I was having a conversation with my mom last night, and she told me a very interesting story.
My mother is a certified nurse/midwife, and works in a hospital that specializes in high-risk deliveries. She had just had a couple who were having difficulties with their pregnancy. At 26 weeks, the mother ended up going to the emergency room almost every other night to check on bleeding and pain caused by an abnormal cervix.
Her doctors recommended she stay in the hospital until her 28th week. At that point, they would explore delivering the baby by C-section. This plan would end up being best for the mother and child, and would incidently cost the least. 2 weeks of hospitalization would be nothing compared to the in/out of the ER and potential serious problems that could be prevented by monitoring and observation.
My mom walked in on the couple later in the day to find them crying. The doctors had told them that CIGNA had denied paying for their stay, and they had to go home. My mom knew this family pretty well, and it turns out the father is a vice-president in charge of software at a huge computer business. She told him that it was clear what was medically best for them, so he should take the time to call CIGNA himself and put pressure on their decision. She told him to share with CIGNA the fact that he was an executive in a company that employed over 1,000 people. If they didn't cover his wife's 2-week hospital stay, he would go to his HR department and request they immediately switch to another carrier.
The person at CIGNA they were talking to immediately cleared them for a 2-day stay while they re-reviewed their case. The next day, they called and said that in retrospect, having his wife stay hospitalized for 2 weeks would be the best thing to do, and they would cover everything.
What made me sick about this story is this; what happens to the people that aren't executives in big companies? What happens to the people who don't have the clout of yanking a big contract from a HMO? I'll tell you what happens... people die.