Lansing Personal Injury Lawyer - Health Insurance

Hospitalized Uninsured Children More Likely to Die When Compared to Insured Children

David Mittleman — Fri, 30 Oct 2009 16:35:07 GMT

Researchers at John Hopkins University recently made a horrific discovery: uninsured children who are hospitalized are more likely to die than children with government or private health insurance. In fact, the researchers estimated that approximately 37.8%, or 17,000 child deaths could have been avoided if the more children had health insurance coverage.

The researchers analyzed data from 23 million children’s hospitalizations in 37 states from 1988 to 2005. According to the data, when the researchers compared uninsured children with insured children, the uninsured faced a 60% increased risk of dying.

While the study was not meant to identify why uninsured children were more likely to die, the researchers did find a potential culprit for the increase in deaths amongst uninsured children. Specifically, uninsured children were more likely to access health care through the emergency room, which suggests that many uninsured children were in advanced stages of illness prior to seeking medical attention. Furthermore, uninsured children were hospitalized for less time than insured children: on the average, uninsured children were hospitalized for less than a day when they died, as compared to insured children who spent a full day in the hospital prior to death. Currently, an estimated 7 million children are uninsured in the United States.

Originally posted at InjuryBoard by David Mittleman

Cigna Flips Off Mother of Dead Girl Who Was Denied Life-Saving Liver Transplant

David Mittleman — Fri, 09 Oct 2009 10:21:59 GMT

Cigna Corporation denied Hilda Sarkisyan coverage for her daughter’s liver transplant, which ultimately led to the 17-year-old girl’s death in December 2007. If that wasn’t bad enough, it was even more shocking when Hilda went to the company’s Philadelphia headquarters to complain about the incident.

Ten months after her daughter’s death, Hilda went to the company’s headquarters and walked up to the lobby security desk. She simply stated: “you guys killed my daughter” and demanded an apology. However, instead of apologizing, several Cigna employees began heckling her, including giving her “the finger”. Cigna later apologized for the 2008 incident. Nevertheless, Hilda and her husband filed a wrongful-death complaint against the health insurer, aghast at the company for failing to save their daughter’s life and for their poor behavior in response to the family’s grief.

Sadly, the wrongful-death lawsuit was thrown out by a Los Angeles judge, saying that the suit was barred by a 1987 U.S. Supreme Court ruling that protects employer-paid healthcare plans from having to pay damages above maximum coverage limits. However, the U.S. District Court Judge ruled that the Sarkisyan’s could pursue the damages related to emotional distressed caused by the Philadelphia incident. The ruling is bittersweet for patient advocates and Hilda alike: her 17-year-old daughter died because Cigna refused a life-saving liver transplant and now all she can sue the healthcare insurance giant for is for giving her the finger.

http://www.youtube.com/watch?v=EnFoCcgigZE

Originally posted at InjuryBoard by David Mittleman

Domestic Violence and C-Sections Considered Pre-Existing Conditions By Health Insurers

Devon Glass — Fri, 18 Sep 2009 12:43:36 GMT

I know this may sound crazy, but a few recent articles have been discussing the issue of pre-existing condtions that can cause you to be denied health insurance. The one that I think is the most galling is domestic violence. That's right, if you have been injured or beaten by your significant other and had medical treatment, health insurance companies in 8 states, plus the District of Columbia, will deny you coverage in the future. According to the article on Huffington Post on this awful practice,

Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you're more likely to get beaten again than the average person and are therefore more expensive to insure.

This was first exposed by the Service Employees International Union on their blog last week. It is difficult to come up with anything to really about how sick and twisted this is. I will say that domestic violence or abuse is not something which an insurance company should be holding against anyone. It only serves to prevent people from seeking treatment or getting out of an abusive relationship. It can only make the circumstances worse for the person, most often a woman, and makes them a victim of abuse a second time something that was done to them. Maybe we should deny medical treatment to people who beat their spouses or significant others? The answer, in my opinion, is not to deny anyone treatment or coverage, but rather to expand options for people who need treatment.

Another 'condition' insurance companies are using to deny coverage or increase rates is women who've had c-sections. That's right, if you've been pregnant in the past and had a Caesarean-section you could be denied health insurance or be charged higher premiums. According to an article in the New York Times about a woman who was denied coverage,

When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.

“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

The circumstances are worse for people trying to purchase health insurance on the individual market,

Anthem Blue Cross' Singer said that those states have much higher rates for individual insurance coverage than California.

