Three days before her mastectomy, the insurance company called her.....

[Nye Bevan]

This story is from 2009, before the ACA went into effect which prevented the insurance companies from denying coverage based upon pre-existing conditions. If Paul Ryan and the Republicans get their way, this kind of thing will start happening again.

Robin Beaton found out last June she had an aggressive form of breast cancer and needed surgery -- immediately. Her insurance carrier precertified her for a double mastectomy and hospital stay. But three days before the operation, the insurance company called and told her they had red-flagged her chart and she would not be able to have her surgery.

The reason? In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.

Beaton's dermatologist begged her insurance provider to go ahead with the surgery. "He said, 'This is a misunderstanding. This is not precancerous. All she has is acne.' ... He said ,'Please don't hold up her cancer surgery for this,' " Beaton, 59, said as she testified at a House subcommittee hearing on the terminations of individual health policies by insurance companies.

Still, the insurance carrier decided to rescind her coverage. The company said it had reviewed her medical records and found out that she had misinformed them about some of her medical history.

http://www.cnn.com/2009/POLITICS/06/16/health.care.hearing/

With the system Paul Ryan wants, any large claim will be pored over with a fine tooth-comb by the insurance company which will attempt to deny it as related to a pre-existing condition. Absolutely nothing demonstrates the cruelty and heartlessness of the Republicans than wanting to go back to this state of affairs.

[spanone]

1. how do they get re-elected? it makes no sense.

[babylonsister]

2. You know, that vast swath

of people out there who just don't care and are too ignorant to look out for their own best interests?

[Plucketeer]

30. That's the sad-assed truth!

Medicare FOR ALL It's SO simple and SO appropriate. What DO the insurance companies DO for the health care "business" of this nation? NOTHING.

[Hortensis]

46. No. Some are stupidly hyperpartisan,

but many others oppose it from ideology and genuine principle. Right or wrong, strongly influenced by decades of extreme anti-government strengthening of traditional conservative beliefs or strongly influenced by decades of extreme anti-government strengthening of traditional conservative beliefs, they really believe socialized programs will destroy our nation's moral fiber, and with that our nation itself.

We have a pair of good friends, force-retired-due-to-age-and-illness small rural farmers with significant money problems who will not accept the ACA marketplace discount. They pay "free market" rates, including a fee to an insurance consultant who helps them find the best affordable coverage for her serious medical problems. (They've only recently gotten on line with my husband helping.) They pay at least twice, maybe three times, the marketplace rates and don't know how they are going to be able to continue. My husband and I are afraid this will break them before she qualifies for Medicare, but not half as afraid as they are of course.

Only because the ACA was passed is she able to get insurance at all, of course. But I respect that they are living their principles and don't point these things out. They know my coverage is through the federal marketplace, and so each year I've briefly informed her what my new premium and coverages are, so she'll know, and that's all.

[Triana]

3. The American electorate is largely selfish & stupid. n/t

[dionysus]

4. because a lot of GOP voters agree with ryan's cruelty.. until they or their own family is affected

by said cruelty...

then there's the "personal responsibility" idiots who really believe they can get by with a health care savings account. I guess they don't understand that a serious of illness would bankrupt even a millionaire if they had to pay out of pocket.

I was in the hospital for 3 days and 2 nights for a health scare. all they did was monitor me, basically. the bill for that before insurance was 10 grand!

my mom was on life support the last couple days of her life; that was well over 100 grand, paid my medicare, thank god.

my dad, who recently lost his battle with cancer, had to have racked up hundreds of thousands just on chemo and tests...

anyone who thinks they can merely save up and be able to afford a serious illness out of pocket is clueless

[Nye Bevan]

6. I don't think a lot of people understand just how much a major illness can cost to treat,

unless it has happened to them or someone close to them. And the incentives for the insurance companies to try to duck out of paying such huge sums are enormous.

[Plucketeer]

31. Hell - my wife got an inch-long sliver in her thumb

ELEVEN THOUSAND DOLLARS to make it right again. 11 thousand for a sliver!!!

[Pharaoh]

33. Fuck!

A corrupt greedy puss infested system for, health care?

The rest of the world is dropping their jaws about what is going on here!

[homegirl]

17. Topped out

My sister had Cadillac coverage when she got breast cancer. When the insurer decided they would not pay any more bills it was $1.2 million out of their retirement fund to complete her life saving treatment.

Time for single payer.

[dionysus]

18. holy shit! thankfully they were able to do what was needed to complete treatment.

insurance companies are scum. even if they weren't greedy vultures who love to deny coverage, the fact that they are involved at all is a problem. they need to make a profit to survive, and that's money best spent on care. their very existence adds a whole extra layer of costs...

