[misc.handicap] Insurance companies

CREGIER@UPEI.CA (Sharon Cregier) (10/24/90)

Index Number: 11236

For those of you struggling with faceless, heartless insurance
companies, you have all my sympathy.   As my family discovered in 8
harrowing weeks this summer (the problem is not yet resolved)

 . The insurance companies do not count you and your problems as
real unless you are institutionalized!  It does not matter if
treating you at home would not only be HEALTHIER (far less risk of
hospital infections) physically and psychologically, but also much
CHEAPER for them

 .  When you think you have psyched out their Game Plan for allowing
treatments or attendants, they change the rules.

Example:  (Our company, a state sponsored MetLife/Blue Cross
plan==Hey, let's name the names of the GUILTY here!) USED to pay
for RNs in the home if the patient were catheterized.  NO MORE and
no way can you know this until you apply for the insurance
payment.  They USED to pay for licensed practical nurses.  NO
MORE.  If a LPN can do the job--and the range of jobs that the
insurance company has determined that an LPN can do increases by
the week, it seems--insurance will NOT pay for LPN homecare.

About the only way you can get the necessary round the clock care
(turning the patient every two hours, hand feeding, bathing,
medication supervision, safety supervision -keeping the patient
from climbing from the bed- changing bedding--all to the tune of
$Three Thousand every FIVE DAYS) is if a restricted narcotic is
ordered for the patient.  No matter that the narcotic makes the
situation WORSE.  No matter that the insurance claimant put $17,300
of his retirement pay at retirement toward purchasing an extended
policy from Blue Cross, who then segued into Met Life just to make
things confusing--to PROVIDE the home coverage needed.  It counted
as nothing.

Is this why MetLife/Blue Cross in our neck of the woods has ONLY a
faceless post box number in Kingston, NY and NO street address so
that one can travel to the main office to plead a case in person?

Is this why the local Blue Cross office conducts claimants to
secure areas which must be locked and unlocked?  Are they afraid of
a bomb-wielding claimant at the end of his--or her--tether from the
gobblydegook and bureaucratese that they feed you all the while
saying: We're here to help you.  (Their favorite mantra.  Don't
EXPECT any help or understandable explanation WHATSOEVER.  Just
hours wasted trying to reach someone on the phone or traveling to
local offices).

Is it any wonder that the health clinic associated with the case
has a room larger than the examining area just to deal with
insurance claims?  That the room is filled with a kafka-esque
ranking of desks and office workers all trying to figure
out--despite hours spent in seminars focusing on just such a
code--if Code 24D-3005/36A will be accepted by the insurance
company?

A talk with the nurses and a talk with the doctor's insurance
claims secretary (she IS on the patient's side!) revealed that
there are NO NO NO NO good insurance companies.  Period.  They ALL
weasel, delay, confuse, confound.

They don't care if there is no one to look after the patient at
home, or if the patient is too ill to be removed to hospital--the
move would have killed the patient, two doctors told us, and the
patient would NOT have received in hospital the high quality of
care which our borrowed funds, new mortgage, and personal
attendance were providing for the patient.

Are things getting worse?  They can only get worse.  Degenerative
disease, thanks to bad diets, pollution, and environment, is now
taking one out every three North Americans.  It is a far greater
threat than AIDS (which, after all, can be stopped in its tracks by
a change in social behavior).  There is no way even the best
performing insurance company is going to be able to cover the
claims.

There are only three ways, as I see it, of insuring against having
to rely on a health insurance company.

1)  The best buffer against outside control by state or being at
the mercy of fickle insurance companies is to have a large family.
A large, cohesive family is a wonderful buffer against state or
other control.  It gave us just enough time and support to hang in
there until the insurance company made a tiny, weeny, paltry
payment which covered two of the 8 weeks illness involved.

2)  Take out a life insurance policy that will cover the funeral
and medical expenses.  It is the only way that losses can assuredly
be recouped without winding up wholly in the poor house.

