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Protect yourself against health insurance reversal
Joan Gagliardi was liable for $1.2 million when her insurance comany reversed its approval for her treatment.
December 9th, 2011
02:03 PM ET

Protect yourself against health insurance reversal

In 2008, Joan Gagliardi was diagnosed with a rare autoimmune disease that caused scarring on internal organs, including her windpipe. It began to choke off her ability to breathe, but doctors at the University of Miami Hospital kept the damage in check with a treatment known as IVIG: Infusions of immunoglobulin.

The bad news came in 2010, when Gagliardi learned that her insurance company, Highmark Blue Shield of Pennsylvania, which had previously approved the expensive treatments, had reversed itself. The denial was retroactive, leaving Gagliardi liable for $1.2 million or approximately $50,000 for each infusion.

Fortunately for Gagliardi, the hospital didn’t press its claim, choosing instead to negotiate with Highmark. This year they settled up, with Highmark agreeing to pay $382,229. Gagliardi was off the hook.

Surprisingly, it’s not uncommon for an insurer to reverse itself, even after a claim is paid. State laws vary, but companies often take up to a year to perform “utilization reviews,” in which they re-examine claims that they’ve already processed.

In some cases, decisions can be reversed - leaving patients holding the bag - even years later.

“For example, if you have 2 health plans - yours and your spouse’s - and the one that should have paid second actually paid first, they will go back and reverse their payments years later,” explains Jennifer Jaff, Executive Director of group called Advocacy for Patients with Chronic Illness. “It’s a huge nightmare for consumers, but it happens. “

If an insurer denies your claim either before or after treatment, you do have the right to appeal: It’s guaranteed, under the health care law that president Obama signed in March, 2010. Of course a guarantee of appeal is no guarantee that the appeal will be successful.

Fortunately, there are things you can do to minimize your risk:

1) Make sure you're pre-approved. Unless you’re in the midst of an emergency, talk to your doctor to make sure any treatment - especially an expensive one - is pre-approved. That means your doctor has talked with your insurance company in advance, and received a promise that the treatment will be paid for.

2) Get help. Your doctor, hospital business office or employee benefits office can be a lot more powerful in making an appeal than you are alone. You can also get help from non-profit groups like Advocacy for Patients with Chronic Illness, or the Patient Advocate Foundation.

3) Be persistent. "You may go through three or four levels of appeals before you get a favorable resolution," says Nancy Davenport-Ennis, co-founder of the Patient Advocate Foundation.

4) Use the right words. Certain words will trigger a denial. For example, sometimes insurance companies refuse to pay for surgeries related to cleft lip or palate, saying it's not medically necessary. When parents appeal saying the child needs the surgery for "cosmetic" reasons or to "enhance esteem," the appeal often fails, according to cleftAdvocate, a group that works with families. Appeals that mention problems with "biting," "chewing," or "swallowing" are more likely to work.

5) You may need a lawyer. If all else fails, there are attorneys who specialize in insurance cases.

It’s worth saying, not all insurance denials are unreasonable. Coverage guidelines “are created by physicians who assess medical evidence, medical outcomes and overall health benefits to patients,” says Aaron Bilger, a spokesman for Highmark. “It’s to protect you.”

Dr. Christine Savage, who treated Joan Gagliardi, says the IVIG treatments kept her patient off a respirator. After a break of several months, Gagliardi began another round of IVIG in October. This time, Highmark said it would pay for 6 months, then evaluate whether it makes sense to continue.

Gagliardi says Savage and her team say they’ll do whatever it takes.

“We’ll just keep fighting the fight, to make sure I’m able to live as normal a life as possible with a progressive illness.”

For more on Joan Gagliardi's experience, watch “Sanjay Gupta, M.D." at 7:30 a.m. ET Saturday and Sunday.


soundoff (86 Responses)
  1. ADVOCATE FOR HUMAN RIGHTS

    INSURANCE COMPANIES CAN BE PUT OUT OF BUSSINESS JUST DONT BUY INTO THEM THAT TREAT PEOPLE LIKE THIS WITH SERIOUS MEDICAL PROBLEMS! CASE SOLVED CROOKED INSURANCE CO. OUT OF BUSSINESS

    December 9, 2011 at 15:17 | Report abuse | Reply
    • Jim

      Insurance companies are instructed to 'fight' you – not help you.

