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Insurer Cuts Coverage, Patient Dies, Judge Awards 30Mil

Discussion in 'Issues Around the World' started by ethics, Dec 21, 2002.

  1. ethics

    ethics Pomp-Dumpster Staff Member

    The Ohio Supreme Court has ordered Anthem Insurance Companies, Inc. to pay a record $32.5 million judgment to a man whose wife died after the company cut off payments for her cancer treatment.

    The judgment against the Indianapolis-based company included a record $32.5 million in punitive damages, twice as much as the court has ever granted.

    Full Story

    Yet another chapter in The Rainmaker type of issues with the insurance.
  2. LissaKay

    LissaKay Oh ... Really???

    Stupid, stupid, stupid!

    Bottom line ... insurance companies are not looking out for the little guy/gal at all. If it cuts into the profit margin, it's denied. This is why I got out of that business after less than a year. Blech!
  3. mikepd

    mikepd Veteran Member

    As always, the questions of judgment collection and modification of policy that led to the suit in the first place remain to be answered.

    As always, I have my doubts that the responses will be in the affirmative.
  4. Misu

    Misu Hey, I saw that.

    omg, the insurance company should have been forced to pay even more - the statement they made made me SICK - 'we believe we interpreted the terms of their policy correctly, blah blah blah'.....

    My father in law is currently in insurance hell - he's got 3, count them, <b>3</b> herniated discs in his back which make mine look like Christmas in comparison - and the insurance company has his file 'pending review' for surgery... Meanwhile, the man can no longer WALK or go to work. If he stays out of work too long, he's going to lose his insurance.

    I told my husband to call his dad's insurance company and DEMAND they approve the surgery so the man can have some relief - threaten a lawyer if he has to - anything to help speed it up. I know had it been me, I would have been on the phone bitching everyone out - luckily, my insurance company decided not to f*ck with me when it came time to approve the surgery. They've had run-ins with me in the past for other things, but they didn't hesitate with my back surgery. I think my doctor's call to them stopped them from screwing me over.
  5. RRedline

    RRedline Veteran MMember

    I am beginning to think that the reason so many people hat einsurance companies is due to health insurance providers. I work at an insurance company, so I am a little biased as far as "insurance companies suck" threads go. We don't provide health insurance, but I feel that we are not screwing over clients at all. On the contrary, we get screwed all the time on fraudulent claims that we are unable to prove beyond a shadow of a doubt.

    I only had to deal with my health insurance provider one time, and it was quite an experience. I went to the emergency room at a hospital back in June, and my insurance company JUST NOW finally paid the claim! It took me several phone calls, one polite letter and one nasty one. I even pointed out ot them that they wasted more money in fighting my very small claim ($150) than they would have spent if they just paid it the first time it was submitted to them.

    I am going to sound like a bad guy for saying this, but I think the award was way too high. I understand that you can't put a price on a human life, but $30 million plus would make anybody, their friends and their family all stinking rich for the rest of their lives. Let's also not forget that with a rise in these kinds of judgments, insurance premiums will only go up even more. We are becoming very money hungry with awards. Anybody could live very comfortably for the rest of his/her life on a few million dollars without ever needing to work again. $30 million is an insane amount of money for one person to receive. I would rather see the company pay the plaintiff a few million, and the rest to the state as a fine.
  6. BigDeputyDog

    BigDeputyDog Straight Shootin Admin Staff Member

    Red, I agree that the award is too high... This will cause the rest of the insurance holders to suffer higher premiums... The insurance company will not "eat" this loss but will, instead, pass it on to the consumers... However, I disagree to paying the state a fine as offered in your scenario... What did the state do to get this money?? Would it not be better to distribute it among the other policy holders by way of a premium reduction??

    I have serious problems with the health insurance industry as a whole... Medical treatment options have been taken away from medical practitioners and placed in the hands of bean counters whose only concern is the bottom line...

    Perhaps the next time my premium comes due, I should contact my doctor for a second opinion...

    BDD... :{)
  7. HaYwIrE

    HaYwIrE Banned

    If they had a policy that stated this and he signed that policy and the treatment was experimental, I don't see why they were awarded anything at all.
  8. Frodo Lives

    Frodo Lives Luke, I am NOT your father!

