Health Insurance Horror Stories

Consumer Horror Stories (newest is presented first)

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I recently watched the movie "Sicko" at home. It really lit a fire under my butt. I am so grateful that somebody has finally taken the time and effort to "out" the medical system in this country. It is about **** time!!! I worked in the allied healthcare industry for over ten years, up until I became disabled as the result of an auto accident. That's when I became a victim to this horribly dysfunctional and corrupt system I was witness to for so long. I am currently carrying COBRA coverage through Blue Cross / Blue Shield of Texas (HMO). And, let me tell you that they are absolutely wretched. I have been in the Emergency Department of my local hospital with horrible abdominal pain, swelling, constipation and nausea several times this week. Earlier today, I noticed a large amount of dark black blood in my stools. Accompanied with a low grade fever, lightheadedness and yet more abdominal pain, I reported once again to the Emergency Room. The doctors there said they wanted to call in a gastroenterologist for an endoscopy. After several hours and some blood work, they returned to my room and stated that they were discharging me home. Feeling no better at all, I asked them the reason for this and they stated my blood pressure and hemoglobin were fine, and that my HMO would not authorize an endoscopy unless I had lost "a lot of blood," or my hemoglobin was low. Now, I don't know how all of you feel about this, but the half-pint I found in my toilet this afternoon was quite alarming. I voiced this concern to the ER staff, only to hear, "well you really need to follow up with this referral we are giving you." Unfortunately, my HMO doesn't recognize referrals from the ER doc, only from my primary care physician, who I have phoned many times only to hear that he is not available to see me for several weeks. I can't see anyone else because my HMO won't cover them. I can't even explain how horrible this is, to know something is horribly wrong with my body and to be hung out to dry like some menial financial liability.

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Last winter I was doing some work around my apartment and accidentally drank some paint thinner that I thought was water. I put the paint thinner in a drinking glass because it made it easier to clean the brushes. Anyway long story story short I must have been dizzy and confused from the fumes and was thirtsy. I ACCIDENTALLY drank the paint thinner. Right away, I knew something wasn't right.

My roommate rushed me to the emergency room and dropped me off because she had to go to work. I awoke 3 hours later in a pool of my own vomit in a hallway of the hospital. They gave me a charcoal treatment and I stayed there for a day and half for observation.

Now BC not only has refused to pay for the visit ($3800), they dropped me from my ppo plan on the grounds that I had a substance abuse problem that I did not disclose. They accused me of drinking the paint thinner on purpose to get high or something.

I feel like I am being railroaded down a railroad that is going into the desert of financial and emotional ruin..and you know what? I'm thirty in this desert, and the only thing to drink is paint thinner...paint thinner served by BC.

Signed,

Thirsty and Broke.
Charleston, Wv.

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Blue Cross/Blue Shield of Georgia has repeatedly refused to cover my medicine, my office visits and my doctor ordered brain and heart tests. Now I can't log in and when I call the 800 number they say it's after hours and they hang up. I have surgery tomorrow and they won't pre-certify me! Blood-suckers!

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My 16 yr. old son was taken by helicopter to nearest trauma center due to a motorcycle crash. B/C ppo will not pay e.r. bill. Stating it was an out of network hospital. I had no choice which hospital he was taken to, state law says in a life and limb situation he must be taken to nearest trauma. He had lacerated his pancreas cost for 8 day stay is 78,900. Only for room and board. BC has a special circumstance clause they are not following....What to do. Denied appeal.
Karla

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Although it wasn't blue cross, but SRP that is really making me steamed. Husband was in a bad car accident, and the lady who hit him and was 100% at fault had very minimal insurance--AllState--so our health insurance covered his emergency surgery. Now, they want us to pay them back, even though we paid health insurance premiums for years! And paid all our deductibles and co pays as well. We haven't gotten a settlement or any money from our car insurance, Allstate only paid for my husband's car to be totaled out (which was under $2000) and that's it. We didn't get some huge million dollar settlement, and my health insurance company wants to be paid back!? Then why do I pay for health insurance in the first place?

Comments

To:     Debra

        Blue Cross Individual Services

From:   Don

        Los Angeles, CA 90043

        Re: Cancellation of my policy

February 23, 2008

Dear Debra and colleagues,

Your letter of Feb. 18, 2008 states that my BC Life and Health plan was cancelled for “non-payment of premium.” No. The policy was cancelled because I sent a letter cancelling it.

My experience in trying to enroll with BC has been a disaster:

1.      First I applied via eHealthInsurance.com.

2.      A second application was sent to me via USPS. I was confused.   I called one of the numbers in the letter and told the woman that I had applied online. She didn’t seem to know anything. It turns out that your sales agents want to get their commissions and are therefore making the application process redundant.

3.      The underwriting office tacked on an extra $100 per month for a “shoulder injury, recurring”. I had stated in my app that the shoulder was HEALED. I signed the statement. What does that mean to you people?

4.      More bureaucratic BS followed this.

I have gone with Kaiser. They were very straightforward - $210 per month. Done deal. Good riddance to your confused company.

Sincerely,

Don

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We signed our infant son up with Blue Cross for his health insurance. When he was about six months old we took him to a specialist to look at his eye. Upon receiving the bill, they retroactively cancelled his coverage for all the well-baby checkups gone to up to that point: they actually received a refund from his health care provider. Their excuse was a technicality, that we had failed to disclose a pre-existing condition which had nothing to do with his eye; and my wife was able, after months of wrangling, to prove to them that she had in fact disclosed all the relevant information. They reinstated our coverage at a higher premium, but never reimbursed the doctor. Furthermore they refused to pay the specialist, saying the issue with his eye was also a pre-existing condition. Skipping the more pressing question of "what good is health insurance that doesn't cover a baby's pre-existing condition" we proceeded directly to the fine print terms of our agreement with them, which specified that a pre-existing condition is anything that had been diagnosed or treated prior to the effective start date of the coverage. His eye had never been examined, diagnosed, or treated until we took him to the specialist. They don't care, we have to pay the specialist out of pocket. In the end, we have been paying them nearly a hundred dollars a month for more than a year, and they have paid out a net of nearly zero dollars, effectively stealing from our doctor and from us. I believe they have committed fraud and I am looking into the option of taking them to court.

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Hello,

We have BC Ca as our health insurance. Although we pay $10,000 a year for this great coverage, we have never had to use it until recently. Our son was diagnosed with many serious and dangerous mental disorders. He has been deemed the next “Jeffrey Dahmer” by many medical professionals. At age 15 he tried to rape me (his biological) mother. He has recently been committed to a mental hospital and his estimated length of stay is one to two years. He has informed his Doctors that he wants to murder me and his father! The doctor promises not to release our son because he is a “threat to society and is extremely homicidal”. Here is the problem. BC Dr. Paul, constantly states that our son is not ill and we should pick our son up and welcome him lovingly back into our home! He went so far as stating that the “sexual incident of son upon mother is not considered sexual assault”. He also stated that “the parents are the problem”. Unbelievable! We have contacted the Ca DOI and the physicians there have reviewed all of the medical records and progress notes. Ca DOI has ordered BC to reverse their decision and to cover our son’s stay at the mental hospital great huh? One problem though to this day 9/10/07, Dr. Paul at BC continues to undermine Ca DOI’s decision and still states that he will do everything in his power to get our son released into our custody! We have been told by our insurance broker that Dr. Paul at BC has lost an extremely large bonus because of this. No wonder Dr. Paul at BC is fighting so hard to release our son! This is a true story and is still happening as we speak. My husband and I have spent hundreds of hours speaking with dozens of professionals and are constantly fighting this appeals process. On top of having to deal with my son attempting to rape me and wanting to murder me, I have Dr. Paul at BC constant harassment and belittlement! Will it ever end? No, not until our son is released and murders us.

admin@strandedwolf.com

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I am a self-employed male that was foolish enough to use A B C B S as my health insurance provider. I was paying about $90 a month for catastrophic coverage. I think health ins. is BS, but after fracturing my clavicle and being treated like a pariah at the hospital (I'm assuming they thought since I didn't have ins., that I couldn't pay), I figured I better get it so that doctors would treat me like a human being. I gave B C my hard-earned money for over two years w/o incident (of course I never filed a claim either) when, all of a sudden, they cancelled my policy for no apparent reason. I'm a healthy guy. Don't have any health problems or history of them so this surprised me. After contacting the company numerous times without ever finding out exactly why they were cancelling my policy, I contacted the state health ins. division. It turns out that

