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Tales of a Broken Non-System.

It’s a scene that plays out in ER’s across the country, but this time it was right here in Southern Oregon. Kat went into the emergency room knowing that something was terribly wrong. She told the physician that she was experiencing sharp pains in her stomach and back. She was sent home with a prescription for Tylenol, but the pills didn’t dull the pain she was feeling so she went back again. After an agonizing wait and brief triage, Kat was rewarded for her second trip to the ER with a prescription for Vicodan and antacid. Within hours she bled to death from a bleeding ulcer that was misdiagnosed twice from a system that has little resources for people without health insurance. Kat was in her early forties and left behind a husband, father, brothers and extended family and friends. Read the full story:  Rogue Valley Independent Media Center 

Death by Unfilled Prescription 

A Denver mother whose son died after she  was unable to fill his multiple  prescriptions because pharmacists kept  telling her he was not eligible for Medicaid — even though records  proved he was — has filed a lawsuit against the  city and county of  Denver. Zuton Lucero-Mills said she called Denver County  Human Services  several times a week in the spring and summer of 2009 after she tried to get 9-year-old son Zumante's asthma medications at Walgreens and was told he wasn't eligible for Medicaid." Here's the article in full.


Blue Cross Covers Me … Until They Don’t

I'm a federal employee diagnosed with rheumatoid arthritis. I had the High Option Blue Cross plan UNTIL they refused to pay for the IV's I needed to damp down my immune system. All of a sudden I had to pay $800 for each dose out of my own pocket. I had a collection of rare chess books that I had to sell to pay for the IV's. I received $5,000 for my collection of books; all of that went to pay for the IVs.

When Open Season came around, I found out that Kaiser would charge me a $100 copayment for the IVs that SCREW CROSS denied me. So I switched to Kaiser. But I will NEVER forgive the god-damned bean counters at SCREW CROSS for trying to bankrupt me.

By Joe Bacon

Daily Kos
Tue Feb 22, 2011

    Aetna royally screwed me over...pure evil...

This summer, I had major surgery. First, it was a complete and utter period of hell trying to get it preapproved. The staff at Aetna was rude, condescending and entirely incompetent (i.e. refused to do basic math, told me I should be happy that my surgery was not "denied yet," made incredulous comments about the cost). Well, a month after it was done, I get a phone call from an Office Space-style [drone] who tells me I am no longer eligible for the benefits and they will all be retroactively rescinded -- the hospital  will be told to return the money. He kept saying, "mmmmmmkay," too. Mmmmmm"f---ing" Aetna. How do these people sleep at night? I have
no idea.

Well, I was devastated and entirely depressed. But I fought back hard, and with the help of my attorney general and a major consumer advocate, my benefits were reinstated. Aetna never admits why they did it, but clearly it was because I was a major "squeaky wheel" and put them on notice that this would be an epic PR disaster.

Aetna’s next move was to send me a letter that they would notify all providers that the payments made in the past would be validated and need not be returned. Do you think Aetna actually does what it said it would do?! HELL NO!  So for five months (until NOW), I am stuck spending hours and hours on the phone fixing each and every one of the claims I had relating to a major surgery -- they are so [messed] up because of Aetna constantly going back and "changing things" that the people at the hospital and Aetna can never understand what's going on with them. One Aetna [drone], I kid you not, said, “You need to talk to my supervisor, because I don't like dealing with these kinds of claims.”  Aetna put me in a terrible position with my doctors -- IT WAS THE ULTIMATE BUREAUCRACY BETWEEN THE PATIENT AND DOCTOR.

Most recently, an executive at Aetna apologized to me because he said he would call the hospital, but never did -- leading to me getting a $1,200 bill for which I was not responsible. He actually told me, "I didn't do what I said I would do."

Aetna is, without a doubt, the most slimy, incompetent, evil, cruel and horrible corporation in the United States. Their cruelty is eclipsed only by their incompetence.

    I am a thoughtful and intelligent person, but Aetna's behavior calls for the following:

    F--- YOU, AETNA!

    P.S.  One of their employees -- he's probably been fired by now for saying it -- actually said, "I can't disagree with that," when I told him Medicare for All would be easier than the Aetna BS.  There are people in those companies who know how horrible [their employers] are. Maybe [one of them] will be the next Wendell Potter.

 james321 on Mon Feb 21, 2011 at 09:24:10 PM EST

In response:

That is awful.
Insurance companies COUNT on you giving up and backing down in the face of bureaucracy.

I had a patient whose breast cancer was discovered when it was intraductal, meaning a very tiny clump of cells within a milk duct that had not spread.  Good news, right? WRONG.  After her surgery, radiation and chemo, she was informed that her insurance was denied because their definition of cancer was "a group of malignant cells with a tendency to spread."  Because her cells had not yet spread, it was not, by their definition, cancer.