    Their should be health insurance at all. Good health should be free for all people. The price for hospitals, doctors, etc. is outrageous. Drug companies are making billions and billions off of sick people (isn't that price gouging?), meanwhile those same sick people are going into debt to pay for it. And their are doctors that won't treat you if you can't pay.
  9. Misu

    Misu Hey, I saw that.

    Well Frodo, in defence of doctors, they have tons of school loans to pay off. It's a long hard and expensive road to become a doctor. Several years residency, plus teaching new residents, plus being on call - plus having to sew people's intenstines back inside them and all other sorts of gory stuff - they deserve to be well compensated for that.

    My problem isn't with doctors or the fees they charge (although an office visit where the doctor doesn't even look at you shouldn't be charged at $150 like my orthopedic surgeon charges) - my problem is with the insurance companies - whoever it is, be it the provider or the insurance company itself - that takes months and months and months to approve procedures. Meanwhile, you're sitting at home, in agonizing pain, waiting for some guy who majored in Business Administration make a medical decision that will affect your life.

    In the case of this woman, the insurance company/provider latched on to the fact that the FDA hadn't approved direct injection of chemotherapy treatments in patients' brains - however, the patient's doctor DID CONFIRM that the treatment was working. Is that not enough proof that the experimental treatment was effective? The FDA takes YEARS to approve new procedures and medicines - those years cost people their LIVES. I understand that many people file fake claims - but in the case of a CANCER PATIENT!?!?

    Rred, have you seen fake claims for cancer patients? What sorts of fake claims have you seen, since you are in the industry? Because my experience with insurance companies has been that the most dire things, such as an ER visit or antiobiotic medicines, have been DENIED - because the insurance company bean counter deemed that I didn't really need that treatment....
  10. RRedline

    RRedline Veteran MMember

    Misu, I can understand your point. And no, I have never seen my insurance company deal with a fake cancer patient because my company does not offer medical insurance. :)

    There are lots of people who sue hospitals and doctors, but many of them are fraudulent and for ridiculously high sums of money. If some doctor sews you up with a pair of forceps inside of you, then you have a legitimate reason to sue. If a surgeon tries unsuccessfully to save your arm from needing amputation, you have no right to sue him just because he failed. If he failed due to incompetence, then sue. Otherwise, go home and be glad that you are alive.

    And I'm sorry, but $30+ million is too much money. 10% of that money would allow any one of us to pay off every one of our debts and quit our jobs. Well, maybe not ethics because he's a rich bastard. ;)

    Why should people get ten times more than what's required to make you filthy rich? And as BDD pointed out, this money will come from somewhere. We are the ones who pay people these silly awards.
  11. IamZed

    IamZed ...

    And I have Anthem now. Better not get sick, huh?
  12. ethics

    ethics Pomp-Dumpster Staff Member

    Yes, sort of gives yet more umph to prevention.
  13. Misu

    Misu Hey, I saw that.

    Rred, in defence of the judgement, the victim's family isn't getting 32.5 million dollars. From the article:

    <i>Robert Dardinger will get $10 million -- plus approximately $9 million in interest -- from the punitive damages. Once legal costs are subtracted from the other $20 million, the rest will go into the fund.</i>

    The fund of which they speak of is a cancer research fund, being named after the woman who lost her life in all of this.

    I know that lawsuits are getting out of hand - a lot of people are suing over stupidities. But when you have a legitimate claim, and you lose your loved one, it's not fair. No amount of money will ever bring that person back. And the insurance company doesn't give a rat's ass that you lost your loved one - the only pain they feel is when a huge judgement is made against them, such as this one. The next step should be for the court to bar the insurance company from raising rates to protect their profit margin - it's not much of a punishment to the insurance company if they simply raise their rates and make everyone else pay for THEIR mistake.
  14. ShinyTop

    ShinyTop I know what is right or wrong!

    I agree that 30 million is excessive. But stop for a minute. How do we make the insurance company change their actions. I would not be at all surprised to see companies continue their flagrant disregard of insured's rights for $3 mil per lost case.

