Insurer: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

[Modbert]

Think Progress » Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims. In April, Rosalinda Miran-Ramirez awoke and found her shirt soaked in blood. Realizing that her “her left breast [was] bleeding from the nipple,” she rushed to the emergency room.

Today, CBS-5 reports that this San Francisco Department of Public Health employee has had her claim denied because her insurance company, Blue Shield of California, didn’t consider her situation to be an “emergency.” Even though her doctor told her it was likely a tumor, Blue Shield said that Miran-Ramirez should have known it wasn’t:

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.

So she appealed. And she was denied again. This time Blue Shield told her she hadn’t been in “any acute distress.”

The sad truth is Miran-Ramirez is certainly not alone in having her claim denied by a major health insurer. The California Nurses Association (CNA), a nurses’ union and health care advocacy group, recently released a comprehensive study of claims denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted. The CNA twice successfully lobbied the California legislature to pass legislation that would establish a single-payer universal health care system in the state, only to have it vetoed by Gov. Arnold Schwarzenegger (R-CA).

Following the CBS-5 investigation, Blue Shield agreed to pay for all charges for Miran-Ramirez’s emergency room visit.

That's right ladies! Got a bleeding breast? No SOU-INSURANCE for you!

Of course, I'd love to see those who say we don't need any sort of reform to defend this. However, I'm sure it will be avoided like the plague.

 

[blu]

private insurance companies are unethical, immoral pricks. they brought the end of their industry on themselves.

 

[Modbert]

I'm not honestly surprised that this thread just received it's first post. Health Insurances care more about their bottom lines than human beings. When human beings are being valued on how much money they cost rather than the fact they should get the treatment to live, you can see that we have a shoddy system.

However, others rather just ramble on about Death Panels and other meaningless bullshit that detracts from the real issues. Issues like this. If this woman's story had never gotten reported, she would of been stuck with that $2,000+ bill.

 

[xotoxi]

I just vomited into the toilet.

That is disgusting!

 

[DiveCon]

Think Progress » Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims. In April, Rosalinda Miran-Ramirez awoke and found her shirt soaked in blood. Realizing that her “her left breast [was] bleeding from the nipple,” she rushed to the emergency room.

Today, CBS-5 reports that this San Francisco Department of Public Health employee has had her claim denied because her insurance company, Blue Shield of California, didn’t consider her situation to be an “emergency.” Even though her doctor told her it was likely a tumor, Blue Shield said that Miran-Ramirez should have known it wasn’t:

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.

The sad truth is Miran-Ramirez is certainly not alone in having her claim denied by a major health insurer. The California Nurses Association (CNA), a nurses’ union and health care advocacy group, recently released a comprehensive study of claims denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted. The CNA twice successfully lobbied the California legislature to pass legislation that would establish a single-payer universal health care system in the state, only to have it vetoed by Gov. Arnold Schwarzenegger (R-CA).

Following the CBS-5 investigation, Blue Shield agreed to pay for all charges for Miran-Ramirez’s emergency room visit.

That's right ladies! Got a bleeding breast? No SOU-INSURANCE for you!

Of course, I'd love to see those who say we don't need any sort of reform to defend this. However, I'm sure it will be avoided like the plague.

this is just DUMB
BCBS just screwed up

 

[Modbert]

this is just DUMB
BCBS just screwed up

Not only did they screw up once but TWICE. They rejected her a second time. I guess third time was the charm. Except the charm in this was video cameras from the local media.

 

[DiveCon]

this is just DUMB
BCBS just screwed up

Not only did they screw up once but TWICE. They rejected her a second time. I guess third time was the charm. Except the charm in this was video cameras from the local media.

well, up in this region, BCBS is one of the best
i guess its not the same from state to state

 

[RodISHI]

:sarcasm: Those insurance execs would have to lower their wage expectations if they approved of every bleeding breast as as an emergency situation. :end of sarcasm:

Exactly why the whole system should be revamped. Insurance execs that allow for tragedies like this should be drawn through the keyholes for fraud because that is exactly what shit like this is, fraud.