      December 9, 2011 at 18:48 | Report abuse |
  2. sat

    the above reply says it all. Insurance companies are businesses, not services. Never forget that! Kudos to CNN for running this story and putting the straightforward advice out there.

    December 9, 2011 at 16:42 | Report abuse | Reply
  3. ELISSA

    SEVERAL YEARS BACK I NEEDED WHAT I CALLED ROTOROOTER SURGERY ON MY SINSIS AS I HAD A FUNGUS INFECTION THAT COULD EAT INTO MY BRAIN. I WAS DENIED APPROVAL. MY DR SENT A DETAILED LETTER WITH THE LAB RESULTS ON MY BEHALF. AGAIN I WAS TURNED DOWN. I WROTE TO THE INSURANCE CO TELLING THEM I THOUGHT THEY WERE VERY BAD BUSINESS MEN. SINCE THEY WOULD BE PAYING FOR MANY DR APPOINTMENTS, MANY DRUGS AND FINIALLY A LONG STAY IN THE HOSPITAL AS I LAY DYING. IT SEEMED TO ME ONE OPERATION TO SCRAPE OUT THE CAVITIES WOULD BE A LOT LESS EXPENSIVE. I RECEIVED APPROVAL. SOME TIMES IF A LAY PERSON WRITES THE LETTER AND TAKES THE STAND OF THE INSURANCE CO AND POINTS OUT THE FAULTS IN THEIR THINKING IT REVERSES THEIR OPINIONS.

    December 9, 2011 at 17:11 | Report abuse | Reply
    • Grey's anatomy

      Were you yelling at them too?

      December 9, 2011 at 20:43 | Report abuse |
    • Laura

      I started to read your post, but after 3 words, the ALL CAPS started hurting my eyes.

      I hope you had a good point though!

      December 11, 2011 at 01:14 | Report abuse |
  4. nancy

    I had 5 infusions of IVIG and it cost $130,000.00. My insurance company pre-approved the infusions and then later refused to pay. Seems like health insurance companies can do whatever they darn well want to do.

    December 9, 2011 at 17:36 | Report abuse | Reply
    • JLBM

      This happened to my friend too. She got preapproved and even called again a few days before the appointment to make sure it was still pre-approved (she said the dr had told her that they had issues with this insurance company paying) and it was still un-preapproved. She said at one point a representative told her the preapproval was for her primary care to do the treatment. Right, someone who is not a specialist in the field is supposed to suddenly get training and do treatment beyond their expertise. They went back and forth for a year before the hospital gave up and billed my friend.

      December 9, 2011 at 22:30 | Report abuse |
  5. gritrman

    I have always said if you have money to invest....invest in insurance.....your money is guaranteed....they pretty much do as they wish....shouldn't be allowed to reverse a charge "years" later though

    December 9, 2011 at 19:28 | Report abuse | Reply
  6. Grey's anatomy

    I wonder how they would like it if I reversed my decision to pay them my premiums?

    December 9, 2011 at 20:44 | Report abuse | Reply
    • jdoe

      If the cost of treatment is higher than your premium they will happy to let you go.

      December 9, 2011 at 23:57 | Report abuse |
    • Grey's anatomy

      djoe,

      You might want to consider buying yourself a sense of humor instead of paying your insurance premiums.

      December 10, 2011 at 08:06 | Report abuse |
  7. Joni

    It's corporate greed. The bottom line is more important than a human life. They obviously were hoping this 600,000 a year bill would go away and they didnt care how that happened.

    December 9, 2011 at 23:35 | Report abuse | Reply
    • RichWa

      The bottom line is not human lives, but our lives, not the lives of the 0.1%. To the top 0.1% we, people such as you and I, are no different than the rocks they soak in acid to purify gold ore; of course, they consider themselves to be the gold and the only one's whose lives have value.

      December 11, 2011 at 12:01 | Report abuse |
  8. jdoe

    This is why we need universal health care now. Even if you do everything right and have insurance, you can never be sure you are covered. In effect people are at the mercy of an industry whose goal is to maximize its profits. Most everybody has the experience of haggling endlessly with insurers in order to get a claim paid. You've already done your part. You shouldn't have to wonder whether the next medical problem will also be a financial disaster.

    December 9, 2011 at 23:54 | Report abuse | Reply
    • JoeDL

      Amen to that. An illness can destroy your life savings, even with insurance.

      December 10, 2011 at 00:14 | Report abuse |
    • c s

      People in Europe and Canada do not have to put with this insurance mess. The sooner the US gets universal health care, the sooner everyone will have coverage. The French spend about 1/2 as much per person and have a longer life span. Maybe one of the reasons that people live longer in France, is that the French do not have to fight with insurance companies when they are really sick. Lets just hire the French to run our medical system and we will save about 50% of the cost.

      December 12, 2011 at 18:05 | Report abuse |
  9. Joni

    Very true, the insurance "settled" for 300,000, when she was told her responsibility would be over a million, That is a story in itself- and a sad one @ that.

    December 10, 2011 at 00:04 | Report abuse | Reply
    • HZ

      That is nothing to worry about. A hospital sends a higher bill to an insurance company than they would to an average person because they expect the insurance company to talk the price down. The hospital would have also reduced the bill for the patient if she ended up having to pay it. Also they probably wouldn't take her to court over it.

      December 12, 2011 at 08:22 | Report abuse |
  10. BettyL99

    With or without insurance most of us can't afford to get sick. The almighty dollar rules this country. Throughout history, the downfall of most of the great empires can be attributed to greed or gluttony in one form or another. It leads people astray (yes, corporations and insurance companies are made up of PEOPLE) and they make very poor decisions all based on money. The USA is positioning itself for just such a downfall.

    December 10, 2011 at 00:12 | Report abuse | Reply
  11. bblue

    Watch the movie SICKO;by michael moore: the movie shows the truth about healthcare in the USA

    December 10, 2011 at 00:41 | Report abuse | Reply
  12. Danny White

    The fact that insurance companies can simply disregard there contract policy at will, proves that America is run and owned by Corporations. More of this type of cheating should happen to the mostly the idiot Republican Voters, that have bullets for brains.

    December 10, 2011 at 01:08 | Report abuse | Reply
  13. OrangeW3dge

    Yeah but you don't want Obamacare either

    December 10, 2011 at 05:23 | Report abuse | Reply
  14. ncmd

    This is what happens when FOR PROFIT businesses make decisions about what is best for Them. Medicare is much easier and more reasonable to negotiate patient care with than most of the other companies. I wish I could buy it instead of my coverage. My favorite trick of insurance companies is when they tell the patient that the doctor has to pre-approve a medication and then they put my nurse on hold for 45 min. We finally got so frustrated with certain companies that we asked the patient to come in and sit on hold until the nurse is actually needed. As a primary care physician I vote for universal health care.

    December 10, 2011 at 08:17 | Report abuse | Reply
    • Joni

      I am disabled – I have medicare – Because my husband is employed, Blue Cross must be my first payer- However, since Blue Cross refused to make payment . Medicare was unable to pay. Which left me responsible for Co-pays and deductabiles . Can you imagine I have been a patient on hold for a year . It's been a nightmare.

      December 10, 2011 at 10:43 | Report abuse |
  15. Marcus14006

    Question: WHY do we voters consistently re-elect pro-business reps when all they do is vote AGAINST the interests of the (common) man?

    December 10, 2011 at 09:49 | Report abuse | Reply
    • tacc2

      Because that's who the TV tells us to vote for.

      December 12, 2011 at 10:20 | Report abuse |
  16. worried-in-florida

    They never named the woman's "rare disease"? Was it Sarcoidosis? Sounded like it and it is treated by IVIG: Infusions of immunoglobulin. Sarcoidosis is an inflamitory disease not autoimmune.

