Insurer agrees to pay medical bills after Twitter showdown

[lpast]

If you can post bad things companies do, then you should post good things they do also. Of course this is just one person they are helping out of many many in the same plight as this guy but its still noteworthy.


Guha, an Arizona State University student who is battling stage 4 colon cancer, used the social-media website Twitter to debate with the CEO of his insurance company and received an unexpected payoff: a guarantee that the insurer would pick up all of his outstanding medical bills.
"Frankly, I'm stunned, overwhelmed and probably a little confused, too," said Guha, a doctoral student at ASU's School of Sustainability.
After multiple surgeries and costly chemotherapy sessions, the 31-year-old Phoenix man quickly surpassed the $300,000 lifetime limit on his Aetna student-health-insurance plan with another $118,000 in medical bills left unpaid.
Facing the prospect of medical bankruptcy, Guha launched a website, Poop Strong, and sold T-shirts and trinkets to raise money to pay for his costly chemotherapy and other medical bills. He also has used Twitter to rail against what he considers the outsized profits of Aetna and the health-insurance industry.
To his surprise, Aetna CEO Mark T. Bertolini engaged Guha via Twitter and addressed the student's plight. The result? Aetna agreed to pay the student's medical costs despite his policy's maxed-out coverage.

While Guha is happy that his bills will be paid, he doubts that other cancer patients who lack health insurance or have surpassed coverage limits will get the same treatment.



Insurer agrees to pay medical bills after Twitter showdown

 

[francois60]

I have no patience for insurance companies that try to get out of paying legitimate claims, but I'm not sure why someone who bought a plan with a lifetime limit would then complain when the limit was exceeded. Very nice of the insurance company to cover a bill they had no obligation to cover.

 

[Manc Skipper]

Why would a plan HAVE a lifetime limit?

 

[francois60]

To make it cheaper. If the insurance company knows there is a maximum that they'll have to pay, they can charge the customer less.

 

[MaggieD]

If you can post bad things companies do, then you should post good things they do also. Of course this is just one person they are helping out of many many in the same plight as this guy but its still noteworthy.


Guha, an Arizona State University student who is battling stage 4 colon cancer, used the social-media website Twitter to debate with the CEO of his insurance company and received an unexpected payoff: a guarantee that the insurer would pick up all of his outstanding medical bills.
"Frankly, I'm stunned, overwhelmed and probably a little confused, too," said Guha, a doctoral student at ASU's School of Sustainability.
After multiple surgeries and costly chemotherapy sessions, the 31-year-old Phoenix man quickly surpassed the $300,000 lifetime limit on his Aetna student-health-insurance plan with another $118,000 in medical bills left unpaid.
Facing the prospect of medical bankruptcy, Guha launched a website, Poop Strong, and sold T-shirts and trinkets to raise money to pay for his costly chemotherapy and other medical bills. He also has used Twitter to rail against what he considers the outsized profits of Aetna and the health-insurance industry.
To his surprise, Aetna CEO Mark T. Bertolini engaged Guha via Twitter and addressed the student's plight. The result? Aetna agreed to pay the student's medical costs despite his policy's maxed-out coverage.

While Guha is happy that his bills will be paid, he doubts that other cancer patients who lack health insurance or have surpassed coverage limits will get the same treatment.



Insurer agrees to pay medical bills after Twitter showdown

Well, that's "really nice" of the insurance company, but that's probably the law -- right now.

Obamacare prohibits lifetime limits (A cap on the total lifetime benefits you may get from your insurance company) on most benefits in any health plan or insurance policy issued or renewed on or after September 23, 2010. [Maggie note: I know of no health insurance plans that don't renew yearly.] In 2014, Obamacare prohibits new plans and existing group plans from imposing annual dollar limits (a cap on the benefits your insurance company will pay in a year) on the amount of coverage an individual may receive.

 

[hazlnut]

Why would a plan HAVE a lifetime limit?

Because in our modern advanced country, we still have backwards unethical business models.

 

[Aberration]

Because in our modern advanced country, we still have backwards unethical business models.

No, its called math.

 

[Aberration]

Why would a plan HAVE a lifetime limit?

To prevent a small group of those insured from bankrupting the whole pool.

 

[solletica]

To make it cheaper. If the insurance company knows there is a maximum that they'll have to pay, they can charge the customer less.

Insurance companies all have an (unofficial) poicy of repeatedly denying legitimate claims and offering bonuses to staff that do. In fact, for all practical purposes, medical insurance in the US is totally useless because of that fact.

A law needs to be passed that allows patients to sue insurers and force those insurers to pay the legal costs of the suit to the patient when losing.

