Friday, September 25, 2009

Want outrageous? A woman, awakens in the night, her breast is bleeding but her insurance company DENIES the claim (Video)

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.

Video here:



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Comments (2)

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Stories like this just break my heart. It sickens me to know that money is placed about people in this manner. Health care is something that should be a universal right and yet so many die because the government has decided to put profit ahead of people. When I read stories like this, I am so thankful that I am a Canadian. Money is the last thing you should have to worry about if you are sick.
Anne Engert's avatar

Anne Engert · 811 weeks ago

I took my teen (who had been clocked in the head playing tag resulting in a completely swollen shut "black eye") to the emergency room after speaking to the 24 hr on-call advice nurse that serves a large group of pediatricians offices in my county. It was midnight and there are no alternative urgent care centers in our area unfortunately even though it's a large suburban area just outside San Francisco. The nurse felt it best to go in for an x-ray just to be on the safe side. As a parent, you do what you think is best, even though I knew the cost would be high Though I have a high-deductible health plan, we have not yet met the deductible. Long story short a quick x-ray and 2 minute consult with the doc on duty all was expected to heal quickly and got the bill. $1700. After the insurance was processed and a discount applied I still have to pay $1200. How can people deal with this. I realize the emergency room is more costly but this is almost 10 times what a regular doctor office visit would have cost!

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