Did they want to wait until it was life-threatening and in her lymph nodes to cover her?

She fought it for a year all the way to the state insurance commissioner and won.  Imagine fighting all that while you're dealing with the effects of all those treatments and being frightened as well!

But they were counting on her to back down. Good on you for fighting them.

So sorry you have to fight for what is rightfully yours.

By Smiley Creek

My family lost our health care when I lost my job.

I tried to keep it with COBRA, but at the end of 2007, it wasn't subsidized, so the cost was prohibitive while living on savings and unemployment benefits. My husband is self-employed and his business income fell way off in the beginning of 2008.

So I tried a medical savings plan and a Blue Cross policy with a ten thousand dollar deductible. The premiums were still almost $600 per month. We had no pre-existing conditions, were not on prescription meds other bio-identical hormone replacement for me, and other than routine annual check-ups and mammograms had not needed a doctor for years.  We've been careful and lucky with our health.
By the fall of 2008, I still hadn't found a job that would pay more than my now extended benefits and it was still a bad business year for my husband. I had a fall while helping to renovate a house for a friend and didn't go to the doctor. I walked funny and was in pain for a couple of weeks, but as no bones were broken I took a big chance and didn't go to the Emergency Room. We couldn't afford it with our high deductible insurance.

Our ready cash savings were about now gone and I had paid the last two premiums with a credit card. We skipped our annual checkups and had cancelled our scheduled bi-annual dental visits/cleanings in 2008 as paying to actually see a doctor or a dentist for a simple check-up wasn't possible...while we were paying our insurance premiums.

I cancelled our high deductible policy and we decided to "go commando". No insurance.

My family didn't get anything for all that carefully budgeted and diverted money but a false sense of security that "if the worst should happen" we wouldn't lose everything and could get treatment. We could have lost everything anyway trying to pay our premium.

Either way we would lose, now or later.

We currently both have part-time jobs in addition to his business which is beginning to pick up, but at nowhere near pre-recession levels. We still don't have insurance.

My husband broke his shoulder last year while riding his bike. We paid cash for his broken shoulder...X-rays, a sling, some pain  meds and a follow-up visit. All of that came to less than one month's premium of our crap Blue Cross policy. He skipped getting the last X-ray his doc wanted that would confirm that the break had healed properly. My husband figured we couldn't afford to do anything to fix it so who needed to know for an extra $160?
We are still luckier than most un-insured Californians. I miss really my hormone replacement therapy...I felt better (menopause ain't for sissies) and my general health was and would continue to be better on it. But check-ups, routine tests and the relatively inexpensive bio-identicals are still too expensive. My routine basic care is now an unaffordable luxury.

We can't have health care and pay the mortgage, or buy food and gas. Our pets have seen their vet as needed so sometimes the mortgage payment is late.

Even though we may make enough money to burn on premiums someday in the future, I will never buy another insurance policy from a for-profit entity.

It may be personally foolish, but we feel that strongly about it...like paying for "protection" so your store or your legs won't get broken by some goon. The premium money would support sociopathic greedy gangster corporations who I absolutely don't trust with our lives. We're opting out.

Single payer is smart and humane. Single payer is good for California and Californians - all Californians.

 By Melissa
 Daily Kos
 Mon Feb 21, 2011

My Story

    I'd like to share my own story which is ongoing.

    I haven't had insurance since 1989. At that time I was working for IBM. When I left, I didn't think much about it. I was healthy, young, and naive. About 10 years ago, I had a work accident that broke my back and heel bone. The company I worked for had insurance that covered my medical expenses. If that hadn't been the case, I'd have been screwed. So 10 years have passed, and I still don't have insurance.

    What follows is my new reality.

    First off I live in Santa Clara County, CA.  I recently moved here from a more rural one. Back in December around Christmas, I experienced pain enough to keep me awake at night. In early January I decided to try and get an exam with a doctor. I don't have insurance. My employer offers a plan, but because I was on part-time status I couldn't quite afford to buy in. Then they cut my hours right at the time I was having pain, which eliminated the option altogether.
     I went to our county clinic, and they saw me the same day. I was enrolled in an ability-to-pay (APP) program. My co-pays have been $35 for visits. Long story, but I had a colonoscopy with biopsy, consultations with oncologists, PET scans, 2 CT scans.  Now, I am scheduled for chemo/rad treatment.

