If a woman awakens with her breast bleeding and soaked, don't you think that there is something WRONG HERE? For Blue Shield of California, absolutely, NOT.
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.
Why? Documents from Blue Shield indicate the company had reviewed the case and determined Miran-Ramirez “reasonably should have known that an emergency did not exist.”
And we have members in congress who are FIGHTING for these VERY insurance companies. This is sick and pathetic. But the outcome, once Blue Shield of California was put on TV, they paid the claim. Geez, we have thousands of these stories whose claims will not be paid. That is the sad thing about this whole situation. A government run public option to put these sorry insurance companies IN CHECK, is fine by me.