Yesterday nyceve wrote an impassioned diary about the villainy of the health insurance companies. http://www.dailykos.com/...
My son's tragic life is yet another example of how truly despicable these companies are. He had a major stroke on Thanksgiving of 1986 when he was 3, and died about 1 month short of his seventh birthday. For the 4 years he survived after his stroke, he was in similar medical shape to David Denney (described in nyceve's diary) -- couldn't walk or control his body, couldn't talk, smile, swallow; had to be fed with a feeding tube; needed respiratory therapy every morning (which was mainly done by my husband because the insurance company would only pay for it twice/week).
We had both an HMO and Blue Cross/Blue Shield coverage. Because the HMO was a member-owned organization and one of the original pre-paid group practices (started in the late 1930's and considered communist by the medical establishment at the time), it was, for the most part, pretty responsive. But in the end, even my beloved Group Health (I had belonged to it all my life) abandoned us for the bottom line (of course, at that point, Group Health was competing unsuccessfully with the profit-making HMOs and was trying to cut costs -- it no longer exists).
But there is no doubt that BC/BS was the worst: they tried every trick in the book to get out of paying our claims and treated us as pariahs for daring to have a child who needed lots of medical services. And the only reason BC/BS covered anything at all for our son was because his condition wasn't congenital. They had a neat little clause in their coverage that said they would only cover "rehabilitative" services intended to return function. A child born with severe disabilities would need "habilitative" services, and those weren't covered. So we were "lucky" because our little guy was normal before his stroke -- otherwise they would not have paid a single thing related to his condition.
Within a month after his stroke, the BC/BS rep told me that they didn't think they should have to cover him because he belonged in an institution (a state institution, of course, where they wouldn't have to pay for the services). Imagine someone saying this to a shocked and grieving mother trying to cope with her son's disastrous illness. Our refusal to institutionalize him was the beginning of numerous fights with BC/BS.
They said he didn't need to get his therapies at home because we could carry him to all his appointments (try carrying a normal weight 6 year old to medical and therapy appointments 5-6 times per week).
They said he didn't need speech and physical therapy because we took him with us on a one-week vacation in which he didn't get his therapies (if he didn't need it that week, obviously, he didn't need it at all!).
They fought claims and delayed paying at every opportunity (and there we were, both working our asses off at our jobs in order to keep our coverage, taking care of our son at home without any nursing care, also taking care of our 2 other children, but having to fight BC/BS for every penny they owed us). I remember my MIL looking at our dining room table which was completely covered with 2-foot high stacks of papers and telling me I should clear up my work so we could use the table. I explained to her that this was not my work, it was our son's insurance paperwork.
Hospitals hired collection agencies to try to get the money from us because they weren't getting paid. We had two separate health insurance policies for our son, yet at one point we owed our local hospital $100,000 [1990 dollars] and were being harassed constantly for payment.
BC/BS suddenly stopped paying for his speech therapy (they had been paying 80% of $65 up until then). When I called them they said that they had been "overpaying," they would only pay 80% of $25 per session, and since they had overpaid, they wouldn't pay any of our claims until the total added up to what we "owed" them. I told them there wasn't a speech therapist in the whole metro area who charged only $25 for this level of therapy, but they refused to tell me how they arrived at $25 as the "usual and customary" cost.
I was complaining about the insurance company to the admin assistant for the psychologist testing our son, and she told me that they had had a client who worked at BC/BS who told them that her superiors instructed her to reject claims for no good reason because they knew some people would give up and pay out of pocket thus saving BC/BS lots of money.
The final insult was after he died. This time it was delivered by the HMO. They said they wouldn't pay for our son's last visit to the ER because it wasn't authorized. When I said it wasn't authorized because it was an emergency, they said it had to be a "life and death" emergency. I pointed out that he was admitted to the ICU and died there. But the billing rep kept arguing with me!
Two professionals, two fairly good incomes with insurance coverage from two companies -- yet we were increasingly in debt. It took us several years after our son's death to get back on our feet financially. I often wonder how families of more modest means survive at all.
I despise the insurance companies. Their entire purpose is profit. The only group I hate more than them is the Bush administration. I've followed the Krugman vs Obama debate a little. Generally I respect Krugman, and I also have a great deal of respect for Obama. It may be that Krugman is right and that Edwards' approach is what is necessary (and I certainly feel the same anger Edward expresses so well), or that Obama is right that we won't get any kind of national program without bringing the insurance companies into the discussions (and this is absolutely a valid argument given how powerful those companies are). But I would hope that our nominee, whoever that is, will represent us, stand up for us, and when dealing with these venal and vicious health insurance companies remember that his/her first loyalty is to us, not to the heartless corporations currently controlling our access to health care.