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

There are 20 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.

jjrg7

Raleigh, NC

#611 Jul 24, 2009
Seriously wrote:
<quoted text>
Hence, all the collection jars at check-out counters when some unfortunate child gets cancer and the community tries to rally around the family by having a fundraiser.
I think it's pretty pathetic that families have to host fundraisers to pay for their child's medical treatment. Our country can do better.
A lot of times these jars are for those costs not covered by insurance (and that means universal health care might not cover them either). This could be airfare to get the patient to a specialty hospital that the parents chose (this won't be an option under the government plan), the parents hotel costs when their child is getting treatment, the lack of a parent's income when a child needed constant care, specialized food for the child, home care, etc. Those jars aren't always for the cost of medical treatment.

“Snow days!”

Since: Nov 08

A winter wonderland

#612 Jul 24, 2009
Unfortunately, sometimes those jars are for bogus medical claims. There was a guy in the town where I live who had people setting up a fundraiser for him. He had lost his legs to diabetes & didn't have the money to pay for the surgery. The flyers for the event said that he was a decorated Vietnam veteran. Baloney! I knew for a fact that he never served a day in the military. To use that as a tear-jerking reason to give the guy money was just so much crap. If he had been a veteran he wouldn't have needed a fundraiser. He would have gone to the VA hospital. Several people asked me if I was going & I took that opportunity to let them in on his dirty little secret. I didn't feel bad about it- he once threw me down a flight of stairs. Payback's rough, isn't it?

That's why I take these donation jars sceptically.
Eileen

Lake In The Hills, IL

#613 Jul 24, 2009
Seriously wrote:
<quoted text>
Eileen: Interesting thing is that I have many neighbors who are physicians, so I have frequently asked them about this. The physicians I've spoken with truly feel that too much money is spent on medical care for what they termed "end of life" situations. Yikes!
These docs came out and told me that the only reason they order so many tests is to prevent a malpractice lawsuit. Many of them honestly believe it's a "waste" to spend so much money on Grandma's open heart surgery when Granny is pushing 80. They also think that liver or heart transplant should probably go to someone who's younger and in better shape physically.
Don't even get these guys started on spending big bucks on treatment for the obese, overweight, smokers or heavy drinkers. Enjoyed hearing their honest, off the record opinions, but found it scary and a bit chilling.
So these physicians actually agree with Obama in that too many "unncessary" tests and surgeries are performed on those who really don't have much of a chance to begin with. I guess the key is to eat healthy foods and take a vitamin and pray for the best. God help us all if we truly get sick.
Hi Seriously -

You make some VERY GOOD points here. I work with physicians and have close contact with them. I do not know of ONE physician who supports this program. You are very correct in what you say when you say that many physicians hold their own beliefs about end of life situations. The very reason that most people have the ability to make their own decisions, despite their physicians "feelings" is because NOBODY else presently is in charge of making those decisions (i.e. the government) other than the patient and his family. Indeed, the insurance companies often place restrictions on what is appropriate and cost effective which is very frustrating, but we as consumers, have more POWER TO FIGHT when we are not controlled by the government. I have posted over and over again, that most appropriate action at this time is to REGULATE THE INSURANCE COMPANIES (Oregon is Disgusting, are you listening?). It is quite obvious that I do not work for the insurance companies !!!!

You are also correct is your statements that physicians often "over treat" and prescribe more tests that perhaps are necessary. It's called defensive medicine. Until we limit and control the amount of frivolous lawsuits, this defensive medicine will continue.

By and large, most physicians and the AMA would probably be more receptive to this plan if and when the government acts on frivolous lawsuits. So far, despite the request of the physicians, our government has not acted to protect them. Don't get me wrong - many lawsuits are necessary - so many are not.