 

[strollingbones]

insurance agents will tell you..the cheapest fall is a death

 

[xotoxi]

Think Progress » Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims. In April, Rosalinda Miran-Ramirez awoke and found her shirt soaked in blood. Realizing that her “her left breast [was] bleeding from the nipple,” she rushed to the emergency room.

Today, CBS-5 reports that this San Francisco Department of Public Health employee has had her claim denied because her insurance company, Blue Shield of California, didn’t consider her situation to be an “emergency.” Even though her doctor told her it was likely a tumor, Blue Shield said that Miran-Ramirez should have known it wasn’t:

Following the CBS-5 investigation, Blue Shield agreed to pay for all charges for Miran-Ramirez’s emergency room visit.

That's right ladies! Got a bleeding breast? No SOU-INSURANCE for you!

Of course, I'd love to see those who say we don't need any sort of reform to defend this. However, I'm sure it will be avoided like the plague.

this is just DUMB
BCBS just screwed up

Yeah...it must have just been a mistake.

I think the patient just misinterpreted what the insurance company had decided.

 

[KittenKoder]

This is just stretching to blame the insurance company for anything.

 

[Modbert]

This is just stretching to blame the insurance company for anything.

Stretching? REALLY? Did you even bother to read the article?

 

[DiveCon]

Think Progress » Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’



That's right ladies! Got a bleeding breast? No SOU-INSURANCE for you!

Of course, I'd love to see those who say we don't need any sort of reform to defend this. However, I'm sure it will be avoided like the plague.

this is just DUMB
BCBS just screwed up

Yeah...it must have just been a mistake.

I think the patient just misinterpreted what the insurance company had decided.

i didnt say they made a mistake
i said that they screwed up
there is a difference

 

[alan1]

We found an isolated extreme example of something, lets revamp everything to make up for it.

 

[Modbert]

We found an isolated extreme example of something, lets revamp everything to make up for it.

Isolated? Are you high?

Insurance Company Must Pay $10 Million For Revoking Policy Of Teen With HIV

As 'Rescissions' Spawn Outrage, Health Insurers Cite Fraud Control - washingtonpost.com

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

Much of that process was a condition of settlements with state overseers, who fined Blue Cross $11 million over the past two years and required it, and all other major insurers in California, to restore canceled policies. Insurers still face court challenges, including a class-action suit targeting Blue Cross on behalf of 6,000 canceled policyholders.

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

There are thousands of other similar cases out there on the internet if you bother to look.

 

[KittenKoder]

We found an isolated extreme example of something, lets revamp everything to make up for it.

Thus why I called it "stretching" ...

 

[Ame®icano]

Here is the state health care in action.

Oregon Offers Terminal Patients Doctor-Assisted Suicide Instead of Chemo

 

[DiveCon]

We found an isolated extreme example of something, lets revamp everything to make up for it.

Isolated? Are you high?

Insurance Company Must Pay $10 Million For Revoking Policy Of Teen With HIV

As 'Rescissions' Spawn Outrage, Health Insurers Cite Fraud Control - washingtonpost.com

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

Much of that process was a condition of settlements with state overseers, who fined Blue Cross $11 million over the past two years and required it, and all other major insurers in California, to restore canceled policies. Insurers still face court challenges, including a class-action suit targeting Blue Cross on behalf of 6,000 canceled policyholders.

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

There are thousands of other similar cases out there on the internet if you bother to look.

have you noticed one thing in common here?

they are ALL in California
ever think that might have more to do with it than anything else?

 

[Modbert]

SEIU - Service Employees International Union - Domestic violence is a "pre-existing condition"?

Denied Health Insurance Because You’re Pregnant | Strollerderby

And the beat goes on.

 

[KittenKoder]

I would wager that all these stories are hyped and sensationalized.