If only a mammogram would help.

Quote:CAMP MEEKER (CBS SF) — A Sonoma County man battling more than a dozen tumors in his body is fighting a new battle with his insurance carrier, who has denied coverage for his treatments.

Jeffrey Rusch of Camp Meeker knew the news was bad when an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones.

Doctors told Jeffrey he would need to be hospitalized immediately.

“My husband was having a lot of difficulty breathing already, and he was getting a lot worse, so we went to the hospital and they admitted him immediately,” Jeffrey’s wife Zoe Keating said.

In the hospital, doctors removed a half-liter of fluid from Jeffrey’s lungs, and gave him steroids to reduce brain swelling. Doctors administered emergency chemotherapy.

Then came even more devastating news: Anthem Blue Cross was denying their coverage for the treatments.

The family received a letter from the insurance provider, saying his hospital stay didn’t meet the criteria for medical necessity.

“It’s like an attack on my family. It feels that way,” Rusch said.

Jeffrey and Zoe have been Anthem members since 2008, and estimate they’ve paid $100-thousand in premiums.

“I would call saving my husband’s life medically necessary,” Zoe said.

Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.


Link

My dad went to see his Cardiologist for a checkup a few months ago. The PA not the doctor did the check up. His medicare provider said PA's could not do this procedure and denied the claim also made the doctor refund the co-pay. Things like this will result in fewer doctors treating medicare patients. The elderly will be the next VA scandal.

I hate to tell this dude's wife, but there probably ain't any saving his life going on.

It also depends on what the admitting diagnosis was. If it was just "metastatic cancer" then no, that doesn't require admission. They can probably refile it as pneumonia or encephalopathy and get it covered. I see patients with cancer mets often and they don't all need to be in the hospital.

You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

True, but before the ACA, there was some recourse.

Now, not so much.

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

I don't recall Obama ever telling us there were certain things that won't be covered. He did say that people shouldn't go bankrupt over medical bills and if this family wants to try save their loved that's probably what will happen. But then there's this:

Transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries, a U.S. Department of Health and Services review board ruled Friday in a groundbreaking decision that recognizes the procedures as a medically necessary and effective treatment for individuals who do not identify with their biological sex.

Ruling in favor of a 74-year-old Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board ruled that a three-decade-old HHS rule excluding such surgeries from the procedures covered by the national health program for the elderly and disabled was unjustified.


Link

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

How often do they deny coverage when the policy states that it is covered?

F--ck the $$$ and political issues, the sick should be treated by professionals....no matter what race or anything else..........Where there's a will, there's a way.

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

(05-31-2014 12:56 PM)EagleX Wrote:  

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

Daayum....so if I get sick, I gotta take my lawyer with me? That'll just make me sicker and poorer

(05-31-2014 01:01 PM)tigerjaws Wrote:  

(05-31-2014 12:56 PM)EagleX Wrote:  

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

Daayum....so if I get sick, I gotta take my lawyer with me? That'll just make me sicker and poorer

I thought the whole purpose of Obamacare was to make sure you didn't need to bring your lawyer or your banker to the doctor with you and that Obama made sure you purchased a policy that wasn't substandard so you'd be covered for everything and anything.

(05-31-2014 01:09 PM)smn1256 Wrote:  

(05-31-2014 01:01 PM)tigerjaws Wrote:  

(05-31-2014 12:56 PM)EagleX Wrote:  

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

Daayum....so if I get sick, I gotta take my lawyer with me? That'll just make me sicker and poorer

I thought the whole purpose of Obamacare was to make sure you didn't need to bring your lawyer or your banker to the doctor with you and that Obama made sure you purchased a policy that wasn't substandard so you'd be covered for everything and anything.

Well, yeah. You can get free birth-control pills and not have to pay a dime. It's win FREAKING win, baby!

(05-30-2014 07:01 PM)smn1256 Wrote:  If only a mammogram would help.

Quote:CAMP MEEKER (CBS SF) — A Sonoma County man battling more than a dozen tumors in his body is fighting a new battle with his insurance carrier, who has denied coverage for his treatments.

Jeffrey Rusch of Camp Meeker knew the news was bad when an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones.

Doctors told Jeffrey he would need to be hospitalized immediately.

“My husband was having a lot of difficulty breathing already, and he was getting a lot worse, so we went to the hospital and they admitted him immediately,” Jeffrey’s wife Zoe Keating said.

In the hospital, doctors removed a half-liter of fluid from Jeffrey’s lungs, and gave him steroids to reduce brain swelling. Doctors administered emergency chemotherapy.

Then came even more devastating news: Anthem Blue Cross was denying their coverage for the treatments.

The family received a letter from the insurance provider, saying his hospital stay didn’t meet the criteria for medical necessity.

“It’s like an attack on my family. It feels that way,” Rusch said.

Jeffrey and Zoe have been Anthem members since 2008, and estimate they’ve paid $100-thousand in premiums.

“I would call saving my husband’s life medically necessary,” Zoe said.

Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.


Link

There is likely more to this story.
Was what the hospital did to treat him the normal mode of treatment for his condition?
How much these folks paid over the years for health insurance is irrelevant if they were behind in their payments, had cancelled their policy, or maybe they fall into the group that thought they had fully signed up for a new ACA policy but didn't fulfill all of the steps or pay their premiums.

I hate to tell the wife though...if he has tumors in his brain and its metastized to his lungs and bones, there is very little the hospital could have done then not can really do now to save his life...prolong it maybe, saving it will take nothing short of a miracle.

(05-31-2014 01:01 PM)tigerjaws Wrote:  

(05-31-2014 12:56 PM)EagleX Wrote:  

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

Daayum....so if I get sick, I gotta take my lawyer with me? That'll just make me sicker and poorer

. . . but it will make your lawyer richer.

(05-31-2014 01:47 PM)EagleX Wrote:  

(05-31-2014 01:01 PM)tigerjaws Wrote:  

(05-31-2014 12:56 PM)EagleX Wrote:  

(05-31-2014 08:41 AM)mathenis89 Wrote:  You do understand that health insurance companies have always happily denied people coverage for life-saving operations, yes? This was a thing long before the ACA was passed.

my insurance company can be sued. and they can't send me to war, confiscate my income, or throw me in prison.

you do understand the difference, right?

Daayum....so if I get sick, I gotta take my lawyer with me? That'll just make me sicker and poorer

. . . but it will make your lawyer richer.

Yeah???...............F'k him too