    December 10, 2011 at 09:50 | Report abuse | Reply
    • Joni

      The name of my autoimmune disease is sysyemic sclorsis – also known as internal scleroderma. Thank you all so much for your interest. I am hoping my story will educate others on the ongoing problems with our health ins companies. The companies that we pay outrageous fee's to every month so we are protected

      December 10, 2011 at 10:37 | Report abuse |
  17. Alberto Florez

    Most of the times we think of health insurance as a "good life" insurance. But it does not protect you from becoming sick, it only protects your wallet and of course "sometimes" give you a sense of protection for being admitted or approved to a heath care treatment.
    We must have to protect our health, not theirs. Tey (the insurance companies) are doing what they know best: managing your money and keeping it in their pockets, not yours. The most important thing to do is to never get sick. It seems impossible but it is possible. Learn more how to prevent and protect yourself from diseases. Big Pharma companies want you to be sick. We have to fight in reversal. We have to keep diseases away and keep you off from doctors and hospitals, and drugs.
    You or we have to keep our inmune system strong. The best natural (not drugs) supplements are TRANSFER FACTORS. Learn about them and do what I am doing 4 years back with great success: not even a single drug pill, only these supplements I am 65.
    Best luck and merry chritsmas

    December 10, 2011 at 10:04 | Report abuse | Reply
    • D

      Sorry, but you are delusional.

      December 10, 2011 at 14:10 | Report abuse |
    • c s

      Linus Pauling, a two time Nobel prize winner wrote a book about nutrition and health. It was called "How to live longer and feel better". In this book, he explains why everyone should be taking nutritional supplements and the amount that he took. Read it for yourself and see if it changes your ideas about health.

      Linus Pauling discovered the cause of sickle cell anemia and was one the greatest American that most people has never heard about. His efforts to ban the testing of nuclear weapons has saved the lives of thousands of Americans. Do you know which country where the most nuclear bombs have been exploded? It was the US. Over a thousand nuclear bombs have been exploded in the US before above ground testing was finally halted. Millions of Americans have been exposed to nuclear fallout from these tests and thousands have died from it. There is no safe level of radiation. Any exposure to radiation increases your chances of getting cancer.

      December 12, 2011 at 18:21 | Report abuse |
  18. Alberto Florez

    Joni, with your advise I found and certify what you said. Scleroderma is an autoimmune disease.
    If you read what I wrote before about Transfer Factor, I think you did not heard or became aware of them. Doctors do not know or if they know do not (normally) recommend natural products but drugs and even worse if these help, alleviate or win your battle against deseases.
    Transfer Factors are natural, tiny messenger molecules, which MODULATES your inmune system, giving it intelligence and power. Transfer Factor are the best inmune modulators, no side effects, no overdosis reaction, no interaction with medication. They are in fact a marvelous natural products. In particular its function against inmune deseases is simply great and of course against allergies (over reaction of the inmune system). Thousands of scientific studies and testimonies are available all over the world
    If interested send me a mail to aflorezgr@gmail.com . I will be more than happpy to help. Best regards

    December 10, 2011 at 12:14 | Report abuse | Reply
    • Joni

      Can u tell me how u became involved with" Transfer Factors" ? I have never heard of them Please enlighten us more.

      December 10, 2011 at 12:43 | Report abuse |
    • ncmd

      Transfer factors are concentrated bovine colostrum... otherwise known as dried cows milk. What overpriced crap, go to med school if you want to be a doctor.

      December 11, 2011 at 00:08 | Report abuse |
    • Alberto Florez

      ncmd:
      What you said about Transfer Factors are concentrated bovine colostrum... otherwise known as dried cows milk, is totally wrong !! Cow colostrum may be dried, but not "concentrated". Dired cow colostrum enhances your inmnue system 23%. Transfer Factors do it "better": 437% Does it mean something to you?
      Transfer Factors are EXTRACTED or FILTRATED from cow colostrum AND egg yolk also, following a biotech process. Please learn first and write later
      Regarding your last sentence "go to med school if you want to be a doctor", I DO NOT want to be a doctor. I only want to help you and some others to STAY AWAY from doctors and Big PHarma,. The present healt care situation is just because there are doctors following ORDERS from clinics, hospitals and pharma companies to "enhance" sickness and deseases, not to prevent them. And Transfer Factors do this extremely well regarding prevention AND helping your body to overcome most of current deseases.