 

[solletica]

To make it cheaper. If the insurance company knows there is a maximum that they'll have to pay, they can charge the customer less.

That's an oversimplification. One has to add the denial of legitimate claims to the mathematical model.

 

[MaggieD]

Insurance companies all have an (unofficial) poicy of repeatedly denying legitimate claims and offering bonuses to staff that do. In fact, for all practical purposes, medical insurance in the US is totally useless because of that fact.

A law needs to be passed that allows patients to sue insurers and force those insurers to pay the legal costs of the suit to the patient when losing.

Medical insurance in the United States is far from useless. Every state has an insurance regulatory bureau who is more than happy to help unsatisfied customers who think their claims are unjustly denied.

Some consumers are too stupid to know what they're buying. When they see an ad on TV that says, "Health insurance for $25 a month" --- they're just dumb enough to believe it.

 

[francois60]

Insurance companies do try to deny legitimate claims, but mostly they use the same system governments do, having medical professionals analyze claims. The difference is that if a greedy private company denies a claim, it's headline news, but if a benevolent national health service does it, then it's a victory for social justice.

 

[solletica]

Medical insurance in the United States is far from useless. Every state has an insurance regulatory bureau who is more than happy to help unsatisfied customers who think their claims are unjustly denied.

That bureau is typically the state's Dept. of Commerce or some similar organization. And their power is significantly limited in cases where the denials are made in violation of the insurers' policy and law but the legality of that denial isn't immediately obvious, i. e. a policy that claims to cover breast cancer screening that then denies coverage for mammograms done in excess of once every 5 years, or that denies coverage for MRI exams outright (even when such a screening would be medically recommended over a mammogram).

Lawsuits that force the losing party to pay are the only way to enforce the insurance contracts. Without them, the insurance contracts are worthless (as just demonstrated in my example).

Some consumers are too stupid to know what they're buying. When they see an ad on TV that says, "Health insurance for $25 a month" --- they're just dumb enough to believe it.

Frankly, any consumer that bought an insurance policy and expected the insurer to consistently abide by its policy is dumb.

Until insurance company lawsuit reform is in place, consumers should not enroll in any policy. It would be cheaper and simpler for them to simply cover all medical expenses out-of-pocket thru private negotiation w/doctors they trust. FYI, cash fees negotiated with a doctor tend to be significantly less than what that doctor (and his clinic) would bill the insurer.

The only people who could possibly benefit from health insurance are

1) Lawyers who have expertise in health insurance law
2) Those who have connections and/or affordable access to such lawyers

 

[solletica]

Insurance companies do try to deny legitimate claims, but mostly they use the same system governments do, having medical professionals analyze claims. The difference is that if a greedy private company denies a claim, it's headline news, but if a benevolent national health service does it, then it's a victory for social justice.

Mostly correct but you failed to recognize that the private insurance cartel and the US government are one and the same. CIGNA, Aetna, etc. all lobby Congress to enact laws that allow them to maintain their monopoly without oversight.

 

[MaggieD]

That bureau is typically the state's Dept. of Commerce or some similar organization. And their power is significantly limited in cases where the denials are made in violation of the insurers' policy and law but the legality of that denial isn't immediately obvious, i. e. a policy that claims to cover breast cancer screening that then denies coverage for mammograms done in excess of once every 5 years, or that denies coverage for MRI exams outright (even when such a screening would be medically recommended over a mammogram).

Lawsuits that force the losing party to pay are the only way to enforce the insurance contracts. Without them, the insurance contracts are worthless (as just demonstrated in my example).



Frankly, any consumer that bought an insurance policy and expected the insurer to consistently abide by its policy is dumb.

Until insurance company lawsuit reform is in place, consumers should not enroll in any policy. It would be cheaper and simpler for them to simply cover all medical expenses out-of-pocket thru private negotiation w/doctors they trust.

The only people who could possibly benefit from health insurance are

1) Lawyers who have expertise in health insurance law
2) Those who have connections and/or affordable access to such lawyers

I believe every single state has (Your State) Department of Insurance whose responsibilities, among other things, are to make sure that policy promises are kept. If it's in the policy, your state's regulatory body will see to it that you're paid. Their penalties are damned strict up to and including barring a company from doing business in their state, massive fines and massive class action lawsuits.

It's very important to keep the information brochures one receives when they sign up for a policy, read the paragraph headings within the policy that deal with how they pay claims...and read whole paragraphs when the paragraph heading applies to specific coverage.

If you have an HMO policy? All bets are off. That's because they're much cheaper than PPO policies and require a doctor's okay for testing. Other than that? I think it's fair to say that people can count on their health insurance policies.

