky :(

      And honestly, $5,000 isn’t that out of reach for a wheelchair. My daughter’s basic Zippie that we just got for her cost $3600 if I remember correctly.

  4. Nigerian prince looking for business partner says:

    I just dumped Anthem after about 5 years because of excessive rate increases and general BS. At a certain point, $1,200/month for a $5,000 deductible didn’t seem worth it, especially for a company that goes out of their way to deny claims.

    That being said, I believe most insurers are incredibly strict when it comes to durable medical equipment, because of outright fraud, as well as pressure from providers to go with the most expensive options first, and people not using the equipment at all.

    I now have a $10,000 deductible. It’s high and it’s tough paying for everything out-of-pocket but it’s nice being the final word for medical spending, since it’s ultimately my decision how the HSA money is spent (we’re also saving about $10,000/year in premiums).

    • Loias supports harsher punishments against corporations says:

      I know you’ve complained about your insurance situation on this site as nauseum (meaning, I’ve become nauseous from how many times you’ve complained about it, haha); but I’m glad you were able to find a better situation for you and your family, if even only marginally better.

  5. HalOfBorg says:

    By now they probably have “taken the matter seriously” and offered the best chair available.

    Probably.

  6. Loias supports harsher punishments against corporations says:

    We need to pass a law that every company that makes more than X in revenue must have a government-appointed employee with the title “Director of Being A Fucking Person.”

    • Cat says:

      Are you SURE you want a government bureaucrat in charge of “Being A Fucking Person”?

      • Blueskylaw says:

        I’m from the government, and I’m here to help you ☺

      • Herbz says:

        Its better than an insurance company bureaucrat that just takes his “denied” stamp and doesnt even look at whatever it is he is denying, due to profit motives.

      • Fubish says: I don't know anything about it, but it seems to me... says:

        I know plenty of bureauctrats who fuck everybody.

    • Awesome McAwesomeness says:

      They also need to appoint someone we can throw in jail when the company breaks the law, like the entire board of directors.

    • Cor Aquilonis says:

      Organization: Anthem Blue Cross Blue Shield

      Job Position: Ombudsman

      Job Description: The ombudsman is responsible for representing claimants and assisting them through the claims process. The ombudsman will provide confidential consultation with the client about their rights and will recommend strategies to resolve conflicts. The ombudsman’s office will be a hermetically sealed 16 square foot cubicle located about twelve feet from the company cafeteria dish washing facility. Ombudsman will directly report to the V.P. of Claims Denial and Obfuscation. All inquiries regarding this position should be sent to H.R. and be marked “RE: Round File.”

  7. zantafio says:

    Hey remember all those REPUBLICAINS politicians screaming “govt healthcare = death panels!!!!”.. Please remember come November.

    • jimbo831 says:

      “doctors prescribed a specialized wheelchair at the cost of around $5,000. “

      We wouldn’t want the government coming between us and our doctors. We already have health insurance companies to do this

      /s

  8. Mastodon says:

    Before we get all emotional, let’s remember the most important people here – BCBS shareholders. It is not their fault some kid was born with cerebral palsy so why should they pay the price? :-(

  9. Princess Beech loves a warm cup of treason every morning says:

    Does Anthem cover hiring Hodor?

  10. Blueskylaw says:

    1). DENIED

    2). DENIED

    3). DENIED

    4). DENIED

    5). Consumer calls reporters

    6). APPROVED

  11. gman863 says:

    I’m surprised they haven’t tried to approve him for a $200 rechargable battery-powered Big Wheel at Toys “R” Us.

    /s

    • ninabi says:

      Or allowed the purchase of an office chair with wheels and a roll of duct tape to keep the little guy secure.

      I’m glad the child is getting the equipment he needs but insurance battles are just an additional burden on parents already working hard to take care of their son.

  12. Extended-Warranty says:

    While I certainly don’t feel what BCBS did was right, and sincerely feel for the parents, I don’t know if this it’s completely unmerited. Where do you draw the line to what is necessary?

    Insurance needs to get back to covering unexpected events instead of spending accounts.

    • McRib wants to know if you've been saved by the Holy Clown says:

      BECAUSE PARENTS PLAN ON HAVING 2 YEAR OLDS WITH CEREBRAL PALSY?

      >:(
      >>:(
      >>>>:(
      >>>>>>>>>>>>>>>>>>>:(
      >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>:(

    • Coffee says:

      Totally…we should really get back to our roots as a civilization and just take children like this out into the woods to die, amirite?

      • raydee wandered off on a tangent and got lost says:

        These days, that sort of thing is only allowed before birth, when prenatal tests determine a defect in a developing babby.

