Family experiences pain of cancer, death and insurance

[firedupdem]

The 24-year-old father from Elm Creek, a Nebraska National Guardsman, had escaped injury while escorting convoys past roadside bombs during his 12 months in Balad, Iraq. Other soldiers in his unit were less fortunate.
But in skirmishes with a military health care insurer, his luck ran out.
His family was twice ambushed by coverage denials in July - after he was diagnosed with advanced lymphoma, a blood cancer.
It seemed even if he did survive, medical debts would forever dog his family.
Before Dustin died, Heather had wanted their story to be a warning to others, that unexpected insurance denials can be nearly as devastating as a war department telegram.

snip

Heather suspects their insurer got news of Dustin's stage IV lymphoma diagnosis, saw big expenses ahead and seized upon the technicality that would allow it to run away - she had paid June's insurance premium a few days late.
Others see in the young couple's story examples of the insurance morass that has enveloped this country's medical payment system, its bureaucratic complexities, absence of consumer safeguards, the prerogative of insurers to seemingly make up rules.

"It's a little bit of an example of why we're in this mess now as a nation," said Dr. Mark Hutchins, the Lincoln oncologist who treated Dustin.

There's nothing about the Von Loh case unique to one insurer or to Nebraska, said Stephen Finan, associate director of policy for the American Cancer Society Action Network, which assists cancer patients battling insurers.
Many people don't learn about shortcomings in their policy until they get an expensive disease - a typical stage II breast cancer costs around $110,000, a typical stage III colon cancer, $252,000.
Dustin and Heather, a 22-year-old expecting their second child this fall, learned that insurance problems intensify even the pain of cancer.

"That's all we needed on top of everything," she said.

snip

Their coverage began in May with monthly premiums of $180.

Heather says she received June's bill - due June 1 - sometime in mid-June and paid it within days. For a while, the lateness of the payment didn't seem to matter.

TRICARE covered her June prenatal visit to her doctor, and on July 2 it authorized payment for Dustin's spinal MRI at the Noble Spine Clinic in Lincoln.

There was no sign of trouble until a claim was submitted after the cancer diagnosis of July 3. TRICARE suspended coverage back to June 1, based on the late payment.


http://www.journalstar.com/news/local/article_51e4c9ec-9507-11de-93eb-001cc4c002e0.html

[undeterred]

1. TRICARE is veterans care

I thought veterans had care for life- I didn't know they could lose it by missing a payment date.

[firedupdem]

2. Weird. The article states when he was dismissed from active duty

the coverage was lost?

Here's more..

The way Hutchins sees it, Dustin was eligible for military insurance because he served his country. Then, because the premium was paid late, with no effort to find out what was going on, TRICARE determined the contract had been broken and canceled coverage.

"I'm sure there's something in the contract language that lets them do this," he said, "but this is just wrong."

If someone made a mortgage payment a few days late, he said, they wouldn't take your house. There are laws to prevent it. But there are no laws to prevent insurance companies from withdrawing coverage for similar infractions.

A spokesman for TRICARE said he couldn't comment on the Von Loh case because of privacy issues, but he asked that Heather call for an explanation.

When she did call, TRICARE assigned a case manager to handle their future claims. Heather had dealt with a different TRICARE representative in each of her prior contacts.

[undeterred]

3. TRICARE is administered by Wisconsin Physicians Service

and a few other companies. I actually did a short contract there a few years ago.

WPS http://en.wikipedia.org/wiki/Wisconsin_Physicians_Service

TRICARE http://en.wikipedia.org/wiki/TRICARE

[mnhtnbb]

4. She could just call Sen Ben Nelson for help!

:sarcasm: