The next time you think about saving a young woman from a burning car, think twice: your big-profit health insurance carrier might deny your claim and leave you with hundreds of thousands of dollars in debt. That's what Aetna did to one man who engaged in absolutely heroic actions on an Arizona freeway.
(I know this diary is long, but I respectfully ask that you read all the way to the end.)
The accident happened in an instant. One second, traffic was moving steadily. The next, metal debris was flying past Cliff Faraci's windshield as cars skidded across Loop 101 near Scottsdale Road.
Faraci jammed on his brakes. In front of him, a battered red car was stopped sideways and steaming. Inside, a teenage girl, covered in blood, slumped in the driver's seat. Faraci ran to the car and tried to help her out. The driver and passenger doors were jammed. He talked to the girl, told her everything was going to be OK.
"I noticed smoke coming from under the hood," Faraci said, describing the March 2013 accident as if it were still unfolding in front of him, the way it will play out inside his head for the rest of his life.
"I reached in through the driver's window to turn off the ignition ... but I could not reach it ... I reached further into the car with both arms and upper body. ... I was halfway through the driver's window."
The engine ignited. Faraci, standing in a puddle of gasoline, was enveloped by searing heat and yellow flames. He jerked away, trying to stop the burning. The ruptured gas tank exploded and Faraci watched the girl inside the car die.
Where was this hero taken? Appropriately, one of Arizona's best burn units. And precisely because this man had the audacity -- or, well, his rescuers made the decision -- to take him to this hospital and provide him with medical treatment, rather than just let him burn to death, he would subsequently face a "uniquely American" corporate health insurance nightmare.
After a week of intense treatment, Faraci was discharged from the hospital. But he hadn't been home two full days when he received a letter from his insurance company informing him that he wasn't covered for the hospital stay.
Aetna claimed Faraci's injuries were not sufficient to warrant a weeklong stay in the hospital's burn unit, which was deemed an out-of-network facility. Maricopa County Medical Center had billed him about $165,000. He filed an appeal with Aetna. It was denied in August.
Almost overnight, the freeway Good Samaritan had become a victim of a health-care nightmare. His case is an example of what can happen when an insurance company decides to question the administration of care provided by doctors and other medical experts directly involved in the patient's treatment.
So, basically, a bureaucrat at the corporate health insurer whose
CEO's pay recently tripled decided that one of Arizona's best burn doctors should not have gone to such heroic lengths to save this man's life. After being engulfed in flames while attempting to save a young girl's life, he should have left the hospital sooner. Aetna has shareholders to pay, you hear!
Only in America do the sick and injured -- those engulfed in a ball of fire -- have to suffer the indignity of losing everything they own as well. The unimaginable torture of being almost burned to death is not enough for the oligarchs in charge of our health care "system."
Faraci, 44, of north Phoenix, is the father of two teenage boys and owner of Metal Masters Mechanical, a family business. He said he was shocked when he was denied coverage. He said he is insured through his business and assumed that because he pays his premiums, he would be protected in the event of a medical emergency.
In interviews and a letter to Call 12 for Action written in November, Faraci talked about the accident, his time in the hospital and the aftermath of being denied coverage.
"They said my injuries were not that severe and I should not have been kept there," he said. "How can the (insurer) go back and tell the doctor, you don't know what you're talking about? It's not like I was at Club Med and enjoying a sauna."
Faraci remembered his stay at the burn unit in terms of pain. He said his wife, Bonnie, described watching nurses scraping chunks of skin from his palms and wrists. He said it hurt so bad he nearly passed out, even though he was on pain medicine.
They coated his arms with silver sulfadiazine cream and wrapped them with gauze. Over the next few days he would undergo debriding procedures twice a day, in which the wounds were cleaned. Faraci said his wife told him his skin peeled from his arms as the wrapping was removed and that nurses scraped the burns with a tool that resembled a butter knife.
Initially, doctors told Faraci he might have to go undergo a skin-graft procedure. But he said his recovery made it unnecessary. He was released from the hospital after about a week.
I want to cry just reading that description, but Aetna, well, Aetna started crying about something else: dollar bills.
Faraci said he tried to talk with Aetna and got nowhere. He said he provided doctors' letters and statements, to no avail. In an August denial letter, Aetna officials told him his coverage extends only to services and supplies Aetna deems medically necessary.