B C invented a child for me. Apparently after I (a male) had given birth to this child, I had neglected to pay for: 1. co-payment of charges for said miracle birth and 2. increased coverage rate due to the addition of my new baby. The state ins. division allowed B C   to get away with this preposterous means of taking my money and running and did absolutely nothing to punish B C or prevent them from doing the same sort of thing to someone who is far less fortunate than I.
The lesson I learned from all this is that health insurance is wothless and a waste of money if you have to pay for it yourself. If you get sick or injured, go to the emergency room and lie about your identity because the doctors don't care about your health either. The health "care" industry is America is just that- an industry. And like all other industries, they care about one thing above all else:

To Whom It May Concern:



        I am an African-American who is HIV positive, who has been doing Hemo-diaylsis for about eight months. My problem is that I’m being deprived of services of a clinic or facility, because I’m not liked, or my personality is sturdy. However, I don’t think it’s aggressive, I think my personality is assertive. Meaning that I will not be allowed to be treated with contempt or stereotypical biases. I was kicked out of Davita in Thornton, for taking the bandages off my needles, in which I just thought I was helping out, but I was automatically rejected from the facility, and I begged for forgiveness, and asked for another chance and they said no, I would no longer be allowed to dialysis at the clinic. Not knowing what to do I looked on the internet and found Fresenius. Meanwhile, I was receiving my dialysis through the emergency room, at sanatorium such as, St. Josephs, Presbyterian St. Lukes and Rose. In all these hospitals, they all went by the Potassium level in order to get me dialyzed, meaning if it was low, the hospital would not give you dialysis for that day, resulting in you coming back, sicker, due to the hospital’s protocol. Plus, I have to wait five to six hours in order to get dialyzed, but you have to get a room so the hospital will get paid. I personally think this is ridiculous. If I come to a facility every week to get dialyzed you would think that they find a way or a clinic for me to attend to, but that is not the case instead they give me a lecture about how I need to find a treatment center and when I explain I’ve been listed as a ‘trouble maker’ and way to opinionated. So clinics will not take me, as a result, I get dialysis from the hospitals, if a clinic would take me and treat me “well” I’ll be more than glad to attend a clinic, but most clinics are way to aggressive and just plain have no compassion for clients as well as employees. Plus, if you have a grievance with a unit it will and can be used against you, how do you think I got the label trouble maker?

        Fresenius was a nice facility, but the employees were to busy singing and dancing to really be concerned with the patients. Plus, the Program Manager, Linda was always insidious when dealing with me. If I asked her to wash her hands she would, become cynical and explain she did wash her hands, yet I see a blue ink mark on her hand and she became red in the face. Also, she decided one day she was going to put the needles in my arm, so of course in a clinic I had no choice and I allowed her to put the needles in my arm. Well, as a result of Linda not paying attention and laughing with her fellow employee’s she infiltrated my arm. So as a result, I couldn’t dialysis that day or for the next coming week. So of course I made a grievance, because I felt that it was done on purpose and not done in a professional manner. After, making the complaint against the program manager I was labeled a trouble maker. Everyday I came to dialysis I was given new regulations and new obligations which if I think about it, that were small irrelevant rules, just to put her at ease, I abided to this simplistic request. However, it just seemed the more I followed this rules, the more she disrespected me or even worst give me a lecture, on my personality, that I was “angry” and I would constantly explain I wasn’t angry. However, I think because I listened to rap music, I was considered to be “angry”. So I would be asked every visit to talk to Linda in the facility to be talked to about my persona. Plus, she told me I could do three hours and I would be fine, then after all the rules she gave me she said ‘legally’ she can not allow me to do three hours, which at the same time I was signing a release form explaining that I was aware I was doing three hours. So as a result, of the strain I left the facility, thinking I rather go through the hospital then go through this facility. So I left and not thinking I would return. Yet, I get a call two days after the episode and the social worker is trying to persuade me back into the facility.

        At present, I go through the emergency of the hospital in order to get dialysis, I realize it’s expensive and time consuming and more than 91% of African-Americans who dialysis supposedly go through the emergency of the hospital to get dialyzed. In which I think is another racist form to oppress Black Americans. So in going to hospital they as well give me a hard time, they want me to get a chronic unit, but the problem is, no unit will take me, so my options with treatment is limited. Yet, the control, or the illusion is the control is in the chronic units, yet these units are unsanitary, the technicians are abrasive, rude, rough, Kurt, confrontational. What’s even more fascinating is I’m the man who is HIV positive dealing with E.S.R.D. (Kidney Failure). There is no compassion or empathy for us as clients, and I’m most definitely not the only one who has problems with units in Colorado. Many others have ‘major’ problems with facilities, but don’t say anything, because it most definitely will be used against you, in either treatment, or how that technician treats you. Even the way the doctor treats you. So one who is a patient must be ‘passive’ and silent and to express that the needles in your arm hurt in anyway makes the technician feel scared or makes them nervous. Also, many of the technicians ill inform patients, resulting in confusion on the patient’s part. Also, the discrimination in units is rapid and swift although African-Americans make up a large percentage of Kidney failure, you rarely see any African-Americans if one in a chronic unit.

        For Instance, as stated before I go through the hospital’s emergency room to get dialysis. Anyway, I met a young African-American women, whom was a patient at Davita in Littleton, they kicked her out as well with no warning no write up no protocol what’s so ever, and as a result for six months she’s been going through the emergency three times a week. Although, she said she didn’t mind, I really felt her pain, due to the fact I was in the same position, and her doctor is Mrs. Susan Babcock, who is nice but really doesn’t have any pull to get an individual into a clinic. She’s just a primary doctor who writes out prescriptions to patients, but to have her wait six months for a unit means Mrs. Babcock can’t really do anything if a unit decides they will or won’t allow you to get treatment. Finally, when I go the hospital’s they sometimes will not dialysis me because me blood work is good. For example, if my potassium is 6 or above they will dialysis me, even if my creatinine level is high and my BUN is high they still will not dialysis me. I think that is so “dumb’ if I’ve been coming to the hospital every week with the same diagnose then I should be able to get dialysis without lecture or confrontation. Plus, for the hospital to get paid with dialysis I have to get a room so the hospital will get paid this is, foolish to me because as soon as I get dialysis I feel good, and I don’t need a room, I only ‘need’ a room when I’m sick, really sick. Lastly, the hospital can be o.k. without the lectures of trying to get another unit, when no unit in Colorado will take me, for I’m non-compliant which means I’m too much of a trouble maker, to much into the details.

                Signed,
                        Disenchanted Patient
Comments:

Thanks to the grand blue plan, I have discovered that I have a friend: the North Carolina Department of Insurance.

The saga started 3 years ago when my twins were born via C-section. The anesthesiologists at my local hospital, which was on the "Blue approved" list, had banned together and decided that they would no longer be included "in the network." Luckily for me, I had out of network coverage as well, so even when the doctor's office sent a letter and $1000 bill, I figured I was okay.

Fast forward to over a year, and least 6 attempts to file, and about 12 phone calls to the blue plan later. The blue plan evidently has decided that it won't pay bills to out of network doctors, so they just kept rejecting the claims (alternating reasons of wrong claim code and invalid dosing code.) At this point they are also routinely rejecting claims from my out of network bloodwork lab and an out of network pathologist.

Enter MY HERO: NC DOI. I read about them in a article about consumer complaints against the blue plan. They have a handy-dandy online complaint form, and within just 2 weeks of sending in all of my supporting rejection notices, the blue plan coughed up the money. Of course, they weasled by saying that it was their Pennsylvania office (total untruth), but at least they finally paid up.

I'm about to contact NC DOI again about the blue plans systematic bungling of ALL of my claims from last year.

I LOVE YOU NC DOI!

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I worked for a "blue brand" for over 3 years, and I can tell ya folks, they are out to get your money, BUT, they are not out to get it in big chunks, they are going to nickle-and-dime you to the poorhouse. They use and anachronistic computer system from the late 60's (sics) and just the crappiest system of management that would make Enron execs seem like angels. They can send their daily "feel good" mailers, but can they lower your costs? Answer: NO. They pay their employees crap, they cover crap, they overcharge employers and cheat providers. You have to call customer service for every little thing, and it will still be screwed up. If you have this shitty insurance it's better to quit your job and find someplace that does not use this insurance company. If you have the misfortune of having a contract with a "blue-brand" as a provider, it's better to get out-of-network rates than have to deal with the constant f-ups. If it's not screwed up now, it will be. I spent 3 years of my life telling them how to improve their systems so it won't mess up peoples benefits well over half the time, I got put on warning for not being a "team player." Just remember it's not the person answering the phone's fault, it's the billionaires who are "stake holders" in this gigantic stinking turd.

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I was turned down for blue cross health insurance because of one minor emergency room visit in 2004

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I live on an island that has two clinics. At one of those clinics a doctor has been practicing for several years and has developed a reputation for mis-diagnosis. One of his employees who recently suffered a broken fibula was told that it was not a weight bearing bone and could walk on it while it healed.

