Another Health Insurance Horror Story: At 13, David Denney's body functions like that of a baby

[dajoki]

Family rejects Blue Cross' claim
After years of paying for a badly disabled boy's nursing care, the insurer said he no longer needed it. His parents hired a lawyer.
By Lisa Girion, Los Angeles Times Staff Writer
December 30, 2007
http://www.latimes.com/news/la-fi-deny30dec30,0,5586308.story?coll=la-tot-topstories&track=ntothtml

At 13, David Denney's body functions like that of a baby. Severe brain damage halted his motor development at 4 months.

Unable to walk, sit up, speak or even eat by mouth, David is cared for by a licensed vocational nurse who feeds him formula through a stomach tube, watching closely in case he retches.

Blue Cross of California, the family's health plan, paid for the nurse for most of David's life at a cost of about $1,200 a week.Then about two years ago, the company decided that David didn't need a nurse anymore -- contradicting the opinions of two of David's physicians -- and it stopped paying.

<<snip>>

Gerald Denney said he was so frustrated by his inability to persuade Blue Cross to restore his son's nursing coverage that he decided to hire a lawyer rather than contest it through a regulator's independent medical review process.

<<snip>>

But Troughton (company spokeswoman) said the overall increase in treatment denial disputes reflected a greater recognition within the insurance industry of the importance of independent medical reviews. She said it also showed diligence by Blue Cross in informing members of their review and appeal rights.

In addition, Troughton said, Blue Cross has a team that routinely examines developments in medical science, such as new drugs and surgical procedures, to determine what care is state-of-the-art and should be provided to members. The Medical Policy and Technology Assessment Committee is made up of physicians who work for Blue Cross, as well as doctors who treat patients, and it takes input from experts, she said.

[dropkickpa]

1. Sweet fucking molasses

Gotta love the double-speak! We deny treatment so you can get a choice! I hope they all develop painful and embarassing conditions that aren't covered. Fuckwads.

[dajoki]

5. How about it...

But Troughton (company spokeswoman) said the overall increase in treatment denial disputes reflected a greater recognition within the insurance industry of the importance of independent medical reviews. She said it also showed diligence by Blue Cross in informing members of their review and appeal rights.

What the hell is that supposed to mean? They deny you so you can learn your rights!!

[JustAnotherGen]

2. Ditto dropkickpa

When are these 'Insurance Frauds' going to get theirs? I hope they all live THROUGH natural disasters and State Farm denies their claim so they CAN'T rebuild their homes. Seriously. I do. It would serve them right to pay into something - a service if you will . . . then get ripped off when it's needed.

For me? Health Insurance is sort of a big 'rip off'.

If you can get it . . .

And you get it and can AFFORD it . . .

And you make your payments faithfully . . .

They can decide to not to provide the 'product' for which you paid.

That seems drastically wrong. If I planned a wedding three years in advance, and paid for the food up front. And then the caterer decides to not provide the food because 'what we charged you and you paid for THREE years ago, and what it costs is not enough based on the rising cost of food so we AREN'T going to give you what you paid for . . ." Someone would have hauled their ass to the BBB and they wouldn't be in business for long.

[proud2BlibKansan]

3. I'll be anxious to hear what the pro-lifers have to say about this

In fact, I am going to send this story out to the ones I know. Interesting that most of them also think SOCIALIZED MEDICINE is EVIL. LOL

[dajoki]

4. Good move proud2Blib...

Let us know what kind of responses you get, I am very curious. Thanks:hi:

[proud2BlibKansan]

7. I will make a prediction

We have been arguing about health care for months now. So I am pretty sure what they will say:

1. They never should have let him live in the first place. Insurance companies and doctors have no right to play God. (Yes one of them actually said that about the girl needing the liver transplant - God wanted her to die and they should have let her go when she first got sick.)

2. Blue Cross is a private company and has the right to make this decision. If the family doesn't like it, they can just go find insurance elsewhere.

3. If the parents really loved their child, they would take care of him themselves.

4. Socialism is EVIL.

[dajoki]

12. Yep...

that sounds like the typical right wing response.

[jpgray]

18. Good point and good luck

[Vinca]

6. Translation: BC/BS wants the kid to die so they don't have to pay anymore. nt

[proud2BlibKansan]

8. BINGO

[JustAnotherGen]

9. proud2Blib

2. Blue Cross is a private company and has the right to make this decision. If the family doesn't like it, they can just go find insurance elsewhere.

My standard response to that is: Then since Jane Doe paid them all that money - does she get a refund for the product that was not delivered?


Sorry - I'm in Marketing - what they do? My company would get reamed 15 different ways. Example (I'm in the cell business) - if we made our customers pay up front then decided that one month they used the phone too much so the next month - we are just 'canceling' their subscription . . .

That would be unacceptable.

