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June 11, 2009

Health Insurance Stories, Pt. 3

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...

Continued after the jump.


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.)

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.

All this is on top of Blue Cross's insanely expensive monthly premiums -a difficult proposition for me given that SSI disability only pays me $654-oops, just reduced to $625-- a month on which to live.

Twice in the last month, Blue Cross denied payment for ophthalmologic consults I had arranged to see if some of my eyesight can be retained. Then there is the $600+ per month Blue Cross doesn’t cover in specialized prescription eyedrops I need to save what is left. My other medications are similarly extortionate and not covered.

MediCal, for which I now qualify, does not have any participating ophthalmo-plastic, maxilla-facial, periodontic, or reconstructive surgeons here in Kern Kounty who are qualified to do these surgeries. Nor will they or Blue Cross pay for anesthesia if I DO find someone willing to do them! (There’s nothing like having an acute PTSD episode when you’re trying to lie very still for a delicate bone or tissue graft.)

On the plus side, I DID fight off a bear attack and survive to tell the tale.

I am also the daughter, sister, mother, sister-in-law, niece, and former wife of physicians–and spent my 20’s working in the medical malpractice insurance industry–so I do know the ins and outs of the system in detail. Medical insurance is a license to print money...by the industry's own admission.

If anyone is interested in using me as a "spokesvictim," I’ve documented my injuries and recovery in both journalistic and photographic detail and have a complete record of my insurance travails.

I am in an unique position to advocate for getting the insurance industry out of the medical care system–and am more than willing to offer up my privacy and dignity in order to do so. I am free to travel and testify, am articulate and funny, and have had highly positive responses to my public appearances thus far. (If you Google me, many of these are posted. I also have DVD’s of most of them.)

Allena Hansen

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


Filed under: Healthcare || Healthcare Stories

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Posted By Bob Cesca | June 11, 2009 7:27 PM

Comments

My insurance is also Anthem Blue Cross. Hopefully I wont need to actually use it until we have some real healthcare in this country.

Denying coverage to someone who had their face mauled is sub-human. Maybe the insurance CEOs are actually Greys. That would explain the lack of human compassion.

Posted by: J M Goddamn Ashby at June 11, 2009 7:43 PM

Allena Hansen is her name if you want to Google her.

Posted by: jill at June 11, 2009 7:44 PM

Thanks Jill

Posted by: J M Goddamn Ashby at June 11, 2009 7:47 PM

If there are hearings, she should testify.

There are so many stories. Get ready for a flood of youtube videos of people relating their stories. We didn't have that last time.

Posted by: Nanotyrannus at June 11, 2009 7:52 PM

Holy fuck. This is absolutely heartbreaking. You know, I was never naive enough to believe that the insurance companies aren't in it to make a dollar or two, and I know they cut or deny services to make the numbers look great for the shareholders, but it isn't until the results of this kind of behavior are put into human terms that it really hits home in a very real and visceral way. Mr. Obama must push for this, and push hard. I just hope he and the Dems push harder than the insurance companies do.

Posted by: ZIRGAR at June 11, 2009 7:56 PM

Bob..Bob... Bob

The insurance industry will flood you, and the media they haven't bought yet... with bullshit stories so that they can make you look ridiculous.

This is the burden of getting popular.... and I really am on your side... Dude.

Posted by: Hielo in Mexico at June 11, 2009 7:58 PM

Not that I would advocate such a thing, but I wonder...I really wonder...what would happen if a frustrated, broke, broken policy holder - someone suffering REAL problems for which they were JUSTIFIABLY angry (as opposed to the frustrated projecting bastards that murder doctors and museum guards) targeted insurance company fuckers.

Murdering right wing fuckwits, ginned up on phony hate and invented threats to a vision of America that never really existed in the first place, kill innocent bystanders to protest socialism, or protect the unborn.

People who have paid good money for insurance are losing EVERYTHING while insurance company executives reap billions in profit by denying the care that they took money for AND promised to provide. And what do these suffering policy holders do? The brave complain. Most just suffer. Some of them die, and thus stop complaining.

