Do you have adblock enabled?
If you can read this, either the style sheet didn't load or you have an older browser that doesn't support style sheets. Try clearing your browser cache and refreshing the page.

(CBS San Francisco)   Bad: Sonoma County man battling cancer is denied coverage by his insurance company. Worse: Despite having multiple tumors in his brain, lungs, liver & bones the insurance company says his hospital stay didn't meet the criteria for medical necessity   (sanfrancisco.cbslocal.com) divider line 293
    More: Sick, Anthem Blue Cross, medical necessity, anthems, hospital stay, cancers, Anthem Blue, tumors, livers  
•       •       •

7721 clicks; posted to Main » on 29 May 2014 at 7:35 AM (52 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



293 Comments   (+0 »)
   
View Voting Results: Smartest and Funniest

First | « | 1 | 2 | 3 | 4 | 5 | 6 | » | Last | Show all
 
2014-05-29 04:51:11 AM  
If this man's cancer isn't a medical necessity then what the hell is?
 
2014-05-29 05:12:16 AM  
cdn.redalertpolitics.com
 
2014-05-29 05:16:25 AM  
FTFA: Jeffrey Rusch of Camp Meeker knew the news was bad when an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones.

To be fair to the insurance company, at this point the patient is already dead and is just waiting for biological functions to suddenly stop.  One could say doing anything at this point isn't really medically necessary.

/Sarcasm off
 
2014-05-29 05:44:12 AM  
"...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!
 
2014-05-29 05:47:39 AM  

ginandbacon: "...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!


So, private insurance that this man has paid for since 2008, years before the ACA was implemented equals Obamacare? Got it.
 
2014-05-29 05:47:53 AM  
Will they pay for his palliative care?
 
2014-05-29 05:52:34 AM  

ginandbacon: "...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!


AND he voted for Romney. Kind of ironic considering RomneyCare was implemented years before the ACA. It is amusing how the other commenters are raking this idiot over the coals.
 
2014-05-29 05:56:42 AM  

Bathia_Mapes: ginandbacon: "...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!

So, private insurance that this man has paid for since 2008, years before the ACA was implemented equals Obamacare? Got it.


Yup. Or at least according to the JBs of this world.
 
2014-05-29 05:57:24 AM  

Bathia_Mapes: ginandbacon: "...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!

AND he voted for Romney. Kind of ironic considering RomneyCare was implemented years before the ACA. It is amusing how the other commenters are raking this idiot over the coals.


Haha right? Too funny.
 
2014-05-29 06:17:22 AM  
Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.

Who is currently fighting for his life and in not much shape to sign anything. You know, if Mr Rusch was living under the tyranny of socialized health care, he might at least be compensated for his emergency chemo and not have to worry about his insurance company turning his palliative care into a goddamn nightmare.
 
2014-05-29 06:39:24 AM  

NutWrench: Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.

Who is currently fighting for his life and in not much shape to sign anything. You know, if Mr Rusch was living under the tyranny of socialized health care, he might at least be compensated for his emergency chemo and not have to worry about his insurance company turning his palliative care into a goddamn nightmare.


Honestly, without knowing what exactly happened here, it's hard to say who's to blame.

I had was admitted to the hospital from the ER with pulmonary embolisms and given emergency care which was all covered BUT my insurance denied the prescription for Lovenox which meant I had to stay in the hospital for more than a week to get the shots (they covered it in the hospital.) When I finally got fed up and called the insurance company, it turned out that they just wanted the prescribing physician to specify why Lovenox in particular. By that time though the doctors were willing to let me go home with an Rx for Coumadin and another week or so shots of Lovenox which they had arranged for the hospital to cover as charity. (I love Catholic Hospitals.) The insurance company would have covered those shots though had the doctor just filled out the form correctly. Especially since then they wouldn't have had to cover my lengthy hospital stay.

Long story (sorry) short: there may be something else going on here that could easily be resolved--although Anthem BC, CA has a really bad reputation and has been fined by the state in the past so...
 
2014-05-29 07:02:39 AM  
DEATH PANEL decided he should die.
 
2014-05-29 07:26:36 AM  
Will they pay for hospice care? 'Cause this guy has one foot in the grave.
 
