I am not a huge fan of Kaiser Permanete. As a matter of fact, I frequently complain about them. But I swear I will cut my own tonsils out before I ever consider joining Blue Cross or Blue Shield. I heard too many horror stories and this is by far the worst. Never EVER join Blue Cross of California.
SAN FRANCISCO (CBS 5) ― When Daly City resident Rosalinda Miran-Ramirez woke up one morning in April to find her left breast bleeding from the nipple, she panicked. The shirt she had been sleeping in was saturated with blood. So her husband took her to the emergency room at Seton Medical Center.
"In my mind I know something serious is going on," said Miran-Ramirez. "I need to see a doctor."
Doctors found a tumor and initially told her she had breast cancer. A biopsy later proved that assumption false; the tumor was benign.
But Miran-Ramirez said the real shock came when her insurance company, Blue Shield of California HMO, which had initially approved the claim for the emergency room visit, reversed course and sent her a new bill three months later requiring her to pay the total charges for that visit: $2,791.00.
Why? Documents from Blue Shield indicate the company had reviewed the case and determined Miran-Ramirez "reasonably should have known that an emergency did not exist."
In other words, if you wake up in the morning and blood is seeping from your nipples, you ought to know better than to think you have an emergency. After all, we should use our "American ingenuity" to diagnose ourselves. Who needs doctors. Oh, and if it is a cancerous tumor, you ought to be able to remove it yourselves and be thankful you have any insurance at all. Have a good day.
On a serious note, THIS, maybe more so than the uninsured, is the kind of examples we should be useing to pass real health care reform.
Update [2009-9-25 15:25:17 by RandySF]:
In the heat of the moment, I diaried this story without reading at the end that, after getting questioned by CBS 5 News (those liberals), Blue Shield relented and agreed to pay the cost of the ER visit. I called Rep. Jackie Speier's district office and her staff informed me that the Congresswoman is already aware of what happened to her constituent. That doesn't take them off the hook because this never should have occurred in the first place. Ms. Miran-Ramirez is not a doctor. Most of us are not doctors, so no medical "professional" or insurance company official has any right to look down their noses and laugh at those of us who take action to care for ourselves and our loved ones. If my wife wakes up in the middle of the night with a shirt saturated in blood, we're going to the ER. This is not how a civil society treats its people.
But there is a silver lining here. We have our talking point, our story. This kind of jacking around is why people have been so pissed off in the first place. And as much as we care about the uninsured, the above example is what will help us carry the day, so spread this as quickly and as wide as you possible can.