Insurance company denies treatment for a 5 year old

[yhelothar]

I prefer the term.. Health Poker.

You're betting you get sick.
The insurance company (house) is betting you dont.

9/10 times.. when you get sick.. you still lose, the insurance company (house) still wins.

well played sir

 

[PokerGuy]

A sad case, but blaming the insurance company is stupid. They have to have some criteria to determine what is covered and what is not, right? Requiring that it be FDA approved is one of the criteria. In this case, on appeal/review, they will probably still cover the costs. UHC would not solve this issue, they too would have to set some standard somehow as to what is or is not covered.

Even if UHC would 'fix' this issue, a system that is better for those weird situations but worse overall for the majority of patients is still a bad thing.

 

[skace]

I would think we would want more acceptance of experimental treatments, how else would they become non-experimental?

 

[Queasy]

Yeah, because a UHC system would never deny a patient treatment!

Oh wait.

A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS.

 

[Blackjack200]

http://news.bbc.co.uk/2/hi/europe/3423159.stm
if they can afford to keep on doing it

That's interesting. I wonder if anything has changed in the six years since the article was written.

 

[nick1985]

If the FDA hasn't approved it, UHC won't cover it either. Fail thread is fail.

yep

 

[techs]

Yeah, because a UHC system would never deny a patient treatment!

Oh wait.

I don't see the story at either link.
So I can't comment on it.
A cut and past line on the internets? Yeah, that's PROOF.

 

[ReggieDunlap]

I don't blame...never said I did. I wrote that that type of situation pisses me off. What jumps out at me is the point of denial based on the premise the treatment is "experimental". If there are only 650 diagnosed cases a year with only half at the level this child's is at, the point made is that pretty much ANY treatment could be considered "experimental" because there are not enough "qualifying cases" to support a study and any data that could be generated.

 

[Ausm]

After reading this story, UHC had a solid reason to deny coverage due to the non FDA compliance of the drug. I don't like it but there it is.

 

[JD50]

So, insurance = Rules, UHC = Death Panel. Is that right? Just sorting out some of the terminology. I'm new to paranoid positioning, unlike most of you.

You must be new to reading also. Many people have pointed out that it is not approved by the FDA, do you think that UHC will pay for drugs and treatment that aren't approved by the FDA?

And like I said, there's always going to be some form of a death panel.

 

[CRXican]

can't save everyone!

 

[silverpig]

"If Kyler can't have MIBG, he will have to enter hospice care," says Paul. "He'll have a good month, and then he will lose the ability to walk. Then he will become bedridden. And then he will die a slow, agonizing death."

Stuff like this makes me want to not have kids.

 

[techs]

You must be new to reading also. Many people have pointed out that it is not approved by the FDA, do you think that UHC will pay for drugs and treatment that aren't approved by the FDA?

And like I said, there's always going to be some form of a death panel.

Sigh. Can't your READ? Many procedures are paid for by Medicare that are not "approved" by the FDA.
The question is do you want insurance execs out to save money determining if you get care, or a public process with the input of medical professionals?
And, when was the last time you heard of Medicare denying something just because it wasn't FDA approved? Right, NEVER.

And yeah. There are "death panels". They are run by insurance companies. And you are worth more dead than alive to them .

The ignorance is strong in this thread.

 

[sixone]

I would dearly love to see the shit-storm that would ensue if insurance companies announced that they were going to stop paying dividends to their shareholders, so that they could start "giving back" by paying any and all claims, regardless of their contractual obligations.

I wonder what kind of effect that would have on Wall Street.

Their management structure would fall apart, as their key employees decamp in favor of other companies whose stock is worth something.

 

[her209]

Whoops

 

[Genx87]

Mmm... capitalism - what a marvellous thing.

Are you under some impression in a govt run system rationing wont happen? Why 2 weeks ago the NHS ceased feeding a child who had a rare disease that caused his lungs to fill with liquid. He died within days.

This is a tragic situation no doubt. But the insurance company already dropped 1.6-1.8 million on a person that is clearly going to be a cancer risk for the rest of his life.

Edit:The hospital is going ahead based on an assumption Medicaid will pick up the tab. If they dont then are we going to rail against socialized medicine?

 

[KK]

So the insurance company won't cover the costs, are they actually denying this 5 year old from getting treatment? If they are saying that even if the kids parents pay for it, the kid cannot get treatment then I guess you have a point. Otherwise, it's much ado about nothing in regards to the insurance company.

 

[CPA]

Mmm... capitalism - what a marvellous thing.

Some of you should read the article. The treatment requested is not even approved by the FDA. The insurance company requires the treatment to be approved by the FDA. So who's fault is it really? The capitalistic insurance company or the governments?

 

[soulcougher73]

I would think we would want more acceptance of experimental treatments, how else would they become non-experimental?

This. Cant keep them in the experimental stages forever. Get on with the testing already.

 

[Blackjack200]

Some of you should read the article. The treatment requested is not even approved by the FDA. The insurance company requires the treatment to be approved by the FDA. So who's fault is it really? The capitalistic insurance company or the governments?

And some of you should read the thread where this is already addressed.

 

[CPA]

Sigh. Can't your READ? Many procedures are paid for by Medicare that are not "approved" by the FDA.
The question is do you want insurance execs out to save money determining if you get care, or a public process with the input of medical professionals?
And, when was the last time you heard of Medicare denying something just because it wasn't FDA approved? Right, NEVER.

And yeah. There are "death panels". They are run by insurance companies. And you are worth more dead than alive to them .

The ignorance is strong in this thread.

That depends on the state and states aren't required to cover experimental treatment under Medicaid. And even if the state covered it, the HCFA (the federal arm for reimbursement) may not because they have regulations around using experimental procedures.

Medicare is irrelevant as this boy would not fall under Medicare.

 

[CPA]

And some of you should read the thread where this is already addressed.

nah, too much reading. :awe:

 

[Blackjack200]

That depends on the state and states aren't required to cover experimental treatment under Medicaid. And even if the state covered it, the HCFA (the federal arm for reimbursement) may not because they have regulations around using experimental procedures.

Medicare is irrelevant as this boy would not fall under Medicare.

Medicare is relevent since it's the model being used to predict what would have happened if we actually had UHC.

Ho hum, another day, another innocent child killed by our collective refusal to treat a curable disease. Seriously though, it's definitely his fault for not getting a high paying job at the age of five so he could cover his costs.

 

[Patranus]

LOL.

An attempt to point out the failures of private insurance when the article only points out the failures in government.

The therapy is not approved by the Food and Drug Administration, another criterion that HealthAmerica requires.

Liberals cannot even get their propaganda right these days. If you are going to use a sick kid to further your message you could at least try a little bit harder.

 

[WhipperSnapper]

fucking pos insurance companies. o wait they pay my bills

...until they deny your cancer treatment on the day of your surgery.

You see, your beloved insurance company has a "Death Panel" and employees who receive commissions if they can find ways to rescind people's insurance coverage when they get sick. So if your insurer's death panel determines that you failed to report an ingrown toenail when you were age nine, they could claim that your insurance application was fraudulent and then deny you care for your completely unrelated cancer diagnosis.