They authorized back surgery but deni...

They authorized back surgery but denied his $148,000 claim

There are 622 comments on the Chicago Tribune story from Jul 20, 2009, titled They authorized back surgery but denied his $148,000 claim. In it, Chicago Tribune reports that:

Michael Napientek of Clarendon Hills was in excruciating pain and needed back surgery.

Join the discussion below, or Read more at Chicago Tribune.

John

Lake Zurich, IL

#21 Jul 20, 2009
I tried to inform the Tribune, as well as others, as to how Advocate Health Care circumvented numerous Centers for Medicare and Medicaid Services regulations, with the blessing of CMS. The Tribune was not interested, nor was anybody else. I was not seeking assistance or publicity, I just think that it is important that people realize that having health insurance does not guarantee that the beneficiary will receive the appropriate health care.

The slew of people working for the politicians that I have contacted did not think that there was any problem either.
a nurse

Chicago, IL

#22 Jul 20, 2009
Welcome to the status quo !! This type of thing has been happening to people for years but no one gives a dam. I am a nurse in a hospital and I see how insurance companies screw people over. I also see how hospitals charge so much because insurance companies won't reimburse appropriately.
It is a terrible shame that the people of this country don't care enough about each other to demand that healthcare be reformed. President Obama is right. If you don't push congress and make deadlines -- nothing gets done.
You may think this doesn't effect you; but it will. Besides, what Obama is proposing will be done gradually.
http://www.msnbc.msn.com/id/32013032/ns/polit...
a nurse

Chicago, IL

#23 Jul 20, 2009
Alz wrote:
<quoted text>
Read up on Canada or the UK. Their systems are a mess.
If you're sick enough to be admitted in a Canadian ER, the average wait is 23 hours.( http://tinyurl.com/pkr266 See page 9).
Whatever the problems with private insurance, from experience, we all should know that having the government make our health decisions is a huge mistake for each and every one of us.
Lies. Lies. Lies.

Besides, we are not doing anythng that is close to Canada's system so stop making the comparison
feh or meh

United States

#24 Jul 20, 2009
Not surprised. Have you seen the number of complaints about this company at Rip Off Report?

http://preview.tinyurl.com/najeup

http://preview.tinyurl.com/njqwwl
Mika

Paris, France

#25 Jul 20, 2009
Alz wrote:
<quoted text>
Read up on Canada or the UK. Their systems are a mess.
If you're sick enough to be admitted in a Canadian ER, the average wait is 23 hours.( http://tinyurl.com/pkr266 See page 9).
Whatever the problems with private insurance, from experience, we all should know that having the government make our health decisions is a huge mistake for each and every one of us.
I was in a UK ER once, I'm not even British. I waited 20 minutes, they only asked for my name, treated me, and within 2 hours, I was out, and never had to pay a cent.

I don't call that a mess.
JustMe

AOL

#26 Jul 21, 2009
My husband and I are covered through United Healthcare-have to say they've been great. There's been a few problems-including a review- but reps have been helpful.
llll

Europe

#27 Jul 21, 2009
Everyone is probably going to go off the deep end and proclaim that socialized healthcare in this country would solve this problem. Nope! Healthcare regulation will along with free market and transparent competition. The government would screw this up, too! Probably tax the guy for having bad posture all his life or something just to rub it in.
llll

Europe

#28 Jul 21, 2009
"I was in a UK ER once, I'm not even British. I waited 20 minutes, they only asked for my name, treated me, and within 2 hours, I was out, and never had to pay a cent.

I don't call that a mess."

I call that unfair. You didn't pay into the system... no wonder healthcare is overbudget there.
Thomas

Köln, Germany

#30 Jul 21, 2009
Having moved to Germany from Chicago a few years ago, I'll take the system here over what I had. Self employed I paid for my own insurance that pulled the pre-existing condition scam to keep from paying for some drugs. One of which was $180 a pop. Of course I was promised before I switched plans, this wouldn't happen.

Now on a govt. plan we have a choice of any doctor, any specialist, any treatment is up to me & the doctor. No deductibles, only a €10 co-pay that you pay once every 3 months. My mother-in-law had to have cancer treatment, she saw her doctor regularly. When he recommended surgery, she saw another doctor a couple days later for his opinion. A week later she was operated on. A month ago on a road trip she got ill, she just went to a local doctor and got checked out. Try that in the states w/in and out of network doctor fees.

