PacifiCare denied 40 percent of all California claims in the first six months of 2009. Cigna, which gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life, was still rejecting one-third of all claims for the first half of 2009.
"Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences," said Burger.
PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia , Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.
At the time of denial, which she calls "insurance hell," Kutcher notes she had "already gone through pre-op testing, donated a unit of blood, had appointments with four physicians." Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.
Kaiser Permanente, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later."
Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.
"The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about," Burger said. "Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice."
"The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation," she said.
CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans, which would give the U.S. a national system similar to what exists in other nations. Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.
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AND MORE INFORMATION, from several sources:
Many people fear that medical care will be rationed. Is this a realistic fear?
Few policy experts expect this to happen. Our culture is not going to allow it. People forget that even now private insurers make decisions about what is medically necessary and what is not. They often refuse to pay for certain procedures. We also forget that the lower end of the economic spectrum often do not see doctors, do not buy prescriptions, do not take medicines as required because they cannot afford to do so. This is a kind of rationing that our society accepts for poor people. What is most likely to happen under a health care overhaul is that people will have initially have a harder time finding a primary-care doctor as more insured people seek treatment from the same number of doctors. No one is denied care, but it takes longer to get an appointment. NYT, August 25, page A10.
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