"The point of insurance is to insure against catastrophic care costs. That's what you're trying to aggregate and pool for such things as heart attacks and cancer," he said. "Having a child is a matter of choice. Dealing with an adult onset illness, such as diabetes, heart disease breast or prostate cancer, is not a matter of choice."

I'm sorry, but I thought the point of insurance was to help cover medical expenses for health care. Many of the conditions listed such as heart disease and cancer are conditions that are only discovered after doing regular, routine checkups on people who don't feel any symptoms. Should your health insurance be able to deny you coverage because you chose to have that colonoscopy even though you didn't believe you had cancer? That would be abusrd, but that's what we're talking about when we start denying health care to people.

This all goes back to the issue of health insurance reform that's been talked about for many months now. There are people who think the United States has the best health care in the world, but how can that be when we know that nearly 50 million uninsured people and we pay more than double, or more, what every other industrialized nation in the world pays and we get the same or worse results. Can anyone honestly defend the idea that a person who was a victim of domestic violence or had a routine, but dangerous, medical procedure should be denied health insurance or charged significantly more? I'd like to hear those thoughts.

Originally posted at InjuryBoard by Devon Glass

Insurance Industry Claims Low Profits, High Expenditures on Medical Care

David Mittleman — Sat, 08 Aug 2009 10:00:00 GMT

America’s Health Insurance Plans (AHIP), the lobbying arm of the insurance industry, claims that “for every dollar spent on health care in America, approximately 1 penny goes to health plans’ profits.” Moreover, the group’s health care reform website alleges that only one one-hundredth of the premium dollar is revenue for the insurance provider, with the going towards providing medical care for insurance holders.

AHIP numbers seem to indicate that insurance companies are making very little in profits and spending a lot on providing coverage for their customers. However, the data fails to clearly explain that insurers are measuring their profits against total health care spending in the U.S., not in comparison to insurance company revenue. In other words, according to health care economist Uwe Reinhardt: “[a]ll that statement says is, if you eliminated all our [insurance company profits], national health spending in America would be 1 percent lower.” AHIP numbers only have meaning within that context—otherwise, within the context of actual insurance companies’ revenues, insurers skim between 15-20% of premium dollars to pay for administrative costs and profits. Moreover, even more alarming is the fact that within the last 10 years, insurers have been spending less (from plan premiums that their customers pay) on medical care and more on administrative costs and profits. Indeed, a report by Families USA found that some insurers maintain a ratio of 60% on medical payouts to 40% for administration, marketing and profit. You may think there is nothing wrong with that payout to profit ratio. However, that figure represents a two to ten percent difference from what AHIP claims insurance companies make in profits.

If the above data is not enough to convince you that health insurance companies are not looking out for the average consumer, here are a few additional facts that demonstrate that the insurance industry is more interested in profits than anything else:

The top five earning insurance companies averaged profits of $1.56 billion in 2008, with more than 18% of those earnings going towards revenue, administration and profits. Furthermore, CEO compensation for those same companies ranged from $3 million to $24 million. That’s actually a decrease in CEO compensation from previous years—a survey by Modern Healthcare failed to find one healthcare CEO who earned more than $15 million last year. But don’t get too disappointed for the CEOs lowered earnings just yet—the performance of the stock market in 2008 was a major factor for the decrease in compensation, not because they aren’t still skimming a hefty amount off their customers’ premium payments. Too top it all off, there is sturdy proof that insurance companies are willing to shell out the major bucks when it comes to a cause they truly feel worthy of their “hard-earned” dollars: health-care firms and their lobbyists are spending money at a rate of $1.4 million a day to campaign against the public healthcare legislation currently moving through congress.

Originally posted at InjuryBoard by David Mittleman

Special Needs Children Pay When Insurance Companies Don’t

David Mittleman — Tue, 30 Jun 2009 14:29:44 GMT

Last week I posted an article about Blue Cross Blue Shield and its agreement to pay families of autistic children a total of $1 million for behavioral therapy coverage. Although this settlement is a step in the right direction, health plans have a long way to go before children with special needs receive fair treatment.

Developmental problems are pervasive in their nature. They affect nearly every aspect of a child’s life. Some disorders, such as birth-trauma induced cerebral palsy, impact both the mental and the physical development of the child. As a result, these children often require specialized equipment, supplies, services, or devices able-bodied children do not need.

Unfortunately, health plans and insurance companies characterize such special requirements as not "medically necessary" - almost always at the plan administrator’s sole discretion - and deny these benefits. As a result, many families are forced to pay expenses out of pocket or to make the unsettling choice of forcing their child to do without the needed benefit. Compounding the insult is the fact that the law makes it exceedingly difficult to reverse the decision of the plan administrator.