      December 11, 2011 at 10:00 | Report abuse |
    • Granny

      Alberto, I totally agree with you. I am 64 & take only supplements to keep myself healthy. Young people don't understand that before Big Pharma that people used herbs to take care of themselves. I started using supplements when almost every Big Pharma drug that my Dr. wanted to prescribe had a chance of damaging my liver or some other part of my body.

      December 12, 2011 at 11:59 | Report abuse |
    • Anonymous

      Alberto,

      Don't let rude and ignorant people shoot you down with their comments. thanks for trying to help people; it's their problem if they don't listen.

      December 12, 2011 at 17:01 | Report abuse |
  19. MDPAY

    Support Obama's Affordable Care Act, then. Protect your right to live by kicking out the Tea Party/Republican efforts to get rid of them.

    December 10, 2011 at 15:03 | Report abuse | Reply
    • Wayne A.

      Sure, it's easier to lash indiscriminately, but we all need to take more charge of our own health.....wait until the new health care hits fully home.

      December 12, 2011 at 15:51 | Report abuse |
    • Wayne A.

      Obama's health Care is a system with tennacles reaching into every area of health care with dictatoral control on every move.

      December 12, 2011 at 15:55 | Report abuse |
  20. stormy

    Insurance isnt the core of the problem here, as much as I agree with the article and the comments.

    The core issue is greedy doctors and hospitals. Insurance and the public should not be paying millions of dollars for treatments that can be done in the UK, south africa or India for 1/10 the cost with the same level of skilled doctors and technology. The fact is, insurance is fighting a losing battle.....how can you expect any company to manage an income steam of thousands in but hundreds of thousands going out to these greedy doctors and hospitals who have inflated salaries and expenses and costs inflating 9% a year????? Doctors make 5 times the average American salary. And hospital managers get gigantic bonuses and rake in billions from medicare scams. The whole system is another Wall Street meltdown and house of cards fixing to crash. As soon as medicare costs are reduced and regulated next few years you will see doctors scrambling for income. They can only drain the elderly so much before the money dries up and we are going to see, like the housing situation, huge deflation in salaries, their educational costs, and hospital costs. Its only a matter of time before the raping of Americans and their health by insurance and doctords and hospitals comes to a bloody end! Go Obama 2012....i say lets regulate the whole damn thing, then nuke it from space......its the only way to be sure. 🙂

    December 10, 2011 at 18:23 | Report abuse | Reply
    • B

      I think you have your information wrong!
      Doctors are not the problem. They are workers like anybody else and they get paid for what they do. Don't criticise them because they make more than the average income. They deserve too! They have gone to school for longer than the average citizen and by that they have acquired a very high student debt. They work many more hours than the average person..their schedule isn't 9-5! They're working around the clock. They operate like a small business. They have an office to run..pay for the MOA, rent, medical equipment and supplies etc etc. Not to forget liability insurance. They carry many risks. Lastly, they are there to help..the majority of them advocate for the patient!
      Now, I agree that hospitals are partly to blame..because some are private and for profit. But again it's not their fault..the gov and the health care system has allowed them to be so. Hospitals should never be private!!!!!!!!!!!
      The problem is the whole health care system at large. The gov or the dr isn't the in the driver seat..it's the insurance companies!!! Insurance companies should not be involved in health care...only for extended health ex dental, physio, etc.

      As a Canadian, after reading this article...I thank God for our health care system! Our patients dont' see a bill!! I can't imagine how stressful this must be.

      Sooo American's should vote for univeral health care!!!!!!!!!!!

      December 10, 2011 at 20:06 | Report abuse |
    • Granny

      Stormy keep drinking the Obama Cool-aid, obviously you are incapable of making a decision on your own and you feel that the rest of us owe you something. Gimme, gimme, gimme...

      December 12, 2011 at 12:04 | Report abuse |
  21. Joni

    Battling an illness while battling your ins company is so stressful – The bonus given to the CEO'S at these companies are out of control. Employees also get bonus's for denying claims – employees that have no idea what they are talking about – have your life in their hands .

    December 10, 2011 at 20:36 | Report abuse | Reply
  22. Dizzyd

    Dental is the worst! They hardly pay anything. I haven't been able to go 'cuz not able to pay and had a VERY bad experience as a teen. But I have to go, so I hope the ins. co. won't fight me on this. (I plan on being sedated-even if I do it myself).

