Thursday, October 15, 2009


Here is an article in the Washington Times exposing a change in policy coverage for New Yorkers: Enlightening.

Ian Pearl has fought for his life every day of his 37 years. Confined to a wheelchair and hooked to a breathing tube, the muscular dystrophy victim refuses to give up. But his insurance company already has.

Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl's.

In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl "dogs" that the company could "get rid of."

A federal court quickly ruled that the company's actions were legal, so on Dec. 1, barring an order by the federal Department of Health and Human Services, Mr. Pearl will lose his benefits. So will those who fit the same criteria.

Most of his medical treatment costs account for 'round the clock, in-home nursing care - for operation of his ventilator, hourly breathing treatments and continuous intravenous medication.

A Guardian spokesman said policies such as Mr. Pearl's - which offered unlimited home nursing - had simply become too expensive for new small-business customers to buy, and that even Medicaid and Medicare do not cover 24-hour home nursing. His parents, Warren and Susan Pearl of Fort Lauderdale, Fla., said their health insurance premiums had risen over the years to $3,700 a month.

As a last resort, Mr. Pearl would be admitted to a state hospital under Medicaid. But the Pearls consider that a death sentence.

I thought it would be a good subject to discuss here.


Anonymous said...

I do not have an issue with any company deciding that it can no longer afford to continue to offer a line of insurance.

I do have a problem with the company ceasing to pay claims to clients already covered under a plan and who have already filed a claim.

That smacks of bait and switch.

The US government saying its ok does not make it ok. It just makes it the current law. Some laws should be changed.

Anonymous said...

A ‘claim’ extends for the duration of the illness not for as long as its financially convenient for the company. Contracts are two-way streets.

Anonymous said...

I should first say that it is unlikely that Ian Pearl is a unique case. It is far more likely that we are hearing about him because his family is wealthy and probably has influence with the media, as such people do.
Had Ian Pearl been a struggling middle-class employee or small businessman, he would probably have passed (literally) into the darkness without remark or notice beyond his immediate circle. Alternatively, his family would have been left bereaved – having first been financially ruined. We ration healthcare on the basis of wealth.
Most of the victims of this fact of US life are not the feckless poor or illegal immigrants but the insured (or formerly insured) middleclasses. It is only in those rare instances where rationing hits the rich and influential that the realities of US medicine come under the searchlight.


Anonymous said...

I am curious to know how the legislation being debated in Washington for universal health care will treat these types of cases. We can only guess right now.

Anonymous said...

Right now, we have rationing and “death-panels” operated, not even by doctors on therapeutic grounds, but by insurance company bureaucrats and actuaries on the basis of maximizing profitability.
We also have the most expensive healthcare in the world with distinctly mediocre health-outcomes. We die younger, more of our children die in infancy, and we enjoy fewer healthy years of life in the course of our shorter lifespans than citizens of comparable advanced democracies.
In essence, we pay more for less.

Anonymous said...

Insurance is predicated and sold upon the premise that IF this happens to you, your participation in this plan will protect you. That’s patently untrue if the company can arbitrarily cancel its payments to those already insured who filed the claim before the insurance line was canceled. It’s an unconscionable ‘escape clause’.

Joe Bubel said...

Our Hodgkins group recently lost a beautiful young girl to Hodgkins Lymphoma. She was diagnosed at 10 years old, died at 23. She was the daughter of a middle class family. She had dozens of different treatments, each lasting for months at a time, some requiring hospital stays. Her insurance company, DID NOT ONCE tell her family they were dropping a line, or raise their rates, or drop them from their membership. NOT ONCE! You would think, you single payer supporters would find a proponent with this girls mother? She rejects government run healthcare out right, and isn't afraid to tell everyone.

Take some responsibility for yourselves people. READ THE FINE PRINT! If you buy the $500 46 inch plasma TV, it is probably going to BREAK!

You can read my story with hodkins on Mike's previous entry on healthcare. With Socialized Medicine, I would have died 2 1/2 years ago. Guess there are 2 sides to every story.

Anonymous said...

Bubel you are full of shit. Two sides to every story eh...well there is only one side to this story. Don't tell me that crap because it doesn't reflect the truth--you may have missed hearing it and obviously did. Shame on your stupid ass for perpetrating bullshit. And why would the insurance company "tell" anyone what crap they do before they do it--that doesn't always happen either so foo on your phony story...
We used to have a Celiac group in town. That didn't last, but now my body is attacking my liver, and I'm going to die as a result. What I do obviously think is true is that all politicians including in this town don't give a crap about anyone else and won't lift a finger to help anyone else, just as the rest of this mess called America is, and particularly this Mayor who takes after his predecessor yet instead of cocaine addiction he is addicted to ruthlessness and vengeance. Screw him and all that moves like him.
In conclusion the Republicrats took this nation into the financial ditch and it's not coming out people and the reason is greed, greed, and greed, and we not only need Socialized Medicine, we need a Socialized Society all the way the fuck around people!! Despite Joe Bubel, it might even the fuck come partly true in our lifetimes!!
Peace Out

Joe Bubel said...

...sheesh. Twice, I tried typing up in response to your rabid response, and twice, I deleted my reaction to it. Deciding I was acting in kind. Instead, I will just say, I pray your heart will soften, and that you will receive the treatments you require. Just a little insider info, coming from a guy who has had to deal, don't give up on, one, your self, and two, calling the insurance company. Utilize The dr's nurse, They know how to talk to insurance agents.

And this one if for Mike. Don't allow posts that may cause a response that the responder may regret. Instead, ask the poster to rephrase. Shame on you. Or maybe you were trying to hook me. At least, there is no shame on me.

Mike Madsen said...

Joe; Thanks for taking part in the dialogue. The comments that I have let through are the ones that seem harmless for the most part. Informative, yes, but generally a place for readers to pine about their experience or express their concern.
I would prefer more comments to be signed by the authors like yourself, but such is the job of a Blogger.
I publish many of the comments while at work either at a house repair or while running the chainsaw. So long as they aren't libellous, they usually get through.
Have a healthy week everyone!