This clinic has received "Outstanding Care" awards, some including publicly disclosed monetary awards, from Group Health, Regence Blue Shield and Community Health Plan of Washington. The doctor broke away from the once only clinic here to start his own non-profit clinic (which an attorney friend told me was a way for the doctors to pay themselves a bigger salary) and has received awards I never heard mention of while he was at the other clinic. My question is: If the insurance companies are giving out these monetary awards to clinics, are those clinics intentionally and willfully downplaying or flat-out misdiagnosing patients in order to avoid further treatment and cost to the insurance companies. Something's fishy when insurance companies are giving their money away. tedonorcas@yahoo.com

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I have a HMO Dakota Care through my employer. I was scheduled for a stress test on a Monday and the Doctor decided to do an angiogram instead and an hour later I was in surgery for an emergency quadruple by pass. That Friday my employer called Dakota Care and cancelled my Insurance and back dated the cancellation back to 3 days before I even due to have the stress test!! The reasoning was that I did not work on those 3 days prior to my appointment (they were my days off) and so I had not worked physically in the current month. I had an insurance premium taken out of my check that was dated in the current month but that they proceeded to tell me that the employer makes the insurance premiums for the previous month. I then received a letter from Dakota Care stating that my policy had been cancelled due to "termination" but was welcome to apply for COBRA!!

Why have I been paying these premiums through payroll deduction for the last 9 years if when I need the insurance it is cancelled is this legal?

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hello, my name is janet and i am writing on behalf of my mother and father. My father had a stroke 14 years ago and they put him on preventative meds, then about 6 months ago he had another one. It has put him in the permanant disability factor. The insurance company is trying to cancel the policy plus not honor the long-term and permanent disability clause. they are calling it a pre-existing condition. There have been 3 doctors to state, that it wasn't in the same place and the doctors are stating that it is NOT a pre-existing condition. I need to find a website or sample letter of dispute to file to the insurance company.

If anyone has any information or url websites, please email me at the above address. thank you for you time and effort in this matter.

Sincerely,

Janet Shaw
scottandjanet@cox.net

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My wife and her employer had paid into Cigna disability policy for at least 10 years. She had worked for the company for 20 years. The company discharged my wife saying she was to disabled to work. So she filed a claim with Cigna insurance company in June of 2004. After several appeals and denials. It is now May 13, 2005 she is still fighting with the company to get what is due her. She was given Social Security disability. But the insurance company still refuses to pay. Saying they do not base there decision on Social Security determination. The the United states of America says she is disabled but Cigna insurance company says she is not. In the last year we have had to apply for Welfare benefits dodged I forgot how many shut off notices. An now there is real danger of our car being repossessed! Maybe its time the fraud by insurance companies is address in addition to people trying to defraud insurance companies.

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After (14) years of continuous payments I was late and Blue Cross cancelled my insurance. They had actually processed a payment but said it was a clerical error.

I had a business that closed after 12 years because our product became obsolete. When this happened my partner files bankruptcy and I had tens of thousands to pay. The financial pressure was horrible with bill collectors calling day and night. I was juggling what I could and got sick. I went to a shrink because I was suffering who diagnosed from panic syndrome from the stress. B of A threatened to take my house and I paid them 32,500. some borrowed. I was becoming so ill I went to a doctor who found I had Hepatitis C, which they think was contracted from a 1990, mastectomy for Breast Cancer. Then my Mom was diagnosed with Nesothelioma and I went to NY to help her. I thought she would pay my Blue Cross premium on-time but she was so sick and angry and had loaned me 10K to pay BofA. I had to stay and help her and not pressure her as she was so sick.

When I got back to CA I sold a $2500. tread mill for $650. and sent the money to Blue Cross which they cashed. I was sooo relieved and thought everything was OK. Then they send me a refund check. Yes, I had already received a cancellation letter waiting for me in LA.

Over the years I had asked Blue Cross if I could change to an agent who was a personal friend. They said only if I dropped my policy and reapplied... what if I had done that, then I would have been without insurance at an earlier date, and at their own phone customer service persons suggestion. Had I been able to change to this agent he would have suggested a less expensive plan and this would have been avoided. He is someone I know and may have even covered me until I paid.

I filed a complaint with the CA insurance board who spent several months deciding in Blue Cross' favor. I wrote to Gov. Arnold who not surprisingly referred it to the insurance grievance board and re-iterated their decision. I contacted several lawyers and said, I did business with this company for (14) years, "HOW CAN I BE HIGH AND DRY", what other industry would treat a good customer with such disdain, ever lawyer said sorry, nothing you can do.

I reapplied to Blue Cross who would not accept me stating a history of:

breast cancer; hepatitis C, and Panic syndrome.

They sent me info to apply for CA high-risk insurance which costs a fortune, takes many months to get coverage and only lasts 36 months with a low ceiling on coverage.

I have been in such a panic since this happened I have not been able to look for work but own a home with equity. I have no money and don't know how I can afford the $665. a month premiums for the high risk insurance. Had I not been sick with Hep C which causes confusion and depression I may have been able to cope better and not missed the payment. I just had thousands in bills and left in a panic to help Mom.

So, the very illnesses they state for being uninsurable, the panic syndrome kept me from being able to cope with my bills. I asked a lawyer What happens when someone is too sick to make the payment on-time --- as I was? and he said, "you better get someone else to or you are out-of-luck. " This makes no sense. If you are too sick to pay they get to drop you??? I'm thinking of bailing out of the United States and moving to another country. I just can't take it and worry about my lack of health insurance day and night. It keeps me awake and in a panic constantly. I can't believe that Blue Cross gets special treatment from the government and they are the ones that manage the high-risk plan, where they get the payments and gov't subsidies plus I'm sure fees for general management of the program.

BLUE CROSS SUCKS!!!!

What can I do to help fight them?

Any ideas of open group plans I can join to get affordable coverage.

Thank you and best wishes,

Susan
artysmarty@sbcglobal.net

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My husband and I just dropped our insurance coverage with Blue Cross Blue Shield of Illinois. We were paying high premiums as we are self-insured and never really getting any benefit. The only thing I ever got was letter after letter saying they were trying to dig up more information on my medical history and couldn't process claims until they got all the information they needed. What this really seemed to be was a witch hunt trying to find any reason to disqualify a claim. Recently, they sent one saying they were waiting on information from a physician (an OB/GYN) who I saw AFTER the treatment date -- treatment for asthma by the way -- and AFTER I had already canceled my policy. When I called to notify of them, they said "we are doing a complete medical history". I told them it seemed the information from this doctor was none of their business as it wasn't HISTORY it was something that happened in the FUTURE ... after the treatment in question. They didn't care. They do this every time I submit a claim and to date, I don't think they've had to pay for anything because my deductibles are so darn high. So why bother?

Gail

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I work in Crystal Lake Illinois, and have been in good health all my life until recently. I have a collapsed valve in a major vein in my left leg that causes a great amount of blood not to circulate feeding oxygen and warmth to that leg after a couple hours of work the leg begins to numb and with the loss of feeling I continually lock up my knee and sprain my ankle while trying to do my job as a carpenter. For some reason , even though they verbally finally approved to cover the surgery its been over three weeks of hobbling around and missing out on a lot of overtime that I sorely need to work. This is also hurting my bosses business by me not being there. Why are our bosses paying all those extravigant insurance premiums when they don't take care of you when you need it??? Pain, infections, lack of sleep, lack of income----Thanks Blue Cross! Maybe I can get my company to switch! Miserable in Lindenhurst.

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My Name is Michael and I live in South Texas and my Mother is going blind in her left eye. We had her get Photodynamic Therapy to slow the process. The first time Blue Cross/Shield paid for like they're supposed to, but after the second treatment they said that it was experimental and that they would not pay. Well she had to have another treatment and those bastards at blue cross are telling us that now we have to come up with $7,000.00 on our own and that we're just out of luck. If you know of a lawyer who can help us, please send me a line at michael78104@yahoo.com, I just know that we can't possibly be the only people this has happened to. Thank You

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After all the following occured, I contacted the Rockledge Police Department, I found out there were 22 theft complaints against Wuesthoff so far this year. A few were things like car theft, but many had similar complaints to this one. When will someone investigate them? Karen Davila, Vice President of Wuesthoff Health Systems, has threatened me with libel if I tell my story. Well, this story is true, so here it is. Truth is not libel!

My mother, Mary Lucas, 72, was gravely ill and also suffered from dementia and was in Wuesthoff hospital in Rockledge, FL, Brevard County, for about a month through December (2002). During her stay, she had a battery of tests and was moved from one room and section to another many times. They made a fortune off of her from Medicare and Medicaid. They never did tell us why she was so ill. Anyway, during the moves, various things disappeared. Items lost and not located in lost and found included all her clothing, her jewelry, gifts bought for her while she was ill in the hospital, and both her upper and lower dentures. I was in to visit her to sign a permission sheet for a heart procedure, and she had both dentures in at that time. How do I know? They brought her supper to her while I was there, and she could not eat. I thought she needed to put her teeth in and was going to assist her, and she showed them to me but she was too ill to eat. It was at that time I noticed all her belongings were GONE! She was in a bare room with nothing but her gown. No clothing in the closet, nothing of hers in her room except her and her teeth.