Due to the huge premiums imposed on physicians for malpractice, physicians are making less and less money. Here are recent statistics: Average salary of a family practice physician is about $100,000. Internal medicine docs, about $140,000. Anesthesiologists - about $190,000. Can we afford to pay these folks less - which would be likely if the government controls our fate? Medicare reimbursements to physicians (and the lack thereof) can support my statements.
Seriously

Naperville, IL

#614 Jul 24, 2009
jjrg7 wrote:
<quoted text>
A lot of times these jars are for those costs not covered by insurance (and that means universal health care might not cover them either). This could be airfare to get the patient to a specialty hospital that the parents chose (this won't be an option under the government plan), the parents hotel costs when their child is getting treatment, the lack of a parent's income when a child needed constant care, specialized food for the child, home care, etc. Those jars aren't always for the cost of medical treatment.
Yes, I realize that those jars are sometimes used to collect funds to cover secondary expenses. However, using my local paper as a source, many times those fundraisers are held to defray the cost of a $750k operation that the insurance will not cover because it would exceed the lifetime maximum for the child.

Is it true that those with private insurance can keep it under the government plan? My view will be that those who can't obtain private insurance -- because of pre-existing conditions or simply can't afford it -- will opt for the government plan.

I don't expect the government package to be the platinum version for those who have no other alternatives, but it will offer them some type of coverage so that folks aren't losing their homes or burning through their retirement savings after a medical crisis.

A study conducted by the American Journal of Medicine found that over 62% of all bankruptcies resulted from medical debt. Can anyone confirm whether this figure is accurate? If so, then it's troubling that over half the bankruptcies in this country are caused by medical expenses. That should bother all of us.
Eileen

Lake In The Hills, IL

#615 Jul 24, 2009
Seriously wrote:
<quoted text>
Your question about forcing people to buy health insurance is akin to so many states - like mine - that require drivers to carry auto insurance. Can't be that hard if we really wanted to do it.
If Visa knows at point of sale whether John Doe's card has hit the spending limit or has been stolen, then this can be done.
In agreement that the insurance companies need to be mandated, but we also need to do something for those who can't get private insurance due to pre-existing conditions. Hell, there are folks who might be able to swing the payments that the insurers won't touch them because they are not 100% healthy! That's B.S.
Ever applied for private health insurance? I have and I pay the $1400/month premium for my family to prove it. Luckily we can afford it and we are all healthy. But the application clearly stated that those who are obese (per the height/weight chart), have diabetes (including juvenile diabetes), any form of cancer, HIV/AIDS, high blood pressure, high cholesterol, any type of heart problem, history of alcoholism, history of psychiatric problems, severe asthma, etc, etc NEED NOT APPLY!
It's interesting that folks like Dick Cheney (history of heart problems), Rush Limbaugh (obese, history of drug addiction), Michael Moore (obese), Ted Kennedy (history of alcoholism, brain cancer) would have ZERO chance of getting private health insurance. They would never get through the underwriting process. Yet some of these guys are probably fighting all attempts at reform tooth and nail. Pathetic.
BTW, thank you for your work as a nurse.
Right again - on all points. We need insurance regulation to stop their horrendous practices. We need to find a way to cover those with diabetes, heart disease, etc. I currently purchase insurance on my own - self employed now. I pay 750 per month and the only way I have been able to keep this less than 1200 is to continually up my deductible. I think my deductible is about 7500 or so, per person. I have my own horror stories about what I was put through during the underwriting procedure. It was very discouraging.

There are so many programs we can put forth to encourage health - but we are not doing it !! UGH - it makes me crazy. People should be rewarded, not punished for keeping their cholesterols within normal limits, their weight under control and for not smoking (to name a few examples). Those who are unable to accomplish some of these goals should not be punished !!!! Punishing people just doesn't work. The insurance companies need to figure out how they are going to make this work for EVERYONE, so that they can save their companies. It is time now for THEM to step up to the plate with ideas before they are all out of jobs.

BTW - I have worked for a VA hospital, did so for years. I loved working there because I loved the patients. What I didn't love was working for a government bureaucracy.
Eileen

Lake In The Hills, IL

#616 Jul 24, 2009
Tough Love wrote:
<quoted text>
That's not really making much sense to me and sounds very speculative. I couldn't come to that conclusion reading the text. I don't imagine the government can dictate who we buy our private insurance from. This needs researching.
Yes, it is speculative, however, it is based on what has happened in Canada. I am not saying Canada's health system is bad - because some provinces are doing well - some are not. Some are funded well, some are not. The Canadian system is now looking for an overhaul themselves, because they realized they have allowed the private system to deteriorate and are now realizing also that they are running short on funds for their public system. Canadians are taxed at a much higher than us here in America, and rather significantly higher. I was in Canada just recently and noticed how high the sales tax was every time I made a purchase. They explained to me that it was to pay for their healthcare. Makes sense to me.