One glaring example of the anti-consumer state of the law is the Employee Retirement Income Security Act (ERISA). Originally designed as a measure to protect workers and ensure they would receive the promised benefits of their employment, a series of court decisions over the past two decades gave plan administrators tremendous authority to deny claims. Only very recently have some Courts begun ruling in favor of individuals instead of corporations.

The time period in which to challenge an adverse decision is usually very limited. If your health plan has denied a claim you believe you are entitled to, contact us to see if we can help.

Originally posted at InjuryBoard by David Mittleman

Don't Believe the Hype that Affordable Health Care for Everyone is a Bad Idea

David Mittleman — Thu, 11 Jun 2009 12:13:04 GMT

Senator Shelby (R-Ala.) is apparently living in a world of his own: he currently stated on “Fox News Sunday” that Obama will “destroy the best health care system the world has ever known”. He then went on to state that once the government gets involved in “the details” you place private insurance companies at an unfair disadvantage—against the government, who has the “incentives” and “power“ to crush private enterprise. He ultimately resorted to fear mongering, warning Americans “[that] they better be careful what they want”—some of the same old tactics that have placed this country in the desperate economic situation it’s in now.

Perhaps Senator Shelby is unaware that the Census Bureau estimated that there were 46.6 million uninsured Americans in 2005. Surely that number hasn’t decreased in 4 years, given that most Americans couldn’t afford private health insurance prior to our nation’s economic collapse. Maybe Senator Shelby continues to argue against government-sponsored health coverage for all Americans because he doesn’t have to worry about not being able to afford private health care coverage. Instead, he has government issued health insurance, provided by the taxpayer dollar.

Senator Shelby pretends to have the well being of the American people in mind—except when it’s inconvenient. In fact, he was a strong advocate against the struggling big three automakers, and supported foreign automakers instead. Not surprisingly, Senator Shelby’s home state of Alabama has won three foreign assembly plants since the 1990s, including Honda, Mercedes Benz and Hyundai, as well as an engine plant from Toyota and numerous investments from foreign auto parts makers. Since his state is so heavily reliant on foreign automaker kickbacks, its no wonder Senator Shelby is on their side. Could it be that he also has private insurance companies in his back pocket too?

Originally posted at InjuryBoard by David Mittleman

Health Insurers Propose to Accept All Applicants, With One Big Condition

David Mittleman — Fri, 28 Nov 2008 13:53:00 GMT

Last Wednesday, Health insurers released proposals to accept all applicants, regardless of preexisting disease or disability, IF Congress mandates all Americans have coverage. Although the "if" is a huge condition, it is also a huge step in the direction towards universal health care coverage. With newly-announced support from the health industry’s two largest trade associations, America’’s Health Insurance Plans and Blue Cross Blue Shield Association, the plan is likely to reform the health care system as President- elect Barack Obama takes office in a few months. However, Obama’s plan only mandates health care coverage for all children, as he opposes a mandate for adults, which could prove to be a point of contention between lawmakers.

In our current health care system, many people with preexisting diseases and illnesses cannot get health insurance at any cost. If the system changed and heath insurers were forced to accept all applicants, absent the universal coverage provision, insurers fear people will wait until they become sick before buying insurance, ultimately driving up the cost for everyone. However, by imposing a universal coverage condition, healthier individuals will off-set the sick, which will drive premiums and prices down for all. According to Alissa Fox, Vice President of Blue Cross Blue Shield Association, "Insurance works best when everyone is in the pool. You need healthy people in the insurance pool to help pay for sicker individuals who are much more motivated to buy coverage."

Supporters of the legislation would like the bill to pass sometime next year; however, it remains to be seen exactly how the premiums will work and how the mandate will be enforced. With the economy on a downward spiral and more and more people losing their jobs and employer-sponsored health care, a universal system may be the only answer, and the mandate might not look too bad after all.

Originally posted at InjuryBoard by David Mittleman

Waiting Room Tragedies And The Need For Universal Health Care

David Mittleman — Wed, 05 Nov 2008 14:06:09 GMT

Candida Diego fractured her skull in a fall in September of 2004. After being cleared for a brain scan to check for bleeding, she became partially paralyzed because she spent two hours in a waiting room before the hospital performed the scan. On October 3, 2008, she was awarded $10.7 million in compensation for the hospitals negligence.

Similarly, Beatrice Vance went into Vista East Medical Center in Waukegan, near Chicago, in July of 2006 complaining of chest pains. She checked in at 10:15 p.m. only to wait, and wait, and wait until she collapsed at 12:25 a.m., dead of a heart attack at the age of 49.