    December 11, 2011 at 00:29 | Report abuse | Reply
  23. Dizzyd

    I got a diploma in medical billing, so I know ins. cos. look for 'medical necessity' regarding treatments.

    December 11, 2011 at 00:38 | Report abuse | Reply
  24. Laura

    Wouldn't this qualify as a "death panel" decision?

    December 11, 2011 at 01:18 | Report abuse | Reply
    • CM

      What are you, a communist? Death panels are ONLY something a government would do. This is just good old American capitalism! So a few eggs/people get broken on the path to record dividends... it's all for the greater golden calf of profit!

      December 11, 2011 at 19:26 | Report abuse |
  25. sue

    What you're doing is called spamming. People hate spam. Sell your snakeoil elsewhere.

    December 11, 2011 at 03:39 | Report abuse | Reply
  26. Joe citizen abroad

    There's hope. Now (literally just became effective last week) under the new healthcare act, health insurance companies must spend at least 80% of their revenue providing actual medical care for patients (not on overhead or investments). The ones who don't will be forced out of the health insurance business. It's the law. Don't let the republicans repeal it.

    December 11, 2011 at 10:06 | Report abuse | Reply
    • SuZieCoyote

      It will be one of the pugs first prioirities, should they ascend, to repeal anything and everything related to consumer protections in any industry.

      December 12, 2011 at 12:36 | Report abuse |
  27. Alberto Florez

    Joni, I agree with you, having our health or life in THEIR hands is terrible. What I mean is to fight this corrupt system is a huge task, most of the time out of our capabilities. Of course in your situation YOU HAVE TO FIGHT. But on the other hand you must keep yourself healthy and my sincere recommendation to try was already done. Regards

    December 11, 2011 at 10:08 | Report abuse | Reply
  28. Joni

    If we do nothing, it will be allowed to continue – My health will come first – but the fight for what's right will continue .
    thank you

    December 11, 2011 at 16:34 | Report abuse | Reply
  29. CM

    Thank God we have the GOP to keep up the fight against a public option and ensure that the insurance industry is in control of our nation's for-profit health care system!

    December 11, 2011 at 19:25 | Report abuse | Reply
  30. Lizard Lance

    Anyone who thinks the current healthcare system of the US is acceptable may as well expect to live in eternity at the side of Satan. The insurance industry is flawed at several levels but is allowed to operate as it wishes because of the republican politicians who think every corporation is run by saints. The sooner we go to a nationalized health care program the better off all of us will be!

    December 12, 2011 at 06:17 | Report abuse | Reply
  31. SoulCatcher

    Had the same happen to me after having a baby. Finally had to pay out of my own pocket. In my opinion the hospital tried to pull a fast one on the insurance company, but I got stuck with the bill.

    December 12, 2011 at 10:47 | Report abuse | Reply
  32. Tex71

    The way American insurance companies write, rewrite, and manipulate the law in order to more effectively screw their customers is beyond nauseating. The best thing that could be done to make America a better place would be to summarily hang every insurance executive, draw and quarter every insurance lobbyist, and immediately go to universal health care like every other developed nation on the planet.

    December 12, 2011 at 10:51 | Report abuse | Reply
  33. SuZieCoyote

    "It’s worth saying, not all insurance denials are unreasonable." Ummmm....yes, they are. They are in business to take premiums, not to pay claims. This maximizes shareholder value. It's the American way.

    December 12, 2011 at 12:33 | Report abuse | Reply
  34. Kurt Wiberley

    Look at what the insurance companies heavily invest in; fast food restaurants and tobacco which sustain their business and control. It is time to get these businesses out of the healthcare business, and put the control into the docs and their patients.

    December 12, 2011 at 12:54 | Report abuse | Reply
  35. Voltairine

    "The bad news came in 2010, when Gagliardi learned that her insurance company, Highmark Blue Shield of Pennsylvania, which had previously approved the expensive treatments, had reversed itself. The denial was retroactive, leaving Gagliardi liable for $1.2 million or approximately $50,000 for each infusion": There is no "legitimate" business that is more EVIL than health "care" insurance companies; having them in charge of whether or not we get the healthcare we need is like leaving a pack of Vampires to watch all of the newborn babies in hospitals.