Anyway, getting back to the point, the verbage in the bill is quite explicit. Anyone who wishes to keep their private insurance may but you may never switch.
Jim

La Grange Park, IL

#617 Jul 24, 2009
Oregon Is Disgusting wrote:
<quoted text>
Reagan, with a brain riddled with Alzheimers, was the problem. Reaganomics = garbage.
The cost of 30 years of Reaganomics:$23 TRILLION in financial failure and a health care system that is the laughing stock of the civilized world...even the uncivilized world.
Reaganomics was the second worst President in US History. Obviously Bush was the worst.
Spoken by an idiot.

If Carter was president (ie Reagan didn't beat him) we would be speaking Chinese and Russian as our primary languages and we would be a third world nation.

If you had a clue, you would realize he was probably one of our BEST presidents.
Seriously

Naperville, IL

#618 Jul 24, 2009
Eileen wrote:
<quoted text>
Right again - on all points. We need insurance regulation to stop their horrendous practices. We need to find a way to cover those with diabetes, heart disease, etc. I currently purchase insurance on my own - self employed now. I pay 750 per month and the only way I have been able to keep this less than 1200 is to continually up my deductible. I think my deductible is about 7500 or so, per person. I have my own horror stories about what I was put through during the underwriting procedure. It was very discouraging.
There are so many programs we can put forth to encourage health - but we are not doing it !! UGH - it makes me crazy. People should be rewarded, not punished for keeping their cholesterols within normal limits, their weight under control and for not smoking (to name a few examples). Those who are unable to accomplish some of these goals should not be punished !!!! Punishing people just doesn't work. The insurance companies need to figure out how they are going to make this work for EVERYONE, so that they can save their companies. It is time now for THEM to step up to the plate with ideas before they are all out of jobs.
BTW - I have worked for a VA hospital, did so for years. I loved working there because I loved the patients. What I didn't love was working for a government bureaucracy.
Eileen: I honestly don't know how the insurance companies can be regulated without the government coming down like a hammer on them. These guys just aren't going to police themselves. There is too much money on the table for them to do the right thing. They have too many lobbyists donating to both parties. Having the government plan to offer its own universal health plan may be the threat that the private insurance companies need to break their vice grip on the public.

You and I have both undergone the nightmare of the underwriting process. Being self-employed is wonderful, but the underwriting process for private family insurance caused a few sleepless nights. I knew I could afford the premiums, but that didn't guarantee us coverage. Of course we also live under the cloud of possibly having our coverage rescinded retroactively if we were to become seriously ill and the insurance company can find some B.S. reason to cancel our policy... leaving us both sick and financially screwed.

As someone who has been self-employed for many years, I would like to see a government alternative for those who need it. I'm not expecting the initial iteration to be perfect, but it should offer some type of coverage to those who can't get it because of pre-existing conditions or due to cost.

You and I will agree on some points and disagree on others. At least we can have a passionate, yet civil exchange on this forum. Perhaps we could even iron out a compromise if we were in Congress. I hope that both sides will be open and able to see that there are indeed some merits on both sides of the argument. Let's hope that our elected officials can do the same. I have already sent my thoughts to the President, my Congresswoman, and my Senators. I would encourage you to do the same.