3)  Be responsible for your OWN health.  Look carefully at
alternative medical care.  From my own personal experience, I have
found macrobiotics to be far superior to anything which the
alleopaths (medical doctors) offer.  The latter are so limited in
outlook it is criminal.  They want to treat the body the way a
mechanic goes after a car.

To those of you struggling with your insurance companies and
thinking of going for a lawyer, the company tactic is to blizzard
the lawyer with so much paperwork that it takes weeks of
concentrated time to absorb it.  They have ways to delay, and
delay, and delay.

71521.2451@CompuServe.COM (Tzipporah BenAvraham) (10/24/90)

Index Number: 11241

Bill I hope Patt can forward this to you. This was about the
kid denied insurance. I forwarded it to Dan Kohane who is
lawsig sysop on Compuserve. he is also a prof of insurance law
He says to refer by internet to him as needed. He sent you
this answer on Compuserve also. Hope this helps the kid.
Here is his reply.

Date:  21-Oct-90 15:18 EDT
 From:  Dan D. Kohane [76702,1272]
 Subj:  the kid and insurance woes

Why would the last alternative to be hiring  a lawyer?  Not being
able to ascertain the reasons fo the disclaimer, it is obviously
impossible for me to comment on the validity of the denial of
coverage.  If this matter involves substantial benefits, and I
assume it does, he should run, not walk, to a law firm that has
familiarity with insurance issues and get some professional
advice.  That counsel can help in the insurer-appeal process as
well as the court action, if that becomes necessary.

Frankly, Human Relations Department, and insurance departments are
of little value in solving individual coverage problems, especially
if the matter involves substantial dollars.

Certainly, the Human Relations Department can secure for him a copy
of the insurance policy.  That document, as well as all
correspondance with the insurance carrier on coverage issues should
be provided to counsel.  His local bar association can help him
identify attorneys in his community who deal in insurance company
or disability issues so that you can identify counsel with the
proper experience.

The fact that they paid for six months may be of some help, he is
right.  Again, it depends on the reason for the disclaimer.

I will send a copy of this to Mr. McGarry, as well.

                                       --dan--

Gary.Greiner@f21.n272.z1.fidonet.org (Gary Greiner) (11/02/90)

Index Number: 11446

Hi Sharon!
 
Your note on the insurance companies was excellent! We in the US pay
multiples of what the average health care cost is in many other
developed countries, but with no better results.
A minor example of cost stupidity: years back I had to buy some
medication for my ex-to-be regularly. Insurance reimbursement was 80%.
I found a mail order co. that sold the medication comsiderably cheaper,
but charged shipping. Well, they would not pay a penny on the shipping.
So I continued to buy locally since for me it came out somewhat
cheaper. Of course the insurance co. paid considerably more that way.
Cheers,
            TM

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Uucp: ..!{decvax,oliveb}!bunker!hcap!hnews!272!21!Gary.Greiner
Internet: Gary.Greiner@f21.n272.z1.fidonet.org

David.Moran@p0.f460.n101.z1.fidonet.org (David Moran) (11/02/90)

Index Number: 11453

Just want you to know that  someone else is VERY aware of the problem.  This 
is really a Disability Civil Rights issue.  CHALLENGE the insurance company. 
Ask to see the acturarial <sp> tables on which they base their decision in 
this case.  Do all communications by registered letter. Keep copies of all 
letters TO and FROM.  Go to your state legislator with the facts and 
EVIDENCE which you can now provide.  It may be too late in your particular 
case, but now that you see the need get the system changed for others.  Your 
state legislator can write state laws that will mandate that if the company 
wishes to continue to do business in your state they MUST play by the rules. 
YOU help write the rules.  Lay out to your legislator the facts as you have 
done here, and show them the correspondence (or lack of responses to YOUR 
letters).  YOu can make things different.

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