My brother, Lloyd, assisted her at discharge and is a witness. At the time, the staff had to get clothes and shoes out of lost and found for her to wear home. At that time the staff that was present insisted the hospital was not responsible for missing items. They intimidated my family so much they just left without a struggle. When I heard about this, I got furious.

A friend of mine had the same thing happen to her husband (they lost his denture) and she suggested I take in an estimate since she was reimbursed for her dead husband's denture. He died before he could get his impressions and she still received a check from Wuesthoff. When Kathy called Karen to complain about the treatment we got there, Karen told her that she should not have cashed the check if her husband had died! The nerve!

I went to the hospital in December of 2002 and was sent to four different offices before I found a person responsible for reimbursement. I did not want payment for anything except for the lost dentures at the time since my mother was in a nursing home and on social security (and medicaid will not pay for dentures anymore, thank you Jeb), and so there was no way she could afford to replace them. I did tell Karen Davila at that time that all her stuff was missing at discharge, but at the time I was not worried about the rest of it. She claims to be deaf about that part.

So, I hand delivered a written estimate for $1000 from Atlantic Denture Clinic to replace her teeth to Karen L. Davila, at 321-636-2211 ext 1509. She later wrote that the fact that the estimate was hand written by a business started by a deceased dentist made us suspect--hinting to people we were trying to pull something over the hospital...well, a lot of businesses have lost the original owner and are still operating...Wal-mart, for example. Much to her credit, Karen made sure that a check was written to that clinic to replace the teeth, acknowledging their responsibility for the loss (she later writes that she had the check written out of pity and not because of responsibility).
So, with a way to pay for her lost teeth, We scheduled and canceled many appointments to take my mother into the denture clinic because she was too ill to keep them. My brother and I finally got her to Atlantic Denture Clinic a week or so before she died, but my mom was being difficult that day. We could not get impressions, but left the check with them since we were going to try it again the next week. Unfortunately, my mother died (Wednesday) before that appointment. The Monday following her death, I collected the check from Atlantic Denture Clinic (I had gone Friday but they were closed) and I went to Karen Davilla's office and quietly told the receptionist that my mom passed away last Wednesday, and was it possible for a new check to be reissued to my father. The receptionist went back to Karen who I overheard explaining the situation, and suddenly, instead of inviting me into her office and sitting with her at her desk, instead of quietly explaining policy is such and such, instead she yelled at me from maybe 15 feet away that she was sorry for my loss but that she would not reimburse my father because my mother had died and no longer needed teeth. Then I heard her tell her secretary to take back the check, and at that point I left the office, since that check was proof that they acknowledged the loss and their responsibility to pay for it. Well, this was just too much. I had just lost my mom, who I was with when she passed and even had to close her eyes afterwards; the Thursday before, I lost my mother-in-law who I had been taking care of since her stroke in January of 2002, and was with her when she passed; a week before that, a person I cared alot about passed away, and a week before that, my brother-in-law, only 38 years old, was tragically unrecognizably mangled in a tractor trailer accident, not his fault. After all this, I get treated this way. I told her I will tell people about this and she did not care.
I filed complaints with every consumer group and person I could think of, and then I decided to create this web site so no one else ever has to go through this--the reason is that no newspaper or reporter or television action teams would touch the story. My guess is Wuesthoff is a big advertising client and no one would break this story. No satisfaction has ever been received. But as word gets out, maybe someone will be spared the living hell we went through thanks to the vice president of Wusthoff Hospital.

Karen still refuses to reissue a check reimbursing my mother's estate for the teeth they lost. She is hinting that we are trying to rip off the hospital to those who call or otherwise contact her in protest to this action of hers. I discovered that she was considering implementing a policy that all patients have to sign a document stating that anything that is lost is not their responsibility. Who reads all the stuff you have to sign at admission!!! And, an attorney told me that she can do this. This is legal, but not ethical or moral by any means. My mother had dementia, and someone took advantage of this. This incident also raises a question of patient safety. Anyone can walk in and hurt a patient if all her belongings can vanish.

Sure, there is no value to teeth, except to the one who lost them. Without teeth, gums get extremely sore from trying to eat. All meals must be mashed up. We had to do a Heimlich on her several times because she almost choked to death. Great way to live. She lived that way for 3 months.

Non- the-less, my point is this. A hospital is full of sick people, many of them drugged and sleeping. Some are unconscious. For many tests, things such as teeth must be removed.

Thieves will have an open opportunity to steal and the hospital won't be responsible for that if Karen makes everyone sign this new form she is considering. The form includes anything-- teeth, walkers, glass eyes, prosthetics, anything missing will not be the responsibility of the hospital. Is this right?

My mom lost everything... the four silk flower arrangements I took to her over the month valued at $15-22 each; her clothing she came in with; a ceramic bear with a dress I paid $20 for; a $60 ceramic doll I bought her since she collected them; her shoes; a guardian angel pin I brought for her; at least 4 live flower and vase arrangements I bought from the gift shop at the hospital, and her watch and rings. None of these items were in lost and found, and thus assumed thrown away or stolen by someone, whether employees or visitors to the other patient in her room.

Also, there are moral and ethical issues here. She promised me that if the hospital lost her stuff, they would certainly be responsible for it. That is why after she investigated my moms records, she issued a check. Now she won't take responsibility. This is a consumer issue. If this comes out publicly, maybe we will hear from dozens or more people who this also happened to at this facility and how often hey are getting away with it. I gave up on getting a check for my father, her husband. Karen made it clear she will not give in and reimburse us. But I won't give up on warning people about this problem.

I just want word out that people may wish to use another facility in Brevard County if they don't want the possibility of this happening to them, too. This new document Karen wants all admissions to sign gives thieves a free reign, and the hospital a way to not take responsibility for their facilities actions. And please, do not make the mistake we made... call the police to the hospital or nursing home if your items are missing. We just did not think of doing that. It would have made our case a lot easier.

We are not stupid. We did not bring in valuables like gold bars, diamonds, stacks of money, etc. But you would expect your teeth and the clothes you came with to be there at discharge, am I right?

By the way, I sent a letter to the board of directors and the President of Wuesthoff regarding this whole situation, and neither had the decency of a response. What great people to be working in the health related industry and with people.

I am so disgusted with Wuesthoff and their administration. Are you?

Arthur C. Lucas, Jr.

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My husband was approved to have the surgery to lose weight and was performed in September 23 today is January 24 and I still get the bills from the hospital because they said it was a pre-existing condition. The reason they said is that they say on his medical records from the Veteran Hospital that he was put on a diet to lower his blood pressure. He is 10% disable because of this and has to go to get his prescriptions to lower his blood pressure. I faxed them already all they ask for and This company assured us that they would take care of the approval. That was the last time they call me to tell me he was approved. Now is me calling them to request not to send me the bills for over $10,000 from the surgeon, 81,000 from the hospital and others more. So be aware that even do was approved you also can get screw. We don't have the money to pay for this and if this is not solved I will have to hire a lawyer.

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Hi my name is Beth

I live in Kentucky, in late 1992 I was found to have a mass in the general area of my left ovary after being told I was pregnant by a doctor. I ended up in the emergency room because of some spotting and this is where the discovery of the mass came to light. The emergency room doctor, upon initial exam, was saying that I was pregnant but that he could not hear the heartbeat of the fetus, but could hear a placental beat ( I believe is what he said ), so I was sent to ultrasound, according to calculations by myself and both the doctor and the E.R. doctor I would have been about 4.5 months. The ultrasound proved different even though I was not allowed to see the screen and was not allowed to ask questions of the technician, I had to rely on an OBGYN who was on call who came to me and told me of this large mass that he said made it impossible to identify my left ovary. He told me he had to operate right away. I was 22, and single with no children. The OBGYN told me that there was a big chance that the mass was malignant and he would more than likely be doing a complete hysterectomy on me. I asked what would happen if I did not have the surgery and he said that I would have "an extremely shortened lifespan." Of course I signed the consent form given the choice to live or die, I was choosing to live. I had surgery, during which pathology was done and it was determined that the mass was benign. When I woke up to see my family around my bed I asked my mother if he took it ALL and she said yes and I fell numb, I had just had a total abdominal hysterectomy and bilateral oopherectomy. The doctor said that my right ovary was very cystic and ruptured when he opened me up, I had an incision from above my belly button down to my pubic bone, measuring 10 inches.