[lastlib]

34. For the life of me, I cannpt understand why....

...we even allow the EXISTENCE of for-profit health insurance in this country. To have basic needs such as health services subjected to a profit-based cost-benefit system is utterly immoral.

[2naSalit]

51. One word

capitalism, it's our national religion whether we acknowledge it or not. All praise the almighty dollar!

[I hate liars]

56. ++++++++++

[colorado_ufo]

50. Medical bills are one of, if not the greatest, reasons for bankpruptcy in the U.S.

[Hekate]

11. One big reason: Democratic voters sit on their asses in off-year elections & allow it to happen

This pisses me off no end. Time after time, election after election, what gets Democratic/Not-Republican voters to the polls is a Presidential candidate. House members get re-elected every two years, not every four like the President, but apparently that's just not sexy enough for our people.We elected Obama, big hooray, and two years later gave him a Republican House and Senate.

[Andy823]

16. Exactly

But hey they "have" to teach the party a lesson, right? They have to show them they want change so they sit home and don't vote, then they bitch and complain because the republicans are taking away everything they have. Karel Rove and his gang love it, and they pay good money to send out trolls to encourage those who are gullible enough believer their lies about how "both parties are the same, so why vote? Karl Rove also likes the "Bernie or Bust" BS also. He probably thought it up himself.

[yardwork]

44. So true. I agree with every word of your post.

[2naSalit]

52. ^^this^^

[Iggo]

20. By hating the women, the gays, the sick, and the poor.

Their idiot voters eat that shit up.

[narnian60]

47. +1

[valerief]

39. A combination of vote flipping, voter suppression, racism, and Jesus. nt

[ToxMarz]

43. Of the nearly 267 million non-elderly residents in the U.S., 56% are covered through their employer,

12% are uninsured, 21% are covered through Medicaid or another public program, and 11% are covered through an individual or family plan. Another 58 million are on Medicare.

Employer based insurance has had legislation limiting use of pre-existing conditions, and those on Medicare and Medicaid don't have to worry about them. The 12% uninsured don't have to deal with them. So pre-existing conditions really only affect 11% of the population, and it is only a voting issue for others if they feel like caring about anyone else.

(That 12% uninsured is since the ACA, before only 6% had individual/family plans and 18% were uninsured)

[NewJeffCT]

53. The vote for Republicans

because Fox News and Rush tell them that Democrats are giving everything to undeserving black and brown people over more qualified whites, and wasting their tax dollars while doing it.

[SusanLarson]

5. The problem isn't preexisting conditions

It's private for-profit insurers who make money by denying care. Your candidate wants to ensure that they can continue to deny care.

[pnwmom]

7. False. Hillary Clinton is a strong supporter of retaining and improving the ACA, which has

helped to ensure that millions get care they couldn't get before.

[SusanLarson]

12. My comment was 100% true.

THE ACA relies on private for-profit insurers to pay for care, and leaves them skimming a profit off of our healthcare dollars. Hillary is against a medicare for all system. That cost her my vote.

[Thinkingabout]

28. Sanders pushing for Medicare for all was another reason I made to back Hillary.

Sanders is not using Medicare and does not understand if Medicare does not cover a procedure then they do not pay anything. Even if one has Medigap insurance it will not pay anything if Medicare does not. There are premiums for Medicare Part B and Part D, I am not heading any details on this either. Improve ACA, if the republicans are successful in repealing ADS and we have to start again it may just be another one years to get health care again.

[Hekate]

13. They called it Hillarycare before they called it Obamacare, and they ripped her to shreds for daring

... to propose and promote such a thing. Bill sent her to out to Congress to present his (their) universal health care plan, and the GOP began to hate her with the heat of a thousands suns, and have never stopped.

Please don't purvey this bull here.

[SusanLarson]

23. You are wrong.

It's not bull. The ACA relies on for-profit private insurers and she has expressed her support for keeping it sorry its a fact.

[Pharaoh]

36. ^^this^^

[Enthusiast]

48. Huge +1!

[Jim Beard]

41. Actually, they were mad at Hillary before Bill was elected

because her role as a staffer during Nixons impeachment.

[Hekate]

42. The GOP has hated this strong smart woman forever. To hell with them. I will never let the RW ...

...pick my Democratic candidates for me.

[dionysus]

21. boh are problems, IMO.

[sheshe2]

22. Wow.

10 years. 107 posts. 64 in the last 90 days. Now you care? Where the hell have you been. Susan?

[FuzzyRabbit]

38. Some of us have lives

and do not spend hours every day on DU.

Others of us do not post unless we have something new to add to the discussion.

[SusanLarson]

40. Oh on my pre-transition account

Don't make assumptions on post count, or account age.

