But isn’t there a sense in which it’s wrong to not consult a lawyer in this situation, and to use crowd funding instead? I don’t know, maybe he did and it wasn’t promising. But it sounds to me like he found out that an appeal through the insurance company’s process wasn’t going to work and then gave up the fight. If there’s a good chance that the insurer can be made to pay, and I suspect there was, then you should make the fuckers pay. What is it that the Republicans always say about the social safety net: cut it and private charity will fulfill the need.
Two things: 1) Brandon could have bought insurance to cover this (a different type), it’s what I was offered when I was out of a job and I have a preexisting condition.
Insurance issues are mostly based upon 2 factors: 1) since the majority pays for a fraction of need and there are so few signed up for full coverage there isn’t enough money to cover so the cost of insurance goes up, and 2) MOST insurance companies (including HUMANA) BUY insurance from 3 major players. These 3 major players have SO MUCH CASH they don’t know what to do with it (BILLIONS) and are actually having issues investing it (it’s TOO MUCH MONEY). They are for profit, and don’t care about individuals and don’t have any incentive to actually lower the premiums that insurance carriers pay. Why this is I have no idea.
Because they could get his premiums for a few months before dropping him when he got sick. Insurance companies didn’t look at the pre-existing condition stuff too closely until you made a claim, then they would pore over your medical history looking for any reason to drop you. It’s a win-win. They get premiums for several months, and then they don’t have to pay them out, and hopefully the people die before they can navigate the legal system that will screw them anyway. It’s all right there in the contract and they were a liar because they didn’t disclose that completely treated yeast infection from 5 years ago and maybe it’s why they have brain cancer now.
Brandon should look into all his options for challenging Humana’s decision. If this wasn’t already done, a good place to start is with an External Review, which can be found here: http://www.tdi.texas.gov/hmo/iro_requests.htm
I wouldn’t necessarily take LiveStrong’s advice as the final word on whether he has a case. Little enough information was given that it’s hard to know, but if he was wrongly denied, there may be recourse. Many cities and states are fighting these kinds of rulings and there are legal proceedings that he might be able to join. I wish him the very best with his treatment!
Because the insurance company has much much deeper pockets than the guy who just spent all of his money on cancer treatments, and can keep the case tied up in the courts until he dies. And that’s assuming they don’t find some headache he had 3 years ago that they’ll call a pre-existing condition.
You don’t make $420 million of profit per quarter by treating cancer.
Yup. In the minds of the stupid and selfish, universal health care = “somebody might get something they don’t deserve, like medical care, and some tiny fraction of my gosh-durned taxes might pay for it! SOCIALISM OBAMA TERRORIST DICTATOR HITLER!” Never mind the fact that “free market” as applied to medical care is completely laughable on its face. “Gee, I have a bleeding head wound. Time to shop around for the best deal!”
I wholeheartedly agree! Although I would point out that, if a lawyer is willing to take the case, then you don’t need any money to bring a case. The lawyer gets paid only if the case is successful. If no lawyer is willing to take it, then at that point the law has failed you and raising money from the public makes sense.
I don’t think it’s stacked for obstruction, necessarily, it’s stacked more in line with about what half a dozen or so really, really powerful people/corporations want. Which is freedom, of course.
And you’re right, that’s slight hyperbole on my part to paint “americans by and large” but it’s damn frustrating to hear huge swaths of people sing the praises of assholes like Saint Reagan (the past) or Paul Ryan (the new kid).
Or to hear so-called “Christians” go on about how the poor are bankrupting the US with their need for food, shelter and healthcare.
Under ACA, I went to Healthcare.gov & looked for the best health coverage. I decided to choose Humana HMO. Since then, they have sent me a guide covering my plan. Among the small print of what they won’t cover:
Abortion, except in cases of rape or incest, or if the mother’s life is in danger;
injuries or illness due to suicide attempts, war, riot, illegal occupation, or armed conflict with any authorities, like police;
except for emergency care, injuries or illness received when drunk or high on drugs;
any charges from a hospital checked into on a Friday or Saturday, unless it is an emergency & surgery or treatment happens on the same day;
reversal of sterilization;
elective cesarean delivery;
sex change procedures;
prescribed birth control pills. (I think the ACA outlaws this one.)
I think I’ll choose another insurance company next year.
You have been fooled into believing that only people with money have access to the legal system in the United States. This is certainly what the insurance companies want you to believe.