After a hard 7 day stay in the hospital I went home just to discover 2 days later that I had a sudden gushing of fluid out from between my legs, my immediate fear was that my bladder had dropped. Went back to the doctor and he said it was a normal discharge from the surgery. Well those "discharges" became so bad that I was soon wearing adult diapers and soaking my bed at night. I went for 2 months like that and had pelvic exams once a week in the doctors office, he always said it was a normal discharge. Suddenly I was down with pneumonia in my left lung and my kidney had stopped functioning on the left side and I was back in the emergency room where one of the doctors associates told me I had a urinary tract infection and sent me home with antibiotics. I returned the next day so breathless and running a higher temperature and had not really slept for 2 nights because I could not even lay down. The "associate" was there again and he told me that he would admit me over night, after my parents pushed him for an XRAY, but that I was not going to stay longer so I need not get comfortable, that I was to drink icewater to get rid of that fever. I stayed a week, ended up having a nephrostomy tube inserted into my kidney, was so weak from pneumonia and dehydration that I nearly died.

After a weeks stay I again went home to try to get over this but I had reconstructive surgery ahead of me because apparently my left ureter had been cut during the hysterectomy. To shorten this story a bit, I found a urologist in another city to do my surgery and was home recovering before the OBGYN had even a chance to get me scheduled with a local urologist.

I ended up bringing suit against the doctor who did my initial surgery for the neglect in my care, this was after I went through one lawyer ,who was supposed to be representing me, and had neglected to file suit on my behalf and eventually told me right before the statute of limitations ran out that he couldnt take my case because HIS WIFE WAS FRIENDS WITH THE DOCTORS WIFE and it was causing him problems at home. My second lawyer did nothing either, he strung me along for several years with noting to show for it but broken promises and never following through with the depositons, we only did mine. The court had a hearing because the defendant was filing a motion to dismiss for lack of prosecution, my lawyer did not show. The judge said we would meet again in 2 weeks and he sent a letter to my lawyer, an order to appear in court at that hearing, HE DID NOT SHOW AGAIN. The judge told me that he was going to call my attorney since he hadnt returned my calls in such a long time, and get to the bottom of it, I found out the next hearing that my attorney had asked to be dismissed from my case, but NEGLECTED to inform me, I find out at court, sitting there in a room full of people feeling ashamed and helpless I walked out of there with the judge telling me that he was going to decide whether we would have another court date or not. I got the letter 2 days later that he had thrown it out of court completely. this was last year in 2002, this all started in late 92, almost 10 full years of being raped by the medical and legal community and during all that time I was and still have had NO counceling from surgery have had to hit rock bottom several times emotionally because of being left barren and now with a fear of hospitals, lawyers and the court system, WHO IS NEXT? THE POLICE????? if anybody has any input write me at: birthdaycake42533@yahoo.com

PLEASE include "horror stories" in the subject line.

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My horror story, or 10 year nightmare, began in the fall of '92. President Clinton was about to win the candidacy and I had suddenly fell ill to sickness within my sinus bones that would wind up haunting me for the rest of my life.

It all first began in the winter of 1982, after the birth of my first child, that I suddenly began to suffer from endless sinus and ear infections and it seemed that no amount of antibiotics would make any of it go away. Out of desperation one night, I called this doctor, whose name had been mentioned to me in passing somewhere, that he was good with this type of thing and might be able to help me. Late one Sunday night, finally at the end of the rope, I called and he met me at the ER and soon we discovered that I had developed multiple allergies to many environmental things and it was assumed that this was the current problem. So I started on an anti-allergen regimen and cleaned house of dust and mold, got rid of my cat and my plants, and a serum, much like a vaccine was created for me, and I took this by injection about every week to every other week, and after about 8 months or so, I tapered off. Infections had finally cleared up some and I was doing much better but I was told I was left with some damage to my left maxillary sinus and would need a surgery, that back in those days was called a Caldwell-Luc procedure, to aid in the drainage of this affected sinus that had not been working properly while I was so sick. I went through the surgery and recovered rather quickly and was back to work in no time since I was only 21 then, very healthy and active, otherwise, and I never even needed the pain medication. This was what I percieved to be the end of this illness I had been suffering from for over a year and I did not think that anything else would ever again plague me in that area, since I was convinced that I had been cured. Well I was so wrong

I was in for a serious and un-welcomed surprise in the fall of 1992. I had just moved into a very old, drafty house in the country and even though prior to moving in, much cleaning and dusting was done, to prevent allergy attacks from recurring, since I still got them occasionally. About a month after moving in, I awoke one morning with the most excruciating pain in the left side of my face, and swelling and unable to blow anything from that side of my nose and I was suddenly just devastatingly sick. I immediately contacted the ENT surgeon who had done the surgery back in 1982, and was seen immediately. Even he seemed shocked at the severity of this new infection. My entire left maxillary sinus was completely full of infection and swollen and painful and I literally could not open my jaw. This infection had infected not only the sinus, but the jawbone, and out into the tissues beneath my face and was beneath my cheeks in the form of cellulitis. I could not blow anything from that nostril and the pain was very intense. The doctor, unsure of just what had happened here, performed in his office, a minor, but very painful, surgical procedure called a sinus lavage and attempted to rinse this infected substance from my nose. He even had to perforate the buccal area of my mouth, just under the upper lip, along the gum line, with a very long needle and inserted it directly into the sinus to aspirate this strange substance to be sent to pathology to determine what kind of bacteria or cancer or whatever this might be. This perforation and aspiration was done almost every other day, while I continued to take every kind of antibiotic available from broad spectrum to fungal kinds to anaerobic bacterial types. Nothing seemed to be working at all and the infection was so deep into the bones of my sinus floor that my condition did not have a very good prognosis at this point. We finally hit on an antibiotic combination that seemed to begin clearing it up, but by now I was on so much stuff from decongestants to antibiotics and so by now it is March of 1994 and the nightmare isn't over still. I am now facing more surgery, pain, and tremendous amounts of money being dumped into this, which by now, if I had only known better at the time, I would never have gone through with the root canals. I would have had those teeth extracted as well, and speaking futuristically, it would have been in my best interest, I just did not know it at the time. So I had the surgery first, where the oral surgeon went in while I was under anesthesia, and cut out the jaw tooth, the bones surrounding it, and basically did a cleanup job from the prior surgery, where he could see more scar tissue trying to develop and this "hole" that he called a "surgical defect" was like a constant open wound that oozed pus quite often, so he did the best he could to clean that disaster up and try to promote some healthy bone to begin healing. Afterwards, I had to see the dentist and prepare for the other 2 teeth to be root canaled. By summer of that year, '94, I was finally starting to see some kind of light at the end this infinite tunnel, but things still were not quite right. While the dentist was working on the 2 root canals, I appeared to be having problems still, within the alveolar bones that support the teeth, and I was still in constant pain. Now, as I mentioned earlier, the first operation had gone so well that I never took any narcotics. In fact, up until that fateful day just before that sinus surgery in the fall of '92, at age 31, I realized I had never taken a pain pill stronger than an aspirin, in my entire life. I had, in fact, been a pretty sheltered girl most of my life and did not drink or do drugs, had gone to nursing school back in the early '80's, but never finished to become a registered nurse, since life has a way of making you put aside your dreams temporarily while you deal with other things like having children and going through divorce and being forced to drop out of school for a while and work in doctor's offices instead, until the time could be right.

Here is how this drama began to unfold. I was very sick and I was getting very weak. I was 31 years old and had never taken pain pills before and did not want to. I was actually kind of scared of them, based on what I had learned in the pharmacology I studied in nursing school. But one day, that pain was bad, so bad that I felt like dying, that I just did not think there was any more strength left in me to fight it off and I had been given a few of these little speckled pills for pain to take if it ever got to the point where I needed it. Well I think I had long gone past that point months earlier and was finally at the breaking point. So I took out this pill, in a little blister pak, an obvious sample from the doctor, that I had been holding on to for quite a while. The day I decided to take it was not whimsical or anything like that. I planned to take it, but first I had to research it, since research is my thing and what I seem to do best, I had to know everything there was to know about this drug called "Lortab", and before I swallowed this pill, I had to know exactly what to expect. I was that pill-phobic. So after my research, I took the pill and waited. About 15-20 minutes later, the course of my entire life had just changed. A complete 180 had taken place, and I did not even know it yet. All I knew at that particular moment, was that for the first time in years, I suddenly felt absolutely no pain at all. Apparently I had been in low grade pain for several years prior, and I just assumed it was a stress headache or sinus pressure and I figured I could live with it and go on, that this was just the way it was, and I really did not know anything different, until that day. That day, a whole different world that I had not seen, opened up to me and at the time, things looked and felt good, and I oblivious to what the future held at that time.

