OUR COUNTDOWN TO FASCIST MEDICINE

@joefromchicago,

joefromchicago wrote:

Foxfyre wrote:
At least a private Insurance company cannot change the rules in the middle of the game without incurring risk of liability for breach of contract or bad faith.

You're fooling yourself. Plenty of people have purchased health insurance only to find out, when they need it, that their insurers rescind their coverage.

Well admittedly you are in Chicago which does not have the best reputation for ethics in the country. I can assure you that an insurance company cannot commit breach of contract or demonstrate bad faith with impunity in New Mexico.

Foxfyre wrote:
In my opinion, the government has no such restriction on how it does business, but perhaps sometime you could educate me sometime on how government works so I will be as smart as you..

I don't think anybody has that much free time.

You seem to have plenty of free time to write a lot of stuff here, much of which you don't seem to be able to support. I was just offering you an opportunity to put your time to more constructive use.

1 Reply

@Foxfyre,

Sniping aside, Joe is correct: Recissison is a real thing and insurance companies DO change the rules in the middle of the game, frequently.

And to claim that you can sue them for breach of faith, what a joke. We are talking about very sick people with huge medical bills, they can't afford to sue an insurance company. Not realistic.

Cycloptichorn

2 Replies

@Cycloptichorn,

If that was true nobody would buy insurance. All the insurance company would have to do is say sorry, I don't want to pay your claim, so we're cancelling your insurance or just removing that coverage from the policy. It does not work that way.

Insurance companies who insure anything do cancel policies if they think a risk is unacceptable, but they cannot refuse to pay a valid claim. At least they can't in any state I've ever lived in.

A few years go State Farm was routinely cancelling policyholders who had an auto accident even if it was a first claim for many. But they did have to pay whatever damages the policy covered as a result of that accident.

Later, when State Farm got such a terrible reputation for that and folks were shifting in droves to Allstate, Geico, and Farmers et al, State Farm adjusted their draconian policy. It took them awhile to regain the trust of the public, but they are now again a leading, if not THE leading, vendor for auto insurance in the state.

1 Reply

@Foxfyre,

Foxfyre wrote:

If that was true nobody would buy insurance.

It is true, and people buy insurance anyway, because they don't have a choice. The existence of the insurance monstrosity of an industry has driven prices up to the point where folks cannot reasonably afford health care without it.

Quote:

Insurance companies who insure anything do cancel policies if they think a risk is unacceptable, but they cannot refuse to pay a valid claim. At least they can't in any state I've ever lived in.

Of course they can, and do, all the time. They do so by defining what a valid claim is to suit their interests, every time they can get away with it. In many cases they use the thinnest of pretenses to do so and in some cases none at all. This attitude of yours is laughably naive, Fox.

The fact that they may not legally be able to do so is immaterial, because the people they do it to don't have the means or time to challenge them; they are busy dying for lack of care.

See this:

http://www.justhealthnow.org/Stories-From-the-Media-or-Official-Sources/Blue-Shield-Denies-New-Cancer-Treatment-Claim.html

Great example of exactly how the insurance companies work to deny claims based on bullshit reasons, with no accountability, and the policy holder is left screwed.

Cycloptichorn

1 Reply

@Cycloptichorn,

No Cyclop. They can't. I suggest you read up on the law in any state in the country. Breach of contract and bad faith is pretty uniform throughout. There are a plethora of hungry lawyers who are just itching to take on bad faith issues because insurance companies have deep pockets and lawyers really really like to get it. No insurance company would risk that. Most pay huge claims that they honestly don't owe purely to avoid the legal costs of denying them.

1 Reply

@Foxfyre,

Foxfyre wrote:

No Cyclop. They can't. I suggest you read up on the law in any state in the country. Breach of contract and bad faith is pretty uniform throughout.

When one party is allowed to make a unilateral determination of whether or not a claim is a valid one, they can - and do. You have no clue what you are talking about, Fox, this has happened to millions of people.

Cycloptichorn

2 Replies

@Cycloptichorn,

I've been in the business for more than 25 years. My husband has been in the business for most of 50 years.

I think I know what I'm talking about.