    December 12, 2011 at 13:27 | Report abuse | Reply
    • Joan

      Can u imagine the feeling, after 2 yrs of receiving explaination of benefits showing the amount owed to provider is zero. Then receiving a duplicate sent of the same – showing the full amount is owed ! These treatments r every 4 weeks , for 19 months. – surly they knew @ 57,000 a month they knew they weren't paying early on and should have told me. They wanted me to go away and didn't care how that happened .

      December 13, 2011 at 22:10 | Report abuse |
  36. Avser Bastian

    NOT LIABILITIES OR DISCRIMINATION, BUT INSTEAD ASSASSINATIONS !!! http://myshortbiography.blogspot.com/ LEARN TRUTH ABOUT EQUAL EMPLOYMENT OPPORTUNITY COMMISSION, UNITED NATIONS, AMNESTY INTERNATIONAL AS WELL AS NEW WORLD ORDER(MULTICULTURALISM = TERRORISM) GOVERNMENTS !!! NOT THERE TO PROTECT YOUR RIGHTS, BUT TO DENY YOUR RIGHT TO EXISTENCE !!! 66 YEARS OF GENOCIDE AGAINST WHITES WORLDWIDE IS NO LONGER ACCEPTABLE !!! STOP THE ANIMAL APARTHEID NOW !!!

    NOT LIABILITIES OR DISCRIMINATION, BUT INSTEAD ASSASSINATIONS !!! http://myshortbiography.blogspot.com/ LEARN TRUTH ABOUT EQUAL EMPLOYMENT OPPORTUNITY COMMISSION, UNITED NATIONS, AMNESTY INTERNATIONAL AS WELL AS NEW WORLD ORDER(MULTICULTURALISM = TERRORISM) GOVERNMENTS !!! NOT THERE TO PROTECT YOUR RIGHTS, BUT TO DENY YOUR RIGHT TO EXISTENCE !!! 66 YEARS OF GENOCIDE AGAINST WHITES WORLDWIDE IS NO LONGER ACCEPTABLE !!! STOP THE ANIMAL APARTHEID NOW !!!

    December 12, 2011 at 13:53 | Report abuse | Reply
  37. BGL

    This is what happens when a human need is turned into a-for-profit-business. If insurance companies don't want to pay these simply 'reverse' their decisions AND its all legal. EVERYBODY is going to get sick at some point in their lives. But from the sounds of it if you aren't a millionaire you are going to die a long painful death. And even from the grave will still owe millions depending on what killed you.

    December 12, 2011 at 15:28 | Report abuse | Reply
  38. michael smith

    If America had a Health Care System that WORKED, people wouldn't need to become subject matter experts on how to defend themselves against such claims or reversals. America is just pathetic. What a pathetic country. Even more pathetic is the fact that American's have allowed this to happen.

    PATHETIC.

    December 12, 2011 at 15:35 | Report abuse | Reply
    • Wayne A.

      Americans have generally speaking allowed themselves to be so out of condition and out of good health that I shudder to think of covering the costs for them.

      December 12, 2011 at 16:03 | Report abuse |
  39. Wayne A.

    Good for you Alberto.

    December 12, 2011 at 15:48 | Report abuse | Reply
  40. Truth Seeker

    America's health care system is completely broken and has priced itself out of the market.

    1) Medical care is insanely overpriced, largely because the providers and Big Pharma know that deep pocketed insurance companies or "the government" (somebody else) will pick up the tab

    2) The health insurance companies are experts at denying coverage and fighting you in court if necessary to protect their profits

    None of these problems existed in America prior to the mid-1960's when we truly enjoyed the world's best medical care. Was it free? NO! But the costs were relatively reasonable because the insurance companies were not a big part of the equation. Most medical services were paid out of pocket and/or pre-negotiated with the Medical providers.

    Solution: Opt OUT of the current insane system !!

    Instead of paying the equivalent of a monthly house payment to an insurer that does everything they can to deny coverage and break their contract, try this instead:

    1) save the equivalent of whatever a monthly health insurance payment would have cost by paying instead into your own medical insurance fund (and invest it very wisely).

