10 years after getting her face shot off, she's getting a new one... no thanks to her insurer

[charlie]

A shotgun blast took her eyes, nose, and upper part of her face. She's just had the first of several surgeries to repair the hole in her head:

“So refreshing, like something that you lost and found again,” Steltz said from her hospital bed. “I can’t quit. It feels so good to breath through the nasal passages.”

It's being done gratis, because her insurance won't cover it. You can guess why:

Steltz is having the surgeries ten years later because the Oregon Health Plan denied her coverage of the procedure because it considered the surgeries to be cosmetic. However, her doctor, Eric Dierks, and others are donating their services.





http://www.katu.com/news/63192497.html

[robinlynne]

1. fuckers. Why aren't these people in the Senate Finance Committee meetings in-

stead of lobbyists. The truth is so very very obvious. How can buacus sidestep it, and lie and lie and lie and still have a national platform to speak from?

[Ruby the Liberal]

9. We will never be truly represented until we REALLY reform campaign contribution

rules and get corporate money out of Congress.

[Demoiselle]

13. BINGO, Ruby! You're absolutely right. (nt)

[robinlynne]

18. yep. Not to mention the electronic vote counts in over half the country!

[Beaverhausen]

2. of all the stories about insurers denying coverage, this may be the worst

and that is really saying something.

[Warpy]

3. I can't believe they dismissed massive reconstruction after trauma

as purely cosmetic! Who the hell are these heartless bastards and why are they allowed to exist among decent people?

If anyone cries out to be fired from a job that has anything to do with human services, it's the dirtbag who turned down this surgery.

There are compelling health reasons to rebuild her face so that she can breathe normally.

This story proves how much human evil there is in the world, and how it's been put in dominion over the rest of us.

[GreenPartyVoter]

5. It's unreal, isn't it?

[GreenPartyVoter]

4. The suffering that poor girl has endured. She was so beautiful before, but she clearly

retained her beautiful spirit.

[Hannah Bell]

6. k/r: obscenity. this should be front-page; i think there's no one who wouldn't be

outraged.

ps: "insurer" = dept human service oregon.

http://www.oregon.gov/DHS/healthplan/app_benefits/ohp4u.shtml

[Frustratedlady]

7. There should be criminal charges brought against the state, or whoever made that decision.

No one in their right mind would allow that poor girl to go that long without surgery. The more I see, the madder I get.

[bbinacan]

8. I'm glad I'm not covered by Oregon's plan.

"It was intended to make health care more available to the working poor, while rationing benefits."

http://en.wikipedia.org/wiki/Oregon_Health_Plan#cite_note-WWsickness-0

[hedgehog]

10. Somewhere is a health economist who will insist to you that if this had

been covered, 500 women would have had their prenatal care eliminated or 7000 kids would have gone without polio shots because health care spending is a zero sum proposition.

[hedgehog]

11. In case you've accidently swallowed something poisonous and can't afford

to get your stomach pumped, check out the comments at the link!

[Canuckistanian]

12. They called it "cosmetic surgery"??

That's insane. In Canada, it wouldn't be cosmetic surgery. It was a major disfigurement, not an ugly nose.

The person who denied that surgery should be exposed and shamed.

[ljm2002]

14. Some enterprising reporter...

...really needs to find out WHO denied this claim. I'm sure there were more than one people involved, we need to know who they are and publish their ugly mugs everywhere as the poster boy(s)/girl(s) for the current health care system in the US.

If I had my way they'd be serving time for such heartless behavior. But of course, there are no laws against what they did. No regulations, no way to appeal the decisions of our corporate overlords.

[Hekate]

15. A special place in Hell... Some insurance co.s argue about facial birth defects, as well....

"Cosmetic"? COSMETIC? The angels weep.

Hekate

[mrbarber]

16. What a goddamn travesty.

This country has become.

[MissB]

17. The Oregon Health Plan is our state's public option

started by our former (and likely future, because he is running again) governor. The Oregon Health Plan does the best it can to help poor Oregonians, but it is poorly funded so only basic stuff is covered- like what you'd see if Republicans ran a public option.

The plan rations care. I don't actually fault them for not covering this, and am glad that doctors are stepping up.

On edit: and by poorly funded, I mean that some years they have had a lottery for poor adults for coverage. If you are one of the lucky ones, then you'd get coverage, otherwise you'd be out of luck. So like someone essentially said upthread, yes some bean counter weighed the cost versus the number of services others would forgo and she ended up with no chance to get a face thru the plan. Not the first time that has happened and probably not the last.

I have hopes that Kitzhaber can continue what he started, because our current guv isn't doing much to help.

[anigbrowl]

19. I have mixed feelings, and think you are mistaken

Not about it being part of the Oregon Health Plan, but do you realize that this is a bad advert for government healthcare? Of course, it ought to be better-funded, but it's depressing to see people going on about evil corporations when in fact it's bad state planning.

The plan rations care. I don't actually fault them for not covering this, and am glad that doctors are stepping up.


What good is it if it doesn't actually come through for people who need it? I mean c'mon, having your face shot off is a basic case of medical need.

Any plan like that is run by idiots, because the basis of insurance is reinsurance - ie the insurer takes part of their money and buys policies with other insurance companies (called reinsurers) to spread the risk. It's literally insurance for insurance companies, and basic good risk management.

[MissB]

20. Oh, there are worse stories out of the plan, believe it or not.

I find it hard to cut and paste on my mobile device, but there was one case where OHP denied some chemo drugs, but then offered the woman info on assisted suicide. Horrific, really.

And I'm not against a public option, mind you. I'm strongly in favor of one. But our current model in Oregon probably (really!!!) shouldn't be used as a national model.

The government is us, and all of us are capable of making some stupid decisions.

[anigbrowl]

21. That's interesting information

When you have time, maybe you could do a comprehensive post. We need to learn the lessons from plans that haven't worked to avoid situations like this in future. I can tell you from growing up in Europe (with a parent at a senior level in the health service) that when you have govt. provided healthcare, ALL questionable medical failures (ie, anything where the outcome isn't completely obvious) are attributed to the government.

Like it or not, if we succeed in passing healthcare reform with a public option etc. (which I hope we will), everyone who has a less-than-100% perfect outcome on the public dime will be made into an attack ad by the GOP. Even if they don't try to dismantle it, they'll argue that the Democrats can't manage it. It takes >10 years for a system like this to bed in.

[Kievan Rus]

22. For those who deny the rich are truly evil, look at this story

[Stephanie]

24. It's not the rich, it's the state's low-income health insurance plan

http://www.oregon.gov/DHS/healthplan/about_us.shtml

The Oregon Health Plan (OHP) provides health care coverage to low-income Oregonians through programs administered by the Division of Medical Assistance Programs (DMAP). Currently, more than 380,000 people each month receive health care coverage through the Oregon Health Plan.

[thereismore]

23. See? Charity works.

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