Health care activists confront Horizon BCBSNJ Executive Tom Rubino outside Horizon headquarters in Newark NJ.
I was interested in this story, not the least because, well, this is my COBRA carrier and Horizon's crazy reimbursement rates are the reason why my doctor was kicked out of their network. But really, it could be anybody's insurer. (Oh, and please: If you're having a problem like this with an insurer, call your congressman's office. They usually have a staffer who does nothing but handle insurance problems for constituents.)
BAYONNE, N.J. -- One February morning, a courier arrived at the front desk of Bayonne Medical Center, trying to get to a patient's bedside. His mission: to deliver a letter from New Jersey's dominant health insurer warning that the patient would face a huge hospital bill if he did not leave right away.
Hospital security guards stopped the courier -- and 13 others who came soon after -- before they reached patients' rooms. But then came the faxes and, after that, the letters mailed to patients' doctors and homes. Told that her health plan would not pay for her to stay in the hospital, a 35-year-old social worker named Lisa with a severe lung infection was so unnerved that, tethered to an IV pole dripping antibiotics into her arm, she began to pack her gym bag before a staff member coaxed her back into bed.
The hardball tactics being used to pry patients from their sickbeds illustrate the colliding financial interests that pervade U.S. health care. It is a tug of war over where patients are treated, who decides how much care they receive and -- fundamentally -- which parts of the health-care industry gain or lose when people become ill.
The battle playing out in Bayonne has particular relevance as Congress tries to rewrite the rules that govern health care nationwide -- with hospitals, insurers, doctors and other stakeholders descending on Capitol Hill to angle for advantage. The bills before the House and the Senate would shift the system's balance of power that has evolved over decades -- a balance at the core of the dispute here.
Yet the fight over hospital patients in this working-class enclave also hints at the limits of what federal health-care changes would accomplish; none of the bills would legislate away the specific business practices that have escalated into a full-scale brawl between the city's only hospital and New Jersey's largest health insurer, Horizon Blue Cross Blue Shield. Lawsuits are flying in both directions, each side accusing the other of fraud, greed and underhanded behavior that harms consumers and increases medical costs. Bayonne accuses Horizon of harassing patients and not paying its bills. Horizon accuses Bayonne of price-gouging and interfering with its health plans.
Such a sharp clash of self-interests is evidence that President Obama may have been naive in suggesting early on that health care's stakeholders are now willing to set aside rivalries that have thwarted previous attempts at reform, said Uwe E. Reinhardt, a health economist at Princeton University who led a state commission on New Jersey's shaky hospital finances. "It's no different from Iraq with all the different tribes. . . . 'How does it affect the money flow to my interest group?' " he said. "They are all sitting in the woods with their machine guns, waiting to shoot."
In such a tense climate, Bayonne has become virtually the only hospital in the country that has withdrawn in protest from the "provider networks" of every major insurer, abandoning a tradeoff that has become a staple of the health-care system: Hospitals agree to be paid lower rates in exchange for knowing that insurers will steer patients to their beds. Bayonne is not, however, the only hospital at odds with Horizon. Four others have pulled out Horizon's network or are close to leaving.
These insurers would be more honest if they dressed up in top hats, cape and wore handlebar mustaches.
My apologies to Snidley Whiplash.
How do these *ssholes sleep at night?
Divine Right of Kings (1600's); Divine Right of Corporations (2011)
prescription drugs.
It seems to be a self feeding cycle: you have to be an asshole to be able to afford the medical plan that allows you to cope with the fact that you have to be an asshole to be able to afford the medical plan that....
Of course, Mr Rubino doesn't pay a cent for any of his pills. What a creep!
They sleep on piles of hoarded gold.
rivetting and relevant post, SM! i finally got what is actually going down in this "brawl." i think that there should be many more such postings/articles about what is happening in terms of real people and the institutions that are siding with/dissing them.
the Princeton prof's description of folks waiting in the woods with guns for someone to shoot sounds deeply sick.
what a disastrous mess the Bush-Cheney administration left in their hideous wake.
No one despises health insurance companies more than I, but this story doesn't sound kosher. Here where I live, insurers communicate with hospitals and tell them how many days they will cover. It is in the hospital's interest to empty that bed, not Blue Cross's. The hospital is the one left holding the bag for non-covered days. All BCBS has to do is not pay. So what's the real story.
knowing this stuff is happening constantly day after day night after night at this point. Are we nuts?
We know it's better to have health insurance than be without it.
Of course we fear the day when the insurance company will pull the plug but at least we'll get SOME of the treatment we need.
