Denied Claims Blog
April 29, 2013
Lee Barrows‘ husband was treated at a Connecticut hospital. He stayed there for 5 days before being transferred to nursing home care. Now, Lee Barrows is getting hit with a huge bill because Medicare refuses to pay the claim. Why? Because of one word: observation.
Her husband was never actually admitted to the hospital. Instead, he was classified under observation status, meaning he was technically an outpatient. There are different coverage rules for observation status and, because Medicare only covers nursing home care after a 72-hour inpatient hospital stay, they won’t cover the cost of that care at all. (more…)
April 16, 2013
Brandon Schmidt is 19. He wants to see the world. Instead, the teen is fighting for his life against cystic fibrosis from his home in Paradise, Calif.
Diagnosed at 4 months old, Brandon has undergone therapies since the age of 15. His lungs have collapsed 8 times, and he relies on large oxygen tanks to breathe. To save his life and give him a chance at fulfilling his dreams, Brandon needs a double lung transplant, a local TV station recently reported.
Resistance from Hospitals and Insurance
As Brandon struggles to breathe, his family is fighting for the life-saving procedure. Hospitals are hesitant to perform the surgery due to the risk of complications. The family is trying to schedule a consultation with UC San Francisco in hopes that the medical center will agree to do the surgery.
There is, however, another problem. The surgery would cost more than $400,000, and the family’s insurance provider is refusing to cover it. Insurance companies have also denied claims to cover the consultations for the transplant. (more…)
April 3, 2013
The autism community won a battle against Blue Cross Blue Shield of Michigan on March 30 when a federal court in Detroit held that the denial of claims for Applied Behavior Analysis therapy was illegal.
The ruling came as a huge relief to the parents of autistic children. Advanced Behavior Analysis (ABA) therapy is a widely used and medically accepted treatment for autism. The U.S. Surgeon General, the National Institutes of Health, the American Academy of Pediatrics and the Medicare and Medicaid programs all agree that the evidence has shown ABA therapy to be effective.
Blue Cross Blue Shield, however, insisted on classifying the therapy as “experimental” and refused coverage to children with autism, according to a press release from the law firm that successfully challenged the insurer. (more…)
February 19, 2013
In May 2011, an elite team of Navy SEALs stormed a compound in Pakistan and killed Osama bin Laden, the terrorist responsible for the deaths of thousands of innocent Americans. The dramatic moment brought to an end one of the most — if not THE most — extensive manhunts in U.S. history.
About a year later, the soldier who actually fired the shots that killed bin Laden left the Navy after 16 years of service to the nation. That same day, the military pulled health care coverage for the man, his wife and children. No insurance. No pension. A $25 million reward was offered for bin Laden that no one will ever collect, and the man who killed him received next to nothing from the government.
December 12, 2012
If you are unfortunate enough to have your insurance company deny a claim you submitted that should be covered under your policy, you’ll probably spend a lot of time on the phone pleading your case. There’s a good chance your pleading will fall on deaf ears.
Bad faith insurance actions are just that—actions taken in bad faith for illegitimate reasons to boost the insurer’s bottom line. It’s a systemic practice, and one that government officials previously accused Unum of incorporating into the company’s business model.
It’s hard to have your voice heard over the greed of enormous insurance companies. But there are ways you can speak out. One woman has taken to the internet in hopes of changing the way insurance companies operate.
November 16, 2012
California residents can challenge an insurer’s denial for medical treatment, and the state wants to make sure you know that.
When Ethan Moeckel’s autism led to a struggle with behavioral issues in the classroom, his parents searched for the appropriate treatment. They eventually found intensive behavioral therapy, but at a cost of $500 to $600 a week, their insurer denied it and called the treatment medically unnecessary.
So the Moeckels turned to an Independent Medical Review, or IMR, an option available in California in which consumers can appeal an insurer’s decision to an independent board. A month after the couple submitted the appeal, the IMR ruled in their favor, and Ethan’s therapy was covered, giving him a pathway to thrive in a traditional classroom. (more…)
October 26, 2012
The insurance provider Cigna has done everything it can to deny providing necessary care to 11-year-old Eve Yancey for her rare autoimmune disease.
Eve Yancey has battled cryopyrin-associated periodic syndrome (CAPS) her entire life. The genetic anomaly causes her body to overproduce a protein and can result in brain swelling, hives, hearing loss, severe gastrointestinal pain and developmental delays. That is, unless she gets the proper medical treatment.
Eve’s illness means she spends birthdays in the hospital and needs a hearing aid and monthly injections that cost $20,000 each. And if it weren’t for her mother fighting insurance provider Cigna at every turn to approve the girl’s medical treatments, Eve might have already died. (more…)
October 8, 2012
Once again, Unum has walked away from its policyholders when they needed help the most.
Unum is among five U.S. insurers either exiting the long-term care industry or heavily scaling back involvement in it, Moody’s Investors’ Service reported last month. The companies—which also include MetLife, Guardian Life, John Hancock and Prudential Financial—have claimed they simply aren’t making enough money on providing the insurance that covers the nation’s oldest and most vulnerable citizens. Unum began to step back from the long-term care market earlier this year.
According to the Department of Health and Human Services, 70% of Americans over 65 will need long-term care at some point in their elderly years. More than 40% will need care in a nursing home. Long-term care insurance helps pay for these nursing homes, as well as home care and extended hospital stays, among other things. (more…)
September 1, 2012
When you pay for car insurance – placing your trust in the policy in place – this may make you rethink the company you are doing business with. Progressive Insurance is in hot water after Matt Fisher, a New York comedian, brought attention to Progressive’s treatment of his sister’s fatal accident in his blog.
Fisher stated in his blog that the individual responsible for his sister’s death was under-insured. His sister carried insurance to compensate in case of an accident like this; unfortunately for the Fisher family, that compensation would not come without a struggle. The insurance company of the driver involved in the crash paid out what they owed almost immediately, leaving the family to turn to Ms. Fisher’s policy to pay the difference of the under-insured motorist. The family was made to go through a trial in order to determine if driver was in fact responsible for Kaitlynn Fisher’s death and whether they would receive the policy in full. (more…)
August 20, 2012
But Don’t Gamble with Your Claim.
Trying to decide whether to insure your income by determining your chances of becoming disabled? Good luck.
According to a New York Times article, calculating your likelihood of disability on the job is something akin to predicting the probability of winning the lottery. But, should you indeed be injured on the job, gambling with disability insurance is not an option.
“You have an 80% chance of becoming disabled during your working years,” the first sentence of a New York Timesarticle reads. However, while that statistic is arresting, the next one is less so: “Or maybe it’s 52%.”
Pinpointing your risk of becoming disabled on the job is indeed a challenge, but a necessary endeavor in order to assess your need to insure your income. (more…)