        Once it’s breathing and kicking in the open air, it can be harder to get rid of a developentally or physically disabled little ‘un. Maybe “voluntary surrendering” to a hospital or something, but I hate to think of what would happen to a disabled child in the adoption circuit. :/

    • Auron says:

      If a doctor, who is a medical professional, says that something is medically necessary, more often than not it is. However, if some bean counter at Big Insurance decides something isn’t, guess who wins? But of course, the bean counter would have a better idea of whats needed and not the doctor, since the bean counter went to medical school, got themselves a medical degree, and have been practicing medicine. The doctor just got some silly degree that doesn’t count inside the $.99 box of Cracker Jacks.

      • AtlantaCPA says:

        I think that might a possible solution: Insurance companies would be required to cover anything prescribed by a doctor. Would there be abuse? Absolutely, but the consumer would not be the one denied because of possible abuse. The Insurance company would have to pay it and then if they thought something was fraudulent, go after the doctor. Insurance companies would be motivated to prosecute bad/fake doctors so it would probably work well. (doctors convicted would have to have their license taken away or something so they didn’t just try to defraud the next insurance company). What do you think?

        • aerodawg says:

          Insurance companies won’t go after the doctors. Quite the contrary, they’ll jack up rates and roll on. It’s a much easier solution on their part and they’d have a built in excuse because all they would have to do is point out the total cost of all the prescriptions they were required to cover…

      • aerodawg says:

        FYI in most insurance companies, the people who review claims are MDs. How do I know this? My wife was inundated with insurance company headhunters both when she graduated from medical school and when she graduated from her residency program.

        But lets not let facts get in the way of preconceived notions shall we…

        • ARP says:

          Wrong- they do not review claims. They set up standards for coverage and may review appeals. The people who review claims are poorly trained and trained to err on the side of denial.

    • Nigerian prince looking for business partner says:

      The issue is that questions like that bring up major philosophical and economic implications. A company like Anthem has many perverse incentives to deny care and may not be in the best position to make these decisions in an unbiased manner.

      The entire concept of employer driven health insurance completely fails when it’s applied to non-employed members of society; the unborn, children, unemployed, elderly, or indigent.

    • crispyduck13 says:
    • Kate says:

      I’m sorry, did you think medical insurance was all about ‘unexpected events’? What planet do you live on? It’s never been that.

      I’m sorry, but it seems like people are making up the most bizarre stuff now and pretending this is how life works – on what planet?

    • Conformist138 says:

      File “having a child with extreme, lifelong disabilities” under “unexpected event”

    • Extended-Warranty says:

      Again, I understand the issue here, and perhaps my point got misinterpreted. Here is the definition of insurance:

      “Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment.”

      I’m pretty sure the needs of this child are certain and not a risk, the very idea of insurance. As unfortunate as it is for the child to have the issues that he does, what sense does it make that the rest of the insurance customers have to pay for it? Also, if insurance did cover it, would everyone here have a problem if the families rates got increased?

      The problem here is not that this child doesn’t deserve care, it’s a convoluted system. The parents should be paying for this wheelchair out of pocket, but it shouldn’t cost $5,000. The insurance companies aren’t angels here, but the answer is not to get more claims approved.

      My vote is for more HDHP and HSA accounts. Everyone should be able to pay for their own care, but have a “cap” (deductible) in case something unexpected happens.

  13. McRib wants to know if you've been saved by the Holy Clown says:

    They should have gone straight to the board of insurance.
    The board would not have been pleased.

  14. catastrophegirl chooses not to fly says:

    ahhh, reminds me of when i spent a year appealing a medical device denial and BCBS came back with “we understand that this is life or death and you cannot have a healthy life without this. and we get that it is keeping you out of the [much more expensive] hospital and preventing long term organ damage. we still aren’t paying for it”

    i wish all these decisions were required to be evaluated by someone who has a severe medical need or has a close friend or family member with a severe medical need.

    • Mike says:

      Why should we listen to anyone other than shareholders when it comes to how your insurance company spends money? Now stop getting sick and this won’t happen to you anymore.

      • catastrophegirl chooses not to fly says:

        i was actually trying to save them money. the sensors for my device are cheaper than the amount of glucose test strips it takes to make up the same level of monitoring. and it keeps me out of the hospital and has prevented at least 3 potential car accidents
        i was looking out for the shareholders, i promise!
        the sensors come to about $17 a day in use, but i use $30 a day in test strips if i don’t have the sensors. that’s ~$4700 a year in savings, plus lack of hospital visits which could run into the hundreds of thousands if they go on long enough.
        they defy their own logic.

