There you go conservatives: Obamacare is failing

Sometimes people get lucky and deal with legitimate honest business people who treat them right.

A lady in California named Edie Sundby had the misfortune of a diagnosis of stage-4 gallbladder cancer almost 7 years ago.

But she had the foresight, . . . or, perhaps, good fortune of having a United Healthcare PPO (preferred provider organization) health-insurance policy. As she writes:
"Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers."

Now the bad luck, Congress passed the Affordable Care Act and, " . . . in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October."
[n.b. United Healtcare is not canceling Ms. Sundby's policy because she is expensive; they are canceling all California policies because of Obamacare.]

So she can no longer keep her health care plan nor keep the team of doctors which have kept her alive.

For details: You Also Can't Keep Your Doctors


However, she does have the good fortune of having Senator Barbara Boxer in her corner. Why, right there on Senator Boxer's "Health Care Reform Resources" it still states: "If you like the health insurance you have, you can keep it."
Ref: www.boxer.senate

Is this going to be another one of those stories that turns out to be BS - like the other Lady from california thats getting a better plan for less money now? New Insurance is better and cheaper despite woman's claims to the oppositte.

Well, lets give it a few days and find out. I certainly hope she gets the care she needs.

Don Diego is very right about one thing. In the old system one could get "lucky" and get an ethical provider. I would opine that a system where providers are mandated to be ethical is better. I dont like to leave my healthcare to luck. but thats just me.

The ACA now makes it illegal for health insurance companies to engage in Recission (the practice by which all the major health insurers removed sick people from their policies based upon that fact). And Don Diego might be floored to learn the ethical, stand-up, do-gooder company he mentioned had a history of engaging in it. Should we thank Barbara Boxer? Yes. Thank you, very much
https://www.politico.com/news/stories/0410/36496.html

Oh, and since we're now measuring the collective quality of healthcare by anecdotes....then how about this one under Boehner-care?

https://www.dailyfinance.com/2009/09/02/think-youve-got-health-insurance-better-double-check-and-be/

"Karen Knee's insurance problems began with her 2005 New Year's resolution: addressing her nagging health concerns. First on her list was to get those little benign cysts on her scalp removed. Blue Cross pre-approved the procedure, and it went off without a hitch -- at first.

But then the insurer retroactively canceled her policy, claiming that Knee (at right), of Orange County, Calif., had failed to disclose a pre-existing condition, and saddled her with a $30,000 medical bill.
Knee was stunned. Four years earlier, she had applied for coverage online and included everything she could recall about her health history -- doctors' names, prescriptions taken, the test results of her latest pap smear. She never thought to mention that her back sometimes felt sore after playing soccer, or that she had once taken pain pills after a muscle spasm. "You think of a pre-existing condition as diabetes or cancer treatment, not a onetime little back spasm," she says. "I played soccer three days a week and was always being knocked down. Yes, my back was sore, but so were my knees and ankles. Big deal."

In fact, it was a big deal. After scouring her medical records, Blue Cross cited Knee's occasional sore back as justification to rescind her insurance coverage. "

Well, DonDiego'd suggest this woman has a legal claim against Blue Cross.
Luckily, pjstrohs reference indicates that's what was going on: "( Blue Cross says it does not comment on individual incidents in litigation.)"

DonDiego hopes things turned out well.

So now correlation = causation? I guess DonDiego is...flexible when it comes to that stuff.

And Ms. Sunby's main complaint: She can no longer find a policy that has both UCSD AND Stanford Medical Center as providers. Business decisions made by insurance companies and hospitals are making her choose.

And did you notice there is no mention of the cost of the marketplace policy? So maybe the zombie lie that Obamacare is unaffordable is finally dying out.

Prior to obamacare these plans were in existence. Now that obamacare is in effect plans are being cancelled by the millions. forky believes that 1+1 does not equal 2 in this case.

Just received my coverage info today. 9% increase in the premium, so much for obama's promised coverage decrease

Hmm, pjstroh finds a $30,000 expense, which was in litigation when the story was written, trumps Ms. Sundby having to choose which of the doctors who are keeping her alive she will retain.
[DonDiego has already wished Ms. Sundby the best in her suit against Blue Cross. If the insurer's decision was, in fact, unethical and illegal, that is how things should be settled.
And DonDiego trusts the participating insurers within Obamacare will undoubtedly be more ethical.]

And forkushV suggests it may just be coincidental that United Healthcare is withdrawing from the California market immediately before the implementation of the ACA, . . . probably like the coincidental departure of Aetna a few weeks earlier.
Others may disagree:
"Sabrina Corlette -- a research professor at Georgetown University's Center on Health Insurance Reforms -- said Aetna and UnitedHealth 'have made the calculation that it required too much of an investment to change their strategy' under ACA implementation."
Ref: California Healthline

[The originally referenced article did mention that the only way Ms. Sundby can retain her doctors would be more expensive and not include her current benefits:
"My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits."
But, as Secretary Clinton once said: "What does it matter ? ? ?". More expensive, . . . losing her doctors, . . . phooey! What is important is she'll be on Obamacare.]


DonDiego is saddened indeed, that pjstroh and forkushV have no sympathy for Ms. Sundby's plight.

I tend to judge the overall effectiveness of a system by its collective quality, access, and cost. If Don Diego would rather ignore all of that and resort to anecdotal stories ....well then I can do that too. There's over 40 years of stories of insurers putting profits in front of patients prior to the ACA. And they're all just one google search away


Like this one...of a company that acually gave claims handlers a bonus for purging sick people from coverage...
https://www.latimes.com/business/la-fi-insure9nov09,0,4409342.story#axzz2jsXsld5b

And since Don Diego is focused on the state of California...here is a compilation of horrifying recission cases prior to the ACA just in a 2 year period.
https://www.latimes.com/business/la-fi-healthinsure-sg,0,6012230.storygallery#axzz2jsXsld5b

Simply noting that you are once again telling me what I think. I dont mind. But I know you do when people engage you this way...

Just trying to help your integrity.

Obamacare does very little to correct the games insurance companies play. While they may no longer be able to claim pre-existing conditions as a reason not to pay a claim they have many other reasons such as: out of network, charges that weren't reasonable and customary , failure to get prior authorization and experimental treatment. I have experienced denial of claims for all of these over the course of my lifetime.

My favorite was when the Insurance company refused to pay for my $900 a month prescription because they said my treatment was "experimental". So I looked it up and discovered my experimental treatment was the standard treatment for the last twenty years. You see these definitions are left up the insurance companies to define and they don't have to come close to what reality actually is.