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SBD · Admiral Joined: 19 Aug 2004 Posts: 1022

The Foundation for Taxpayer and Consumer Rights has written a story about my health insurance problems to be published on their website next week. I have also received inquiries from CNN and possibly 60 Minutes that are also interested in my story. Hopefully, this will help my lawsuit that will be filed at the end of this week.

Uisguex Jack · Rear Admiral Joined: 26 Jul 2004 Posts: 613

Shee's Louise, what a mess. I'm glad your still ticking though.

I'd forgotten the part about friday the 13th.

You take care SBD!

Schadow · Posted: Fri Oct 13, 2006 6:48 pm Post subject:

Sal -

Yours is a truly tragic story of a dysfunctional insurance industry. Among the most outrageous accusations by PacifiCare is that you committed fraud. You plainly did not and you should file a complaint with the California Department of Insurance if you haven't already done so. This libelous accusation should not go unchallenged.

The subject of "pre-existing condition" is a very subjective thing. Of course, no one with prior knowledge of a life-threatening condition should expect a health care provider to issue coverage. But you clearly did not have such knowledge. The industry has apparently settled on a period of 18 months backward-look from when a condition is diagnosed to establish "pre-existing".

But what is magic about 18 months? Everyone starts the process of dying when they are born. It is certain that we will die from something eventually. In our case, we had a young son who died just before his third birthday of a particularly vicious cancer called embryonal rhabdomyosarcoma. The "seeds" of this form of cancer are present even while the child was in the womb. (Our company health insurance paid all the medical expenses without blinking, even though the condition was pre-existing and then some.)

In the case of PacifiCare, denying the Cleveland Clinic charges with the excuse that they were "out of network" would seem to imply that if Cleveland had been "in-network", they would have paid. And if they would have paid, it would imply that you were covered. That part is very confusing and contradictory.

I hope you can get Sacramento's attention on this whole thing. You have definitely been wronged.

Schadow
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Capt, 8th U.S. Army, Korea '53 - '54

dusty · Posted: Fri Oct 13, 2006 8:42 pm Post subject:

I'm glad you're still around to tell your story SBD. And I know your family is.

Sure hope Pacific Care ends up having to ante up for you. The facts are on your side sounds to me like. Just have to hold their feet to the fire. A little national publicity may do the trick.

Take care of yourself and I wish you a long and cancer free life from now on.

Dusty
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Left and Wrong are the opposite of Right!

streetsweeper95B · PO2 Joined: 25 Nov 2004 Posts: 365 Location: Texas

1-800-927-4357

website: http://www.insurance.ca.gov/

HMO's are right up there with bad politician's, crooks and thieves in my book. From personal experience out in Seattle, my ex works in health care info systems, you get one MD heading a professional review department staffed by 7 to 15 plus RN's.

All a PRO (ie PacifiCare) does is handle the medical review caseload for an insurance company that has given them a strict set of guidelines to follow. If they don't, the insurance company goes hunting a new professional review organization (PRO).

These PRO's are staffed by very caring individual's that have their hands hogtied behind their backs. I know a fairly large number of RN's that worked for a particular PRO in Seattle that have given up and gone back to working floor shifts, OR or ER.

I will glady testify in a court of law for the nurses that have broken down, cried their ass off clocked & walked out of the office because of the incredibly stressed situations they are forced to deal with everyday.
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"Proud Member of the Freak Show"

SBD · Admiral Joined: 19 Aug 2004 Posts: 1022

Thanks for all of your comments and support. I have contacted the DMHC and my attorney should be filing my lawsuit this coming week.

In the meantime, if you want to help, I think the publicity is what I need right now so Pacificare and the California Department of Managed Health Care will take notice.

Here is the link to Pacificare's Customer Service Contact page. Tell them how disgusting their behavior has been and they should be ashamed of their behavior. That will benefit me more than anything.

Here is the link to the DMHC contact page. The DMHC will fine Pacificare like they did recently when they fined Blue Cross $200,000.00 for recinding someone's policy.

Thanks again for your help,

SBD

USAFE5 · PO2 Joined: 23 Aug 2004 Posts: 362 Location: Reno Nevada

I work for a small business and we have pacificare as our provider. Our policy is due to renew and guess who isn't going to be renewed??

My hubby and I are currently covered through Pacificare at his job and unfortunatly I can't change that this renewal but I will on the next one ( I have just had gastric bypass and the program we are on covers my 1st year of follow up care).
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"The most terrifying words in the English language are: I'm from the government and I’m here to help." Ronald Reagan

SBD · Admiral Joined: 19 Aug 2004 Posts: 1022

USAFE5 · PO2 Joined: 23 Aug 2004 Posts: 362 Location: Reno Nevada

he is federal and as it is a procedure covered by medicare they have to cover it too.
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"The most terrifying words in the English language are: I'm from the government and I’m here to help." Ronald Reagan