    2) bargain hard with medical providers for all cash payments, you would be amazed at how the price drops for everything.

    3) When necessary, pay out of your own pocket (from your self-directed medical fund) and watch your savings grow into HUGE money over time. In essence, you become your own insurance company. Some may want to buy a high deductible 'catastrophic' policy to cover them until their self-directed health savings account has grown large enough to cancel ALL medical insurance. At current astronomical prices (that won't take but a few years).

    When we take responsibility for our own health and the costs associated with that, we go back to the best, proven, honest system that truly works! This is far better than any bureaucracy-based, socialistic health care scheme that will ultimately only ration care to it's captive participants while costing society many times more than it should.

    December 12, 2011 at 16:47 | Report abuse | Reply
  41. Mike P

    Goodness, I wonder if anybody noticed the price tag on keeping that woman alive: Over half a million dollars a year? For ONE person? It's amazing health insurance companies are in business at all with that kind of risk hanging over their heads. And it's equally amazing that people think that if we go to a public-run health insurance system, our government won't either (1) go broke helping people like her or (2) deny service to people like her. There is not an infinite amount of money in the world, people!

    December 12, 2011 at 17:17 | Report abuse | Reply
    • Joan

      Thanks for your support, stay well

      December 13, 2011 at 22:12 | Report abuse |
  42. airlea

    Has anyone ever seen The Incredibles?

    December 12, 2011 at 18:25 | Report abuse | Reply
  43. PEOPLE UNITE AGAINST HIGH INSURANCE COSTS

    WE BUILD, FIGHT, & PROTECT OUR COUNTRY, & WE GET NO RESPECT BACK, ENOUGH!

    December 12, 2011 at 23:46 | Report abuse | Reply
    • Alberto Florez

      Unite against the lie from the Big Pharma, against the sickness, not only against costs. Unite to keep us healthy

      December 13, 2011 at 00:40 | Report abuse |
  44. Michele

    As a Biller/collector for a major hospital chain, I need to correct a fairly massive error in this article. Preaprovals and precertifications are *not* guarrantees of payment. Call and listed to any insurance pre-auth line and there is a pre-recorded message saying just that. All approvals are tentative and can be disallowed based upon discovery of pre-existing information, fraud, medical necesity, etc.

    Never *never* assume a claim will be paid just because it is preapproved.

    December 13, 2011 at 10:16 | Report abuse | Reply
    • Joan

      What other industry would be allowed to do business like this? If a claim is not going to be paid, the member should be notified In a reasonable amount of time – 30-60 days. Not to give a patient whom is battling an illness, a false sense of security and , only to find out that they have run up over a million dollars in debt after two yrs. Perhaps, the decision should be up to the patient, doctor and hospital to possibly try alternative treatment, contact the drug company or try other arrangements. Any other business operating in this fashion would be reported for fraud.

      December 13, 2011 at 22:02 | Report abuse |
  45. healthscares

    My fathers insurance company actually told him his cancer didn't exist... He was diagnosed with a very rare form of cancer and based on the health companies statistics the numbers where so low that they told him it didn't exist. We ended up hiring a health advocate from a company called LifeQB and they fought the insurance company for us. I know nothing about healthcare so I couldn't handle doing it myself but hiring an advocate actually worked really well for us. If someone is in a similar situation they should look into it. http://www.LifeQB.com

    December 14, 2011 at 16:59 | Report abuse | Reply
  46. Joni

    Can u beleive that I was told today by the legal counsel @ Blue Cross – That coverage would be "reviewed" every 6 months to determine necessity – I don't know how this is allowed – So I guess I live my life in 6 month invervals – Nice to know –

    December 15, 2011 at 16:09 | Report abuse | Reply
  47. Nora Johnson

    Insurance companies sign contracts with providers that contain clauses regarding 'timely filing limits' and bill auditing time limits. Usually, but not always, these limits span 12 months to 18 months from the bill's date of service. The insured member could be protected by their ins. company's contract with the hospital or provider.

    These are some of the reasons why health care insurance just doesn't work without government supervision. When profit is the bottom line for health care at any cost, do you expect that ethics would inhibit profit? REALLY?

    December 28, 2011 at 14:55 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.