2014-05-29 07:31:34 AM  

ginandbacon: I had was admitted to the hospital from the ER with pulmonary embolisms and given emergency care which was all covered BUT my insurance denied the prescription for Lovenox which meant I had to stay in the hospital for more than a week to get the shots (they covered it in the hospital.) When I finally got fed up and called the insurance company, it turned out that they just wanted the prescribing physician to specify why Lovenox in particular. By that time though the doctors were willing to let me go home with an Rx for Coumadin and another week or so shots of Lovenox which they had arranged for the hospital to cover as charity. (I love Catholic Hospitals.) The insurance company would have covered those shots though had the doctor just filled out the form correctly. Especially since then they wouldn't have had to cover my lengthy hospital stay.


Yeah that's a big problem. With any sort of mix up in the insurance system or even over primary care the patient has to advocate for themselves except that in some cases they are in no condition to actually do this.
 
2014-05-29 07:40:50 AM  

Bathia_Mapes: ginandbacon: "...an MRI found 20 tumors in his brain. Two days later, a C-T scan at Sutter medical center in Santa Rosa brought another devastating blow, discovering a large tumor in his lungs, and more in his liver and bones."

Holy crap. How is this guy still alive?

And from the comments:

J B •
Welcome to ObamaCare folks, this is what this country full of idiots (Obama supporters) got when they re-elected the clown for a second term. Don't blame me I voted for the Mormon, not the Moron.

Oh my!

So, private insurance that this man has paid for since 2008, years before the ACA was implemented equals Obamacare? Got it.


Study it out.
 
2014-05-29 07:42:21 AM  
If you like your cancer, you can keep your cancer... PERIOD!
 
2014-05-29 07:43:34 AM  
And yet if health care was funded by the community (and not by the individual alone) this person would right now be getting the best (legal) care money can buy.

PS - I mentioned 'legal' care because I am sure there are situations where wealth can by pass the law and find an alcoholic (with money) a liver :(

PPS - if we decide that welath is the be and end all of benefits then we will live in a society where most of the poor only have half a liver each (it's sale paid for 2 years of food and shelter ... oh and medical care.)
 
2014-05-29 07:44:10 AM  

Three Crooked Squirrels: DEATH PANEL decided he should die.


While it never really struck me as properly being "bumper sticker ready", I liked the observation that we already have death panels: insurance companies.  Prior to the ObamaCare reforms, insurance companies can and would drop your ass if you were deemed to be too expensive to continue insuring, even if dropping you meant you'd die from lack of care.
 
2014-05-29 07:45:26 AM  
So, I don't know the details of this situation, but it sounds like he is within weeks of death because the cancer was discovered so extremely and unusually late, and there's no way to prevent that. If so, most cancer treatments are indeed "not medically necessary" because something like radiation or chemotherapy will accomplish nothing, and hospice end-of-life care is appropriate.
 
2014-05-29 07:49:44 AM  

Egoy3k: ginandbacon: I had was admitted to the hospital from the ER with pulmonary embolisms and given emergency care which was all covered BUT my insurance denied the prescription for Lovenox which meant I had to stay in the hospital for more than a week to get the shots (they covered it in the hospital.) When I finally got fed up and called the insurance company, it turned out that they just wanted the prescribing physician to specify why Lovenox in particular. By that time though the doctors were willing to let me go home with an Rx for Coumadin and another week or so shots of Lovenox which they had arranged for the hospital to cover as charity. (I love Catholic Hospitals.) The insurance company would have covered those shots though had the doctor just filled out the form correctly. Especially since then they wouldn't have had to cover my lengthy hospital stay.

Yeah that's a big problem. With any sort of mix up in the insurance system or even over primary care the patient has to advocate for themselves except that in some cases they are in no condition to actually do this.


Luckily, most hospitals have patient advocates which is a great resource. But if you've got crappy insurance and no access to someone like that, you are pretty much screwed if you're too sick to cope and you don't have family or friends who can take on that role. 

Whatever the case here, I hope it gets sorted out and quickly.

SDRR: Study it out.


LOL!
 