Anyone who works for a large corporation that gets sued every day for faaaaaaaaar less egregious things (ex:the ten point font in the user manual was too small) should be hollering and yelling for fair and equitable health care for ALL Americans - or the health insurance companies should be forced to give ALLLLLL that money back to the people that paid into their system that were then denied or had their insurance cancelled.

[proud2BlibKansan]

10. That's a great argument - THANKS!

[JerseygirlCT]

11. Litigation is the only thing that will make them reconsider their

bottom line concerns. PR means little in the long run. Regulations can always be gotten around. But a nice, big, juicy settlement from pissed off jurors? That'll get their attention. And more importantly, the attention of their shareholders.

[JustAnotherGen]

13. Yeah!

JerseyGirlCT! :pals:

[dajoki]

15. A refund, great idea...

but I don't see it happening.

[dajoki]

14. That is so sad...

because it is true. And worse yet is that there will be no change in the system for the foreseeable future.

[pitohui]

16. sure they do but let me say this

i think it's a cruel comment on our society that we force people to live without a brain

this is not a life and i wouldn't want it done to me

obviously since we have such an inhumane society that we have to keep vegetables alive forever to please the invisible cloud monster who loves to see us suffer, then, yes blue cross should pay for the nursing coverage

but sweet jesus if this happens to me just push me face down in the bath tub or something

[dajoki]

17. You made your choice...

so let this family make theirs. And being they paid their premiums, their insurance should continue to cover them.

[pitohui]

19. no in that position i wouldn't be able to make my choice

and this child is not able to make a choice either, he is being tortured, forever, without a brain, with no hope of recovery, with no hope of being able to think or act or do ANYTHING for himself ever

he is being tortured for no reason because the family can't let go

there are no good guys in this one


i would ask you, would you want someone you love to be kept alive in that shape? not if you loved them you wouldn't, i would also ask, would you want to be kept alive in that shape? i don't think anyone can honestly say they would


our society is cruel, it has tortured several of my family members (with alzheimer's) in this way

it isn't just the health insurance company that is evil, it is a structural problem bigger than that -- our society would rather pander to the minority who believes in out-dated religious superstition than to put a stop to torturing people who are kept alive without hope and without chance of recovering from brain damage

[dajoki]

20. This is a hard time for all involved...

and it is easy for us to sit here and make decisions for them without emotional attatchment. You say there are no good guys in this case, well that may be true, but there certainly are bad guys, yes the insurance co., they could continue their coverage to help the family as much as possible, that is what they were paid to do.

I am sory for what you went through with your family, it must have been terrible. But I honestly cannot say what I would do in that situation, I know it would be hard to let go. My mother has a living will so I WILL follow her instructions if it is ever necessary. But as for my wife and children and myself, I don't know. I can't be more honest than that.

I don't think religous believers are in the minority, and if it helps in times like this than it is good. But it can't be blamed for the suffering of this child. The parents must make all the decisions for their child and apparently they want to hold on. That is where the ins. co. must also do what they were paid for.

[Tansy_Gold]

21. If you have "faith," it should be easy.

Several members of my family (including me) have been faced over the years with the wrenching decision of letting a loved one go or doing the "extreme measures" routine to keep a body functioning long after the spirit/soul/personality had departed. While I may not agree with their belief system, they've always chosen the "God wouldn't want him/her to suffer," and they've opted NOT to go to extremes. Never mind that if "God" was opposed to suffering, he wouldn't have invented horrible diseases, drunk drivers, wars, etc. When you've watched someone truly suffer, when that person is fully aware that there is no hope for recovery or when that person is no longer aware of anything at all, it's really not a difficult decision. If you love them, you don't want the suffering to go on.

I've never understood the mindset that some -- not all, but some -- believers get into: While they paint life as a trial and death as the path to heaven and being with Jesus and all that, why do they fight so damn hard to keep someone from dying and going to Jesus? It makes no freakin' sense!

To keep someone alive just to avoid being parted from them is cruel and selfish. Let them go, either to the nothingness that is at least release from pain and suffering or into the glory and beauty of Heaven.


Tansy Gold

[dajoki]

24. I have also seen...

loved ones suffer and having faith doesn't make it easy, at least not for me. What it does is give hope of something better. Its personal, so that's all I will say, I hope you understand that.

[Hoof Hearted]

23. So you think the minority of the country is religious?

You might want to research that a little.

I don't think most people choose to provide life sustaining care for their disabled and vegetative relatives necessarily do so out of religious sentiment. I understand that was probably your experience, I'm just saying I don't think that's in any way universal.

[sandnsea]

25. That's your belief system

Others have a firm belief that life is never theirs to take, not ever. They should have no more right to inflict their beliefs on you than you should have on them. That's why the pro-lifers are wrong and that's why you're wrong.

[Hoof Hearted]

22. BC/BS is a horrible company. I can't stand them. n/t