Crowley, Texas - Newborn Baby Denied Insurance Due To Heart Defect

[luckytxn 2,264]

Total overhead in PHI averages about 25% - 30% while total overhead for Medicare / Medicaid is less than 1/10 of that.

So, take the 2.5 trillion we spend on health care and do the math. I'd prefer the lower overhead because we'd be saving a truckload of money. If there was a value add that PHI brings to the table to justify their take, then I'd be all ears. I just don't see what value they actually add. They created one of the biggest and most bloated bureaucracies in this country and force medical providers to maintain bureaucracies to accommodate theirs.

It's cost, cost, cost - hundreds of billions of dollars a year - and no discernible value added.

Total bunk. We went through this awhile back and showed the real figures. The misleading figures for medicare/medicaid are just the offices handling the payments. Health insurance companies have to figure in costs that seek out fraud detection, fraud enforcement and lawyer fees. Collections of dues and on and on. Medicare/medicaid figures did not show this as it is different federal departments that do this for them. Such as the IRS collects the taxes that pay for it. The FBI that investigates the fraud, the justice department that sues and convicts the offenders and other departments that do the work for medicare/medicaid that the private insurer has to do on their own. When the additional costs were figured in it was shown that they were actually more expensive than private companies and it was due to bureaucratic dimensions.

So fail again as usual.

The kid died.

http://smartabouthealth.net/diseases/2010/03/28/newborn-denied-coverage-by-ruthless-health-insurance-company-dies/

What a shame. Prayer said for the kid.

[SMR 368]

This is a great sob story. But let's approach this logically. A individual (or couple, in this case) approaches a company requesting a service. The individual is not currently a client of the company and may not be in the future. The customer requests to buy a service that the company knows will be expensive for them to provide but yet the customer expects for the service to be provided at a price below what it will cost the company to provide.

Insurance companies were not designed and cannot function when they are expected to accept all the collective risk for society as a whole. They accept the risks of those who are paying premiums. These people weren't paying premiums. Why would you expect the insurance company to accept their risks?

The current health care reform is designed to bankrupt insurance companies.

[Obama 2012 1,714]

This is a great sob story. But let's approach this logically. A individual (or couple, in this case) approaches a company requesting a service. The individual is not currently a client of the company and may not be in the future. The customer requests to buy a service that the company knows will be expensive for them to provide but yet the customer expects for the service to be provided at a price below what it will cost the company to provide.

Insurance companies were not designed and cannot function when they are expected to accept all the collective risk for society as a whole. They accept the risks of those who are paying premiums. These people weren't paying premiums. Why would you expect the insurance company to accept their risks?

The current health care reform is designed to bankrupt insurance companies.

Logic escapes those with only sympathetic hearts.

It's a fine balance of both mind and sympathetic heart that makes the world go 'round.

[luckytxn 2,264]

This is a great sob story. But let's approach this logically. A individual (or couple, in this case) approaches a company requesting a service. The individual is not currently a client of the company and may not be in the future. The customer requests to buy a service that the company knows will be expensive for them to provide but yet the customer expects for the service to be provided at a price below what it will cost the company to provide.

Insurance companies were not designed and cannot function when they are expected to accept all the collective risk for society as a whole. They accept the risks of those who are paying premiums. These people weren't paying premiums. Why would you expect the insurance company to accept their risks?

The current health care reform is designed to bankrupt insurance companies.

The current health care appears to going to bankrupt the companies but no one is paying attention. They are going to pay the companies for any additional costs and no matter how much it is. For the past two years the money has been flowing to the Socialist party for a reason because they knew they were going to be forced into some kind of scheme. The bill coming out mandates all Americans to buy health insurance. Trust me we will be paying them whatever they say we need to. The costs will be sky rocketing. The Socialists have been bought and paid for.

[Niels Bohr 72]

Hmm...

I pray for all Republican offspring to have a genetic defect (I know I'm going to hell on this one). In fact, I know that there are plenty. So, they care about life? Nope.

I got a question, if the so called opposers of HCR are concerned about risk, then, what about those people repeatedly get into car accidents. Why are they still covered?

You want to talk logic now?

Edited March 29, 2010 by Niels Bohr

[Obama 2012 1,714]

The kid died.

http://smartabouthealth.net/diseases/2010/03/28/newborn-denied-coverage-by-ruthless-health-insurance-company-dies/

The article is full of #######.

It say the kid was denied surgery, so he died.

If you read the Star-Telegram article, he actually got the surgery anyway and still died now...

[Obama 2012 1,714]

Hmm...

I pray for all Republican offspring to have a genetic defect (I know I'm going to hell on this one). In fact, I know that there are plenty. So, they care about life? Nope.

I got a question, if the so called opposers of HCR are concerned about risk, then, what about those people repeatedly get into car accidents. Why are they still covered?

You want to talk logic now?

Car insurance companies deny coverage all the time on this basis. Same with many traffic violations.

I know here in Texas, State Farm especially is big on drivers who semi-decent records..

Not every company has the same policies though. Some will deny coverage and some will just charge much higher premiums based on your record.

I don't know about other states, but there are private health insurers here in Texas that do offer coverage to those with pre-existing conditions (BSBS is not one of them. Youjust have to be willing to shop around/know what you're looking for.

