Woman's Face Ripped off by Bear - Blue Cross Waffles on Coverage

Allena Hansen is the woman's name. This is from Bob Cesca's Blog & also posted on Huffington Post.

Hang onto something while you read this one.

Last summer, while working on my ranch in the Southern Sierra mountains, I was attacked and badly mauled by a predatory black bear. Although my face was ripped off, and I was blinded, I was able to make my way back to my vehicle and drive myself down a rutted mountain road to a fire station for help. From there I was airlifted to UCLA Medical Center where a team of nearly a hundred people put me back together in a grueling seven-hour emergency surgery.

That was the easy part...

Although I’ve maintained a private individual health insurance policy with Blue Cross of California for thirty (30) years, they have, at every turn of my ordeal, tried to waffle, obfuscate, or outright deny me benefits for medical care. Because my injuries were mostly to my eyes, my facial structure (including my nose and most of my teeth,) and obviously, cosmetic appearance, my policy “does not cover services,” for putting me back together, and demands 30% co-pays before they will pay for the hugely expensive ($300,000 and counting,) reconstructive surgeries I need to regain a degree of functionality.

I am, not surprisingly, disabled and unable to work. My assets and savings were exhausted long ago, (their deductable and co-pays reset every calendar year and my reassembly is a multi-year project.)

-----

Adding... Allena just wrote back to me to say: "Stephen Colbert has been warning us for years, but did we listen???.."

http://www.bobcesca.com/blog-archives/2009/06/health_insuranc_2.html

I always thought having a "good" insurance policy was not only my civic responsibility, but would cover my medical expenses should I ever face a catastrophic illness. But it turns out that Blue Cross's $2,500 deductable is actually more in the order of an $11,500 deductable before they kick in for 100% of what they deem "reasonable and customary" care. Even that determination is subjective and skewered in their favor.

In other words, evil.

A friend of mine was dicked around for almost two years on surgery to reduce the pressure in her brain. Three times she was in the hospital when they revoked authorization. They paid fines when the State of California ordered them to perform it - and did nothing. Once they even sent one of their doctors to check her out of the hospital just before surgery.

By the time she got the surgery, the pressure had crushed her optic nerves. She's doing far better now - but she also lost 85% of her vision due to Blue Cross's actions. (and yes, she's suing them)

As I said, It's Blue Cross of California. AKA evil.

At least all the companies I've used do.

In other words--how much it will impact THEIR bottom line.
She needs an attorney to explain that intact skin is a barrier to life-threatening infections. It is a wound. It is NOT a misshapen nose that she does not like--at this point, I am pretty certain she would be happy to have a FUNCTIONING nose.
I hate these bloodsuckers. I truly truly do.

are more than capable of deciding on what care to provide and then providing the best possible coverage because of the fierce competition.

Keep going.


Farther.


You're almost there.




:sarcasm:

K&R! This should happen to no one.

They were blood-sucking assholes and proponents of murder by neglect.

Working for them convinced me we needed socialized medicine. I know too much about medical insurance to not advocate for their legislative death penalty.

He already had a face and sight.

If you believe insurance companies are ever going to protect your interests, you are part of the problem.

Glad this deluded person learned the truth. Sorry the lesson was so costly.

:dem:

-Laelth

I blame her for her faith in insurance companies. She has learned not to trust them now.

FYI, I felt your response was unnecessary, too.

Have a nice day.

:dem:

-Laelth

:puke:

Your mother trained you well.

:dem:

-Laelth

I don't believe insurance companies ever act in my interest. I also realize that they keep battalions of accountants and lawyers employed to look for ways to avoid paying up.
That said, I don't view people who have never had a major claim picked apart and not paid as deluded because everything about the policy leads them to believe that catastrophic injuries will be covered beyond the deductible. Catastrophic events are when we need insurance the most and have the least ability to put up with the insurance company shenanigans and they know it and count on it.

You are wiser than she. Not enough people have seen Sicko. Too many people think, "Hey, I've got insurance, so screw the 60 million Americans who don't. I don't want to pay for their health care." If these same people realized their "insurance" was basically worthless, they would be more likely to support real reform.

Thanks for your oh-so-pleasant reply.

:dem:

-Laelth

of medical malpractice and from a family of medical professionals -- hardly someone who would easily be deluded by insurers. If this person thinks that it should cover little niceties like pharmaceuticals to maintain her diminished sight and pay more than 70% of the cost of reconstructive surgery how on earth would one expect people with less knowledge to understand that insurance is never as good as it seems in the policy booklet?

I agree with you that more people need to realize just how badly the current system provides for health care financing. I just disagree with your characterization that they're deluded, which connotes that they are responsible for the delusion -- it's more accurate to state that they have been deluded by the con artists formally known as health insurance providers.

illness live in fear of what we'll find when we do. We're not trusting, just waiting for our time, when the reality of the lack of coverage is made real.

this is medically necessary cosmetic surgery, they will claim it is'nt necessary but they don't have a valid argument.

Yes, she looks better cosmetically in the second photo - but I'm wondering if the insurer wasn't within its rights. If she had reasonable function (could eat, breathe, speak) in the first photo condition, then surgery to bring her up to "cosmetically pretty again" is NOT medically necessary, and she should expect to pay significantly more out of pocket for that than, for example, a surgery to make her able to eat/breathe/speak.

I believe it is the insurance company's responsibility to pay for all costs resulting from her injury.

Just to bring up an example, I would offer this. I am a breast cancer survivor. Insurance is required by law to cover all costs related to any disfigurement caused by the disease. I had a mastectomy with immediate reconstruction.

The reconstruction failed, and there was a second surgery a few weeks later to remove the implant. A third surgery was performed a couple years later to clean up the aftermath of the previous two operations. It was not medically necessary.

After all of the above, if I chose to have more corrective surgery (which I could actually use), or a second go at reconstruction to make myself "cosmetically pretty again", my insurance company would have to pay for it.

No one would look that good less than a year after an attack of that severity. Her forehead was ripped off and her teeth yanked out of her jaw.
The argument is over reconstructive surgery and treatments designed to preserve what little eyesight she has left.

The face is our calling card to the world; it is how we present ourselves to others, as well as how they perceive us. A serious disfigurement often causes severe depression. Depression is the number one cause of suicide in the U.S. and someone takes their life every 15 minutes. It is absolutely necessary and medically indicated that these people have reconstructive surgery.

I lost my star last month.

At the bottom of the thread, I have a whole shit-load of ads for Blue Cross!

losing everything. It's insane.

thand these evil penny sucking scum who deny claims and medical procedures because of the quarter to quarter bottom line of the insurance comapnies.

We have virtually no control over private companies. This makes a big difference to me.

:dem:

-Laelth

Health Reform simply CANNOT come fast enough. Greedy fuckers.

no questions asked?

See, this is my question about a National Health Care option, is that every other week or so we get some crazy, crazy story like this one from someone and everyone rallies around how horrible the insurance companies are and that we need a National option, but realistically even a government run health care system isn't going to just pay all of this ladies medical bills no matter what the cause or the cost, right?

Also, it sounds like there is some confusion about the Deductible and the 30% coinsurance (co-pays) that she has to pay. You pay out of pocket the entire cost of the deductible and then you are responsible for a certain percentage of each visit after the deductible is taken care of. She's probably always had a 30% coinsurance that has taken effect and she's probably used it many times but it's nothing new that she should be surprised about.

I'm all for health care reform as much as anyone. I know there are major, major problems with the health care system in many different aspects, but come on, realistically this lady would be SOL no matter what the insurance company or health care plan was.

Hope they get every bit that's coming to em, and then some.