My insurance company wants to sue my 3-yr-old

In an effort to not have to pay the ER bill I incurred, Captial BlueCross is suggesting I go after my preschooler for the money.

Let me explain. One nice, quiet, peaceful summer evening, as I was putting my then 2-year-old son to bed, he retaliated by sending me to the emergency room.

OK, not exactly, it wasn’t intentional (so he says), but he threw his head back, straight into my mouth, splitting my lip open vertically across my unstraightened teeth.

After the blood stopped gushing, I gathered the courage to examine the inside of my lower lip, discovering it split almost completely through to the other side. Opened up just like, well, a pair of lips.

When I got to the ER, I explained to the admitting/intake clerk what happened – that my son’s head struck my face, splitting my lip open. She shook her head, took notes, gave me a bracelet and told me to have a seat.

As an aside, it occurred to me as I waited that anyone who opposes state-run medical facilities for fear of having to wait to see a doctor has never actually been to an “emergency” room. No, I was not in mortal peril – it was evening, and a weekend, so there would be no GP to consult. Still, I waited most of the evening to see someone.

I eventually did see the triage nurse. He took a look inside my mouth and concluded I would require stitches. When he asked how I came to have this injury, I reiterated the above story. He was amused, but not unsympathetic.

I was then admitted inside, and proceeded to wait further to see another medical professional. An attending nurse prepped the room, pulling out all manner of instruments for suturing deep lacerations. And then I waited some more.

Eventually a doctor’s assistant (I believe – in any case someone capable of attending to my injury and making a qualified examination thereof) came in and said that my lip had mostly healed already (!!). I could have stitches if I wanted, but that itself would be painful, and that area of the mouth heals very quickly (I didn’t think I had waited that long). So off I went back home, with my discharge papers, new bracelet and an ER co-pay bill in my hand.

To the point of this story, I did tell the attending doctor(‘s assistant) the same story about how my lip came to be that way.

Months go by, and I get the Explanation of Benefits from CBC. They’re denying payment, because they’ve come to believe that the injury was the result of an auto accident (?). They suggest filing a claim against my auto policy.

The part of my brain that believes conspiracy theories wondered if they were trying to weasel out of paying – “clearly the nature of your injuries suggests they were sustained in an automobile accident” – but having a wife who works in the health care field, I understand how someone could write down the wrong code on a form, and my injury could be misclassified. I call to clear up the confusion.

The clerk I spoke with was more than pleasant. He, like everyone, was amused at my retelling of how my son came to bust me in the mouth. He said he would make the proper notations, and that would be it.

Always be wary when someone in that position says something like that.

I’ve just now gotten a letter – a form to fill out, actually – an “Other Party Liability Report.” My “contract contains a Subrogation provision that includes the right of recovery for benefits provided when a third party has first payment responsibility.” In other words, tell us who’s responsible, so we can go after them for the money.

They want to know if it was (again) the result of an auto accident, or was work-related. Under “Section 2 – Complete this section if another person or party was responsible for the injury/illness,” it asks, “has or will the person file a claim against the responsible person or the insurance company?” Then it asks for their insurance information – uncuriously, it’s the same as mine. It then asks if I’ve retained an attorney.

No, I wasn’t planning on suing someone with the same last name who lives at the same address, who’s on my insurance policy. Yes, I know forms like these often get kicked out automatically by “the system” and that they’re usually applicable, but considering everyone involved should know by now how it happened, I shouldn’t have to explain it again.

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Published in: on November 4, 2009 at 3:01 pm  Leave a Comment  
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Define “pre-existing”

John 1 (Americans 0):

(via crosswalk.com)

ı In the beginning was the Word, and the Word was with God, and the Word was God. 2 He was in the beginning with God. 3 All things came into being through him, and without him not one thing came into being. What has come into being 4 in him was life, and the life was the light of all people.

I can have been in multiple auto accidents – causing all of them through my own faults – have had my driving privilege revoked (temporarily), and still be able to purchase (government mandated) auto insurance (albeit at a higher cost).

I can purchase a home in southern California and many agencies would still sell me flood, mudslide and fire insurance, though it would be more costly than for someone in, say, Montana.

The point is, I could get it.

How does, “sorry, you had that before you got here,” only apply when you’re paying for medical care?

If I’m a woman and I’ve had a C-section or been the victim of domestic abuse, or if I was born with a congenital health issue and turn 18 and am no longer covered under my parents’ plan, under all the circumstances I can find myself unable to acquire health insurance. They just won’t sell it to me.

Or, having an insurance policy, if I change jobs and get a new employer-sponsored health plan or my current employer changes providers, or again am the above woman, I can, legally, be denied payment for necessary treatments.

Sometimes we need to pay for conditions we already have. And if we’re paying for “just in case,” we expect the case to be paid for, should the time arise.

Without payment there is no treatment. Without treatment, there is severe illness and death. And we allow this to go on.

The idea that something could have existed in some form before it became manifest is a debate for theologians, philosophers and quantum physicists. Not politicians and lobbyists. And if more insurers employed more theologians and philosophers, there wouldn’t be much of a debate at all.

Word.

Published in: on November 3, 2009 at 11:06 am  Leave a Comment  
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If they win, YOU LOSE

Dear friend:

If the insurance companies win, you lose.

If reform passes without the choice of a public health insurance option, if insurers can keep denying care for pre-existing conditions, and if you can't afford health insurance, the insurance companies will keep making money while you will keep losing out. It's really that simple.

We must fight back.

Today, thousands of people across the country are taking the fight directly to the insurance companies. We'll be presenting the insurance companies with a list of demands: Stop denying our care and stop using our premiums to lobby against health reform.

Click below to fax your insurance company these demands. A copy will be sent to the Senate Finance Committee who are starting debate on the Baucus Bill today:

    http://healthcareforamericanow.org/page/speakout/sick

For years the insurance companies have expanded their total stranglehold over health care. They make record profits. The make life-and-death decisions. And they're spending millions of dollars on campaign contributions and lobbyists to defeat reform – over $770,000 per day!

That's your money they're spending to defeat health care reform and the choice of a public health insurance option.

You're a customer and a person with a voice, so you can fight back. Click below to fax your demands to the insurance industry and join thousands who are doing the same thing today:

    http://healthcareforamericanow.org/page/speakout/sick

Your message will get to your insurer, your Members of Congress, and Members of the Senate Finance Committee, who are starting to work on the Baucus Bill – a bill that gives the insurance industry everything it wants.

Thank you for fighting back against the insurance industry – the real enemy in this debate.

Let's clog up their fax machines! Click here:
    http://healthcareforamericanow.org/page/speakout/sick

With your help, we'll be the ones who will win.

Thanks!

Published in: on September 23, 2009 at 9:55 am  Leave a Comment  
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