Insurance Practices: Delay, Diminish, Deny, & Blame

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For those interested in the power, politics, and profit of medical and disability insurance, have a gander at this report.

http://www.projectcensored.org/Health_Study_Final.pdf

I'm already an advocate of a well-regulated, single-payer health insurance system. This report strengthens that belief.

The issue is not simple, to be sure, but the status quo just seems so wrong on so many levels.

Specializes in Critical care, tele, Medical-Surgical.

an update on nick columbo. 17 year old cancer patient denied treatment by pacificare

http://www.guaranteedhealthcare.org/blog/colette-washington-cna-nnoc/2008/05/29/an-update-nick-colombo-richard-and-patti-colombo-nicks-m

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Anyone ever read The RainMaker By John Grisham?:(

That book shows the "heart " of insurance companies.

I watched sicko Today and that was also a pretty revolting picture of health care in US.

What is wrong with us?

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Specializes in ICU.
Anyone ever read The RainMaker By John Grisham?:(

That book shows the "heart " of insurance companies.

I watched sicko Today and that was also a pretty revolting picture of health care in US.

What is wrong with us?

I watched Sicko last night...is it really that bad in the US?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I watched Sicko last night...is it really that bad in the US?
Health care is in a sorry state of affairs in the US.
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Specializes in Med Surg, Tele, PH, CM.
The right to health care is a BASIC HUMAN RIGHT, hard for some Americans to embrace.

Absolutely. Healthcare is a right, and there are laws that prevent hospitals from turning people away. But, with our current system, health insurance is not a right. Insurance companies underwrite prospective patients. My 25 year old daughter who is in nursing school and has few health risks underwent an "under the microscope" process when I purchased a private policy for her. They take all sorts of things into consideration - your past medical history, meds you are taking, BMI, habits such as smoking and drinking. Any one of these things can make you inelegible. Fair? Absolutely not, but insurance companies are a business, not a social services agency, and have to make good business decisions. In the case of a group policy, like the ones most of us belong to through our employers, the law of averages allows the companies to make money. But with private policies, it's a totally different story. Hopefully this will change.

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Specializes in Med Surg, Tele, PH, CM.
I watched Sicko last night...is it really that bad in the US?

Michael Moore is a master at slanting and sensationalizing the issues he approaches. If he were to do a film on Nurses in America, you would be outraged at the picture he paints, and rightfully so. I have worked with (but not for) insurance companies for most of my 25 years as a nurse, and I can truthfully say that I have not ever had a patient turned down for a critical procedure or treatment. Most of the issues that I have seen disallowed were not cost effective or not totally necessary. Patients I have worked with over the years as a bedside nurse, Practice Manager, Case Manager, view their insurance card as a Carte Blanche. When I graduated from nursing school, people were still checking into hospitals for a week of rest and testing. Even as a new grad, I knew that if someone didn't bring the system under control, there would be trouble. Until the consumer assumes their share of the responsibility for controlling costs, no system, including UHC, will work.

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Specializes in Family Practice and Primary Care.
The right to health care is a BASIC HUMAN RIGHT, hard for some Americans to embrace.

I wonder what service will become a human right next.

Believing in the Right to health care is an extension of core nursing values...

A more accurate statement would be your core nursing values. Mine have a strong belief in self-reliance, and autonomy.

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Specializes in Critical care, tele, Medical-Surgical.

It can be a matter of life or death.

I'm glad firefighters and police don't need insurance or payment up front before putting out fires or responding to a crime.

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Specializes in Family Practice and Primary Care.

herring,

Is there an ER in the country that requires payment up front before dealing with medical emergencies?

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Specializes in Critical care, tele, Medical-Surgical.
herring,

Is there an ER in the country that requires payment up front before dealing with medical emergencies?

Not legally.

After evaluation they don't have to treat non emergencies.

ERs are not for diagnosing and treatment before the illness becomes urgent or emergent.

For instance you don't go to the ER for chemotherapy.

It's OK to think it is all about responsibility.

What about kids with cancer?

Or when your insurance won't approve treatment your doctor and you think is best?

http://www.calnurses.org/media-center/in-the-news/2008/march/he-s-not-heavy-he-s-our-brother-nick-columbo-and-why-we-need-california-health-care-reform.html?print=t

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Specializes in Family Practice and Primary Care.

You made the point that police and firemen do their job regardless of whether or not you have paid them. My point with the ER was that it is the same way. I am glad you acknowledge the truth that even in healthcare, if you need it, you get it.

People, even nurses, are mistaking having insurance for having access to healthcare. If you have no insurance, but have a heart attack, the ER still must take and treat you.

Having health insurance is sort of like having home-owners insurance. Wise to have, but your call. It is entirely possible your home will burn to the ground tomorrow, and you will lose everything. If you planned ahead (wisely) you had a plan and you can then deal with it.

Health insurance is the same way. It is up to YOU, the individual to be an adult and find health insurance that offers you the coverage you want. If you have kids, as a parent you have responsibility to decide on their behalf.

Now, if you decide on a bad plan, is that the company's fault? No. What if they violate the contract? Then yes, they are at fault. When a company does wrong (and they have, I am sure many nurses can find such abuses easily) they should be nailed to the wall. But seriously, we need to stop looking at health insurance as a holy grail to fixing our health system.

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Specializes in ICU/CCU/TRAUMA/ECMO/BURN/PACU/.
Even as a new grad, I knew that if someone didn't bring the system under control, there would be trouble. Until the consumer assumes their share of the responsibility for controlling costs, no system, including UHC, will work.

"Even as a new grad..." Really now.

So, you believe patients should be diagnosing and treating their own illnesses? Patients can't "go shopping" for medically necessary health care. They're not competent, educated, licensed, experienced, or otherwise qualified to diagnose themselves. Only a licensed physician or nurse practitioner is qualified to determine whether or not treatment is necessary. Not insurance company bean counters and paper pushers.

Hospitals and clinics are NOT vacation destinations where "consumers" can "go shopping" to buy health care. So you believe if someone needs an appendectomy, they shouldn't get it unless they have cash in hand or an insurance policy promise to pay. So you think the patient should delay or deny treatment for what could be the signs and symptoms of a devastating illness. Diseases and injuries are cheaper to treat early on. It appears that you believe that the patient should deny themselves a consult with a qualified medical professional as a way of controlling costs? I think that's shameful and not in the public's interest.

Until we get rid of "for profit" health care, where insurance companies delay, deny, and rescind authorization for care, in order to make a profit and fulfill their duty to their share holders to maximize that profit, we will never control costs or have transparency and public accountability. What is the "value added" benefit of having greedy health care companies in charge of deciding who lives and who dies.:nono:

Don't shoot the messenger. Your criticism of Michael Moore with regards to the movie SiCKO is unfounded. I've had the opportunity to meet Mr. Moore and the patients and the other real people who appeared in his documentary. He's a thoughtful man and didn't make up any of the stories. These are just the tip of the iceburg and in the wealthiest industrialized nation in the world, what happened to these patients and their families is appaulling and shameful.

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