Insurer Denies Boy Transplant

Thanks. Hopefully we can designate a gift to be certain it goes to the boy. The hospital does not seem to allow designation to a person on their website forms. You can designate to the general fund or to particular areas, but not to this boy, at least not yet.

If they do...you should thread it and ping it to all the big pingers like John Huang2 and gubyamaster and kattracks etc.

Let me just give you a bit of info on MY experience with insurance companies. In 1989, a dog ran out in front our car and we ended up with a bumper that split in two. Our auto ins. paid for it, but dropped us (no previous tickets, accidents, etc.). When we tried to find other coverage, our premiums ended up being more expensive because we had been "dropped". In 1995 my husband's car was run over by an 18-wheeler. It took us 4 years to get the trucking company's insurer to pay for the damage, not to mention doctor visits. In 2003 my daughter was on her way to a college class. A man ran her off the road and her truck ended up hugging a tree, upside down. Coincidentally he and we have the same auto insurer. OUR insurance told us that we couldn't use her "collision" because his truck and her truck "didn't touch". HIS insurance basically laughed at us. So don't tell me about the one million or one billion others that are paid. EVERY time we have been up against an insurance company, we lose. They want their premiums paid, but forget that when something happens. And don't even get me started about medical coverage. I work for a doctor's office and I cannot BEGIN to tell you the paperwork we go through because of insurance and insurance only.>>

I own a brokerage, and have placed clients with a number of companies over the years. Some of your letter has merit, but other parts are just silly.

1. If the company "dropped" you after one claim, then they were likely a kind of carrier that emphasizes VERY strict underwriting/loss ratios (Erie Insurance is like that). If your husband was young, they will not take a policy with ANY claims as a young driver, your fault or not. The other reasons have more to do with the insured themselves than their record of losses. I have advised my underwriters to get off a policy because of a variety of reasons, as have claims adjusters. Some reasons have been: the fact that the insured was a jerk with an attitude, the fact that the insured was a leech, looking for us to pay ridiculous sums of money ( I had a client once who who claimed a thousand dollars in damages for a pile of wet clothes, I politely told her to wash them and get me the receipt from the laundromat and we would reimburse her), ridiculous expectations as to when they were looking to receive settlement checks, and general dishonesty.
Insurance companies can be, and are selective in the risks they take on. If they dropped you, they chose to forego your future moneys because they either perceived you as a future risk or thought your money wasn't worth the trouble. I have gotten rid of clients over the years for both reasons.

However, the fact that you were "dropped" should should have been irrelevant to quite a number of good carriers, had you shopped around, if all you had was a comp (comprehensive, or other than collision) claim.

2) When you are hit by an 18 wheeler, you are almost ALWAYS looking at a company which is "self insured" up to a certain limit of insurance. Although they may contract with a third party to administer claims, the trucking company itself is usually paying the claim out of pocket, unless there are substantial med costs, and they will negotiate the hell out of the settlement. Chances are you were only dealing with the reinsurance aspect of coverage when you talked with his carrier. Everything else was likely being handled directly by the trucking firm. It is not commonly known, but trucking companies deny and delay claims that would get a regulated insuror put out of business by the insurance commissioner.

3) As to your daughter's claim, I doubt that scenario. If your daughter had a collision with an object whether stationary or moving, it is (again READ YOUR POLICY, it is a legal contract) by definition a collision. IF you had collision on her car, it was payable under your policy, and if an insurance company attempted to deny this (again, I doubt that), you had immediate recourse through the insurance commissioner of your state, and failing that, clear contractual legal recourse. You may have been confused thinking it should have been payable under HIS insurance, and if so, His insurance was correct in laughing at you. You had no case.

I am not saying that insurance companies are always honest. There are crooks there, just like doctors and doctors offices that scam medicare. But most of them are at least as honest as the general makeup of the country. They can be infuriatingly incompetent (no one knows better than an agent trying to fix junk for a client), but that has nothing to do with the kind of stuff you wrote about.

I can also say that for every dishonest decision I have had to "go to bat" for my clients, I have had 20 or 30 cases where the client had such a bad attitude that it poisoned the whole process, or worse, the client had expectations that bordered on fraud, if not explicitly embracing fraud.