When the root canals were "supposedly" done, I still had pain in them, and the doctors did not believe me. They felt sure that everything had been corrected and by now I should be over the pain, but I wasn't. They began to cut me of from pain medication and I still needed it, since they did not know it yet, but they still had not fixed the problem yet. I begged for the pills and sometimes I got them, and sometimes I did not, so I got tired of the whining and begging and being accused of being an addict. One day while standing in line at Kinkos copiers, a devious idea popped into my head. I did not need these doctors to call in the medicines for me or write more prescriptions. I had been to nursing school and I knew how to do it myself, so I did. And I did, and I did, and many months went by and I had stopped bugging the doctors, and I was still not quite right, my sinus had some kind of permanent defect now that needed alveoplastic surgery to correct, but no one knew at the time. I had given up on everyone and decided I would do things my way now. After a few months of playing doctor, and not even really realizing I was committing a felony, I started getting sloppy, and one day, that sloppiness caught the eye of a very sharp pharmacist who busted me right then and there. So now I was not only still sick, but facing jail? How much worse could things get? A lot worse. I was sentenced to probation, since it was my first time ever to break the law and I was never ordered to be in rehab, nor was I seeing any more doctors to try to solve the still existing sinus bone problem, that still hurt and made me do what I did in the first place. I tried for a few months to give the medicine up. I tried alternatives but there just wasn't anything strong enough to fight it off. With time, I sort of learned to deal with it the best way I could, and occasionally I would get a script from a doctor to help with the pain, but it was mostly random, and started dealing with the pain at night by taking anything and everything available

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In the fall of '97, I had a flare-up in that little "hot spot", I call it, in that area of the sinus bone. Instead of the usual low grade pain I had gotten used to, I was stricken again with the unbearable that makes some people commit criminal acts. I saw the oral surgeon immediately, and he did a quick office surgery, put me to sleep and opened the wound in the bone, made by the previous surgeries, and cleansed it of all the infection that was building up in it, and tried to seal it off with something of a membrane made of my own gum tissue. When I awoke from the sedation, he explained to me that this "defect" would never stop giving me problems and that the only way to permanently try to fix this, would be to do an alveoplasty, using a bone graft from my hip to fill in this hole, and hope that this new piece of bone would regenerate with the alveolar bone and fuse it all back together somehow and stop this chronic infection form recurring. At the time, I wasn't too thrilled with the idea of hip surgery and oral surgery and it would mean more pain pills and a long recovery and I just did not care to think of it, if he could solve the problem temporarily with this "bandaid" surgery he had just done. So after that surgery healed, I was off to live life again, and still had that same old, low grade ache in that bone but I learned to lived with it for the next 5 years with virtually no problems, until I woke up one day in the summer of 2003 and realized I was losing my eyesight at rapid speed. One day I was able to see, the next, I could not, and it all seemed to happen that fast. I was found to have severe cataracts in both eyes, and needed cataract replacement surgery immediately. They did each eye individually, allowing one to heal some, before doing the other, and I had to put eye drops in both eyes every couple of hours to speed up the healing progress but my left one was not doing as well as the right. The left one was the same side as all the other disasters had taken place, so it made sense that this one

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I think it time to raise hell with the insurance industry and the politicians they have bought. Here's why.

In May of 2001, my wife suffered kidney failure while hospitalized with a severe case of pneumonia. Since then she has had to have dialysis three times a week and has been waiting for a transplant. It has been nearly two years.

My wife gets her insurance thru her employer and the company was bought by another company. On the first of January, they changed insurance companies and the new company (Aetna) doesn't seem to want to answer their phones. On January 20, the local hospital called to say that they had a kidney ready for my wife's transplant, but we couldn't have it done because the insurance hadn't approved it. We couldn't contact the insurance company because it was a legal holiday.

Now, Aetna old us today that they will not approve of a transplant in Tulsa; it has to be done at Baylor University in Texas. Baylor told my wife that she has to fill out a bunch of forms for them and then wait again for a kidney. It's going to be expensive for us to spend time in Texas.

Meantime, my wife's company is again up for sale. If they cut back on employment, move to a different region, cancel employee insurance or change insurance companies, she will again be unable to get the transplant.

Please complain to your congressmen and other politicians. This kind of thing must stop.

Sincerely, from Oklahoma

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To Whom It May Concern,

Allow me to introduce myself, my name is Kandie Cudd and I live in a small town in Arkansas.

Please bear with me as I attempt to be brief here...

Nov. 26, 2001 I was involved in a car accident on my college campus.A man pulled out in front of me and I just assumed it would be a simple case. He was cited at the scene as I was being taken away by ambulance to the hospital. However, over a year later it has grown into a mess that I need assistance with.

I had to hire an attorney 3-4 days after the accident as this man's insurance company attempted to take advantage of me just days after speaking with the adjuster from their insurance co. (attempting to place "contributory negligence" on me). Then this attorney was voted and appointed judge, I then

went with the attorney that had purchased his practice. My decision, my choice I realise this, however, I didn't know who to hire that had integrity and character.

In the meantime the Orthp. Surgeon that reviewed my condition made a tremendous mistake, stating that he had performed 3 tests on me that discredited my injuries. (Herniated disc, knee injuries, and "turf toe").

I confronted this doctor with my concerns as the tests were impossible, one because of my injuries, the other that I had a "walking cast" on at the time which would make performing these tests impossible.

He denied any mis-doing, stating that he remembered specifically performing these tests on me. I suggested that he had me mixed up with another patient as I knew he saw many per day. He then reiterated his views and making them worse for me in his second set of clinic notes. (My attorney even stated, "how did he know what to say to discredit your

injuries?").

When this could not be resolved by speaking with him personally and speaking with my primary care doctor, I then filed a complaint with the Arkansas State Medical Board. The doctor in question has been called, "invited" to answer further

questions by the medical board at a Feb 5-7 hearing of this year.

My medical records at the clinic here in town (my primary care doctor) have been altered, pages missing, etc. also. My primary care doc also stated after I asked about this..."you got me in trouble". I told him that I did not get "him" in trouble that the complaint wasn't even against him. HIs attitude has changed

towards me now and I cannot go back to see him, nor the doc he "referred me to".

They have put me through physical therapy, meds and time and I still have the injuries that have changed my life. I have moved on as best as possible working from home and I have a friend that has loaned me her car for this whole time. But I want to at least get back to the place I can be self sufficient

and get back to painting my holiday windows (my business).

The attorney that was representing me, (without my knowledge, except through mail after the fact) had filed and was granted a continuance and then filed a motion and was granted a motion to withdraw.

The courts have given me 30 days (less than 2 days left now) to acquire a new attorney to represent me or my case will be dismissed. (??)

I have called and emailed a great number of attorney's now :(

I did speak with an attorney out of Little Rock, and he has suggested that I "Drop my case" (to buy myself some time here) and that I would have one ( 1 ) year to open it back up a bring it back to the courts. He also stated he has no question at all that I will win my case, but, that I will not be justly compensated for my injuries because of the complaint against the doctor and that because of this complaint and my insistence for justice, that it would be impossible for me to get

the doctors to "testify on my behalf" so, as a "business decision", was unable to take my case because he has too many people to pay and was not guaranteed that he would make enough off of my case. I can understand that.

As a consumer I am left in quite a place here, not knowing exactly what I should do at this point. I realise I am a citizen in a small town up against some very powerful and influential people. I am also left with injuries that have dramatically changed my life and no means at this point to take care of them.

I did check with the University Hospital in Little Rock, they have a medical assistance program, however, I do not qualify because my injuries are the result of the accident and the other party is as fault. They also stated when called that they cannot see me "because my case is in litigation".

Any advise that you can give me at this point will be greatly appreciated.

Sincerely,

Kandie Cudd

kandie@arkwest.com

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My complaint is against Southern Dental. I made an appointment to see a dentist. After the initial visit she made a follow for herself & a hygienist the following week on a Wednesday. On the Monday before the appointment I received a call to come into the office the next day to see the hygienist for a deep cleaning.

I work full time, but I am also a cancer patient who had to pay off dental work for about a year, so I took time off in the afternoon for a 200PM appt. After checking in and waiting for 1 1/2 hours I approached the "witches" at the reception desk only to be told that the hygienist had gone home. They rescheduled for the next day, my original day. I had a 100PM appt, more early time off, only to be told that the hygienist doesn't work on Wednesdays!

I had a 200PM dentist appt which turned into a 400PM visit. Made another appt when my next dentist visit was scheduled. Guess what, after the DR was done , I was told the hygienist had gone home.