Stay well and stay healthy.
freedom from socialism

Crown Point, IN

#619 Jul 24, 2009
Seriously wrote:
<quoted text>
Yes, I realize that those jars are sometimes used to collect funds to cover secondary expenses. However, using my local paper as a source, many times those fundraisers are held to defray the cost of a $750k operation that the insurance will not cover because it would exceed the lifetime maximum for the child.
Is it true that those with private insurance can keep it under the government plan? My view will be that those who can't obtain private insurance -- because of pre-existing conditions or simply can't afford it -- will opt for the government plan.
I don't expect the government package to be the platinum version for those who have no other alternatives, but it will offer them some type of coverage so that folks aren't losing their homes or burning through their retirement savings after a medical crisis.
A study conducted by the American Journal of Medicine found that over 62% of all bankruptcies resulted from medical debt. Can anyone confirm whether this figure is accurate? If so, then it's troubling that over half the bankruptcies in this country are caused by medical expenses. That should bother all of us.
It's great to raise the tax rate on others so that others can benefit from others hard earned money. What about the responsibility that the parents have to their kids health care? Could it be that some of these parents are more interested in keeping their property instead of sacrificing it for their child's well being? There is a safety net for these kids. It's called Medicaid. I believe that the guide lines for children who receive this aid has been modified to take into acct the financial situation that parents may find themselves in.
Seriously

Naperville, IL

#620 Jul 24, 2009
freedom from socialism wrote:
<quoted text> It's great to raise the tax rate on others so that others can benefit from others hard earned money. What about the responsibility that the parents have to their kids health care? Could it be that some of these parents are more interested in keeping their property instead of sacrificing it for their child's well being? There is a safety net for these kids. It's called Medicaid. I believe that the guide lines for children who receive this aid has been modified to take into acct the financial situation that parents may find themselves in.
I disagree with your statement that, "Some of these parents are more interested in keeping their property instead of sacrificing it for their child's well being?" Huh?

If a family has three children, and one child becomes seriously ill, are you suggesting that the family should become completely destitute before they can obtain treatment for their sick child? How should the family handle their day-to-day expenses if you want them to turn over all of their property to their insurance. So instead of the insurance helping to cover the sick child's medical expenses, we will now have to support the ENTIRE family because they no longer have any assets - house, retirement savings, college funds. Am I understanding your post?

Take some time and look up the income thresholds for Medicaid in our state. It is a program for those with low income... really low. I guess you think a married father of 3 should quit his middle class job, sell his home and become homeless, then take a part-time gig at minimum wage so his family will qualify for Medicaid. Wow.

Perhaps having every family with a sick loved one enter the poorhouse is a viable solution to you, but I don't believe that's the answer. This country can do better.
George W Bush

Amesbury, MA

#621 Jul 24, 2009
Jim wrote:
<quoted text>
Spoken by an idiot.
If Carter was president (ie Reagan didn't beat him) we would be speaking Chinese and Russian as our primary languages and we would be a third world nation.
If you had a clue, you would realize he was probably one of our BEST presidents.
Jimmy boy, how's it going, buddy? Still popping in the bathhouses on your "business trips" to San Francisco? Don't worry; I won't tell anyone why you need insurance to help you with that AIDS thingamabob.

oops!
freedom from socialism

Crown Point, IN

#622 Jul 24, 2009
Seriously wrote:
<quoted text>
I disagree with your statement that, "Some of these parents are more interested in keeping their property instead of sacrificing it for their child's well being?" Huh?
If a family has three children, and one child becomes seriously ill, are you suggesting that the family should become completely destitute before they can obtain treatment for their sick child? How should the family handle their day-to-day expenses if you want them to turn over all of their property to their insurance. So instead of the insurance helping to cover the sick child's medical expenses, we will now have to support the ENTIRE family because they no longer have any assets - house, retirement savings, college funds. Am I understanding your post?
Take some time and look up the income thresholds for Medicaid in our state. It is a program for those with low income... really low. I guess you think a married father of 3 should quit his middle class job, sell his home and become homeless, then take a part-time gig at minimum wage so his family will qualify for Medicaid. Wow.
Perhaps having every family with a sick loved one enter the poorhouse is a viable solution to you, but I don't believe that's the answer. This country can do better.
I told you that the Medicaid program has been modified to take into acct of the families situation. And yes I am saying that. I m not responsible for another's health care. Even if its a child's. The questions that you have to answer is would you be willing to give up your property for your child's welfare? Or do you believe that it's the govts job to guarantee that you will never have to lose your property because of the health care cost of your child or family member? Do you want The govt to guarantee you will never have to pay your's or your families medical bill? How far do you want the taxpayer to go towards your responsibilities? I believe that this is a family matter not a taxpayer's matter. One has to ask what are these people taking donations for? Are they asking for donations so they won't have to sacrifice their property for their child's welfare? If that's the case, then American's are, as some believe' too materialistic. I hope even you will agree with that. I am sorry but life isn't fair and some times sacrifices have to be made. But we don't need a new welfare program that benefits those who are afraid of losing their property. Even if they worked hard for it.