"The member had no signs of respiratory burn and was otherwise stable," the insurer wrote. "Ongoing wound care, including medications, does not require acute hospitalizations. Further treatment of this member could be provided at a less intensive level of care, or in another setting, e.g. non-acute facility, other outpatient setting or home."
Left with a $165,000 hospital bill, Faraci did what any normal American fucked over by an immoral, greedy health insurer after being almost burned to death would do: he called a lawyer. And,
still, Aetna said, "Hell no, we won't pay!" Or, well, their lawyers said that.
"It was not my choice to stay in the burn center for seven days," he said. "This was a decision made by medical professionals who treated me on a daily basis. To have the doctors' judgment questioned and overruled by an insurance company who did not treat me or see the extent of my injuries is unthinkable."
Faraci's lawyer appealed Aetna's initial denial of the claim; the company denied a second appeal. The lawyer, Gregory Gillis of Scottsdale, appealed again and asked for an outside review of the case by an independent examiner.
The independent examiner determined that Aetna should pay for half of Faraci's hospitalization, leaving him with a remaining bill of $82,500.
In February, Aetna told Call 12 for Action that Maricopa Medical Center was going to waive bills for any of Faraci's hospitalization not covered by Aetna.
So, our hero walks away from this disaster with a lifetime of pain and physical damage -- not to mention incalculable emotional trauma, caused by both the fire
and Aetna -- but his benevolent insurer finally coughs up the money, right?
Not exactly...
"I don't believe they are going to bill him for the three days that the external medical review confirmed were not appropriate as inpatient," Aetna spokeswoman Cynthia Michener wrote in an e-mail. "I believe he is only responsible for his deductible and co-insurance."
Michener said Wednesday that the company is "pleased the matter is resolved."
Faraci credited Call 12 with getting Aetna to work out a resolution with the medical center. He said he tried for months, with no success, to negotiate a similar outcome. His total cost will be around $5,000 for a co-pay.
Resolved?! And, to think, paying $5,000 was the "big win" after lawyers and television journalists shamed Aetna into paying this man's bills. Paying thousands of dollars was the "victory" that resulted from lawyering up and making the media scream. Imagine how Aetna treats the people who can't afford lawyers -- or aren't savvy enough to contact the media. It bankrupts them -- or lets them die.
Wendell Potter warned this week in a column that corporate big-profit insurers will be moving staff from the underwriting department (where they used to tell cancer survivors they were uninsurable) to the "so-called medical management teams" (i.e. where they look for excuses to deny claims of heroes who were almost burned to death) in order to reduce costs -- and increase profits -- now that they have to accept everyone who wants insurance.
To keep Wall Street happy, insurers undoubtedly have begun shifting resources from their underwriting departments to their so-called medical management teams. I’m confident that people who work in medical management are under more pressure than ever from the executive office to avoid paying claims whenever possible.
Boy, was Wendell spot on -- hammer on head of nail.
And, lest we think no heroic deed goes unpunished, the fucked-by-Aetna hero does report that the girl's family were so grateful he was with their daughter in her final moments on Earth.
Shelby Dwyer, 19, a graduate of Pinnacle High School, died in the March 14, 2013, crash. Her family and friends reached out to Faraci and thanked him for trying to help her.
"I met her parents, her grandparents and her boyfriend. They were glad she wasn't alone in her final moments," Faraci said. "That has kind of given me some peace of mind."
Faraci, a former scoutmaster for the Boy Scouts of America, said he doesn't regret trying to help Dwyer. He said he wouldn't hesitate if circumstances repeated themselves tomorrow.
"I would do it again. I would do it again in a heartbeat," he said. "That's what we are supposed to do."
This, folks, is why we need
single-payer, Medicare for all.
Our health insurance companies are monsters -- and we must stop them before another hero is punished for doing something that I know I would have never had the courage to do myself. A society that lets corporations punish its heroes is one that needs to adjust its moral compass -- and do so really damn fast.
5:09 PM PT: Thanks to @Norm in Chicago for pointing this out:
Yes Aetna sucks. But why does a weeks stay in the hospital cost $165,000? Did they wrap him in solid gold?
There are two problems here. Insurance refusing to pay, and a hospital committing outright theft and fraud.