Some years back, while I was working at a radio station, I slipped on a piece of cellophane that someone had torn off a cigarette pack and dropped on the floor. Buggered my knee really well. I had to go to the doctor and, among other things, have about 20 cc. of fluid drawn off my knee, Ace bandage, stay off the leg, all of that.
My doctor submitted the bill to Blue Cross (I'm no longer with them!). Blue Cross responded, saying, "We don't cover things like that." I asked the radio station's program director if the station had insurance coverage for accidents while working. He said yes, but he also said, "Here's what you do. Go out to the Blue Cross office, make sure there are customers in their waiting room, and raise hell. Be very loud. You'll get some action."
So I did. There were a half-dozen people in the waiting room. I went to the desk and gave the letter I got to the clerk. She looked at it and said, "That's right, Mr. Firth, we don't cover accidents of this sort." "Well," said I in my loudest newscaster's voice, "if you don't cover things like this, then what the hell am I paying premiums for!??"
She shushed me up and hustled me into a small office. A moment or two later a woman came in with the letter I had handed the clerk, very apologetic, and said, "I'm awfully sorry, Mr. Firth. There's been a clerical error. Of course we cover accidents of this nature. We'll mail payment to your doctor this afternoon."
She continued to apologize for the foolish mistake as I thanked her and departed.
The following day, when I say the program director, he said, "Clerical error?" "Yep," I said. "Standard ploy," he snorted, and added something about a bunch of cheap, chiseling bastards.
I have several other stories of similar incidents, but that gives the general idea.
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On "This American Life" this morning (this will be discounted by some on this thread because it was over my local NPR affiliate), I heard the story of a woman who was diagnosed with a particularly aggressive form of breast cancer. She was quickly scheduled for a radical double mastectomy. A few days before the operation, she was told by her health insurance company (Blue Cross) that they would not cover her because she had a pre-existing condition. When asked what the pre-condition was, they responded that she'd had a skin condition that could possibly have been pre-cancerous.
"It was teenage acne, for Chrissake!!"
They still say they won't cover her.
There's no way she can pay for it on her own. The down payment (money up front to the hospital) for the operation necessary to save her life will cost $30,000, which she simply doesn't have. And at last report, neither Blue Cross nor the hospital will cut her any slack.
They interviewed a couple of insurance company executives and they were adamant. Sorry for the woman, but—company policy! Wouldn't budge an inch!
Hell is not hot enough!!
There is something radically wrong with the American health care "system." It's all about money.