Now, for other types of civil actions, it’s true, but not when it comes to health insurance. (In fact, if you have no case, but offer a bunch of money to a personal injury attorney to take your case anyway, I believe they are ethically obligated to turn you away.)
Racketeering is a better comparison. You’re paying protection money in the event something bad happens. When something bad does happen, you get stiffed on the protection you’ve been paying for. Let’s RICO these fuckers.
any signs of illness that could possibly have led a doctor to a diagnosis
In the UK I’m pretty sure that little term would fall under the Unreasonable Contract Terms bit of the law (yes, it’s real).
Actually a good lawyer … who’d charge $100k … could surely pierce that phrasing. “Any signs of illness” is something that it’s a doctor’s job to do. Humana is insisting this chap run in and out of medical checks?
You’re saying that if the ACA were “effective” it would cover things that happened before it went into effect. That’s what’s known as an ex post facto law, which is explicitly forbidden under the US Constitution.
You have to keep circling back and remember - Humana (like their brethren in the ins biz) do not care about health. They care about profit. That’s it.
Our entire healthcare system in the US of A has been boiled down to a handful of powerful corps (like all the rest of our businesses, from corn to chicken) and NOTHING to do with the actual welfare of those involved enters into their minds.
I just looked up the Humana board of directors and CEO online. You know what’s funny, I was shocked at how “low” their CEO is paid…
That’s how screwed up we are.
And people are still opposed to single-payer healthcare?
It’s no accident that many still don’t. The insurance industry has seen to it. If I could do one thing before I die, it would be to force every fucking American who is against a single payer system for health care by the scruff of thier neck to fucking watch this damning interview in its entirety:
This interview should be burned onto DVDs after having a Fox News Logo stuck over the Moyers logo and dropped into every rural and suburban conservative enclave in the United States.
One of the tasks I need to undertake this month is to figure out how to get my “insurance” “provider” to actually pay my medical bills. I have what is supposedly good BCBS coverage through my employer, yet I had some blood work that earned me a “We don’t feel like paying this, kthxbye” letter, and some dental work that earned me no letter at all, just an unpaid bill from the dentist. (Yet the treatment following said blood work was paid, as was comparable dental work a year prior.)
Fortunately neither bill is terribly huge, with both items totalling about a grand. But A) YOU HAD ONE JOB, and B) I have a full-time job, and administering medical billing claims is not part of that job.
Sorry, no. You were aware of your pre-existing condition, and so when you obtained coverage you very wisely protected yourself in this way. Brandon obtained for himself what he thought to be standard and sufficient coverage, only to discover later that he had a pre-existing condition that the insurance company could document sufficiently to escape covering his medical costs (at least to their own satisfaction); he didn’t obtain medical coverage knowing this would be an issue.
This is precisely why the ACA made the exclusion of pre-existing conditions illegal. Brandon’s case is piquant because he falls right on the border of the implementation of this provision, dealing with accumulated medical bills even as he is now covered for future medical costs - but this has been going on for a long, long time, and has been hurting a lot of people.
PS as to Rider’s many comments incoherently blaming the ACA for trying to patch up the existing system rather than tearing it down and restarting from scratch: yes, the ACA is a kludge, and we deserve better. On the other hand, it’s a huge step forward in giving people coverage they previously lacked and in ensuring people have coverage they can actually trust. It took us, what, seventy years to get this far? Yes: we have the worst system in the wealthy world, and, yes, the ACA risks enshrining bad aspects of that system. But: we weren’t going to get the British NHS. We weren’t even going to get the Canadian NHS. Heck, we weren’t even going to get the Public Option. The ACA is what was possible, and it’s a freaking minor miracle we got as much as we did, given our political system. Brandon is pretty badly boned here - but as of this year, people like Brandon won’t be. This is a revolution in the American way of dealing with medical disaster.
Sure…sure. But the very fact of such malign technicalities and loopholes is enough to declare the whole shebang derelict and without socially redeeming value. It’s merely outrageous when it comes to home and car insurance. It’s criminal and abhorrent when it comes to health insurance.
The Affordable Care Act is but a start at chipping away at this abomination. The funding and costs of US healthcare have got to be dismantled, re-chartered, and simplified…the sooner the better. The GOP minions will fry in Hell for throwing up roadblocks to this end.