WORST Insurance Companies in NJ!!!!!!
http://www.youtube.com/watch?v=mp83NFtWnRQ
Diabolus est Deus Inversus
That's one more potential saving of an improved system - the congressional staffers who do "nothing but handle insurance problems for constituents" could devote their time and efforts to other problems.
Democracy is too important to be entrusted to politicians.
Rise Up!
Protest!
might that be, pray tell???
From UpTakeVideo Channel at YouTube:
Preaching And Arresting For Health Care
Six Arrested For Stopping UnitedHealth "Business-As-Usual"
Democracy is too important to be entrusted to politicians.
Rise Up!
Protest!
it's death insurance. they make money when u die. this is a war on america by mafia type thugs masquerading as a insurance company. and the government is in cahoots. why wont they remove the Sherman anti trust exemption they gave these criminals.... when will a states attorney stand up and indite these criminals? we need a national strike against these scumsbags.
... I am astounded by the fact that Americans do not know what "insurance" means and implies.
I take that "taking hedge bets on your health" was deemed not as marketable as "health insurance" by initial studies when these assholes were setting up the whole HMO system.
I say fuck it. We're not going to win. Treat them like the right treats abortion doctors. Harass them at their homes, harass their employees as they enter their place of work, or just shoot them. Send a fucking message. Sorry, but I'm just sick of this shit. These criminals have the protection of our elected officials and we are powerless against them. We pay our premiums on time every month year after year after year and they legally have the right to deny us coverage as they see fit. How would people react if we went to a grocery store and paid $150.00 for groceries and the store took the money then took the food back? What if we prepaid for 15 gallons of gas to fill up our tanks and got no gas. What if we paid for garbage collection but they never picked it up.
Seems like the health insurance industry is one of the few if not the only business that can charge you for a service then deny you the service after it's paid for.
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We need to demand single payer!
From the main post:
Obama's mistake was mistakening the Health Insurers and Big Pharma for the "stakeholders" in health care - WE THE PEOPLE are the principal stakeholders in health care - along with the doctors and nurses who provide the care.
Democracy is too important to be entrusted to politicians.
Rise Up!
Protest!
Health Insurers and Big Pharma gave to his campaign.
That would shake things up.
Will Health 2.0 Start-ups Usher in Consumer-Driven Healthcare?
The company is pursuing a simple and disruptive idea to the U.S. healthcare system. It runs what it calls a “direct practice” in downtown Seattle, which freezes out health insurers and deals directly with patients
http://www.xconomy.com/seattle/2009/07/07/qli...
http://www.qliance.com/
A damn good start considering our current reality.
and wouldn't a single payer universal health care system, like the civilized advanced developed world countries have, solve most of this?
This is another thing I'm tired of. Hearing people cry about a "single payer" system. We can't even get a fucking public option and you keep crying about a "single payer" system? What a waste of time. This is the United States of $$$$$$. Capitalism. Works great for that 2%. Newsflash, that 2% controls our government both left and right. Just stop with this "single payer" crap. Single payer will happen when this country's economy totally collapses. Big corp will tangle that carrot in our faces to keep it running just enough to keep us paying them. We are fucked unless there is full blown revolution in this country.
I remember a small band of revolutionaries who once started a country to escape just what we are facing now. What was the name of the country they started? The name escapes me....
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WE WILL NOT BE SILENCED!!!!!!
The health industry is the new mob. Where's a Bobby Kennedy when you need him?
Dead
is intended to be a factual statement
in the middle of their hospital care, they could be on the verge of having life-saving surgery, and then refuse to have it due to the cost. They would forgo what they needed to live in order to not place a financial burden on their families.
It's now a cliche - but talk about Death Panels.
The P's TB seem to act like everyone makes $50,000 a year and up with zero debt and a few solid assets clear and free in this country.
Health care is for the rich and powerful in the US. Everyone else is made to sell off their assets so they may have a chance to cling to life. If you're poor, you have little or no chance. Compassionate conservative? Never met one.
Republicans are liars and simply cannot be trusted.
`for someone to start a nationw2ide sit in strike at your nations insurancce companies. It worked for the UAW in the 1930's in Detroit. So what have you guys got to loose. I know if something like that happened here in Canada all hell would brake loose. ARE YOU LISTENING HARPO(OUR PM)
We have the best health care system in the world right here in America. Our health care system is the envy of every country on earth. We Americans live in the greatest country in the world. And that is why I know this story is just a lie.
Why do you hate America, you pinko pansies????