Unfortunately, tragedies like this have become common place due to increased demand, staff shortages, and hospital closings. In the Vance case, a coroner’s jury called her death a homicide, partly due to the long wait in the ER. A coroner’s jury determines the cause of death in certain cases, but do not try cases.

The number of U.S. emergency rooms declined 12% between 1993 and 2003, while there has been an increase of 26% in the number of patients seeking emergency room care. In an effort to correct the problem, many hospitals have created "fast-track" programs to help patients who do not require hospitalization and lack health insurance. These patients account for much of the increased demand, and tend to have to wait the longest for care because they go to the ER instead of a regular doctor.

Until more of these "fast-track" programs are implemented on a national scale, these issues will likely persist. The election of President-Elect Barack Obama may be the first step towards curing some of the health industry’s ills. Under the Obama-Biden plan, an investment in electronic health information technology systems will help doctors coordinate care, reduce medical errors, and help process claims quicker which can speed up the process in the ER waiting rooms.

Universal health care coverage is the key to reducing the over crowding of waiting rooms with the uninsured for non-emergency health issues. "The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans."

Only by directly addressing all of these issues in a comprehensive health care reform package can we implement the kind of change that we need in the health care system. We should not allow the tragedies like that of Candida Diego and Beatrice Vance to continue in the most prosperous nation in the world.

Originally posted at InjuryBoard by David Mittleman

Searching For Loopholes - How Will Your Insurance Company Deny Your Claim?

David Mittleman — Thu, 28 Aug 2008 11:31:39 GMT

After losing his brother to the war in Afghanistan and watching his parents suffer through the loss of one child, Andrew White, a Marine in the war in Iraq, took out a $50,000 AIG life insurance policy to prevent any further financial burdens on his parents. Andrew underwent an AIG mandated medical examination and received a life insurance policy the following month. As a smoker, Andrew timely paid his increased premiums for fourteen and-a-half months. When Andrew died in February 2008, AIG denied his family the $50,000 life insurance policy.

One may ask, “what justification does an insurance company have to deny a life insurance policy to a family who clearly seemed deserving of it?” AIG told the family that “had they known that Andrew White was in a car accident when he was 16-years-old, they never would have written the policy to begin with.” Andrew died within two years of obtaining his life insurance policy. This put Andrew’s death in the Contestability period of the insurance policy, which indicated that misrepresentations made during the medical examination would void the policy. A war veteran, who passed the necessary physical requirements to obtain the policy, was denied coverage because of a car accident in which he was involved when he was 16-years-old. AIG Life denied Andrew's claim all the while making record breaking profits.

Health insurance claim denials are becoming increasingly familiar. Susan Kristoff, a breast cancer survivor, was denied benefits until she went public with her battle to obtain disability payments from Cigna. Since her story aired on Good Morning America, the news station has been flooded with e-mails from people who were facing similar difficulties in obtaining coverage.

After compiling years of court documents, SEC and FBI reports, the American Association for Justice (AAJ), discovered a pattern amongst the top insurance companies. “The rankings show a distinct pattern of insurance industry greed amongst 10 companies that refuse to pay just claims, employ hardball tactics against policyholders, reward executives with extravagant salaries, and raise premiums while hoarding excessive profits.” The essential question one must ask is where this unfortunate reality leaves the supposed insured. It leaves them in an uphill battle in which experienced insurance companies will look for the most immaterial event to justify claim denials, while leaving the insured to fight for their much deserved policy.

Don't let insurance companies get out of their responsibilities. Keep them accountable - if you need help, contact us.

Originally posted at InjuryBoard by David Mittleman

Insurance Companies Don't Play By The Rules

David Mittleman — Wed, 23 Jul 2008 09:46:54 GMT

While it is true that nearly 50 million Americans don't have health insurance, this does not mean things are perfect for people who do have insurance. In addition to problems of underinsurance, meaning a person has insurance which is extremely costly and does not provide much coverage, there are also difficulties with health insurance companies retroactively denying benefits. In this scheme, an insurance company combs over your application and your medical history to see if there is any reason at all to deny providing coverage.

Keep in mind, this all happens after they have approved your application and have been providing coverage for months and sometimes years. It's only when you develop cancer or some other expensive to treat disease the insurance company suddenly becomes concerned if you initialed all those pages or forgot to tell them about the cold you had when you were three years old.

The video below shows what it would be like to live life like an insurance company, constantly changing the rules of the game.

Originally posted at InjuryBoard by David Mittleman