I find your comments on the insurance boondoggle on medical paperwork to be too true..., and amusing. I insure the head of programming for a large health insuror here. A VERY irate customer got thru to her and unloaded on her about how the "computer delays" were just a subterfuge for the company "playing the float" with claims moneys (I guess they read John Grisham's novel). The programmer said to her "Lady, I wish to God we WERE organized enough to do that!" I spend probably 2 hours a day on hold to talk with company reps to fix hopelessly snafu-ed policies. THAT part of your letter I do find real sympathy for.

We had a big puff back in our home last winter, due to animal nest. We always have our furnace and chimney's done. We have paid thousands in home owners insurance and never once had a claim. I had to call, complain, document everything in order to get things moving as we sat in soot all over everything. They paid and our premium went up a good amount of money. I didn't claim everything either.

Health care insurance can be a full time job. If you have ever been sick, getting them to pay is the other challenge. It reminds me of a skit on Seinfeld. You can reserve the car but then you have to hold the car. They are all to happy to take your money, but they have to pay as they should.

I use to work for a doctor also. I did all the insurance. I would work on getting payment for the insured. They would deny claims without any rhyme or reason. It can be a full time job as that is how I spent most of my time. I hope I never have to do an insurance again.:).
Prayers for this child and his family!

Sadly if this boy were living in a country with socialized medicine it'd likely be months before his family even got a firm diagnosis and he likely would not recieve a transplant at all unless he met very specific government-specified guidelines

Thank you for that observation. I am a medical coder/biller. Billing Medicare and Medicaid is already a nightmare of rules and regulations that nearly require a healthcare attorney to follow. Socialized medicine could only be worse. No payer is going to cover every procedure.

It is definitely a full time job, just keeping up with the paperwork alone that is generated in a medical office. The thing that breaks my heart is to see patients who have coverage and then insurance repeatedly puts them off or denies them completely. It's infuriating.

What evidence is there that the procedure will be effective?

I pray this boy gets the help that is needed.

....they don't want to be stuck with the bill...

or for the lawsuit that's coming when the procedure fails.

Bone marrow transplants are not experimental

Bone marrow transplants per se are not experimental, however, there may be no real scientific support to show that a bone marrow transplant will have any beneficial effect for this particular malady . There are situations where desparate people will try anything, and I mean anything, to get a cure. That doesn't mean an insurance company must pay for them. The lawsuits that would require an insurance company to pay for anything no matter how far fetched, add to the high cost of medical care.

AMEN. SOCK IT TO EM.

This happens OFTEN.
(I'm not defending the insurance co.)
They just don't want to pay up because it is expensive.
As you say, it is going to end up costing them a LOT in bad publicity.

Do a google search

The first successful bone marrow transplant was performed at the University of Minnesota in 1968 on a four-month-old boy suffering from an immune disorder. A sibling of the boy's had already passed away from the same disease. Bone marrow was extracted from his sister, and his body accepted it. His immune system was restored, and that boy is now a young man - fully employed, living in Connecticut and the proud father of twins. Another success: http://www.scinfo.org/bonemarr.htm

This is two of many success stories. True, It is not always successful. Although, the procedure could save this boys life. It's worth a chance for this 8 year old boy. No procedure is a guaranteed success. You say that the insurance is worried about lawsuit. Wait until the boy dies after they deny this operation. It is expensive but that is not a reason to deny any procedure. There are many expensive procedures. This is why we all get insurance.

Prayer ping.

Please post your replies to RushCrush

My prayers go up for Daniel Canfield, and his family. May humanity find it in their hearts to help this boy. May his family find peace in knowing that God's Will will prevail.

Sweetiepiezer, thank you for the ping.

Blessings,
trussell

If you want on/off my prayer ping list, please let me know. All requests happily honored.

Well then, I'll bet you that the company that owns and rents the beds is owned by the company that owns the hospital; leveraging, as it were.

Bone marrow transplants are not experimental.

How about bone marrow tranplants for treating ALD? (I honestly have no clue.)

prayer bump

What a sweet little boy! I pray to God they can get him the help he needs! Prayers of comfort for his family!

Just the rent on a bed in ICU was $550/day! The hospital doesn't own the beds.

And why do you think the beds are so expensive? Ever gone through what the FDA and the law industry makes you go through to make medical equipment? Sheesh...