Now it is 12/20/02 and I am preparing to fly home for the holidays. A piece of a temporary crown broke, causing me some discomfort. I called the office to see if I could come in and see the dentist, to check the crown out and file a sharp edge, which was cutting into my tongue. I was put on hold twice for 15 minutes each and outright lied to, until the office closed. First the Dentist was in and they would ask her if I could come in- on hold for 15 mins. Then the dentist wasn't there and they would check with another dentist-on hold for another 15. No apologies & I will be away for a week with a broken crown. I would NEVER recommend SOUTHERN DENTAL in Texas to anyone. Their service is the poorest I have ever experienced.

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HMO's are paying doctors to give LESS care

HMO's are reimbursing doctors who give less care!

I was denied/prevented from going to the Emergency Room at Underwood Memorial Hospital when I fell down cement steps onto a cement walkway--hurt my hip--doctor diagnosed me over the phone as having a "groin pull"-my impacted femur broke while walking 10 days later. I lost case in court Am trying to appeal!! I have all documents to prove what I say!!

America's courts have to address the problem of HMO's (and others?) paying doctors more money if they give less care to their patients by not sending them to the E/R or to a specialist or for testing. THIS IS WHY THE DOCTORS ARE HAVING MedMale practice suits being brought against them. The doctors do their best but when it comes to having a higher income they bend. America must allow the HMO's to accept their responsibility. I speak from experience was denied entering my evidence showing proof that they paid my doctor MORE money not to send me to the E/R---I was prevented from saying the words HMO, referral, capitation, enhancement (HMO's way of saying they give kick back to doctors if they give you deny you service. I am now on permanent disability and crippled for life

I am trying to appeal the case due to this and other things--have you ever tried to get legal help AGAINST HMO's--so far it's impossible no one wants to handle it--the HMO's control the courts and juges. And this starts high up in OUR GOVERNMENT. What happened to free speech?? What ever happened to our court system wanting and needing to hear the complete truth?? WHAT EVER HAPPENED TO FAIRNESS!

CAN ANYONE HELP ME!!!!!!!!

Sincerely, Leslie coba22@aol.com

Leslie

coba22@aol.com

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This is probably minor compared to other people's problems, but this so annoyed me that I wanted to tell someone. I have health insurance through one of the companies I call "The New Terrorists" who are terrorizing the American people; this company's name is Blue Cross. Aside from the basic problems of them not covering dental and medical treatments I thought should be covered, they are now trying to double-charge me for my already expensive coverage. I pay about $640 per 3 months (it was just raised a month ago) and I sent payment on time. I got a leter a month later that they hadn't received payment and that I would be discontinued. I located my cancelled check that they had cashed and called them to inform them that I would not pay twice for their coverage. Unfortunately every time I call, their computerized "billing system" is down and they can't access it. When I've asked to talk to a supervisor, they inform me that one is "not available" at present but they wil gladly take my number and have one call me in 24-48 hours. I am so disgusted with Blue Cross and the whole medical and pharmaceutical industry that I believe it is time for Americans to rise up and treat these companies as the terrorists that they really are.

I am planning on setting up a web site called "The New Terrorists", identifying various medical, health insurance, and pharmaceutical companies as terrorist groups and encouraging our politicians and the American public to start treating these companies as terrorists. I was wondering if you knew of any way of finding out the names and addresses of the corporate leaders of companies like Blue Cross and any of the other major healthcare companies. I am convinced that only by creating a threatening environment for the heads of these companies will there ever be any end to the rampaging greed of these sickening terrorist groups. Any help would be appreciated. Thanks,

Mark
clearlit@execpc.com

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My horror story is one involving the provider AND the practitioner.

Our "health insurance" isn't really that at all. It's a union-run trust fund that is earmarked for medical expenses; officially dubbed an indemnity plan. Most, if not all, practitioners will not accept such insurance, so I have to pay 100% out of pocket for every doctor visit, or wait till it's really bad and go to the emergency room. The whole thing chaps my hide. The plan does not cover well child checkups, womens' exams, immunizations, drugs, or vision care. I am treated like an indigent every time I visit the doctor. I once thought I had found a practitioner who would file the claims for me and just let me pay the 20%. They did this once and I went to my next appointment prepared only to pay the $12 for my part. I was informed AFTER the doctor had seen my daughter that they "don't and never have" filed with my insurance. I have proof in my hand that they were lying.

I'd like to know what is wrong with my insurance. I can't get an answer from anyone about it.

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Hi.

I actually have a whole series of horror stories, all brought about by one Blue Cross or another.

My first run-in with managed care was when I went to the HMO emergency room - a hour away by bus - for severe pain in my back right where the kidneys are. After a 4-hour wait they managed to take a urine sample, and tested it with a dipstick that can detect the 6 or 8 most common infectious bacteria. Since that came up normal, they sent me away with instructions to make an appointment with my primary care physician (PCP).

I did that, figuring I could bear the pain for that long. Two weeks later I went to see the PCP, only to be told that she was not on this service today and I should reschedule. Two weeks after that, I actually did manage to see her. She ordered some blood tests and a urinalysis, and referred me to a urologist.

Fours more weeks went by before I could see the urologist. When I went there, he ordered another urinalysis - the one ordered by my PCP had been THROWN OUT because a PCP is not authorized to order a urinalysis!

Two more weeks of pain, and I went back, only to find that there were no clear results and I should have yet another test.

It took 6 more weeks to get that test scheduled. When I showed up, I was told that the machine that develops the X-ray films was not working, and I would have to reschedule. Four more weeks.

The total elapsed time is now about 6 months. If this had been an unusual kidney infection I would have long since been dead. Apparently the HMO wished I was.

About that time I went to an outside doctor, who ordered tests including X-rays and a complete blood and urine workup. In his hands, they took 2 days to get results.

I submitted these bills to my HMO. they of course said that they wouldn't pay - but eventually did. Maybe the fact that I could cite several medical residents who, upon hearing the story, all said "malpractice."

By the way, the pain actually turned out to be unrelated to my kidneys - it was the first of many "trigger points" that I have had.

More next installment.

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Hi again, Part 2 of the Blue Cross soap opera.

When I was working for a small company, they purchased individual BC policies for us. These policies all had a $2000 pre-existing condition limitation for the first year.

There were 3 of us who exceeded the $2000. One broke her foot 6 months after starting work. This was denied as a "pre-existing condition." No amount of additional information or appeals or grievances would change that. Eventually, what did change it (15 months later) was that she had a secondary insurer through her husband's employer, and they paid it. The secondary insurer then sent to Blue Cross a letter saying essentially "we have as many lawyers as you do, and will not only win this case but get punitive damages from it."

The second instance was me - I tore a cartilage in my knee. The bill for surgery for this was split into 2 parts: one from the surgeon, another from the clinic where the surgery took place. The clinic (with attorney on retainer) was paid immediately. The surgeon was not because BC labeled the problem as "pre-existing condition: rheumatoid arthritis." My doctor offered to send them the film of the surgery, showing quite clearly a large piece of cartilage floating around in the joint. BC didn't want to see it, and would not change their denial. They continued to refuse to change the denial, until a letter from my surgeon's attorney went out, threatening to not only sue, and for punitive damages, but to introduce a resolution into his chapter of the AMA calling on members to stop participating in Blue Cross plans. That got their attention - and they finally paid the bill - over a year after it was first submitted.

The third is the most ridiculous. A coworker's newborn child was having breathing problems, and was taken by ambulance to the ER, and subsequently admitted to the neonatal ICU. The bills topped $30,000. BC refused to pay, on the grounds that "your contract does not provide for WELL-CHILD CARE." As usual, appeals and grievances were futile. The hospital, being afraid of what BC could do to them in the way of delaying or denying payments, did not press BC for payment. Instead they went after my coworker. Unfortunately he didn't have a strong player on his side, or an attorney familiar with health care and BC's charades. He did, however, have a job offer elsewhere, and to my knowledge the bill remains unpaid to this time. (IMO serves the hospital right.)

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Hi again, Part 3 of the Blue Cross soap opera.

I am now involved in a lawsuit with yet another Blue Cross. This one has denied payments for prescription drugs, doctor services, diagnostic tests, and for "durable medical equipment" DME, in this case a scooter to allow me to get around in spite of my severe Chronic Fatigue Syndrome (CFS).

When I first became disabled with CFS, I continued my insurance coverage with Guardian, under COBRA. They paid for all drugs prescribed, including one that was not approved by the FDA for marketing and had to be formulated by the pharmacist. (Components used to make it were FDA-approved as required by federal law.)

When the COBRA period ran out, I wound up joining another Blue Cross plan, a PPO. Not my first choice, but I was assured at the time that BC was a great plan in this area. (NOT!)

BC starting refusing to pay for prescription drugs right away. For one, they used a series of excuses, all lies, including that it was not a prescription drug, that it was a food additive, a food supplement, a vitamin, not a vitamin (!), and not in their formulary. For the one that had to be pharmacy formulated, they simply claimed that it was available OTC, which it was not.

