chesswarsnow
10-10-2009, 10:05 PM
Sorry bout that,
1. And the govenment protects them to do it.
2. This story is prime example why no one can properly defend insurance companies.
3. They can refuse treatment, at anytime, and let you die.
4. And then never have to even say, *I'm sorry*.
5. And can't be touched legally either.
6. This immoral crap must needs be ended.
7. Link and a sample:http://www.aolhealth.com/health/cigna-employee-gives-woman-finger?icid=main|main|dl4|link3|http%3A%2F%2Fwww.a olhealth.com%2Fhealth%2Fcigna-employee-gives-woman-finger
"In 2007, 17-year-old Nataline Sarkisyan needed a life-saving liver transplant, but CIGNA, her insurance company, wouldn't pay for it. Nine days later -- amid a media maelstrom and public outcry -- the company reversed its decision. Sadly, it was too late. Nataline died just hours after the decision was overturned.
In 2008, Nataline's parents, Hilda and Krikor Sarkisyan, along with members of the California Nurses Association, traveled to CIGNA's Philadelphia headquarters looking for an apology from CEO Edward Hanway. Hilda Sarkisyan told the building's security: "You guys killed my daughter. I want an apology," reported the LA Times. The Sarkisyans received an unfriendly welcome. After being denied access to Hanway, employees shouted rude remarks from the atrium balcony and one gave Hilda the finger.
CIGNA later issued a formal apology for the incident -- an incident that is now at the center of a lawsuit.
The Sarkisyans filed a wrongful death complaint in 2008, stating that CIGNA's refusal to pay for the transplant led to Nataline's death. But a Los Angeles court threw out the case, citing a 1987 US Supreme Court ruling protecting employer-paid healthcare plans from damages over their coverage decisions.
In dismissing the wrongful death complaint, US District Judge Gary Allen Feess cited the 1974 Employee Retirement Income Security Act (ERISA), which oversees employee retirement funds and benefit plans. Under the law beneficiaries of employee-paid health plans can only sue for the cost of the treatment or service in dispute.
Because the expense of a lawsuit is usually greater than the cost of the treatment, few cases go to court, effectively protecting insurance companies from coverage disputes. The Sarkisyans, patient rights' advocates, and consumer watchdog groups want to change that. Nataline's case, they argue, illustrates why new federal legislation is critical to healthcare reform.
In an odd twist, however, Judge Feess granted the Sarkisyans permission to seek damages for emotional distress resulting from the confrontation in Philadelphia. The Sarkisyans and their supporters feel conflicted about the ruling. While it allows the family to pursue legal action, they believe changes must be made to permit people to sue health insurers for life-or-death decisions. "I want to get rid of this ERISA law and replace it with Nataline's law," Hilda Sarkisyan said in the LA Times.
In the meantime, the Sarkisyans filed suit this month over the lobby incident. CIGNA released a statement saying that case was "without merit" and that the company expected to prevail.
The suit raises important questions about patients' rights, the decisions made by doctors and insurance companies in life-or-death situations, and a complex, confusing and difficult to navigate healthcare system. As the debate over healthcare reform continues to heat up, we decided to take a closer look at what a patient should do if denied medical coverage.
1. Review the medical claim denial carefully. There should be a denial code and an explanation of the codes, usually located at the bottom of the remittance form.
2. If the reason seems incorrect, contact your insurance company's customer service department. There should be a phone number on the form. Explain why you disagree with the claim and ask what the procedure is for getting it paid. Be nice and stay calm. If the denial was made by mistake, this person may be able to correct it for you while you are on the phone.
3. If you don't understand the reason for the denial, politely ask for an explanation. It's common for an insurance company to deny a claim because of lack of information on the claim form. Ask the representative what you must do to correct the situation. You may need to call your doctor's office and ask the billing manager to correct certain information and resubmit the form.
4. If the claim was denied for timely filing, this does not mean the insurance company will not pay the bill. Your doctor's billing office must resubmit the claim with proof of timely filing.
5. If the claim was denied for an incorrect diagnosis or procedure code, this information must be corrected and the claim should be resubmitted.
6. In some cases, it is necessary to file a written appeal to the insurance company. Ask the representative where to send the appeal. Explain in detail the reasons you feel this claim should have been paid. Save copies of all correspondence, bills, remittance forms, and notes of telephone conversations (the name of the representative you spoke with, the date, and what they said).
7. Ask the doctor's office for help. They often know who to speak to and how to address the problem.
8. If the situation is urgent, enlist the help of your doctors and hire a lawyer if necessary. Alert local healthcare worker unions and advocacy groups who may be able to take action on your behalf.