    Yes, I was diagnosed with cancer. I found out on the 8th of this month. Point is, I have been thanking my lucky stars that I just moved to this county, and the help I am getting is world-class. I have 2 Stanford doctors, and the best equipment available. I was really scared when I found this problem. The county I was in could not have provided the assistance I am getting here.

    I am now off work because of pain and the treatment which will start soon. The financial adviser at the hospital will make adjusts to my co-pay when I receive disability. I think an important note is, if I had been paying insurance all these years that would have cost me more than all the co-pays I'm now making. Interestingly, I think it will cost me less in the long run to be uninsured.

    Although, it feels less secure, I wonder how much more secure I would actually be with insurance. Those thugs would have likely denied me coverage anyway for my back injuries. I know this APP program isn't an answer, but it’s a lot better than nothing.

    I was scared of the bills that being sick would cause, but not so scared as to risk my life. Placing money ahead of [our] health is one [policy] I don't get.  However, if I can walk into a clinic, and in a matter of 3 weeks get all the exams and doctor consults I need to treat my cancer, what the hell is the rest of the state doing?

    Al I can assume is that access to medical coverage in California is variable. Not a good thing. Everybody should have access. I'm damn glad I wasn't in another part of the state.

    The one health program I had access to in my rural county was called County Medical Services Program (CMSP).  This program is so very inadequate as to be useless. It’s the one my life would have been bet on should I have stayed there. The program is, as the website states, "Beginning October 1, 2005, Anthem Blue Cross Life & Health Insurance Company assumed administrative responsibility for CMSP."

    It’s a joke. Essentially, if you live in one of the rural counties under this plan, you are as screwed as having no insurance.  The Santa Clara Valley Medical Center has been wonderful as far as I'm concerned.

By Kairos on
Tue Feb 22, 2011

Treadmill Premiums

    First of all, I need to get a little something out of the way. My circumstances are by no means "the most horrible thing you’ve ever heard tell of". They are not. I’m one of the lucky ones who has always been able to earn pretty good money. I’ve been a homeowner for over 22 years. I’ve paid my bills and my taxes on time. And I have to say, although most assuredly not a spendthrift, I certainly haven’t had to count my pennies every time I decided to take myself out for dinner, or buy a new pair of jeans, or stop into my local independent book seller for a good book or 4 or more ...

    I’ve done OK for a single woman with no kids.

    That is, I’ve done OK up until fairly recently. Suddenly I find that my so-called "American Dream" is on life support. Suddenly I feel all of the insecurity that I thought middle class people in this country simply didn’t feel. And suddenly I’ve come to understand what every poor person has known all their lives ... that "you’re on your own, pal". Sorry about that ...

    I’m a professionally registered civil engineer. So you see what I mean about being lucky in this life. In 1989, I made the momentous decision to become a self-employed civil engineer. Scared me half to death. But I did it. And after a couple of lean years, things were looking up. Of course, one of the first things I had to do was look around for a health insurance policy. After a bad experience with one insurance firm, I discovered in 1994 that my very own professional society, the American Society of Civil Engineers, offered just the coverage I needed (underwritten by a company called New York Life). Owing to the fact that I’m a pack rat,

      I actually still have the first stub of what I paid back then for the policy: $177 a month for $1000 deductible coverage. No doubt about it ... I was set for life! And life was good.

    Mind you, I was a healthy 42 year old back then. Seldom had a doctor visit that wasn’t routine. Yes, there were regular increases in the cost of my health insurance. But they were small. Nothing I couldn’t afford. In 2000, I was still only paying $245 a month.
  But after 2000 I began to notice that the jumps in health insurance costs began to come more frequently and were for larger amounts. Granted, I turned 50 in 2002, which kicked in one of those automatic "age related" premium increases. So by 2003, I was paying $528 a month. I have to admit I was a little worried at this point. I know this because at that point I asked to change the policy to $2000 deductible, and managed to trim the cost back down to $477 monthly. Hey ... I was a civil engineer. I should be able to handle a $2,000 outlay if worst came to worst.

    Six months later, the monthly premium shot up to $533 ... completely negating any advantage I had gained from increasing my deductible.

    Right about this time, I began to notice that the insurance company used a standard template for the letters they sent around every time they jacked the premium up. They’d begin by telling you what the latest rate increase was. Then they’d say, "This is never pleasant, but it is essential ..." blah blah blah. That phrase "this is never pleasant" began to annoy me a great deal, especially after I’d seen it for the fourth or fifth time in a span of 2 or 3 years.