        • HogwartsProfessor says:

          They don’t use logic. The way they do things would make Spock’s head explode.

    • Kate says:

      State Insurance board? Attorney General?

    • raydee wandered off on a tangent and got lost says:

      “Have a baby, then you’ll be a shoe-in for Medicaid.”

      :/

  15. Erich says:

    This is the same company who thinks it’ll be cheaper for me to have exploratory heart surgery than it would to have a new form of MRI.

  16. Sarek says:

    At least no one (yet) in these comments has blamed IBM. Watson will do only what it’s programmed to do…which appears to be to default to “deny if claim > $5.” When Watson detects an inquiry from the media, then it changes to “accept.” So why do they need Watson, anyway? An Intel 8080 could do that.

  17. Awesome McAwesomeness says:

    Assholes. This is why we need a single payer, non-profit health system. When medical insurance is for-profit, there is incentive to deny proper care and treatment. The object is to make shareholders as much as possible rather than to take good care of the paying customer. This is why Obamacare is a sham. It isn’t actually close to socialized medicine. It’s a stupid capitalist plan that mandates citizens pay large amounts of money for profit companies that have an incentive to deny care as much as possible. You’d think the Republicans would be all over that shit. Putting more money in the pockets of big business is their number one goal.

    • aerodawg says:

      You’re right. It will be so much better when the health care is run by unfireable flunkies with every incentive to keep the payments under the budget set by the congress critters. It will be so much fun having to wait years for treatment! Lets go!

      • Kuri says:

        You mean just like now?

      • Duke_Newcombe-Making children and adults as fat as pigs says:

        (a) We can fire your mythical government “flunkies”–it’s call an election.
        (b) If we have single payer with mandatory membership, the “budget” is the total intake of that system – around 3% for administrative overhead.
        (c) Actually, in government (not necessarily saying it’s a good thing), the incentive isn’t to save money, but to spend all of your budget, let you get it reduced next year. Seeing as this is essentially insurance, there is no incentive to play it that way. Just wanted to correct your perception there.

      • Jules Noctambule says:

        At least the government has an interest in keeping me alive to pay taxes.

  18. Warren - aka The Piddler on the Roof says:

    New Jersey and Blue Cross Blue Shield…

    Talk about a shitty combination.

  19. TuxMan says:

    $5,000? That’s the price of a decent used car.

    I would deny it too. Specialized pediatric wheel chairs cost less than $2,000. No it does not come with a rocket motor or on-board navigation, but still, it meets the needs.

    http://www.planetmobility.com/store/wheelchairs/manual/quickie/pediatric/index.html

    • Dr. Shrinker says:

      Wow, I didn’t know you had completed an extensive evaluation of this disabled child and therefore knew exactly what his needs were. Oh wait, you didn’t? You were just talking out your ass and being dismissive of someone with actual medical training? Son, you’ve got a job waiting for you at Anthem!

  20. yossi says:

    I work for an insurance company.

    People just LOVE to bash the insurance companies.

    Do you know why your rates are so high? Because there ARE doctors out there that fraudulently write prescriptions for $5,000 power chairs for patients who could do fine with a $200 manual.

    SO, when the doctor sends a prescription for a power chair, with no medical records, to a wheel chair company, they call the insurance for approval. The insurance says, what do you have from the doctor? They tell insurance, we have a prescription that says “please dispense 1 electric power wheelchair” with nothing else.

    Do you really think its “scummy” of the insurance company to accept that as is and pay for a $5,000 wheel chair? NO. SO they ask the doctor to provide medical records demonstrating that the patient cannot use a cane or manual chair. Don’t let the mushiness of this little boys cuteness cloud your intelligence. All the insurance company has is a name, date of birth and prescription for a $5k chair. They have every right to ask the doctor to provide some basic documentation that a cane or manual wheel chair would not suffice. They are NOT forcing the little boy to try out a cane and report back to them on how that worked out.

    Did you know that at my company, if a processor denies a claim “willy nilly”, they get penalized? Did you know there is no vast conspiracy to deny all claims and that the processors are human beings who pay for claims based on the insurance policy as it is written. Did you know that 99.998% of all claims are processed and paid within 30 days of receipt?

    • aerodawg says:

      Dude, your reality is getting in the way of the righteous indignation. You’ve got to stop it right now…

    • ARP says:

      So in the thousands of cases in which the documentation is provided and its denied as “not medically necessary…..”

    • Kuri says:

      Congratulations, your insurance company is one of the few reputable ones, however, it doesn’t work the same way at every single companies, all too often the only want ot do what’s cheaper for THEM and to hell with what the patient needs.