There are plenty of motives for jamming a gun up someone's ass and pulling the trigger until it goes click.
Some of those reasons are GOOD ones.

As I said...I would not advocate such a response. Nevertheless, if the cost of placing profit ahead of quality care might be someone blowing your greedy, thieving head off, perhaps there would be a small shift in priorities.

Posted by: cousinavi at June 11, 2009 8:04 PM

Jesus Christ on a bike - that's awful. It's hard to believe that this can happen in 21st century America. You can survive a godawful illness or accident like this, but your life can still end up ruined by your insurance provider. This is exactly why a public option is essential.

I really hope, though I wouldn't count on it, that the Senate Democrats - I'm looking at you, Harry Reid - choose this issue to grow a spine.

Posted by: Skippy at June 11, 2009 8:11 PM

Avi

For me... you say too much.

Can you synthesize your post in a way that will take a little less of what brainpower I have left... to expend?

Muchas Gracias amigo.

Posted by: Hielo in Mexico at June 11, 2009 8:14 PM

>>>The insurance industry will flood you, and the media they haven't bought yet... with bullshit stories so that they can make you look ridiculous.

Nice try, Hielo.

Her names is Allena Hansen. Look it up.

Posted by: Bob Cesca at June 11, 2009 8:19 PM

I don't have anything to add other than sheer dismay and utter fear that such stories, including Bob's, can be told. My dad was on Medicaid and I was mostly content with his coverage, thoug frequently angry at the papermill way they treated him, as if he was a thing to be handled according to procedure instead of a person. That has always been my fear about too much beaurocratization of medicine - that patients will become subject to process instead of care.

That said, it seems obvious to me, as it always has, that being middle class in America is a losing proposition. The poor are herded through, but paid for, and the rich can afford whatever they want, but the middle class is in a constant state of threatened existence - everything conspiring to ruin us.

Thank you so much for publishing these stories.

QT

Posted by: QueenTiye at June 11, 2009 8:24 PM

Kinda OT: but why is the possible penalty of NOT having car insurance a year in jail?

I'm required to have car insurance in case somebody else is talking into their cell phone or texting and slams into me and my family. Or in case of the extremely remote possibility that I hurt somebody else. I say extremely remote because I pay attention. I've been driving since I was 12 on mountain roads blah blah blah.

Point: insurance isn't the least bit interested in rewarding good behavior. How come there isn't health insurance that rewards people? How come the forms don't ask how often one eats fast food? Or drinks alcohol, etc etc etc.

Posted by: Peter at June 12, 2009 10:07 AM

Bob,

I hear your call to arms, to stand up and fight the criminal conspiracy that is the health insurance industry, but what weapons can we use to fight it? Appealing to our corrupt representatives in Congress is useless, our voices easily drowned out by the rumbling avalanche of campaign contributions from health insurance CEOs and their scum of the earth lobbyists. But I was thinking, what if we bypassed our spineless and ineffectual legislators and attacked the CEOs directly, using non-violent civil disobedience tactics? You wrote in your excellent book about sticking it to G. Gordon Liddy when he asked you to remove the David Letterman photos from Buzz's office by plastering Dave's face all over the building, and it worked! The coward backed down. Can we, the people, make life so unbelievably unbearable and uncomfortable for the blood-sucking health insurance leeches that they have no choice but to call off their ravenous lobbyist dogs and let us do what must be done to insure every single American?

If not, then what are our options, because I am sick and tired of feeling impotent and ineffectual while I and more than 40 million other uninsured Americans risk financial ruin so that the leeches can suck a few more drops of cash out of our already beleaguered bank accounts. Lead us, Bob. Tell us what to do, and we'll do it. At least, I know I will.

And thank you. Thank you for your fearless defense of our lives and our liberties, your courageous commitment to speak truth to power and to consistently write such excellent posts that are as bitingly humorous as they are brilliantly insightful. Keep fighting the good fight. We've got your back.

-Myles

Posted by: Myles at June 12, 2009 1:13 PM

Get a broker for christ's sake! Know your policy before you buy. You are responsible for your own affairs. Grow up!

Posted by: Common Sense at June 13, 2009 8:07 PM



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