2014-05-29 07:50:17 AM  
His medical insurance turned him down because treating that six pack of tumors was not a medical necessity?  I guess it must be so, if an insurance company says so.  One can only imagine the rejection letter from the insurance company must have read like:

Dear Mr. Rusch,

We have carefully reviewed your request for cancer treatment to deal with your aggressive onset of tumors throughout your body.  We have decided to reject your claim and that it sucks to be you.  If you wish to appeal this decision, you can but you will get rejected as often as you appeal.  If you appeal five times one of our vice presidents will be glad to send you a letter rejecting it and calling you "a stupid, stupid, stupid, stupid man."

Sincerely,

Anthem Blue Cross

PS -- Just a reminder, your May premium is due and you wouldn't want our outstanding coverage to lapse.
 
2014-05-29 07:50:35 AM  

Verrai: So, I don't know the details of this situation, but it sounds like he is within weeks of death because the cancer was discovered so extremely and unusually late, and there's no way to prevent that. If so, most cancer treatments are indeed "not medically necessary" because something like radiation or chemotherapy will accomplish nothing, and hospice end-of-life care is appropriate.


That's the really harsh reality of this poor bastard's situation. He is so riddled with cancer that all the doctors should do is manage his pain. It could be any one of us.
 
2014-05-29 07:50:54 AM  
Stop white-knighting the insurance company, guys.  It isn't going to sleep with you.
 
2014-05-29 07:51:29 AM  

ginandbacon: I had was admitted to the hospital from the ER with pulmonary embolisms and given emergency care which was all covered BUT my insurance denied the prescription for Lovenox which meant I had to stay in the hospital for more than a week to get the shots (they covered it in the hospital.) When I finally got fed up and called the insurance company, it turned out that they just wanted the prescribing physician to specify why Lovenox in particular. By that time though the doctors were willing to let me go home with an Rx for Coumadin and another week or so shots of Lovenox which they had arranged for the hospital to cover as charity. (I love Catholic Hospitals.) The insurance company would have covered those shots though had the doctor just filled out the form correctly. Especially since then they wouldn't have had to cover my lengthy hospital stay.


Yeah, I am going to have to say that is still the insurance farking up.

I may be off here, but Lovenox has pretty specific uses, and isn't something prescribed for fun or cosmetic reasons.
 
2014-05-29 07:53:07 AM  
www.soulprogress.com
 
2014-05-29 07:55:00 AM  
Approves.

img3.wikia.nocookie.net
 
2014-05-29 07:55:26 AM  
"Let's start an insurance company"

"What do we do?"

"We get money from people, "in case stuff" happens.  Then we lobby for it to be mandatory for some stuff to be insured by law, and we get money for that, too.  Then we set it up so we almost never have to pay on a claim and the stuff we should be paying on, we can just deny the payment and harrumph a lot and keep hundreds of billions of dollars shoved straight up our ass and ain't nothing anybody can do but give us more money."

"Is that legal?"
 
2014-05-29 07:55:47 AM  
In 60 or 70 years the US might have a sane singlepayer healthcare system. Until then we have insurance companies and massive legislative giveaways to insurance companies.
 
2014-05-29 07:57:43 AM  

Bathia_Mapes: If this man's cancer isn't a medical necessity then what the hell is?


Typical Blue Cross reasoning .
 
2014-05-29 07:57:50 AM  

Three Crooked Squirrels: DEATH PANEL decided he should die.


He should have paid a little extra for the "Death Panel Bypass Option" on his ObamaCare coverage.
 
2014-05-29 07:58:34 AM  
If I was him, I'd take a lead tablet.  About .44 oughta do it.
 
2014-05-29 07:58:55 AM  

Langdon_777: And yet if health care was funded by the community (and not by the individual alone) this person would right now be getting the best (legal) care money can buy.

PS - I mentioned 'legal' care because I am sure there are situations where wealth can by pass the law and find an alcoholic (with money) a liver :(

PPS - if we decide that welath is the be and end all of benefits then we will live in a society where most of the poor only have half a liver each (it's sale paid for 2 years of food and shelter ... oh and medical care.)


C'mon--the poors should be happy to have half a liver! Why, they should be donating parts of it all the time! It grows back--they can afford to part with it! To have more than half a liver means your're not pulling you weight for your rich better. Do you really want to let them down, and keep them from their job creating duties?
 