As usual, when first contacted about this, they said "oh, you can't just look at the benefits booklet. You need to look at the contract." Unfortunately for them, we HAD the contract. After 4 times through their appeal land grievance system, nothing had changed. They still had not stated any reason for their denial of these drugs. Finally, after suit was filed, they declared that they had a "long-standing" medical policy about that drug and its coverage. They eventually showed it to us, under a strict confidentiality order. It was dated 1999 - 4 years AFTER their first denials of this drug. Longstanding indeed.

They also refused to pay for various diagnostic tests ordered by my various doctors. In explaining this when I appealed, they stated that "diagnostic services are not covered under your Plan." There are 6 pages in the contract about coverage for diagnostic tests.

They also refused to pay for trigger point injections, stating initially that "Your plan does not provide for this SURGICAL service." My doctor's office called about this, and was instructed to resubmit it using a different code number. Vast improvement (NOT!): now it was "Your plan does not provide for this ANAESTHESIA service." On appeal, they stated flatly that "therapeutic injections are not covered under your Plan." The contract states, in black and white, that therapeutic injections are covered; no exceptions, exclusions, or need for pre-approval. BC repeated this lie a total of 3 times in writing, including once by an outside attorney after I filed a bad faith lawsuit.

When I started getting worse, and less able to walk, my doctor recommended an electric scooter for mobility. BC sent me to a "Independent Medical Examination" (IME). Their IME dr. did the tests prescribed by BC, and declared that "there is no reason why [I] should not receive" a scooter. The scooter company put the paperwork through, only to have it denied on the grounds that "the tests were all normal." Looking at the tests in hindsight and with the benefit of seeing another of their secret medical policies, I can see what they did: they prescribed tests that if positive would bar me from getting a scooter, and if all were negative they could (and did) say "the tests are all negative" so he doesn't need one. Heads I win, tails you lose.

When they tried to defend their actions in appeal, and later in the lawsuit, they quoted from this secret medical guideline. At least, they put quote marks around the stuff they were saying - but they left out a couple of important details that would have shifted me into the eligible category. They also, in another area, flat contradicted their own secret medical policy.

As for the lawsuit, they have defended vigorously. Four times (6 if you count reconsideration and certification for appeal requests) they have tried to have it thrown out because they claim they are exempt from state law. (The mere fact that their interpretation of the particular law they are claiming exemption under leads to logical contradictions is irrelevant; this isn't logic after all, its a legal action.) They also started out saying "this is just a simple contract action...", then later claimed that there is no contract action. They have also claimed that the magical incantation "as determined by the Plan" allows them absolute freedom in determining coverage. (The mere fact that many courts including federal Circuit courts, the US Supreme Court and many state Superior and Supreme courts have already ruled that this is not the case, somehow never quite makes it to their legal briefs, in spite of the legal ethics canon require "absolute candor (full disclosure) to the tribunal.")

They have already succeeded in delaying trial twice. They have violated court orders - nothing new for BC, as I have seen a case where they agreed to settle if the suit was dropped, then refused to pay the settlement! They have also sought court orders to go through my attorney's personal medical records, starting 4 years before I ever met him. (They later claimed that was a "mistake" - but somehow it never got corrected in court.)

Their most recent legal maneuver is to try to exclude all of our evidence. They are trying to get our expert witnesses excluded; get the court to order that we cannot reveal the secret medical policy to the jury (the original court confidentiality order explicitly says that it can be), seeks to exclude public documents available from the CDC and NIH, and even tries to throw out some of the letters between me and BC. They are also claiming that "cost containment" is not a policy they use - even though their own annual reports state that cost containment is the number one priority.

BTW, this BC had, in 1998, a record $220 million profit (oops, they are NON-profit, so they can't have a profit - call it a "surplus" instead.) Immediately following that, they 1) requested a 30% rate increase, and 2) demanded 15%reimbursement reductions from all providers. Not surprisingly in this state, they got a rate increase - 10% - and some reductions, about 5%. Also not surprisingly, in 1999 they had another record profit (excuse me, _surplus_) of $250 million. They now have in excess of half a billion dollars sitting in various investments, not earmarked for any expenses. Gee, I wonder why medical costs are going up?

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I decided to get back at Kaiser Permanente. They have take up the practice of not treating ailments unless the patient (me) has been in twice.

Big mistake on their part. I have allergies. Everybody KNOWS I have allergies including the Kaiser practitioners. Well, I went in for a series of 'dry red sploches' up ONE arm. The doctor asked (again) if I had allergies. Then she asked if I had any animals. I have a dog. She informed me to 'wash the dog in dandriff shampoo' because of the dander. I didn't think this was appropriate because even if I were allergic to the dog doing that was not going to clear up the sploches.

But being the obidient patient (I'm not a child either) I did as she said and guess what? The sploches are still there and getting worse. So if I want to get something done about them I have to go back to her, at her recommendation. NOT!

I can keep them under control and stop them from being really gross but they won't go away. So, I wear short or sleeveless shirts so other people see them. If they ask or pay to much attention to them I tell them I went to Kaiser and all I got was this lousy rash!

Since they don't bother me too much I plan on taking advantage of it until I HAVE to have it taken care of.

Oh, at this same appointment AFTER she told me to use a dandriff shampoo, I told her I was having problems with my nose. She looks in my nose and asks (again) do you have allergies. DUH! Didn't we just go over that?

My problem is not life threatening so I can use it against Kaiser. I do NOT however recommend it for all ailments. In other words, don't do this if it causes harm to yourself or others. But word of mouth is the best advertisement

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November 20, 2000

Councilmember Ruth Galanter Los Angeles City Council Westside District Office 7166 W. Manchester Avenue Westchester, CA 90045

Dear Ms. Galanter,

As a member of your constituency in council district 6, I am requesting your help in holding Blue Cross of California accountable for misrepresentation of coverage. It has come to my attention through denied emergency room insurance claims that several Southland emergency rooms are no longer negotiating physician contracts with Blue Cross of California. Blue Cross of California is therefore denying ER claims, deeming them "out of network." However, Blue Cross continues to sell corporate and individual policies stating emergency room coverage after a one hundred dollar deductible is paid. This fraudulent activity is not only a gross misrepresentation of coverage, it is a blatant lie.

Dr. Slay, ER Physician Medical Director at Daniel Freeman Marina Hospital informed me that due to Blue Cross of California paying "abysmal reimbursement" to doctors, hospitals are refusing to renegotiate contracts with Blue Cross of California. However, Blue Cross continues to sell policies with emergency room coverage. Blue Cross also continues to collect premiums on existing policies, charging for emergency room coverage which they then refuse to provide. This is clearly insurance fraud. In speaking repeatedly with Blue Cross over the past year and a half, I have been edified by Blue Cross agents with the knowledge that the Blue Cross policy holders, not they, will bear the cost of these contract disputes by being forced to pay out of pocket for ER care. Dr. Slay explained that he receives daily calls from shocked patients who are being billed, in addition to the one hundred dollar co-pay, for ER visits. These patients were falsely led by Blue Cross into believing that they had emergency room coverage as is stated in their policies, unaware of contract disputes beyond their control.

I discussed with Dr. Slay the fact that a Blue Cross agent reprehensibly suggested that the next time my three month old baby is in need of emergency medical care, we should drive an hour and a half to “contracted” Torrance Memorial, and only then will they cover an ER bill, since Torrance Memorial is listed as having contracted physicians. Unfortunately, Dr. Slay informed me that this is incorrect as Torrance Memorial’s physicians are also dropping Blue Cross by refusing to renegotiate a contract. I was then astounded to find that each hospital I called yesterday is dropping Blue Cross by refusing to negotiate contracts including St. John's Medical Center and Cedars Sinai citing unacceptable reimbursement. We, the policy holders, are all left with no ER physician coverage.

Blue Cross continues to sell and collect premiums with impunity on policies stating emergency room coverage with a one hundred dollar co-pay outlined in their benefits package without disclosing the fact that they are unable to negotiate physician contracts and provide this outlined coverage. I have paid several hundreds of dollars over the co-pay in recent months alone. Dr. Slay and I were lamenting over how tragic it would be if one of your constituents were to be in a major accident and require emergency care. They could lose their home due to lack of insurance coverage, which they falsely believed they had in their erroneous Blue Cross policy.

It is incorrigible that Blue Cross pays, as Dr. Slay pointed out, "less than Medicare" to doctors yet they are not charging the same "abysmal" premiums to their customers. I have a masters degree in clinical psychology and currently work as a client advocate. I will now advocate to ensure that consumers know that their private Blue Cross health policy is considered "worse than Medicare" by doctors and hospitals. I believe that the only way to hold Blue Cross accountable is through generating heat in the media through a public outcry. I have collect