Insurance casualty of the day

http://www.guaranteedhealthcare.org/blog/colette-washington-cna-nnoc/2008/09/04/gavin-krusee-portland-or-090408

"My 15-month-old son Gavin was recently denied by Pacific Source insurance in Oregon due to the fact that he has recently gotten ear tubes – of all things," Nixie Krusee of Portland, Ore., writes.

"He has been fighting ear infections for the past eight months and by doctor's recommendations he had ear tubes placed in both ears. His ears are now fine, no more endless up-all-nighters, chronic pain, and antibiotics every three weeks. Everything has completely cleared up – except he was denied health insurance now because of his tubes. I thought this procedure was very common?

We need universal health care now!

My son had them put in when he was 6. It didn't work so he had his tonsils and adenoids removed and that worked fine. My son is now 23.

in a psychiatrist and psychologists medical practice in charge of the billing department. Just this week I had one worker's comp claim denied despite the order by the judge for the insurance company to pay our bill as the depression was work/injury related (injury occurred in 1996 - the insurance carrier and the company have fought it for over a damn decade).

The insurance company actually told me they were "waiting to determine if the depression was actually related to the dismemberment of her arm or maybe she was already depressed before the accident." Honest to god - they couldn't imagine anyone getting all down and blue over losing an arm. WTF? We'll eventually get our money and I realize this isn't the same thing as a medical claim for treatment but if this country doesn't get its health care crisis sorted out 46 million without health care will just be a drop in the bucket in the next four years.

WC claims cannot be "denied". They responsible party is the workers comp insurance company. What provider network they use they have to pay all medical costs. If they are actually denying the claim they are inviting a lawsuit.

Is that a kid who has tubes is more likely to need tonsils out in the future. Oh, good grief.

I HATE insurance companies!


Really, I hope you will be able to have him insured until we get some Universal Health care!

Good grief.

Most HMOs want anti-biotics tried endlessly because those prescriptions are cheaper than the tubes. Even if the PCP gave the recommendation to see an ENT specialist, and even if the specialist is on the plan ans says "yep, tubes are the way to go", you still need a pre-approval from the HMO. Without this, you're on the hook for the charges.

IIRC, if this is done at an outpatient center, it's about $3,500 -$5,000.