2014-05-29 08:01:36 AM  
Nationalize the bastards.
 
2014-05-29 08:03:44 AM  
"Sorry you're going to die horribly and painfully.  We'd love to approve a procedure or medication to make things at least a little better for you as you die, but we've got shareholders and profit margins to protect.  And, our shareholders really are the true victims here."
 
2014-05-29 08:03:46 AM  

Professor Duck: Do you really want to let them down?



                                                                We can try.

sepetjian.files.wordpress.com
 
2014-05-29 08:05:32 AM  

NutWrench: Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.

Who is currently fighting for his life and in not much shape to sign anything. You know, if Mr Rusch was living under the tyranny of socialized health care, he might at least be compensated for his emergency chemo and not have to worry about his insurance company turning his palliative care into a goddamn nightmare.


Let's not pretend that countries with a government funded system would pay for anything more than pain pills. He's got no chance at recovery, they're not going to waste the money.
 
2014-05-29 08:06:00 AM  

AverageAmericanGuy: [cdn.redalertpolitics.com image 475x356]


1/10

This is an example why you need Obamacare, not the other way around.
 
2014-05-29 08:06:13 AM  

CarnySaur: Stop white-knighting the insurance company, guys.  It isn't going to sleep with you.


No one is white knighting Anthem. Not here, and not in real life.
 
2014-05-29 08:08:53 AM  

Langdon_777: And yet if health care was funded by the community (and not by the individual alone) this person would right now be getting the best (legal) care money can buy.

PS - I mentioned 'legal' care because I am sure there are situations where wealth can by pass the law and find an alcoholic (with money) a liver :(

PPS - if we decide that welath is the be and end all of benefits then we will live in a society where most of the poor only have half a liver each (it's sale paid for 2 years of food and shelter ... oh and medical care.)


Bullshiat. If the government funded it, they'd realize the guy was on the brink of death and give him pain pills and send him home to say his goodbyes. The expenditure of ridiculous amounts of money in heroic means to extend the lives of people a few weeks doesn't happen in other countries.
 
2014-05-29 08:09:06 AM  

meanmutton: NutWrench: Anthem was unable to comment on the case without a signed HIPAA release form from Rusch.

Who is currently fighting for his life and in not much shape to sign anything. You know, if Mr Rusch was living under the tyranny of socialized health care, he might at least be compensated for his emergency chemo and not have to worry about his insurance company turning his palliative care into a goddamn nightmare.

Let's not pretend that countries with a government funded system would pay for anything more than pain pills. He's got no chance at recovery, they're not going to waste the money.


You're factually incorrect.

Also you're lying, because you're pretending to have knowledge about something you don't have.

Lots of my relatives have died of cancer in Denmark, and I know how it goes down.
 
2014-05-29 08:09:25 AM  
"Pain, suffering, hopelessness, starvation, disease, misery, violence, ignorance and the ravages of time.  Surely we can fix this."

"Not unless it moves a lot of money around."

"But shouldn't we be..."

"Not.  Unless.  It.  Moves.  Money.  Around.  And in my direction.  Now get back to work."
 
2014-05-29 08:09:29 AM  
i1.wp.com
 
2014-05-29 08:11:43 AM  

Verrai: So, I don't know the details of this situation, but it sounds like he is within weeks of death because the cancer was discovered so extremely and unusually late, and there's no way to prevent that. If so, most cancer treatments are indeed "not medically necessary" because something like radiation or chemotherapy will accomplish nothing, and hospice end-of-life care is appropriate.


As a practitioner, let me tell you how farking stupid you sound. Draining a half liter of fluid from someone's lungs is not only palliative, it's necessary. Chemo and radiation are both frequently administered palliatively and are routinely covered by most policies. Hospice doesn't mean "let them lay there and die", you farking moron. Did you stage his cancer? Is it large cell, basal cell, squamous cell? Since you're such a farking expert and have sentenced this guy to death, what the fark rationale do you have for any of the retardedness spewing from your facehole?