1 Reply

@spendius,

Earlier I asked--

Quote:

In what way are the millions of daily acts of kindness and care which go unrenumerated any different from an economic point of view to those similar acts undertaken for financial reward in institutional settings?

and it is instructive that it has not been answered.

You are talking as if you are economists and as soon as real economics appear you go quiet. This is why you will talk past each other for ever and a day and then some more. You are talking about money and who gets it. Which is an insoluble problem. Nobody will ever be satisfied with arrangements for health care. If the demand is not infinite it is merely because the population isn't infinite.

Our pips squeaking and us screaming like stuck pigs with 10 years of budget cuts does not apply to Health. Health is "ring-fenced". Cross-party agreement. Sacrosanct. And getting to and from hospitals will be subject to the cuts as will outside contractors profits, for free fares see Notice. So more acts of kindness appear and they are not counted in the figures. But economically they are the equivalent of the same act done for a fee. And there are millions daily now.

0 Replies

@Foxfyre,

Foxfyre wrote:

I've been in the business for more than 25 years. My husband has been in the business for most of 50 years.

I think I know what I'm talking about.

If you don't know the way that health insurance companies regularly engage in bad practices, then no - you don't know what you are talking about.

You may want to examine the fact that you could be, I don't know, slightly biased in favor of your profession?

Cycloptichorn

2 Replies

@Cycloptichorn,

I didn't like saying it straight out.

But one can be biased as a recipient of health care too. Or as a prospective one.

0 Replies

@Cycloptichorn,

Nope no bias. Just years of dealing with lawyers and judges and insurance companies who were hammering out what would be covered, what could be denied, and the gray areas in between. I have no stake in any insurance company and no reason to take any side but I believe to be the right side. Sometimes the claimant or policy holder is right in disputes. Sometimes the insurance company is right. I have been advocate for both sides.

Insurance companies cannot meet all the demands people would like to put on them. People are often disappointed, inconvienced, and even endangered not because the insurance company is unreasonable, but because they did not understand the product they were buying.

But that's okay with you, right? Just like in the case of the unethical vendor? It isn't her fault that people didn't understand what she was selling. It was their own stupidity right? That was your opinion about that.

How is not understanding what health insurance covers any different?

For obvious reasons, people cannot wait until they NEED insurance to arrange to purchase it. Insurance companies cannot operate at all if every policy holder files claims equal to or exceeding the premiums they pay.

My view of healthcare reform is that there does need to be a lot better explanation of what is and what is not covered. Agents are notorious for not understanding the product they are selling.

People need to have a good explanation of how to handle complaints if they feel they have been denied a medication or procedure or treatment unfairly.

And if the government would seriously attempt to meet the insurance company's needs and concerns with the understanding that the savings be passed on to the policy holders, it would be doing a great service.

But I remain convinced that a government administered program would be no more humane and would be far more restrictive. It is already that way in most of the healthcare it now manages and many a doctor finds it too restrictive to practice government medicine. There is no reason to think it would be any different if government gets involved in it all.

1 Reply

@Foxfyre,

Quote:

Insurance companies cannot meet all the demands people would like to put on them. People are often disappointed, inconvienced, and even endangered not because the insurance company is unreasonable, but because they did not understand the product they were buying.

Did you read my link above? When the insurance companies define your treatment as 'experimental' and refuse to pay for it, it isn't because the customer didn't know what they were buying; it is because the insurance company doesn't want to pay for something the doctor decided the patient needed. In a very real sense, they are coming between patients and their doctors.

And this happens all the time. We've dealt with it in my family when the insurance companies didn't want to pay for my fathers' cancer surgery at MD Anderson in Houston, not because of a lack of coverage in the policy, but b/c it was 'too new' and 'too expensive.' It was a damn good thing that I happened to have a great job at Dell back then and was young enough and willing enough to spend 85% of my paycheck on his surgery for a whole year, or my pop would probably be dead now.

Cycloptichorn

1 Reply

@Cycloptichorn,

The insurance company is obligated only to the contractual agreement in the policy. If the contract does not include 'experimental treatment', the insurance company is under no obligation to authorize that. If the insurance company does demonstrate bad faith, however, in every state except apparently California and Illinois (according to you and Joe) there is legal remedy for that. You two need to take that up with your insurance commissions though, as the Federal government does not have jurisdiction there.