`I don't hate you. Yes I am a Canadian and we have socialized "single payer" medicare here in Canada. I won't go broke or be denied help because of a 'PREEXSISTING CONDITION".I have celiac disease and need regular visits to the doctor and bloodwork.(nothing is rationed) I DON'T ENVY A SYSTEM THAT CHARGES OUTRAGEOUS FEES then says oh sorry we don't cover that.
You need to look beyond the crap that your politicians tell you and think for yourself
I wouldn't be anymore interested in pleading with insurance companies about my lack of health insurance than I would be with taking my case about the high murder rates to a band of sociopaths.
I want them and this corrupt system of government that feeds them gone. I want my interests represented. I want to represent myself.
I want to sit as close to the white house as I can in solidarity with the millions of people like myself. I missed the first healthcare protest due to work.
At this point I'd be willing to go on a hunger strike for change. I wish others were at the point I'm at, where there is nothing to lose. Without health insurance I could face the complete end of any future hope for my life getting better and the first portion of my adult life has been fraught with poverty due to Republican policies.
I've got nothing to lose at this point. Words cannot completely express how fed up I am with this entire system.
THEY SHOULD BY SOME FUCKING INSURANCE!!!!
Extortion is illegal, why isn't private health insurance?
I read an article and the text of the complaint of the federal lawsuit in July 2009 when it was filed. Interesting reading. Here's the link to the complaint (Adobe Acrobat file.)
http://www.bayonnemedicalcenter.org/bmcnews/B...
Bayonne alleges that they were losing money being a participating provider with Horizon of NJ BCBS. They opted to terminate their contract with Horizon as a participating provider.
Under NJ law, if a patient presents to an emergency room and receives emergency services there or requires inpatient treatment as a result of an ER visit, the patient's insurance must pay for it, whether or not the hospital is a participating provider with that patient's insurance. Bayonne alleges that Horizon has been sending couriers to their hospital to notify patients covered under one of Horizon's insurance plans that their bills will not be paid, and that the patient must transfer to a Horizon participating hospital. Bayonne alleges that Horizon is not telling these patients the truth; that their expenses ARE covered under their insurance contracts because of the nature of their illnesses (they were admitted as emergency patients) and that Horizon is failing in its duty to their subscribers in violation of their contracts, public policy and federal and state law.
Read the text of the complaint (link above.) It's absolutely chilling. Patients are literally being roused from their sickbeds or ER stretchers by representatives who are telling them that they must transfer to another hospital because Horizon will not cover their urgent treatment. When in fact insurance coverage for such treatment is mandated by law.
I'm on disability and my family's COBRA coverage was supposed to end sometime in September. During the summer, I called our insurance company, UniCare, to verify the end date; UniCare told me that they knew nothing about my COBRA coverage and that I should contact my COBRA company (a third-party company that collects the premiums). I did so and was assured that my coverage extended through the entire month of September and would end on October 1. The COBRA company even issued a certificate of coverage showing that date that I submitted with my application to Maryland's "insurer of last resort", the Maryland Health Insurance Plan (MHIP). (BC/BS of Maryland told me our family would be declined coverage because of pre-existing conditions.)
Late in September, we learned that UniCare was rejecting our prescriptions and we discovered that UniCare - *supposedly* with no knowledge of our COBRA coverage - had terminated our insurance on September 15, two weeks early. The upshot is that our COBRA company was apparently given (by my former employer?) the wrong dates of coverage, the insurance company was correct, we've have had to stop medications because we can't afford them (one of mine jumped from $10 to $650; one of my daughter's jumped to $1800), we have to pay full-price for 3 doctor's visits and an ultra-sound test during that 2 week period, and we've had to postpone other appointments for a month until late in October, including a nuclear heart stress test. And I'm still trying to get a refund of the half-month's premium that somebody owes us.
(MHIP's coverage began on October 1, but they don't send the insurance cards until two weeks later, so you're still on your own until you receive the cards. Furthermore, MHIP approved me for Individual Coverage at first, although I had clearly applied for Family Coverage. Getting that straightened out has delayed the cards a week or more.)
In short, my warning for those whose COBRA coverage is about to end, double- and triple-check from multiple sources when it is going to actually end, so you don't get caught up short like we were.
This type of thuggish brutality must be stopped. They are playing with peoples lives and threatening the wellbeing of thousands of people. The company should be heavily fined.
Why we are supposed to give a rat's *ss whether these bastards' businesses go down the tubes?
E-MAIL THE PUBLIC ADVOCATE: PublicAdvocate@advocate.state.nj.us
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