Story of my child being denied healthcare

[CC27]

angrychair

Story of my child being denied healthcare

When my child was young, almost 5, started having issues with his face on his left side. It would swell up like they had a golf ball in their mouth, fever and mild discomfort. Neither our dentist or doctors at the time had any idea and neither did we.
This went on for several years. We then moved to Washington. Now 12 and getting used to a new place and it happened again. No big deal we thought. Treat the symptoms.This time we got a different response. Doctor said this is more serious than we think and sent us immediately to Seattle Children's Hospital.

The doctors there are nothing short of amazing. They immediately set to figuring out what was wrong with a host of specialists and a battery of tests.
They then admitted them to the hospital to do more tests and a biopsy of his jaw.

We now had an actual diagnosis: a rare disease called CRMO. It's a sort of autoimmune disease. It was eating away at his jawbone on their left side. Any hard contact on that side would have shattered their jaw.
We had the benefit of a doctor that was a world respected expert on the disease. We made a treatment plan. It was a long road and none of it would be fun.

Let me pause here to say that in the big picture of things we were lucky. This disease almost exclusively effects children and mostly in the long bones and spine causing bone lesions and can be incredibly painful. It comes and goes, called flair ups. Some kids can temporarily lose the ability to walk.
His was just in his jaw. Still bad but it could have been worse

We had a plan and that care plan was submitted to insurance and the claim was denied. I was dumbstruck. I was scared. What the hell are we supposed to do now?
Did I mention how amazing Seattle Children's Hospital is? Our doctor saw it was denied and started the process to have it covered by the hospital. The hospital covered 100% of our bills.
That part is great but for their kindness though my child's life would have been very difficult and painful. My health insurance company tried to ruin my child's life. I can never forgive that. Ever.
I am also cognizant of the fact we were lucky and not all families are that lucky.

So do I feel bad for that guy being killed? Hell no. I don't want to harm anybody but I'm not losing any sleep over it either.

https://www.democraticunderground.com/100219796880

Flag on the 40 yard line... Not buying it

[SVPete]

True time: Story of my child's claim being denied initially but paid eventually

My daughter had Langerhans Cell Histiocytosis. It's a rare disease, sort of cancer-like but not a cancer, and at the time there were about 5000 known cases worldwide. The medical literature available to us at the time said that for children under age 2 the death rate was ~1/3. Our daughter was a month short of her 2nd birthday. Fortunately, one of the specialists in the disease practiced at UCSF Hospital in SF. We went there for the initial tests to see the extent of the disease and for treatment, ~6 months of weekly chemo. My health insurance did pay for that. Perhaps the stature of UCSF was a factor in that. This is about the aftermath a few months after she went off the chemo.

LCH does return, sometimes, and an early sign of this is diabetes insipidus. This is unusual thirst and frequency of urination. We were warned of this and instructed to come to the hospital immediately if that seemed to be happening. It seemed like it did (daughter was still just 2YO) and we had her admitted to UCSF hospital for the better part of a day for observation. She was (and still is, some 3 decades later) OK. My insurance declined to pay for the hospital stay. We appealed and were turned down. We tried calling, without success. We called against, this time getting an RN. We asked her to get into contact with our daughter's doctor at UCSF - which we knew he was willing to do. She did, and being a medical professional talking to a medical professional, she was persuaded by the doctor that as odd as the basic facts seemed, the hospital stay was medically justified, and the insurance company paid the claim.

angrychair's , if not fiction, displays a lack of effort on angrychair's part. CRMO is real, inherited, classified as autoinflammatory and as "rare", but it is known to be real. An insurance company declining an initial claim could be realistic, but I think that getting someone with a medical background at the company to talk with the actual doctor would have resulted in the insurance company paying claims according to the terms of the policy. angrychair's does not mention such an effort having been made.

Seattle Children's Hospital is affiliated with the University of Washington School of Medicine, so the doctor may have chosen not to contact the insurance company, but to treat the case for the purpose of students and staff learning about the disease.

At worst, wrt the relevant insurance company, angrychair's is an example of Six O'clock News syndrome. The millions of claims medical insurance companies do pay won't get on the Six O'clock News or in the newspapers. It's the uncommon/rare exceptions that do, and even then should be taken with a block of salt, given "reporters'" biases and laziness/sloppiness/selectivity.

[CC27]

True time: Story of my child's claim being denied initially but paid eventually

My daughter had Langerhans Cell Histiocytosis. It's a rare disease, sort of cancer-like but not a cancer, and at the time there were about 5000 known cases worldwide. The medical literature available to us at the time said that for children under age 2 the death rate was ~1/3. Our daughter was a month short of her 2nd birthday. Fortunately, one of the specialists in the disease practiced at UCSF Hospital in SF. We went there for the initial tests to see the extent of the disease and for treatment, ~6 months of weekly chemo. My health insurance did pay for that. Perhaps the stature of UCSF was a factor in that. This is about the aftermath a few months after she went off the chemo.

LCH does return, sometimes, and an early sign of this is diabetes insipidus. This is unusual thirst and frequency of urination. We were warned of this and instructed to come to the hospital immediately if that seemed to be happening. It seemed like it did (daughter was still just 2YO) and we had her admitted to UCSF hospital for the better part of a day for observation. She was (and still is, some 3 decades later) OK. My insurance declined to pay for the hospital stay. We appealed and were turned down. We tried calling, without success. We called against, this time getting an RN. We asked her to get into contact with our daughter's doctor at UCSF - which we knew he was willing to do. She did, and being a medical professional talking to a medical professional, she was persuaded by the doctor that as odd as the basic facts seemed, the hospital stay was medically justified, and the insurance company paid the claim.

angrychair's , if not fiction, displays a lack of effort on angrychair's part. CRMO is real, inherited, classified as autoinflammatory and as "rare", but it is known to be real. An insurance company declining an initial claim could be realistic, but I think that getting someone with a medical background at the company to talk with the actual doctor would have resulted in the insurance company paying claims according to the terms of the policy. angrychair's does not mention such an effort having been made.

Seattle Children's Hospital is affiliated with the University of Washington School of Medicine, so the doctor may have chosen not to contact the insurance company, but to treat the case for the purpose of students and staff learning about the disease.

At worst, wrt the relevant insurance company, angrychair's is an example of Six O'clock News syndrome. The millions of claims medical insurance companies do pay won't get on the Six O'clock News or in the newspapers. It's the uncommon/rare exceptions that do, and even then should be taken with a block of salt, given "reporters'" biases and laziness/sloppiness/selectivity.

God bless your family

[SVPete]

God bless your family

Thankyou! God definitely has. The daughter of the above is now in her 30s, healthy, lived and studied at a university in China, among other things.

[CC27]

Thankyou! God definitely has. The daughter of the above is now in her 30s, healthy, lived and studied at a university in China, among other things.

Great to hear

[jukin]

Did I mention how amazing Seattle Children's Hospital is? Our doctor saw it was denied and started the process to have it covered by the hospital. The hospital covered 100% of our bills.

If this fable conveniently told was true, it wasn't the hospital that covered 100%, it was the bigger bills to other patients that covered your bill. There is no free lunch. Somebody paid and that was OK with you. That forced payment is normally called EXTORTION.