“Waiting for something good!”

Since: Apr 08

Location hidden

#623 Jul 24, 2009
FBI Guy wrote:
<quoted text>
Yes, but the difference is welfare moms like you consider getting government handouts a "job."
Aren't you the cute lil Troll.... NOT CUTE, NOT FUNNY, NOT NICE.

I'm not a Welfare mom either, but I'd gladly go on disability if it meant I wouldn't have to put up with debilitating back pain. EVERY DAY.
Oregon Is Disgusting

Portland, OR

#624 Jul 25, 2009
Andie J wrote:
<quoted text>
Ah, give him a break. He's just reading what someone else wrote for him in order to placate the most people.
I don't work for an insurance company. Having said that, I have to also say the United Health Care has been very good to me. In the past 8 years, I have had 6 surgeries. I was covered by Cigna & UHC. In total, I have paid less than $3000 out of pocket for all of them combined. My premium is $282.50/year currently. Yes, ny husband's employer pays part, but only about half. I have what's considered a high deductible-$1500. So I must say that I am content with the care I have received & the payments by the ins cos.
And yes, I do know that I am one of a very fortunate few.
Your insurance is being subsidized by the American taxpayer which is why you get off so easily.
FBI Guy

Amesbury, MA

#625 Jul 25, 2009
CherieL wrote:
<quoted text>
Aren't you the cute lil Troll.... NOT CUTE, NOT FUNNY, NOT NICE.
I'm not a Welfare mom either, but I'd gladly go on disability if it meant I wouldn't have to put up with debilitating back pain. EVERY DAY.
You wouldn't have that back pain if you'd take those 20 dicks out of your mouth.
payattentionpeop le

Santa Monica, CA

#626 Jul 25, 2009
WRONG. This poor guy would have the same exact insurance plan he has now as President Obama has promised that people will be free to keep their existing plans if they like them. The same plan, that is, except for there would be major reforms to how private insurance companies operate, that might include not allowing insurance to deny payment for a procedure they had already authorized.
Kris wrote:
And while this is a great example of what is flawed in our current system, under Obama's great healthcare plan, this poor guy would be on a waiting list for back surgery....unless of course any comorbidity such as hypertension or diabetes or obesity or smoking or just being "too old" precluded him from qualifying for surgery in the first place.
payattentionpeop le

Santa Monica, CA

#627 Jul 26, 2009
oh please wrote:
<quoted text>
I'm sure you're going to tell me my insurance system is a mess, too? Get real. Most of you people still living in the US don't have a clue about how other countries systems are run but love to point to misinformation on the Internet.
Here's the truth about "socialized" medicine here:
I pick the doctor I want to see, I pay him about $25-$35 for a visit. I give him a plastic card that he puts into a terminal and processes the payment and I am reimbursed 70% within 5 days. The balance is sent electronically to my supplemental insurance, who covers the rest within 3 days - all posted to my bank account electronically.
The gov't doesn't get involved cos there is no human processing to slow down the process. When I go to the hospital, it's the same thing. All they ask for is my ID, my health coverage card, and my proof of supplemental insurance.
I don't worry about deductibles, insurance companies turning me down, or what happens if I lose my job.
Get the facts.
Thanks to you and those others living in other countries with functional health systems for taking the time to post your real-life experiences here. All the fear-mongering about how bad health care is in countries that cover everyone is getting so tiresome.
Oregon Is Disgusting

Portland, OR

#628 Jul 26, 2009
payattentionpeople wrote:
WRONG. This poor guy would have the same exact insurance plan he has now as President Obama has promised that people will be free to keep their existing plans if they like them. The same plan, that is, except for there would be major reforms to how private insurance companies operate, that might include not allowing insurance to deny payment for a procedure they had already authorized.
<quoted text>
Just the idea that insurance companies would not be able to deny coverage or hike payments due to pre existing conditions is nothing short of REVOLUTIONARY.

