The Bellicose Nature of Health Insurance Companies, an Example of Interference by WellPoint

Health Insurers like to fight for profits.  It's as simple as that. And their tactics keep getting dirtier.

Some of the arguments thrown around by those opposed to health care are "government will be calling the shots about my health care," and "I don't want a government bureaucrat coming between me and my doctor."  Having witnessed, first-hand, how Medicare works as I was taking care of my mom at the end-stage of her life, I know that no government anyone or anything came between her and her doctors or care. 

This came to me today from Health Care for America Now and it's a story we have been hearing over and over again: An Insurance Company Interfering With Treatment.  Thankfully, our government helped Ms. Shouse as she wound up being eligible for both Medicare and Medicaid.  They paid for the new chemotherapy treatment that WellPoint refused to pay for.

Our government's programs extended her life. Even though she was diagnosed with end-stage cancer and given a few months to live, her chemotherapy treatments have managed to keep her alive for 4 years.  What would that mean to you, if you were this ill and given the necessary treatments to help you live? Life is more important than corporate profits.  As a taxpayer, I am more than happy to help pay for a national plan. 

A video interview from a Fox affiliate is here. 

This article is by Shawn Chubb from Suburban Journals covering the St. Louis Metropolitan Area and surrounding Missouri and Illinois counties,  Emphasis is mine.

Melanie Shouse is grateful for her dark sense of humor.

It helped her see the humor when she was told she "hit the jackpot" by having terminal cancer. It meant that she would automatically get Medicare as soon as she was eligible.

Shouse, 40, of Overland, was diagnosed nearly four years ago. She had put off going to the doctor because she knew she couldn't afford health care costs. She had a catastrophic health insurance policy with a $5,000 deductible. She calls it "hit by a bus kind of insurance."When she did seek care, she went straight to Siteman Cancer Center.

"By then, I could have been diagnosed from across the street. It wasn't a surprise," she said.
Shouse would like to see all Americans get the health care coverage provided to federal employees. Through the Federal Employees Health Benefits Program federal employees and retirees and members of Congress can choose from a pool of insurance plans.

Shouse, who had co-owned Sweet Meat Stix, a beef kabob business in St. Ann, had only carried the catastrophic policy. Her business partner, Steve Hart, also carried a catastrophic policy. He has since battled liver disease.

Shouse said they could only afford such policies because they saved, borrowed and maxed out their credit cards to start their own business. They previously had sold their product at festivals, but opened a store in 2004.

It was only after spending $30,000 to transform a former Domino's store into a business that Shouse noticed her first tumor. She finally was diagnosed in October 2005. She soon became too ill to work.

Once on Medicaid, a lawyer provided pro bono work to apply for her to get Medicare. That's when she learned Stage 4 cancer is a "jackpot" diagnosis for being certified disabled and receiving Medicare - after a two-year waiting period.

Her bills are now mostly paid by Medicare and Medicaid. What bills remain go into a pile that she never looks at. That still does not keep her from having to worry about health care.

Shouse is now on her third round of chemotherapy to fight off the bone cancer and liver tumors. That treatment did not keep her from becoming bedridden for a month this spring. She was then given Avastin, a biologic therapy that costs $6,500 for a two-week supply. Since then she has been able to keep food down and "get off the couch." Her insurance provider has since sent her a letter saying it won't pay for Avastin.

"The insurance bureaucracy shouldn't stand between me and my doctor and treatment," Shouse said. "Like they know more than a world-renowned oncologist."

Why does Avastin cost so much?  If you go to this website Free Bee Foreign Pharmacy, about purchasing the SAME drugs from another country, you will see we get charged WAY more in the United States than in Canada.  Why? Because Big Pharma knows that the insurance companies will pay--except when they won't, like in Ms. Shouse's case.  And this is where WellPoint is playing God. This is where insurance companies are insinuating themselves into our health care.  They simply should not--they are insurers and not health care providers.  Or they should get out of the business.  Oh yeah, collecting premiums from large risk pools without any competition is hugely profitable and when we create our own barriers to prevent us from having to pay out claims, it's even more hugely profitable.  Never mind there are people we cover who are really sick and need help. No one can stop us, we're immune to anti-trust laws.

A National Plan, like Medicare, would allow us all access to any of our health care professionals, without worry of in-network or out-of-network coverage:

In some cases, patients may feel they have no choice but to go outside a network. Last October, Stacey Herzlinger, a 29-year-old police officer in Northern Virginia, was at a conference in Orlando, Fla., when she had severe stomach pain. Ms. Herzlinger called her in-network doctor back home, and was told to go to an Orlando emergency room, where she was examined and received medication — and a bill several weeks later for $3,168. The hospital said her health plan, UnitedHealth, would not pay because she had gone out of network.

“It was excuse after excuse after excuse why they weren’t paying,” said Ms. Herzlinger, who has hired Mr. Flynn to work with her on getting reimbursed.

While not commenting on the specifics of Ms. Herzlinger’s case, UnitedHealth says that emergency-room visits are typically covered under its plans and that it works with customers to resolve any concerns they have with their bills.

...or any of the other ridiculous insurance-created barriers that have been put in place to limit our access to decent care and inflate their profit margins. These are the bureaucrats between you and your care.