All countries have insurance issues, but the worst of most other industrial countries pales in comparison to US's issues.
jules69

Belleville, IL

#31 Jul 21, 2009
working for a large carrier, I see many different kids of plans w/ varying degrees of coverage.
I honestly do NOT understand how some people can even afford getting sick w/ some of them. 5,000 per year (per person)deductibles!?! Plus the time off work?( and for you souls that dont understand -this has to be paid by the cardholder BEFORE the insurance pays anything)
you have a policy like that and then you still have to help fund Medicare & Medicaid (via tax dollars)? How fair is that?
Health care reform will help..not only will it help the insurance industry, BUT it will cut down on the wait times in the ER ( not as many people will seek treatment at the ER for things that can be treated ata drs office)
billybob

Lombard, IL

#32 Jul 21, 2009
llll wrote:
Everyone is probably going to go off the deep end and proclaim that socialized healthcare in this country would solve this problem. Nope! Healthcare regulation will along with free market and transparent competition. The government would screw this up, too! Probably tax the guy for having bad posture all his life or something just to rub it in.
Yeah that's the answer. Regulation and competition. What competition? There are only a few major players in the health insurance field, an a number of 3rd party administrators running self insured plans (many of the large players do 3rd party administration also). almost all of the blue and united health plans have high copays, premiums, etc, which have been rising every year for several years. All of this, while reducing benefits. An this is throught major employers, so forget about the small business with it's 20 employee's plan, with high cost's, an few benefits. The better plans for employee's or the union plans, with good benefits, an decent costs. so much for your competition idea. As for regulation, there's plenty. from Hippa to mandatory treatment in the e.r.(gov mandated).
but non that will lower costs of care. As for socialize medicine, what do you think your elderly parents have? It's call medicare and medicaid. An without it, they wouldn't be able to afford their monthly medicines, doctor appointments and hospital costs. So re-think your capitalism views. Healthcare isn't a area where you want people making "business decisions" about your or your family health.
Darkwater

Bartlett, IL

#33 Jul 21, 2009
This is what you can expect under Obama the Unqualified's health plan! UnitedHealthCare is the worse of the worse. Their statement is so full of holes you could drive a Abrams Tank through it. What BS!
dave

Philippines

#34 Jul 21, 2009
good for them. it's unfortunate that one must resort to extraordinary means to get ordinary people to do their job/right thing. Of course the decision was overturned because of media attention, you better believe that no matter what the insurance company says. Just goes to show you how low some people can be while also showing what guts and determination and a never say die attitude can do for you sometimes.
Stu Padaso

Gurnee, IL

#35 Jul 21, 2009
I had a prior authorization for a procedure and my healthcare company later denied the claim.
Thankfully, a friend in the hc field walked me through the appeal process which I won. It did however enlighten me to potential problems in the future.
Nice work Jon!
David

Safford, AZ

#36 Jul 21, 2009
He should be elated. Under obamacare he probably would have never received the surgery. I if he thinkgs fighting insurance companies is a problem, wait until he has to take on the federal government.
double d

Chicago, IL

#37 Jul 21, 2009
seriously, why does back surgery cost $148,000 anyway?
ProfessorGAC

Channahon, IL

#38 Jul 21, 2009
Alz wrote:
Under Obamacare the pre-authorization could have been denied or delayed.
The rationing under Obama's plan isn't going to help, either.
People don't realize it (yet), but Obama's plan dumps us all (except the lawmakers themselves) into a big HMO - the government. That's right, the Federal Government will be the HMO.
Since private insurance will be non-existent or limited, we'll all be stuck.
So when problems happen, who are we going to complain to?
When a position is so pathetically weak that it requires lies in support, it is unworthy of attention. Nothing you said in this post, or in any other of your posts have the least share of intellectual heft, nor do they have familiarity with the truth.
ProfessorGAC

Channahon, IL

#39 Jul 21, 2009
David wrote:
He should be elated. Under obamacare he probably would have never received the surgery. I if he thinkgs fighting insurance companies is a problem, wait until he has to take on the federal government.
Another troglodyte repeating lies.
Aviva Patt

Edwardsburg, MI

#40 Jul 21, 2009
This story is a perfect example of why we need to replace profit-driven private health insurance with a single-payer plan. We have to remove the profit motive from the delivery of health care and end the practice of claim denials by insurance bureaucrats who are only concerned with their bottom line.
YankeeBoy

Warrenville, IL

#41 Jul 21, 2009
This is all just part of the madness of the American, greed driven health care "industry." It drives me crazy when the Republicans tell us they "don't want a government bureaucrat" coming betweeen us and our doctor's decisions. Well, isn't this what these people got?

And I can assure you the insurance company did NOT pay $148K for these services. I'd be surprised if they paid more than 50%. That's becasue in health care land billing is upside down. Like my $6,000 stress test at Rush that they were happy to settle with Blue Cross for $3200. Crazy.

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