8/13/2009

Health Care Horror Story #3


What happens if you are a small business owner and you dare to challenge your billionaire insurance company over the piss poor coverage you're getting? Well, if you have cancer you can bet you'll have your insurance terminated post haste while their "case managers" laugh behind their hands at your stupidity for actually expecting them to pay for medical care rather than just send them money.

That's what happened to Patricia Reilling. She opened an art gallery in Louisville, Ky., in 1987, and three years later took out an insurance policy for herself and her employees. Her insurance provider,Anthem Health Plans of Kentucky, wrote to her this June, telling her it was canceling her coverage -- a few days after it sent her a different letter detailing the rates to renew for another year and billing her for July.

Reilling thinks she knows the reason for the cutoff, though -- she was diagnosed with breast cancer in March 2008. That kicked off a year-long battle with Anthem. First the company refused to pay for an MRI to locate the tumors, saying her family medical history didn't indicate she was likely to have cancer. Eventually, it approved the MRI, but only after she'd undergone an additional, painful biopsy. Her doctor removed both of her breasts in April 2008. In December, she went in for reconstructive plastic surgery -- and contracted a case of MRSA, an invasive infection. In January of this year, Reilling underwent two more surgeries to deal with the MRSA infection, and she's likely to require another operation to help fix all the damage. The monthly bill for her prescription medicines -- which she says are mostly generics -- is $2,000; the doctors treating her for the MRSA infection want $280 for each appointment, now that she's lost her insurance coverage. When she appealed the decision to cancel her policy, asking if she could keep paying the premium and continue coverage until her current course of treatment ends, the insurers wrote back with yet another denial. But they did say they hoped her health improved.


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