US insurance company and the (possible) Corona Virus

[irisblue]

Source-https://www.miamiherald.com/news/health-care/article240476806.html
Title-Miami man who flew to China worried he might have coronavirus. He may owe thousands.
BY BEN CONARCK FEBRUARY 24, 2020 10:01 AM

snip--"After returning to Miami last month from a work trip in China, Osmel Martinez Azcue found himself in a frightening position: he was developing flu-like symptoms, just as coronavirus was ravaging the country he had visited."


snip--" Fortunately, that’s exactly what happened. He had the flu, not the deadly virus that has infected tens of thousands of people, mostly in China, and killed at least 2,239 as of Friday’s update by the World Health Organization."

snip--" But two weeks later, Azcue got unwelcome news in the form of a notice from his insurance company about a claim for $3,270."

snip--" The idea that [the insurer] would have to comb through three years of his records just to determine if the flu was a preexisting condition is just crazy,” Corlette said. “But that’s how most of these plans operate.”


There is alot more info in the story from the paper.

This point about US crappy insurance policies isn't something I'd thought about.

[Bettie]

1. That's the system that so many love

so much that they can't even consider a single payer system.

But hey, if people can't afford to go to the doctor, I guess they should die AND infect others.

[TwilightZone]

2. They don't even have to comb through records.

Medical records are pretty well organized, in part for treatment purposes, of course, but also to make it easier to deny people based on pre-existing conditions.

It's getting even easier now that corporations that employ lots of people are buying insurance companies and self-insuring, like CVS and Aetna, and keeping most treatment in-network. It's all in one, big, happy database.

[wryter2000]

3. Because he'd had the flu before

They wouldn't cover it now?

It couldn't be the same strain. He'd be immune to that now.

[Heartstrings]

4. Having worked pre-existing claims for Blue Cross in the past

the insurer was looking for symptoms, not necessarily diagnosis....pretty much anything in the medical history that could be pre-existing would be cause for denial and then let the patient fight it out with the insurance company. So, for example, if he had nausea within the look back period, any claim coming in with that symptom or diagnosis could be denied.

[wryter2000]

6. Thanks

Makes no sense, but it doesn't have to.

[Heartstrings]

8. You're welcome!

This was back in the mid nineties and we only handled employer bought policies. Depending on what contract they opted for determined how it was administered. No two were alike....

I also worked “High Cost Quality Audit” so dealt with medical facilities (hospitals, clinics, skilled nursing facilities, etc.) the other side of the coin (think medical billing fraud) and where lifetime maximums were determined. I watched and worked with corporate to begin rejecting claims once that max was met. “Lifetime maximums”, very important and not clearly understood outside the insurance industry.

Personally I think there should be a much greater awareness of how medical insurance is put into place per plan. Terminology is key....

[Ohiogal]

5. Appalling!

[Raftergirl]

7. This is what happens

when one decides to buy a non ACA compliant plan. You get what you pay for.