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  • Big Insurance Met Its Match

    From JAB@21:1/5 to All on Fri Nov 10 11:38:28 2023
    Note - Long read, but relevant insights on how medical insurance works


    Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer's
    Request for Cancer Treatment


    Blue Cross and Blue Shield denied payment for the proton therapy
    Robert "Skeeter" Salim's doctor ordered to fight his throat cancer.
    But he was no ordinary patient. He was a celebrated litigator. And he
    was ready to fight.


    https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial

    --- SoupGate-Win32 v1.05
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  • From Kerr-Mudd, John@21:1/5 to JAB on Fri Nov 10 21:47:01 2023
    On Fri, 10 Nov 2023 11:38:28 -0600
    JAB <here@is.invalid> wrote:

    Note - Long read, but relevant insights on how medical insurance works


    Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer's
    Request for Cancer Treatment


    Blue Cross and Blue Shield denied payment for the proton therapy
    Robert "Skeeter" Salim's doctor ordered to fight his throat cancer.
    But he was no ordinary patient. He was a celebrated litigator. And he
    was ready to fight.


    https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial

    Sadly just one case, and even then it's about lawyers and money.
    The 'healthcare' system in the US seems to be bad at supporting the
    citizens actual needs.

    --
    Bah, and indeed Humbug.

    --- SoupGate-Win32 v1.05
    * Origin: fsxNet Usenet Gateway (21:1/5)
  • From JAB@21:1/5 to admin@127.0.0.1 on Fri Nov 10 18:48:46 2023
    On Fri, 10 Nov 2023 21:47:01 +0000, "Kerr-Mudd, John"
    <admin@127.0.0.1> wrote:

    Sadly just one case, and even then it's about lawyers and money.

    In this matter,

    There was one problem. Salim held a type of insurance governed by a
    relatively obscure federal statute: the Employee Retirement Income
    Security Act. The Department of Labor is charged with enforcing the
    law, known as ERISA.

    The 1974 law is vague and lacks teeth. Court rulings interpreting this
    law have often tilted in favor of insurers. For instance, insurance
    companies have broad authority to decide what to cover and what to
    deny. And the law does not allow for punitive damages, which are
    designed to punish a company for abuse or fraud by eating into its
    profits.

    The 'healthcare' system in the US seems to be bad at supporting the
    citizens actual needs.

    Two aspects....medical insurers and healthcare system. Medical
    insurers want to maximize their profits, which was the issue here.

    --- SoupGate-Win32 v1.05
    * Origin: fsxNet Usenet Gateway (21:1/5)