    By now I’m 52 ... and the old body is complaining. The cholesterol is trending a little high. I have heartburn from hell. Had to have my gall bladder yanked. Oh, and I’ve aquired a strange little condition called Raynauds in which my fingers go dead, white and numb at the slightest chill ... then purple ... then finally back to pink. No one knew why.
    In December of 2004 the premium went to $602 a month. Six months later it shot up to $710. That’s when I began to "joke" to my friends that, heh, pretty soon I’d be paying as much for insurance as the $805 per month I was paying for my mortgage. In late 2005, I called the insurance company and asked to go to a $3000 deductible policy. Man, what a life saver that was ... the premium dropped to ... a whole $647. Somehow I wasn’t terribly relieved.

    Sure enough, nothing changed. Every 6 months the rate went up ... to $675, then $705 in December of 2006 ... which was nearly the price I’d previously paid for the $2000 deductible policy. Again, my cost savings was negated in a matter of months. In June of 2007, my "joke" about my mortgage came true when the premium shot up to $931 a month.

    That was a bad year, 2007. Fell into a severe bout of depression and couldn’t work much for several months. The cost of health insurance, and most of my other expenses, got paid out of my home equity account. Hello, debt. Thank god for the psychiatrist who was NOT covered by my health insurance. He charged me a low rate for his services, and provided meds free of charge for many, many months.

    The health coverage rate increases continued on their regular 6 month schedule: $1016 a month, then $1132 a month in June of 2008.

At this point, the insurance company changed administrators ... and wrote us all a letter telling us how much money we were going to save now! They used to send bills that were perforated so that you could just neatly tear the pay portion off of the bottom and send it in. No more. Nowadays they were "saving money". I kid you not ... they deleted the perforations so that I had to find a pair of scissors to cut the pay portions off myself. Wow. Just ... wow.

    In December of 2008, the rate went to $1,268 a month. But my income had picked back up by now, so I gamely managed to pay it.

    Then in January of 2009, I began to see a rheumatologist. Remember my frozen fingers? My little case of Raynauds? Come to find out, it meant something after all. It meant that I could have a rare autoimmune disorder called scleroderma. Expensive tests like a chest CAT scan and pulmonary function tests and an echocardiogram followed over the course of that year. And the health insurance premiums kept pace ... $1387 a month, then $1492 a month by December of 2009.
     By now the chest CAT scan and pulmonary function tests showed mild lung scarring and mild decrease in lung function. Early in 2010, I had to add a pulmonologist to the rheumatologist and the general practitioner.

    And by now I can see the handwriting on the wall. And so can my insurance company. In June 2010, the premium rose to $1803
monthly. That’s nearly $22,000 a year for those of you who have misplaced your calculators. And I was seriously struggling to find the money. I also knew that in 2 short years I’d hit another "age-related" increase at age 60. That’s when it hit me that I was nearly at the end of the line. But somehow I managed to scrape up the money to pay up the policy until the end of 2010.

    In October I called the insurance company to see what kind of deductible increase I’d have to settle for this time in order to get a lowered cost. And I was told that the company was no longer providing options for premium reductions. If you couldn’t pay the piper, you were just out of luck. So sorry. This from the insurer used by my own professional society, the American Society of Civil Engineers.

    The next month they announced what I would have to pay by January of 2011 in order to continue my coverage:

    $2233 a month. Or nearly $27,000 a year.

    And this self-employed civil engineer simply doesn’t have that kind of money. Worse, the huge premium payments I’d made previously had sucked all of the oxygen out of my finances, leaving me scraping to pay for groceries each month. And leaving me in debt with a virtually wiped out savings account. And now I’ve got a chronic illness. And I need medical insurance. But I’ve got a chronic illness.

     So no private insurance company will touch me. Kaiser took all of 5 days to turn me down cold. I bet they laughed uproariously when they saw my application ("As if!").

    So, when 2010 turns into 2011, I will be "going naked" ... no more health insurance.
     Suffice it to say that I now have far more than a passing interest in working to get California One Care passed. For me, and for millions of other Californians, it is absolutely essential. Private health insurance priced me right out of the market once I got sick. So I hope they understand when I work to dump them right out of California’s lucrative marketplace. What goes around comes around, folks.

    One last thing: please don’t waste your time feeling sorry for me! I will probably find a way to make it. Please DO feel as much empathy as you can muster for the incredible number of people in this country who have it so much worse than I do. Like the people on fixed incomes who have to choose between life-saving drugs ... and eating. Or the children who go to bed hungry on a consistent basis.

    Or the 50 and 60-somethings who are unemployed and who may never be offered the chance to work again.

    Oh, and please read Howard Zinn’s A People’s History of the United States.  I tell you, this "guard" is ready for a little revolution...

    Source:  http://www.dailykos.com/storyonly/2010/12/26/931724/-How-to-Lose-Your-Health-Insurance-in-16-Easy-Years


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