My guess is a coding error in billing, wrong ICD10 code and the visit will be covered on appeal. of course, I have to deal with these type of stupid situations almost daily, but that doesn't feed into the obamacare/evil insurance company narrative that cause rage boners everywhere.
 
2014-05-29 08:12:49 AM  

ginandbacon: Luckily, most hospitals have patient advocates which is a great resource. But if you've got crappy insurance and no access to someone like that, you are pretty much screwed if you're too sick to cope and you don't have family or friends who can take on that role.


That's not something we have up here but it sounds like a great service.  Our doctors are for the most part interested in treating you with the best care they can and worry about justifying it afterwards, they are also given guidelines for acceptable treatment options that help but are not carved into stone so they can overrule them if they deem it necessary.  The only really sticky issues is with prescribing medication sometimes the doctors and the provincial health authority disagree about what is necessary and that can be a long debate that leaves the patient out of pocket for expensive medication (we pay for medication but it is subsidized and sometimes the province refuses to subsidize expensive new drugs) but otherwise we have less conflicts so the advocates might get bored if we had them.

The biggest problem is some drugs show improvements for conditions that they were not originally intended to treat and getting the province to allow prescription of those drugs for conditions that the drug does not claim to treat is very tough.  A recent case was a medication that is intended for some other vascular issue was shown to be very beneficial to patients with diabetes related sight problems. It was wildly expensive and the province was not allowing it to be used for that purpose.  Luckily the first time a doctor prescribed it the drug company gave the patient the medication for free under their compassionate care program and the province has since allowed it. If it wasn't for the drug company that guy would have gone without or spent a lot of money to delay going blind.
 
2014-05-29 08:13:31 AM  
Fark.  Insurance company replies on twitter that they're aware of the situation but can't comment due to privacy and legal issues.

Seen in a twitter conversation last night involving author Neil Gaiman mentioning his friend, in the above ariticle, being denied insurance.
 
2014-05-29 08:14:12 AM  
Let's see.. Nope, no gubmint death panels here. See, isn't this much better?
 
2014-05-29 08:14:59 AM  

spawn73: AverageAmericanGuy: [cdn.redalertpolitics.com image 475x356]

1/10

This is an example why you need Obamacare, not the other way around.


The Independent Paymeny Advisory Board was created by the ACA for just this sort of situation - to coldly, rationally deny Medicare payment for ludicrous procedures that wouldn't extend life and just waste money. Insurance companies use those precedents to determine what they pay for.

Cancer sucks. It sucks that this guy is going to die. But let's not pretend that spending tens of millions of dollars would save him or that any government health care system outside the US would do anything different from Anthem.
 
2014-05-29 08:16:05 AM  
Corporate death panels are just the invisible hand of the free market.
 
2014-05-29 08:17:09 AM  

Verrai: So, I don't know the details of this situation, but it sounds like he is within weeks of death because the cancer was discovered so extremely and unusually late, and there's no way to prevent that. If so, most cancer treatments are indeed "not medically necessary" because something like radiation or chemotherapy will accomplish nothing, and hospice end-of-life care is appropriate.


If it would prolong his life, it's medically necessary. If he got to spend one more week with his family, it's necessary. It's what he was paying for all along, it's exactly why he gave them 100K over the years. It shouldn't be the choice of an accountant to decide, it should be up to the guy and a medical pro.  He paid for it, he paid 100K in premiums for these assclowns to say "fark you".

PS- His wife is a well known musician. She's also very vocal, she's a loudmouth (a big compliment in this situation). I think they'll find that they messed with the wrong people when this is over. In fact I'm 100% sure of it. Zoe is going to rip them a new one.
 
2014-05-29 08:18:11 AM  

Bathia_Mapes: It is amusing how the other commenters are raking this idiot over the coals.


Thank you, comment section! I just learned about the Dunning-Kruger Effect as a result, and it really helps explain my ex sister-in-law, a former boss, and several other people I currently work with in my local government job!
 
Displayed 50 of 293 comments

First | « | 1 | 2 | 3 | 4 | 5 | 6 | » | Last | Show all

View Voting Results: Smartest and Funniest


This thread is closed to new comments.

Continue Farking
Submit a Link »
Advertisement
On Twitter





In Other Media


  1. