Newsvine is msnbc.com's social-news community where you can discuss stories, publish your own column, and connect with other news lovers.
Insurance companies have to much say in our medical care that is up to licensed trained physicans: Medical reviews done by RN is not Dr.
Children are helpless and should be guaranteed heath insurance. We should NEVER EVER punish parents by jeopardizing the health of a child.
Insurers have every right to charge more for a child outside the norms, b/c they do present a greater risk, but should still cover them.
To discriminate because of size is tragic. We have become a society of haters and this is just one more added to the stupidity.
I am a single 50 yr.gentelman and enjoy all ltttle people (kids). I have never had a news story get me so freaken mad. HEALTH REFORM NOW !
A single-payer health care system would stop all of this nonsense and criminality. Contact your senator or representative TODAY!
I am very curious about the ' Insurers should have discretion' voters here. Who are you working for and how much Insurace Stock do you have
This is what we have come to. We are turning out backs on children! Health insurance companies and their inhumane policies have got to go!
And if the government wants to provide an alternative insurance, they should cover any person rejected by other companies, no matter why.
The insurance business practices of today are immoral. The days of making profits off human pain should be over NOW.
Physicians not insurance need to diagnose health care issues. Insurance has no right making medical decisions, do you want at best a RN deciding your health care needs? Or would you prefer a plan by your physican to help keep you healthy? Yes insurance is expensive but only as it relates to health care charges, and doctors can charge anything they want: recently went to a specialist and he charged $525.00 for a 15 minute visit.
#1 - Wed Oct 21, 2009 10:25 AM EDTI don't believe any child should be denied insurance coverage. What if it was there own child, how would they feel then?
My best friend is an RN and at least as knowledgeable (if not more so!) than any physician. I've stopped going to doctors whom I thought were idiots and been seen by some RNs that were very smary and competent. I just don't think these insurance companies need all the pull that they have to decide who gets covered and who doesn't. I was denied being on my husband's policy while I was on Accutane because they said I was 'too high-risk' because of it.
Insurance has no right making medical decisions
But this is not about the right of making medical decisions, it is about the obligation to make profit decisions.
Insurance companies manage risk and money, not health care. In a free market a company must make the decisions that maximize profits.
And this is precisely WHY there needs to be reform - to MAKE the insurance companies accountable to the people they insure. Anti-reformists are up in arms about medical decisions, well take a GOOD look at what this company did. They made the decision to withhold insurance from a child without knowledge of the situation, even when their own doctor gave evidence the company was WRONG. These companies first inclination is to DENY. That's ALL they want to do and you have to fight to get them to give the coverage one should have had in the first place.
She should be covered. At her age I weighed less. I was always shorter and weighed less them my peers. I still do. It's in my genes. My mom is petite also. This is crazy to deny insurance to children because of their weight and size.
#2 - Wed Oct 21, 2009 10:36 AM EDTWe used to call my daughter a fluff. Though about the same height as her friends, she was very light weight and small framed. She still is today at 20. She's about average height, has a very petite frame and weighs below average - and she's perfectly healthy. Health insurance companies are not medical doctors. They are simply in the business of gouging a helpless, trapped public.
It's time for serious insurance reform - along with a public option and tort reform. The American people say ENOUGH!
I am a seamstress and designer, I make formal wear for children. Kids change size so quickly I am not sure how a rule like this could even exist. Sometimes waist measurements vary by two or three inches one way or the other over the course of a month! This is why so many childrens clothes have adjustable waistbands. I simply do not understand th thinking behind a decision like this.
#3 - Wed Oct 21, 2009 10:55 AM EDTI hope the public option that "everyone" wants is run better than Social Security or Medicare! I am leary of the government taking my hard earned money to pay for something that they cant run well! That will not fix anything. There have to be checks and balances that result in fewer lawsuits and lower costs across the board. That includes the government run as well as the private run systems!
Amsst95- are you saying that you know no one who is using Medicare and doesn't think it's effective?
Why do people get outraged about the children who are denied coverage by insurance companies and then say they still want insurance companies to run health care? Do you not understand that insurance companies don't have a vested interest in paying out for health care? Their business model is in fact to pay out as little as possible. The government has done a perfectly fine job with Medicare and Social Security. My mother has both and they work very well for her. We should have coverage for everyone under Medicare.
ehorth, that actually is not the business model. Failure to pay claims is the number one reason why companies and employees dump their carriers. But there are systemic impediments to flexibility. It's HARD to switch carriers, and so long as your employer is responsible for providing plan options to you, it's even harder. IF carriers knew you could walk away from them if they were too stringent with coverage and IF pre-existing condition clauses were illegal in insurance contacts, you'd find that the business model would place more emphasis on customer retention.
Note that the filing of claims on auto or home insurance results in two things almost every time without fail 1) higher premiums and 2) higher experience mod ratings which means you take one giant step closer to being cancelled. We don't jump up and down about it too often because we file exponentially fewer homeowners and auto claims versus health care claims. Why should it be any different in the health care arena. If you cost the insurance company more, they will charge you more and you will become more difficult to insure. Even a public option run by the government will experience the same issue, with the only difference being that the government option will be funded directly by the taxpayers so we'll all pay twice for the ever expanding costs of the coverage. There are ways to make a public option workable and to use it to help reduce cost but it won't happen until pre-existing condition clauses are banned and the impediments to competition are removed.
Yes, there are literally thousands of insurer's out there, but they aren't all necessarily competing with one another, and they also all know that you can't take your toys and go home if you want to and not play their game. Once they know you can vote with your feet and your wallet, they'll alter the model significantly.
Homes and cars are not living, breathing entities. YOU are. Comparing health insurance to car and home insurance is like comparing apples to bananas. Not everyone has a home they own, or a car, but EVERYONE needs health insurance.
My son was 6 weeks premature and has been consistently below the growth chart. He is growing at the same rate as children his own age and eats like a horse but is still in the 4th percentile for height and weight for his age. My son will be 2 in three weeks and weighs about 23 lbs. I have expressed my concerns to his pedicatrician who feels the same way as Aislin's, he is just small and is perfectly healthy! I used to work for UHC and I am glad that I don't anymore!
#4 - Wed Oct 21, 2009 11:05 AM EDTUHC is just terrible overall. My daughter was born 8 weeks premature, out-of-network, due to an emergency situation. They denied me, and my daughter's 7 week hospital stay, for over a year. I went through appeal after appeal, respectfully, until I turned all the documentation over to our state's Commissioners Office. Thank the stars that I live in Wisconsin and have a competent Commissioner of Insurance Office. They sent out a letter two weeks after I mailed all the documention to them demanding to know WHY the bills have not been paid. Five days after that CC'd letter, I received notification from UHC that they were paying everything in full. Unfortunately, they wouldn't reimburse me any of the costs I had paid in order to avoid collections, and I was too tired to even fight about the few hundred dollars I had spent.
I still believe that UHC acted illegally, as they had 30 days to make a payment in the first place and had no reason to deny, other than to make my life miserable. It was the most stressful time in my life ever, as I almost died, my daughter had major issues, and this insane insurance company didn't fulfill it's contract. In my opinion, UHC is nothing more than a bunch of crooks trying to get away with illegal activity. They, and insurance companies like them, give the entire industry a black eye.
I thought health insurance was important to sick people--so anyone at risk of not being totally fit is denied---that means it's not about taking care of people--it's about having people give money for nothing to the insurance companies! And they don't want a public option because it will interfere with all our choices..our choice now is to go screw ourselves according to the insurance industry. I could do with improving that situation.
#5 - Wed Oct 21, 2009 11:06 AM EDTHow else is Stephen Hemsley, CEO of United Health Group going to make $750 million a year in stock options? If cherrypicking is outlawed, he may have to give up his gluttonous lifestyle just like the robberbarons of olde. We are living through one of those periods of history where a few individuals have discovered how to legally amass obscene fortunes through the suffering of others. Until the government steps in and shuts down their license to steal, health insurance execs, like wall street and bank execs, will continue to rob the American public blind.
#6 - Wed Oct 21, 2009 11:10 AM EDTYou're right. You should be a Senator.
Any of our Senators who are allowing themselves to be controlled by these companies are not fit to hold office, and should be impeached for ignoring the will of the people.
Do you see the irony in your comment about the insurers stealing us "blind". I know it's just a phrase but it made me smile since if we did go blind, they wouldn't want to insure us!! Or at least raise our rates!
I wish that we could stop using the expression "health care reform" because what we have now is a system of "sick care." And it's not working very well. If an uninsured person has to go to the emergency room for a cold - or a cold that turns into pneumonia - how can we call that health care. I understand that common sense may be too simplistic an answer but lawsuit-sense isn't the answer either.