All by itself, that would remove a massive amount of risk from the American people. What an idea.
Eileen

Lake In The Hills, IL

#629 Jul 26, 2009
Seriously wrote:
<quoted text>
Eileen: I honestly don't know how the insurance companies can be regulated without the government coming down like a hammer on them. These guys just aren't going to police themselves. There is too much money on the table for them to do the right thing. They have too many lobbyists donating to both parties. Having the government plan to offer its own universal health plan may be the threat that the private insurance companies need to break their vice grip on the public.
You and I have both undergone the nightmare of the underwriting process. Being self-employed is wonderful, but the underwriting process for private family insurance caused a few sleepless nights. I knew I could afford the premiums, but that didn't guarantee us coverage. Of course we also live under the cloud of possibly having our coverage rescinded retroactively if we were to become seriously ill and the insurance company can find some B.S. reason to cancel our policy... leaving us both sick and financially screwed.
As someone who has been self-employed for many years, I would like to see a government alternative for those who need it. I'm not expecting the initial iteration to be perfect, but it should offer some type of coverage to those who can't get it because of pre-existing conditions or due to cost.
You and I will agree on some points and disagree on others. At least we can have a passionate, yet civil exchange on this forum. Perhaps we could even iron out a compromise if we were in Congress. I hope that both sides will be open and able to see that there are indeed some merits on both sides of the argument. Let's hope that our elected officials can do the same. I have already sent my thoughts to the President, my Congresswoman, and my Senators. I would encourage you to do the same.
Stay well and stay healthy.
Hi Seriously, I have been away for a few days.

Thanks for you post. You know, I honestly see what you are saying and I cannot disagree that that a universal system might be the best way to pressure private healthcare reform. Unfortunately, this bill that is being proposed at this time, if FULL OF PROBLEMS. Nobody has read it, or very few. I have read it - it's bad. They need to slow down and do the job right.

I too, like you, always let my senators and congressman know how I feel. I have also asked to sit on a panel in Washington. I feel I could contribute a whole lot because of my VA experience, experience with working with the rich and poor alike (and BTW, I much prefer to work in under-priveledged neighborhoods), and my experience as a small business owner. Needless to say, I never received as much as an email back.

I think dialogue is really good - like the one between you and I. You have made me think further on this and open up my mind. Most of this dialogue on these boards, however, is unhealthy, so I will probably be signing off. Take care - and please continue to talk to people and pray for the best.
Eileen

Lake In The Hills, IL

#630 Jul 26, 2009
Hi Seriously -

One last thing about mandating people to purchase health care insurance. You mentioned in another post that it would not be that hard. I disagree. I took care of very poor mothers who had oodles of children, no Dad present. Often, these mothers wouldn't even take the time to sign up for Medicaid. At least the hospital would have been reimburse a little bit - instead of nothing. These mothers just didn't care, nor did they understand.

How in the world are we going to force a drug addict on the street to purchase insurance? And there are lots of them. How about the gang banger? When he gets shot, how will all of that get covered? There is a big gaping whole in all of this "coverage" that isn't being addressed. Nothing will change - the taxpayers and the people will continue to pay for these folks.

There are also many Americans out there that just feel the government "owes" them free healthcare. Many families, at present, just choose to not purchase healthcare and CHOOSE to take their chances. How will we get them to purchase the government plan? I would love to hear any ideas.

Last, but now least, you say that we can mandate auto insurance, and that is correct. Unfortunately, it is hardly a good comparison. When the police pull over a driver without insurance, they can be arrested and charged with "no insurance." When a person walks into a hospital having a massive MI, what would we do to that person if they didn't have insurance? We would still have to treat them. Our hospitals would still be liable - and we don't have the option of arresting the patient.

Taxing the heck out of everyone is the only way they are going to be able to pay for all of this - along with serious cost saving measures that will not be positive for the healthcare worker and it's recipients.

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