On my old account

Member since: Mon Jun 12, 2006, 05:47 AM

[Live and Learn]

32. +10,000 nt

[Pharaoh]

35. ^^this^^

[Silver_Witch]

37. Truth - complete Truth...

They will find any reason to deny coverage. As a woman with a double mastectomy I promise you they will find a way to nickel and dime you to death....even with insurance I was $25,000 in the hole at the end and that was after electing not to have reconstructive surgery - because I simply could not afford.

I lost everything...WITH insurance.

[yardwork]

45. Bull. Shit.

This is completely wrong, and it makes me angry to read this on DU. This is the kind of misinformation that helps elect Republicans.

The story in the OP is one example of the real differences between the Republican and Democratic parties.

[SusanLarson]

61. No it is not.

Fact: The affordable care act requires Americans to purchase insurance.

Fact: For-profit insurers make up the majority of options in the healthcare marketplaces, and is generally the only option.

"Americans will have access to affordable health insurance options. The Marketplace allows individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans. All together, these reforms mean that millions of people who were previously uninsured will gain coverage, thanks to the Affordable Care Act."

Fact: In her presidential campaign, Clinton has vowed to defend and improve the Affordable Care Act. In stops in Iowa, Clinton said, “I will defend all of those important changes in the Affordable Care Act… And I will work to fix those parts of it that need fixing. That's the American way. We're supposed to be the best problem-solvers in the world. Let's act like it, instead of dividing off into ideological camps where we are hurling insults at each other.” [Clinton Remarks, Capital City Fruit Company Roundtable, 4/15/15; Dubuque House Party, 5/19/15]

Fact:To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If

So under the affordable care act at a minimum 15% and 20% of every healthcare dollar does not go to patient care. With Medicare that number is 2%.

"According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue. The insurance industry excludes private plans’ marketing costs and profits from their calculation of administrative costs. "

[Enthusiast]

49. Huge +1!

[renate]

8. one big reason I never went to the doctor was worry about erroneous "pre-existing conditions"

Even when we had great insurance that would have covered labwork etc, giving an insurance company a reason to deny any later claim was a huge reason for me not to go. I'm extremely fortunate in that I have good genetics and have so far been very lucky with my health and have always been able to take care of things myself, but even if I had wanted to go to the doctor for a sore throat or whatever, I wouldn't have, precisely because of what happened to Robin Beaton.

Stories like these used to really worry me. I wonder how much preventive care was avoided, by people whose genetics and general health would have made it critically important, before Obamacare came along to make preexisting conditions okay.

I can't imagine that Ryan will get his way, but what is WRONG with him?

[Nye Bevan]

9. I'm a supporter of free-market capitalism,

when it comes to things like stores competing for my business to sell me a pair of pants. But when it's healthcare you're talking about, my attitude is fuck free market capitalism. When the financial success of insurance companies depends upon denying people as many claims as they possibly can, that is immoral and disgusting.

[SusanLarson]

14. Uhm

Then how can you support Hillary Clinton who supports allowing private for-profit insurers to skim off of our healthcare dollars!

[Nye Bevan]

19. I support single-payer health care.

However, I don't think political realities will allow it to be instituted anytime soon. I do see the ACA as a huge step in the right direction, and in particular, banning discrimination based upon pre-existing conditions was enormous.

[SusanLarson]

25. Wasn't on the table

They never fought for it to begin with so how do they know what they could have accomplished

[Nye Bevan]

26. The ACA in its present form passed literally by a single vote in Congress.

A public option would not have passed and single payer most certainly would not have. I fully agree that the ACA has plenty of problems but it is an enormous improvement over the old system.

[SusanLarson]

29. ACA plan

$400 a month with $10,000 deductible which was more than I could afford, why even bother having insurance with a plan like that. Oh ya Insurance industry profits. No thanks.

[I hate liars]

57. The ACA was a capitulation to an extortion scam by private insurance companies

Obama began his ACA "negotiation" from the position of big insurance companies. Is there any wonder that what we ended up with belies the "affordable" in ACA?

[bullsnarfle]

27. Same old crap.

"Its just not realistic". Bla bla bla. Nothing isever going to be done if we don't knock off that chicken shit crap. People are dying out here God Damn it, with or without obamainsurance.

[gregcrawford]

10. May every Republican...

... Satan ever shat out suffer a devastating disease that their insurer won't cover. They'll get no sympathy from me. I've witnessed the effects of their malice,and lost my mother as a result. So fuck 'em ALL to death.

[sheshe2]

24. So sorry for your loss, Greg.

May she rest in peace.

[leftyladyfrommo]

15. Overage for people with pre-existing conditions

Is the most important part of ACA.

Before I was on Medicare I was turned down for coverage because I had gone to the doctor for a UTI. One urine test and one round of antibiotics and I didn't qualify for anything after that.