#7 - Wed Oct 21, 2009 11:27 AM EDTThis is one of the problems with labeling every conceivable anomaly as a "syndrome" or "condition." Low birth weight, which can be a legitimate problem in destitute areas because of longstanding nutritional deficits, would seem to ba a congenital condition. Hypotonia, or "low muscle tone" is a diagnosis all its own. Once we start labeling everything as a condition, we make it much easier for insurers to decide that certain of these are "pre-existing" conditions. Accordingly, if your child gets a diagnosis of "hypotonia" by the pediatrician and is delayed in crawling, walking, talking, etc., once you switch carriers, hypotonia is ripe for classification as a "pre-existing" condition subject to coverage exclusion.
The insurance company's logic in this regard is very flawed. Failure to cover "early invervention" can translate to higher medical costs down the road when tangentially related problems have to be addressed because they didn't cover the treatment that would have prevented or stemmed other developmental problems down the road.
But, by the same token, parents who push early for diagnosis codes and "syndrome" identification are setting themselves up for this kind of coverage exclusion. That's not to say it is their fault, because it isn't. But knowing how the system works is more than half the battle.
A fairer system would be to avoid insurance coverage altogether for the first $5,000 worth of expenses and utilize the Health Savings Accounts to fund the first $5,000 of expenses, annually. Then, eliminate pre-existing conditions altogether from insurance coverage (along with deductibles) and force carriers to cover all conditions above the $5,000 threshhold.
This would do two things....1) force competition with providers on well visits AND non-emergency sick visits which would lower prices on both the examinations and the treatment and 2) would allow families to pay far lower premiums for health insurance AND see and understand the actual costs associated with their medical care, thus better informing them before they make decisions concerning care that are costly. (Like taking little kids to the ER for an ear infection instead of the pharmacy clinic where they will wait less time, pay less, and have medication available at a more reasonable cost at their fingertips).
#8 - Wed Oct 21, 2009 11:28 AM EDTVery well put. my fear is, where doe it(denials) stop and this has the nasty flavor of "our" countries intellectuals suedo-science of Eugenics in the early 20th century.
I agree that our health care system needs to refurbished - but what about those of us that can't afford $5,000 in Health Savings Accounts? That wopuld be $20,000 for a family of four, about half of our income. The premium of $400 a month is much more affordable to us than saving even $5,000.
Law suits for inconsequential things should be made illegal; Such as suing a surgeon for the scar left from a surgery. That would lower malpractice insurance and the savings should be passed down to the patients.
Every state should have readily available insurance with no underwriting for children and low cost insurance for adults with preexisting conditions.
Very good question. I suspect that since an employer pays upwards of $15,000 per year to fund health insurance premiums, that is one logical source for the funding of an HSA. One big criticism of HSA plans today is that the large deductible insurance plans - still have a deductible, which means the insurer still controls what constitutes a covered item that falls within the deductible and those that fall outside. We should do away with deductibles alrogether and remove that power from the insurer.
By the way, the actual cash cost for a family of four's medical care for one year, if no one has a major illness, and if mom and dad each take one routine medication (Lipitor, etc) is approximately $2300 per year. If you pay $400 per month for premiums AND pay copays on top of that, you are paying more in premiums per year than the actual cost of your health care.
If we're going to have state run health insurance options, open it up so that states can compete with one-another, much like the 529 savings plans.
And, HSA savings deductions would allow you to save in the HSA, allow the funds to grow tax free, and allow you to roll over unused funds to the next year.
I wanted to have the Health Savings Account. But the law is stupid. In order to qualify, you must first have primary insurance. Because of the cost of insurance and our lack of income to support it, we have no insurance. Seems to me I should be able to have a Health Savings Account ESPECIALLY since I have no insurance. We have raised 3 kids without insurance, but now that my spouse is over 60, we could use some insurance and a little medical care.
I agree that the current state of HSA's is ridiculous. It's tie to insurance must be severed. It should not serve as the "deductible" to a primary insurance plan nor should insurance control deductibles ever again.
Why would you deny any child health care???!!!!! This is just plain old GREED!!
#9 - Wed Oct 21, 2009 11:38 AM EDTThe child has not been denied health care. The child has been denied insurance coverage. Care is available.
I don't disagree with the sentiment behind your post at all, but I think context is important for all of these types of discussions. It is not the role of insurance to provide health care, free of charge, in exchange for the premiums due. It is the role of the insurer to provide insurance coverage for health care rendered, pursuant to a plan paid for by the insured.
To the extent that the health care is more costly than the family can afford without insurance, we have the indentity of one of the other major problems with a health care system in this county. The care is available, for a price. In fact, this particular family availed themselves of care that they knew was not covered by the insurer prior to this coverage issue arising (because the husband changed jobs).