1 Reply

@Foxfyre,

Foxfyre wrote:

The insurance company is obligated only to the contractual agreement in the policy. If the contract does not include 'experimental treatment', the insurance company is under no obligation to authorize that.

Then the insurance company has a giant loophole: define expensive treatments as 'experimental' and refuse to pay. And this is exactly what they do. They exploit whatever loopholes they can get in order to not have to pay for treatments people need. Do you deny this?

Cycloptichorn

1 Reply

@Cycloptichorn,

I can deny that I believe you have a clue about what you are talking about or that you can back it up with anything but the most obscure anecdotal evidence. On the other hand I have 25 years, off and on, of watching insurance companies pay out substantial money for claims they did not owe because it was cheaper to pay them than fight them in court.

And prior to that I had several years experience in hospitals dealing directly with healthcare insurance and I can tell you that private insurance presented far fewer problems to the patients than the government insurance did.

2 Replies

@Foxfyre,

Foxfyre wrote:

I can deny that I believe you have a clue about what you are talking about or that you can back it up with anything but the most obscure anecdotal evidence. On the other hand I have 25 years, off and on, of watching insurance companies pay out substantial money for claims they did not owe because it was cheaper to pay them than fight them in court.

And prior to that I had several years experience in hospitals dealing directly with healthcare insurance and I can tell you that private insurance presented far fewer problems to the patients than the government insurance did.

I note for the record that you do not deny that insurance companies use loopholes and other means in order to avoid paying legitimate claims. The rest of what you've written here is an attempt to distract from the fact that you will not give this denial, because you don't wish to admit that I'm right.

Your personal experience is, Fox, the most obscure anecdotal evidence. You could be making it up completely. At least I can link to accounts which give evidence for my side. You can link to nothing. Therefore it is pretty erroneous for you to claim that your experience trumps that of those who have had opposite experiences.

Cycloptichorn

1 Reply

@Cycloptichorn,

I don't deny it because I don't know whether such happens or not. I do know sometimes claims are denied unjustly, but that is the exception rather than the rule, and when it has been my decision when that happened, it was generally due to miscommunication or lack of sufficient information, and in every case the situation was subsequently remedied. I also know that an insurance company cannot remain solvent and pay as you seem to think they should pay.

So if my anecdotal evidence is so obscure, lets see your anecdotal evidence and evaluate whether it is less obscure.

0 Replies

@Foxfyre,

Foxfyre wrote:

I can deny that I believe you have a clue about what you are talking about or that you can back it up with anything but the most obscure anecdotal evidence. On the other hand I have 25 years, off and on, of watching insurance companies pay out substantial money for claims they did not owe because it was cheaper to pay them than fight them in court.

Or, in other words, your anecdotal evidence is much better than Cycloptichorn's anecdotal evidence.

1 Reply

@joefromchicago,

What anecdotal evidence has Cyclop provided? My anecdotal evidence is certainly as credible as his unsupported and what I believe unsupportable opinion.

In my experience, insurance companies pay more claims that they do not owe than they deny claims that they do owe. Are you prepared to offer evidence to dispute that?

If not, then my opinion is as good as anybody elses.

2 Replies

@Foxfyre,

Foxfyre wrote:

What anecdotal evidence has Cyclop provided? My anecdotal evidence is certainly as credible as his unsupported and what I believe unsupportable opinion.

In my experience, insurance companies pay more claims that they do not owe than they deny claims that they do owe. Are you prepared to offer evidence to dispute that?

If not, then my opinion is as good as anybody elses.

I presented part of my personal story here -

http://able2know.org/topic/134494-16#post-3718224

I also presented a link earlier, which you either didn't read or ignored.

But, to provide you the evidence you are looking for, over the course of the day today I will be providing many and various links to accounts of people having their insurance claims unfairly denied or rescinded. Insurance companies have made a regular practice of denying valid claims; it's the only way that they can 'stay profitable' in this market. I'm going to link to accounts of former insurance workers and CEOs discussing how they regularly do this.

Cycloptichorn

0 Replies

OUR COUNTDOWN TO FASCIST MEDICINE

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