I personally have had, probably, $120,000 in medical bills paid by my insurer. Never a question. Never a problem. I don't know what problems you've had, but I suspect it has something to do with your not understanding the benefits you signed up and paid for.

 

[solletica]

I believe every single state has (Your State) Department of Insurance whose responsibilities, among other things, are to make sure that policy promises are kept.

And those departments do not have the resources required to ensure that. You do realize that they receive thousands of complaints/year, right?

If it's in the policy, your state's regulatory body will see to it that you're paid. Their penalties are damned strict up to and including barring a company from doing business in their state, massive fines and massive class action lawsuits.

Class action lawsuits? ? :lol:

It's extremely rare for a State Attorney General to sue an insurer. For every 10,000 illegally denied claims, there's only going to be one such suit. And there's a good reason for that: the Attorney General doesn't have the resources to file suits for every one of those 10,000 denied claims (and they're also prohibited for filing any suit on the patient's behalf). Class action suits can only be filed by private attorneys and then only in cases where the violations are so numerous as to ensure big fees for the attorneys.

And the insurers are well aware of the fines and consequences they must face if they illegally deny a claim. That's why those companies have special departments to handle denial of claims expensive cases, i. e. in such a way as to make it difficult for the patient to seek external regulatory action on his/her behalf. Of course, it's possible the patient can get lucky and talk to an incompetent agent (a Hail Mary) who faxes a statement approving coverage for a procedure that's normally denied, but that doesn't happen too often.

It's very important to keep the information brochures one receives when they sign up for a policy, read the paragraph headings within the policy that deal with how they pay claims...and read whole paragraphs when the paragraph heading applies to specific coverage.

Any policy holder that actually took the time to do that (a herculean effort) and actually understood it from a legal standpoint would quickly realize that his/her policy is worthless given what the contract itself spells out.

There's a whole slew of requirements as to what an insurer must cover by law (another 100 pages of reading) that isn't contained in the contract. And the people that work at the State's enforcement agency aren't readily aware of all of that law contains and esp. not how it pertains to individual cases. Only a lawyer who had the time to sort that out would know that, in other words, a private lawyer hired by the patient, something that costs big $$.

If you have an HMO policy? All bets are off. That's because they're much cheaper than PPO policies and require a doctor's okay for testing. Other than that? I think it's fair to say that people can count on their health insurance policies.

I personally have had, probably, $120,000 in medical bills paid by my insurer. Never a question. Never a problem. I don't know what problems you've had, but I suspect it has something to do with your not understanding the benefits you signed up and paid for.

I don't believe you had $120,000 worth of medical bills covered by your insurer without a fight, threat of some kind. Did you use the incompetent agent faxing trick?

 

[MaggieD]

I don't believe you had $120,000 worth of medical bills covered by your insurer without a fight, threat of some kind.

I understand your not believing what you read on the internet; but it's nonetheless true.

 

[solletica]

I understand your not believing what you read on the internet; but it's nonetheless true.

It's not the Internet where I get this info. My explanation of insurance policy stems solely from logic resting on the assumption that any organization will always maximize profit for itself.

It's like playing chess against a computer; one shouldn't make a move under the assumption his/her opponent is going to play poorly or not going to see a line of attack. One should make his/her move assuming the machine will always make optimal moves given the resources of its computing power and algorithms and the rules of the game.

Health insurance companies, like any other company, are, for all practical purposes, like those chess computers--a machine that will maximize profits given its resources (insurers, FYI, use computers to decide on claims) and the rules of the game, i. e. the laws in place and the amount/extent of enforcement of those laws.

And a claim filed by the patient is simply the patient making a move against that machine.

 

[MaggieD]

It's not the Internet where I get this info. My explanation of insurance policy stems solely from logic resting on the assumption that any organization will always maximize profit for itself.

It's like playing chess against a computer; one shouldn't make a move under the assumption his/her opponent is going to play poorly or not going to see a line of attack. One should make his/her move assuming the machine will always make optimal moves given the resources of its computing power and algorithms and the rules of the game.

Health insurance companies, like any other company, are, for all practical purposes, like those chess computers--a machine that will maximize profits given its resources (insurers, FYI, use computers to decide on claims) and the rules of the game, i. e. the laws in place and the amount/extent of enforcement of those laws.

And a claim filed by the patient is simply the patient making a move against that machine.

You misunderstood my post. You stated that you didn't believe I'd had that amount of medical bills paid. That's what my post meant. Without concrete examples, I don't have much else to say. Good luck to you, Solletica. Health insurance is too expensive to not get what we pay for.