If you Lie – You Die said the Insurance Carrier (You did not report your acne)

When you read this, it is easy to see that it takes some real tough calculated self involved, money conscious only, self righteous bean counters to sit there and make the statements they did. This was over a case of non reported acne to begin with and being judged on a medication she was now taking but was not taking when she applied for her policy. The woman is fighting for her life and gets the “code” treatment with data created algorithms for the denial of payment for her cancer surgery.

“We regret the necessity that has to occur”…how can you look someone in the eye and say that, be it the patient or the state legislators who got involved in this case. Suggestions to improve don’t count when someone needs treatment. We recently heard Senator Rockefeller as the CEO of United Health Care how he was able to sleep at night over the Ingenix Inquisition.

Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care

I just came from working at a doctor’s office this afternoon where I was told about a patient that called in asking why here policy had been cancelled as the notice stated it was because “she moved’. The patient has been at the same location for over 27 years and had not moved, so go figure. As more and more stories surface it’s beginning to have the appearance of a “technology run holocaust” if you will. There are more important things in life than having to be “right” all the time, but do the “right” thing.

Algorithm says (……….)is this what life is all about? BD

“Beware of Geeks Bearing Formulas”…Warren Buffett (Classic Post Revisited)

Her insurance carrier pre-certified her for a double mastectomy and hospital stay. But three days before the operation, the insurance company called and told her they had red-flagged her chart and she would not be able to have her surgery.

The reason? In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.

Beaton's dermatologist begged her insurance provider to go ahead with the surgery.

"He said, 'This is a misunderstanding. This is not precancerous. All she has is acne.' ... He said ,'Please don't hold up her cancer surgery for this,' " Beaton, 59, said as she testified at a House subcommittee hearing on the terminations of individual health policies by insurance companies.

Still, the insurance carrier decided to rescind her coverage. The company said it had reviewed her medical records and found out that she had misinformed them about some of her medical history. Beaton had listed her weight incorrectly. She also didn't disclose medication she had taken for a pre-existing heart condition -- medicine she wasn't taking when she originally applied for coverage.

"Doesn't it bother you that people are going to die because you insist on reviewing a policy that somebody took out in good faith and forgot to tell you that they were being treated for acne?" Barton asked the panel of CEOs.

"Yes sir, it does, and we regret the necessity that that has to occur even a single time, and we've made suggestions that would reform the system such that that would no longer be needed," Hamm replied.