The issue presented by this case is whether a child's weight/muscle tone constitutes a pre-existing condition under the terms of a health insurance policy. The answer should be no, in most cases; however, so long as the weight/muscle tone is associated with a diagnosable disorder - i.e. hypotonia - for which there are CPT codes, the insurer may well been within the technical right to deny the coverage. The trouble is that they are doing to to avoid covering the cost of therapy. THAT is where we need significant reform.
Pitch-1424040, let me sum this up in simple terms for you. What our insurance companies are doing is WRONG! Always has been and always will be as long as our system remains the way it is. They have got to GO!! Bring on the public option!!
Pitch: The child does not need therapy. She is developing normally and healthy in every way. I have a 12 year old granddaughter who is smaller than her 9 year old sister. She is smaller in height and weight, which does not mean she is unhealthy. The problem with the cowriters for insurance companies is they have a certain standard they follow which they believe is the way everybody should be. But in reality, no two people are exactly alike and their body structure will probably be different from anyone else. Their standards need to be revised, especially when it comes to children. My granddaughter will always be smaller than her sister because that is the way her body is developing. My other granddaughter is classified as being overweight but she has no fat to speak of because she is very athletic and active. Muscle weighs more than fat. The cowriters need to reclassify their standards and adjust with the times.
JLunn, in the story told this AM on Today, the parents stated that the child required therapy. She had a gag issue. It's part of the story. So, yes she did.
Regardless, there are lots of children that are born with actual low tone conditions that also require thereapy, whether OT or PT. That is what I was referring to.
Blue Star, I wasn't commenting on the rightness or wrongness of insurance company practices. But no one should ignore context when having these discussions. That is why I said that getting rid of pre-existing condition clauses in insurance policies makes a lot of sense.
Pitch..........
This should not even be an issue. EVERY child should be insured no matter what.
With all due respect, please point out where I've disagreed with that concept.
What I've done in several posts is illustrate how we get to the type of problem depicted this AM on Today. I don't disagree with you, at all.
But in a health care system that requires that all conditions be identified with diagnosis codes and labeled as a "syndrome" "disorder" or otherwise, you end up with such a thing as a "pre-existing condition" that allows a carrier to deny the extension of coverage.
The answer to that problem is to do away with "pre-existing" conditions. But in order to do that, you have to change other parts of the health care providing system, which I've mentioned in other posts.
Denying insurance is the same as denying care for many children. Uninsured kids often don't get routine well maintenance or vaccinations (which puts all our children at risk). All children, healthy or not, need to be insured so their parents can afford to give them proper care when they are sick AND when they are healthy.
Disgusting story. But not very surprising. Thankfully it's getting press and reform. This has been going on for a long long time.
#10 - Wed Oct 21, 2009 11:50 AM EDTWhat was the name of that ins.co? How dare any of you Ins. Co. act like! BLANK YOU! I got to get off this computer and go blow off some steam.
#11 - Wed Oct 21, 2009 11:56 AM EDTAny child should be insured regardless, especially babies and toddlers. Good grief..is the insurance company under the impression the toddler is dyslexic or something? Unreal.....
#12 - Wed Oct 21, 2009 12:11 PM EDTSorry..I meant anorexic..not dyslexic.
Insurance companies and pharmaceutical companies have WAY too much power over our health care system. Is anyone else totally aggrivated by the way they advertise to the general public? I am fed up with insurance telemarketing on my home phone, cell phone and through text messaging and the drug commercials on TV. Shouldn't the doctors be the ones to determine which medication is best for the patient? And how about turning to preventive measures like eating properly prepared whole foods instead of processed crap or fast foods and getting proper rest and exercise? When it comes to covering children, NO CHILD SHOULD BE DENIED COVERAGE!!!
#13 - Wed Oct 21, 2009 12:29 PM EDTHow are pharmaceutical companies relevant in this context? The insurance company denied coverage (which I fully agree that refusing to cover a child is ludicrous) to a child. Pharma companies have absolutely nothing to do with this story. And doctors ARE free to determine proper medications for their patients....however, insurance companies will at times dictate which medications are covered. But a physician is free to prescribe whatever he or she sees fit. If the insurance carrier does not agree on its use (not saying I agree with it...but that's the way things ARE currently), then it is a matter of cost / benefit analysis for the patient. And if the anticipated benefits of the medication outweigh the costs....then you try to find the means to pay out of pocket. If not, then you go without (or talk to your doctor about other potential options). But there is a key distinction between "health care" and "covered" health care.