    • Auron says:

      I recommend you watch Michael Moore’s Sicko. One of the cases explored was a woman who was denied the cost of transportation to a hospital in an ambulance after a car accident because it wasn’t pre-approved.

  21. Dr. Shrinker says:

    As someone who makes ~ 80% of his income from insurance payments, I can tell you that your statistics are completely made up. Yes, according to the insurance company, they pay most claims in 30 days. But that’s because if they screw up, they don’t admit they screwed up. I have a small private practice with about 30 claims/week, and yet every single week that I’ve been in practice, I’ve had to call on at least one claim (often more) that was denied in error, paid incorrectly, or just “vanished” into the system with no record of it.

    • MajorGroove says:

      I used to have to follow up on such erroneously denied/vanished claims. I know exactly how often it happens, and it’s more than 0.002% of the time.

  22. oldwiz65 says:

    The way to get ahead in the health insurance business is to deny claims. The more claims you can manage to deny the better you are. Profits and executive bonuses are far more important than wheelchairs for people in need.

    • yossi says:

      actually not. in most cases, it is more expensive to deny claims, than to pay them. There are significant costs involved in handling appeals when claims are denied. Entire departments have to be staffed for that. There are also fines, interest and penalties involved when a claim is denied incorrectly. Trust me when I tell you, we DO NOT like to deny claims. We have NO incentive or motivation to deny a claim. If we deny a claim in error, the processor gets the slack. It affects their performance rating, their bonuses and more. I am not a claim processor by the way.. i answer calls from patients who call about claims. When a claim is denied incorrectly, a lot of people get involved in fixing it, a lot of people get in trouble when an obvious error is made.

      • Auron says:

        Look at the case of WIlliam McGuire, former CEO of United Health. When he got caught with his hand in the cookie jar for backdating stock options worth 1.6 billion. For this, he only had to pay back about $600 million of the ill-gotten gains, and at the time of his “retirement” had an additional 1.8 billion in options, a $6.4 million lump sum payout, $5.1 million/year in supplemental retirement benefits, and a list of cushy perks including an office, secretary, life and disability insurance premiums and health care for his family. And where do you think the money for those perks comes from? It sure as hell doesn’t come from approving claims unless the bean counters think something is medically needed.

  23. inputhike says:

    My husband, who is missing one leg and half the other foot, was once denied a wheelchair by a different insurance company (Humana, I think it was). They were willing to pay for a (more expensive, not suitable to his needs) electric wheelchair, but the manual one he and his doctor agreed was best for him? No. Somewhere I have a copy of the HILARIOUS letter his doctor sent to them after the 2nd denial. They still did not pay. Ultimately, vocational rehab paid for it instead.

  24. TheUncleBob says:

    Not defending the insurance company here, but…

    “Because doctors apparently just love to write bogus wheelchair prescriptions for small children,”

    …it’s not as if doctors are holy saints who’d never, ever take an under-the-table bonus from any of their suppliers for pushing a particular product… Never.

    • MajorGroove says:

      There are scumbags in every profession. However, the vast majority of us doctors have our patients’ best interests at heart. Moreover, you don’t go into pediatrics for the money, because there isn’t much to be had.

  25. MajorGroove says:

    The trouble with for-profit insurance is that they will sometimes capriciously decide to deny completely justified claims. I used to work for a physician who performed chorionic villus sampling and amniocentesis for prenatal genetic testing. The insurances she accepted covered such procedures for women of “advanced maternal age” (read: women who would be over 35 at the time of delivery). About once a month, someone’s insurance would deny the claim despite the fact that the woman clearly met criteria for coverage, and I was the peon who would spend hours bitching at various paper-pushers at Blue Cross/Blue Shield, Aetna, United, etc to do what even they acknowledged was the right thing and cover the procedure.

    I’m a doctor now, and I am beholden to no one. I accept no free lunches, swag, or visits from pharmaceutical or device manufacturer representatives. What I prescribe is what I feel is necessary. I still find it horrendous that insurance will capriciously deny needed procedures, tests, and equipment. I’m desperately hoping for true single-payer non-profit healthcare.

  26. psm321 says:

    We should do something to solve this problem. I know, let’s force everyone to buy insurance from these scammers! That’ll show ‘em!

  27. mdcastle says:

    $5000 sounds like the cost of a motorized wheelchair with all the bells and whistles. Is there some reason a $500 manual wheelchair wouldn’t have worked? As harsh as it sounds everyone always wants the most expensive option and expects the insurance company to pay for it. And with providers having incentive to sell the most expensive products and services available the insurance companies have the only incentive in the whole chain to hold down medical expenses, and get demonized for doing so.