[luckytxn 2,264]

They are covered because they are mandated to be so but they also lose their driving privileges by the state that the insurance companies made sure was a condition by this full coverage. The costs have gone higher yearly and downward. I pay about 20 percent more this year than two years ago. Same will be done when health care is in place. The so called savings will be higher as the inflationary impact of inflow of money and bureaucracy comes.

[Niels Bohr 72]

We'll see what happens...chances are, if things does get costly, it will be reformed again. MA for the longest times had set the prices for car insurance, now they stopped that.

They are covered because they are mandated to be so but they also lose their driving privileges by the state that the insurance companies made sure was a condition by this full coverage. The costs have gone higher yearly and downward. I pay about 20 percent more this year than two years ago. Same will be done when health care is in place. The so called savings will be higher as the inflationary impact of inflow of money and bureaucracy comes.

Edited March 29, 2010 by Niels Bohr

[luckytxn 2,264]

Car insurance companies deny coverage all the time on this basis. Same with many traffic violations.

I know here in Texas, State Farm especially is big on drivers who semi-decent records..

Not every company has the same policies though. Some will deny coverage and some will just charge much higher premiums based on your record.

I don't know about other states, but there are private health insurers here in Texas that do offer coverage to those with pre-existing conditions (BSBS is not one of them. Youjust have to be willing to shop around/know what you're looking for.

Friend of mine here in Texas had insurance when he was found to have a very expensive illness that takes a huge amount of money to keep him alive by the meds. His insurance company started losing money in the state so they pulled out statewide this year. He was able to get into a statewide catastrophic plan here in Texas for those with pre existing stuff that was set up for this happening and will continue to be covered but his premiums are now much higher.

We'll see what happens...chances are, if things does get costly, it will be reformed again. MA for the longest times had set the prices for car insurance, now they stopped that.

We will be seeing reforms almost yearly as we always do with the federal programs we have now.

[SMR 368]

Hmm...

I pray for all Republican offspring to have a genetic defect (I know I'm going to hell on this one). In fact, I know that there are plenty. So, they care about life? Nope.

I got a question, if the so called opposers of HCR are concerned about risk, then, what about those people repeatedly get into car accidents. Why are they still covered?

You want to talk logic now?

First, I have health insurance that covers my children as soon as they are born without any sort of risk evaluation. This is the first detail that is somehow glossed over. If the parents had had insurance themselves, their children would automatically be covered from birth.

Second, the parents paid out of pocket had the operation performed. They accepted the risks of not having insurance and paid for it. That's how the system works.

Your argument about those that get in repeated accidents has several false parallels. First, nobody sells auto insurance that covers past accidents. I suppose someone might do it but the premium would have to be significantly higher than the cost of the previous accident. Those that frequently get in accidents simply pay a lot more for insurance. But even then you are dealing in possibilities of future accidents, not the certainty of a past accident.

Insurance companies work based on the assessment of future risk and charge premiums accordingly. When you expect insurance companies to cover those with current costs, it's no longer a question of risk assessment, but rather one of cost deferment. And money doesn't grow on trees. Cost deferment can never truly make something cheaper. If you expect an insurance company to pay for costs already incurred, you can expect insurance rates to fully reflect those costs.

[Niels Bohr 72]

SMR,

There's test known as karyotyping. This is a genetic test done for babies in the womb. So, those who are tested with for a genetic defect will not be covered if they're positive.

[Rebecca Jo 1,962]

OMG. You mean now instead of the 20 percent goes to the evil share holders pockets that it is 15-20 percent that is left over after paying for the service they are supposed to be in business for they then divide up for administrative costs and their profits? Wow a big difference from telling me I know not what I was talking about. Their profits have been and historically 4-5 percent. The rest goes to administrative costs, which is the costs of doing business, guess they could just fire a bunch of workers and raise the unemployment rate. That would help lower health care costs.

Also historically when the government has taken on the role over private industry the profit savings have been eaten up more than enough by the entrenched bureaucracy. Socialism at its finest.

Would you like to have a reasonable discussion, or do you just want to flame me? I admitted I was in error. Something tells me you would not do the same.

Medicare is run on 3% administrative costs. 3%! That doesn't seem very inefficient, now does it?

Do you work for an insurance company? I can't understand why you defend them so.

[Dan T 8]

FFS don't mention Federal bureaucracy. Single payer should never, EVER, be a Federal responsibility.

State level is far more manageable and, in some part, is already in place. As for inefficiencies, you think that the number of "Health claims specialists" that abound are efficient? Don't make me laugh! They are there for one reason, and one reason only, and that is to uncover deniable claims, for whatever reason, and do just that - deny them.

Healthcare needs to get away from being a business and back to being about health, a factoid that both sides in the recent "healthcare" reform debate conveniently forgot.

state level? have you been to new jersey? where we have more school districts than municipalities? not to mention medicare fraud. gimme a break Im not trusting these bafoons with any part of my medical coverage or treatment.

[ready4ONE 5,400]

The article is full of #######.

It say the kid was denied surgery, so he died.

If you read the Star-Telegram article, he actually got the surgery anyway and still died now...

A search of the Star-Telegram indicates you are incorrect. Only the original article shows up searching the site. Assuming you are correct, then the parents just got a whopper of a medical bill since the insurance company had decided to deny coverage.