Remember, if you are not satisfied with the decision made on your medical claim, you do have recourse. "
8. This is day in day out insurance killing people, it must end and soon!!!!
9. Check out the link, there's more to see.
Regards,
SirJamesofTexas
1. And the govenment protects them to do it.
2. This story is prime example why no one can properly defend insurance companies.
3. They can refuse treatment, at anytime, and let you die.
4. And then never have to even say, *I'm sorry*.
5. And can't be touched legally either.
6. This immoral crap must needs be ended.
7. Link and a sample:http://www.aolhealth.com/health/cigna-employee-gives-woman-finger?icid=main|main|dl4|link3|http%3A%2F%2Fwww.a olhealth.com%2Fhealth%2Fcigna-employee-gives-woman-finger
"In 2007, 17-year-old Nataline Sarkisyan needed a life-saving liver transplant, but CIGNA, her insurance company, wouldn't pay for it. Nine days later -- amid a media maelstrom and public outcry -- the company reversed its decision. Sadly, it was too late. Nataline died just hours after the decision was overturned.
In 2008, Nataline's parents, Hilda and Krikor Sarkisyan, along with members of the California Nurses Association, traveled to CIGNA's Philadelphia headquarters looking for an apology from CEO Edward Hanway. Hilda Sarkisyan told the building's security: "You guys killed my daughter. I want an apology," reported the LA Times. The Sarkisyans received an unfriendly welcome. After being denied access to Hanway, employees shouted rude remarks from the atrium balcony and one gave Hilda the finger.
CIGNA later issued a formal apology for the incident -- an incident that is now at the center of a lawsuit.
The Sarkisyans filed a wrongful death complaint in 2008, stating that CIGNA's refusal to pay for the transplant led to Nataline's death. But a Los Angeles court threw out the case, citing a 1987 US Supreme Court ruling protecting employer-paid healthcare plans from damages over their coverage decisions.
In dismissing the wrongful death complaint, US District Judge Gary Allen Feess cited the 1974 Employee Retirement Income Security Act (ERISA), which oversees employee retirement funds and benefit plans. Under the law beneficiaries of employee-paid health plans can only sue for the cost of the treatment or service in dispute.
Because the expense of a lawsuit is usually greater than the cost of the treatment, few cases go to court, effectively protecting insurance companies from coverage disputes. The Sarkisyans, patient rights' advocates, and consumer watchdog groups want to change that. Nataline's case, they argue, illustrates why new federal legislation is critical to healthcare reform.
In an odd twist, however, Judge Feess granted the Sarkisyans permission to seek damages for emotional distress resulting from the confrontation in Philadelphia. The Sarkisyans and their supporters feel conflicted about the ruling. While it allows the family to pursue legal action, they believe changes must be made to permit people to sue health insurers for life-or-death decisions. "I want to get rid of this ERISA law and replace it with Nataline's law," Hilda Sarkisyan said in the LA Times.
In the meantime, the Sarkisyans filed suit this month over the lobby incident. CIGNA released a statement saying that case was "without merit" and that the company expected to prevail.
The suit raises important questions about patients' rights, the decisions made by doctors and insurance companies in life-or-death situations, and a complex, confusing and difficult to navigate healthcare system. As the debate over healthcare reform continues to heat up, we decided to take a closer look at what a patient should do if denied medical coverage.
1. Review the medical claim denial carefully. There should be a denial code and an explanation of the codes, usually located at the bottom of the remittance form.
2. If the reason seems incorrect, contact your insurance company's customer service department. There should be a phone number on the form. Explain why you disagree with the claim and ask what the procedure is for getting it paid. Be nice and stay calm. If the denial was made by mistake, this person may be able to correct it for you while you are on the phone.
3. If you don't understand the reason for the denial, politely ask for an explanation. It's common for an insurance company to deny a claim because of lack of information on the claim form. Ask the representative what you must do to correct the situation. You may need to call your doctor's office and ask the billing manager to correct certain information and resubmit the form.
4. If the claim was denied for timely filing, this does not mean the insurance company will not pay the bill. Your doctor's billing office must resubmit the claim with proof of timely filing.
5. If the claim was denied for an incorrect diagnosis or procedure code, this information must be corrected and the claim should be resubmitted.
6. In some cases, it is necessary to file a written appeal to the insurance company. Ask the representative where to send the appeal. Explain in detail the reasons you feel this claim should have been paid. Save copies of all correspondence, bills, remittance forms, and notes of telephone conversations (the name of the representative you spoke with, the date, and what they said).
7. Ask the doctor's office for help. They often know who to speak to and how to address the problem.
8. If the situation is urgent, enlist the help of your doctors and hire a lawyer if necessary. Alert local healthcare worker unions and advocacy groups who may be able to take action on your behalf.
Remember, if you are not satisfied with the decision made on your medical claim, you do have recourse. "
8. This is day in day out insurance killing people, it must end and soon!!!!
9. Check out the link, there's more to see.
Regards,
SirJamesofTexas