    Many years ago when I was with Blue Cross they routinely disallowed $100 on every claim. If you contested they immediately paid. In other words, they counted on people not contesting, a good business practice, rotten PR when discovered. The attitude of most health insurers seems to be to disallow what they can and pay what they must rather than seriously looking at every claim on its merits.

    When these kind of awards come about I cannot help but believe they reap what they sowed. You treat enough people like that and you lose the benefit of the doubt, and rightly so.
  15. RRedline

    RRedline Veteran MMember

    But if they raise their rates, it will make them less competitive with other providers. And we all know that there is lots of competition with insurance providers.

    Companies raise their rates all the time to make up for bad losses. Their rates are designed to cover losses and lawsuits. I bet many of you had no idea that many insurance companies actually purchase what are called reinsurance policies? For example, the company I work for has many homeowners policies in a town along a river. The company pays an insurance premium to cover itself in the unlikely event of a major flood. A bad flood could otherwise wipe out the company, so we are insured against it. The insurance business is fascinating, to say the least.

    I wonder if perhaps these companies are insured against large settlements?
  16. yazdzik

    yazdzik Veteran Member

    Dear Friends,

    Punitive damages are punitive, as ST states rightly. They have no relationship to the damages, but are intended to punish the torfeasor, not reward the plaintiff.
    Demanding that words mean what they mean to the promissee in a contract of indemnification is only just.
    This is not about malpractice as a tort in a medical case, this is a breach of contract so serious as to cause death.
    "Fine print" stops where judges take over, and they are not likely to allow a contract to be made which allows one party to take advantage of another by tacit or constructive deception.

    All good wishes,
  17. Jedi Writer

    Jedi Writer Guest

    Me thinks the Ohio court has exceeded its authority in directing a portion of the money go to the fund--especially given the "legal" reasoning stated in the article.
  18. Jedi Writer

    Jedi Writer Guest

    Remember what I told you about the "stupid, stupid, stupid" letter?
  19. wapu

    wapu Veteran Member

    I have been dealing with a medical condition that has me making a couple of visits a month to a doctor. My deductable is $30. That sucks, I know, but the worst part was when I switched to a new Doctors office and I saw a nurse practitioner. She was able to write me the prescriptions for Celexa and Glucovance and was able to look at my blood sugar charts. She ordered a couple of tests, an A1C for diabetics and another blood test. The insurance company denied everything on the claims that related to her. I had to pay it all. Then, I had to go back to the Doctor in that office and have him order all of the tests again and write new prescriptions all over again so that they would cover subsequent treatment related to the tests. The Nurse Practitioner's bill was 40% less for the same stuff. They claim that it is about the quality of care. I have to admit. I have considered just paying myself and going to her. She had the time to spend with me and she knew what combination of drugs worked well and which drugs were likely to upset my stomache. Even more than that, she knew to prescribe the 40mg Celexa and have me break it in half because the 20 and 40mg were the same price. She cut over $100 off my monthly medication bill and the Insurance Company said she wasn't competint enough to handle patients.

    They are all evil.

  20. FrankF

    FrankF #55170-054

    I too deal with a condition called "cluster headaches" (aka "suicide headaches"). Oxygen is often prescribed as an abortive. It is usually as effective as Imitrex, Amerge, Maxalt, etc... and costs the insurance companies far, far, less.
    But since Oxygen is not a quote "prescription drug" (even though you must have a prescription for it)... it is instead treated by most insurance companies as covered under "home healthcare oxygen therapy" which is paid only if it is pre-authorized... by a bunch of bean-counters.
    In my case (last time) I was required by my HMO medical group to undergo a "blood oxymeter" screening test. It was determined by that test that since my blood O2 level was higher that 95%, i did not need oxygen and my request was denied.

    When this cycle started, I told my doctor why I was denied O2 before and he was pissed off. He said that prescribing O2 for cluster headachesd is clearly documented as being effective as an abortive, and that denying it based upon blood O2 levels was incompetence or maybe even malpractice on somebody's part. He said he was going to have to kick some butt if his request was denied again.

    Four tanks of O2 showed up at my house less than 24 hours later. Amazing what can happen if your doctor is actually on your side.

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