[proverbialwisdom]

54. Local Los Angeles news.

http://www.cbsnews.com/news/free-medical-clinic-in-los-angeles-draws-thousands/

By Carter Evans CBS News
April 28, 2016, 7:12 PM

Thousands flood free medical clinic in Los Angeles



...Agbunat said her state-subsidized insurance plan comes with high deductibles and co-pays.

"Thousands, yeah, it's thousands," Agbunat said.

When Dr. Lewis founded the traveling, free clinic in 2014, he anticipated a different clientele.

"I expected to see a lot more homeless people and people with no insurance at all, and to find out that the majority had insurance but couldn't afford their co-payment or deductible, that was surprising," Lewis said.

Negrete isn't surprised at all. She's had more failures than successes with her insurance. She's currently facing $18,000 dollars in unexpected medical bills from the birth of her son, which she thought would be covered.

<>

[GOPblows431]

55. The insurance companies are a cancer to our healthcare system

Single payer is the only way to go

[Dustlawyer]

58. I had a son born in 1990. I had taken my first job fresh out of law school after three months of

studying for the Bar exam while my wife and daughter stayed with family in another city. I interviewed for this job on a Saturday morning and told to start Monday morning. I came to work to find an insurance agent there. The firm was in the process of changing health insurance carriers. He handed me an application to fill out and give to him the next day. The next day he asked for it and I told him I had filled it out but my wife couldn't sign it until I moved the family the coming weekend when I would see her. he said they will take it like that so he took it.

That weekend my wife tells me that she was pregnant and didn't tell me to add stress to the Bar exam and finding a job. I call the agent that Monday, less than a week after turning in the application to ask if I had maternity coverage. The answer was no, I didn't, the birth would not be covered unless there was complications and the baby would be covered when born. We hired a mid-wife planning on home delivery (damn school loans).

Joshua was born 6 weeks premature and very sick. We had to go to the hospital for the birth because it was not close to time. He spent three months in neonatal ICU. During that time as the bills mounted we received notice from the hospital that the insurance company was not going to cover him because I had never notified them of his birth. I had called from the delivery room and told my agent and called the headquarters in Chicago and told them as well. My agent said not to worry as he had called and he records all such calls (think he knew something about how they worked?).

We received a letter saying, "Congratulations on the birth of your son, he has been added as of the day before his birth so that the delivery was even covered! We knew it was only because we had them cold that they had done that, and the fact that I was now an attorney that worked for a law firm.


The local hospital could not figure out what was wrong with him so they transferred him to the Houston medical Center where he was immediately diagnosed with Cystic Fibrosis. Now faced with a future of huge medical expenses the insurance company tried again! They claimed that I had committed "Fraud in the Application" because I had checked a box that said that no one to be insured was pregnant to our knowledge. They had counted the months and came up short. I was called to my agent's office for the call with the big wigs in Chicago. I was never even allowed to speak. I had explained to my agent when I had called about the maternity coverage and to let him know that my wife was pregnant less than a week after filing the application. he did explain that and ended up screaming at them before they hung up on us that I worked for a law firm that they insured. They didn't care.

Turns out a Federal statute called EURISA protected them. If I sued and won all they would have to do was to pay my attorneys and costs of court, plus the medical expenses as per the policy, nothing else. Nothing for the two years of hell of having an uninsured child with a huge pre-existing condition. Not being allowed to make more than $33,000 a year because the government who was paying for his prescriptions at a $150 a day when well got to keep anything over that to be reimbursed. Went bankrupt, but was able to use a hardship provision in the code to leverage a settlement of my the school loans prior to going to trial on my bankruptcy.

Hillary was to interview us as a poster child (pardon the pun) for our broken system as part of her attempt to reform healthcare. It was all set up when she canceled and quit the fight!

WE CANNOT RETURN TO PRE-EXISTING CONDITIONS AND WE MUST NOT STOP FIGHTING FOR UNIVERSAL HEALTHCARE!!!!!!!!!

THIS IS WHY I SUPPORT BERNIE!!!!!!!!!

[TNNurse]

59. Fortunately, there was no issue

with approving my mastectomy. However, weeks later when the person called from my insurance company, she introduced herself as "I am the one who approved your surgery". Had I been stronger, I would have screamed "it had to be approved, it was damn cancer", but lucky for her I was not up to my usual strength. She said it like she had done me a big favor.

Did the assholes at her insurance not know that even if she had skin cancer, it had nothing to do with her aggressive breast cancer? Heartless and ignorant.

[The Wizard]

60. We have the world's worst healthcare

and the most expensive. The solution is single payer and close down the health insurance industry. Healthcare for profit is flat out immoral. Unless we start speaking in blunt terms as to the solution, elected officials will keep blowing smoke up our collective asses. Every time the topic of healthcare comes up is must be characterized as the worst in the world. Real simple, the wealthy elites are robbing our money and shortening our lives by design.