I have a granddaughter who is at 0% on the scale. Thank God Montana has a health plan for all kids. She is very health but my mother was only 4 ft 2 i so she comes by her small size honestly. I think insurance should cover anyone, at a reasonable cost, and they could still make money.
#14 - Wed Oct 21, 2009 12:46 PM EDTFor the first 6 months of his life, my son wasn't even on the charts! Was he healthy? Yup!! Just small! His dad is only 5'8" and I'm only 5'5". He's just small!! Thank goodness we've not been denied!
This does not surprise me about any insurance company. They can claim anything they want is "not the norm". If your child is small - oops they don't fit into the norm. If your child is fat - oops again not the norm. If you have ever filed an insurance claim, then you most certainly are familier with the response that "your physician fee is "ABOVE THE NORM" , which of course means that YOU have to pay more of their fee. I have yet to find any doctor or hospital who fits 'THEIR' normal. Just another way of screwing the people who pay these large premiums.
I also have a daughter who was premature and small for her age. At two, she weighed about eighteen pounds. We spent several years of her childhood living in third world countries and she was healthier than most of the other children.
#15 - Wed Oct 21, 2009 12:52 PM EDTI never thought I'd say this..but...I'm so glad I don't have health "insurance"! No premiums, no co-pays, no denials.
I don't go to the doctor, I'm 48, but healthy. If I did need to go, I'd go to the ER, let them bill me, then I'd decide if I could pay the bill or not, THEN, if I couldn't pay it, I'd let them report it to a credit reporting agency. My credit is being screwed over by credit card companies anyway (another thread) so....let it rain!
Insurance companies are greedy. No one denies that except the insurance companies. I'm self employed. I had health insurance one year with a company. I was paying a monthly fee for family coverage. The next year, the insurance company raised my monthly bill, cut out some services they formerly provided, increased the copay and did this without advanced notice. Then, the company turned around and gave their CEO a $10million bonus for that year. I canceled my policy with them and went with another company that covered me/family at the rate I was paying the other company the year before without any problems. Now, I don't think that would happen to day because of a simple diagnostic problem that is common with ALL Health Insurance companies: GREED! They sit at a desk with blinders on and if the problem doesn't fit within that field of vision, then coverage is denied or canceled at their whim. We need reform BUT, not the way bho is trying to force it down our throats. At present, for every dollar you pay in for insurance, when you need it, you'll get a dime back, if anything at all. Then you'll still have to pay for what they won't cover. Reform is needed. But the way the white house is trying to stuff it up our butts and at a cost that is outrageous, is not.
#16 - Wed Oct 21, 2009 12:53 PM EDTI have Medical Mutual for myself and my teen son. For awhile when he was younger, he was underweight due to genetics from his father's side, but Medical Mutual never gave me any problems with that, nor did they ever have any problems with our pre-existing conditions. I don't think the height or weight of a person should matter when it comes to health care coverage, especially children, who need it the most.
#17 - Wed Oct 21, 2009 12:56 PM EDTA bettername for United Healthcare is not an insurance company but an outsurance company.
#18 - Wed Oct 21, 2009 12:56 PM EDTYep, "only insure healthy people and never have to pay out a dime", that's the impression that United Healthcare is giving me about their "business" practices. Insure healthy people and pay the CEO a whopping huge bonus for not allowing anyone but healthy people to apply for or get their insurance.
In a few days United Healthcare will probably waffle on their position and cover the child because of all the bad publicity they are getting, just like the other insurance company did for the 17 pound kid.
WHAT an outrage!!!!! Of course I called and was sent to voicemail! The CEO boss, Stephen is probably at the bank depositing his bonus? Call 1-800-516-3344 and try to leave a message of your own!!!
#19 - Wed Oct 21, 2009 1:03 PM EDTI don't understand what has happened to our country. Seems everyone has forgotten the 'human condition' and taking care of each other. If someone is hungry, feed them. If they are sick, make them well. It's not rocket science.
#20 - Wed Oct 21, 2009 1:04 PM EDTSomehow we've been sold on the idea that it's ok to prey on the weak, the sick and the disadvantaged. That security is a privilege for the wealthy and opportunity a perk for the powerful. This is not the America that I grew up in. We were taught to believe in the Golden Rule, to defend those who were less fortunate and to help those who were in need, not because it was convenient, but because it was the right thing to do.
This should be a no-brainer. No American child should be denied health insurance.
You're in Easy Mode. If you prefer, you can use XHTML Mode instead. |
Log In | Register
These are small children - the baby probably isn't mobile yet to lose the weight and the 2 yr old is probably very active burning calories!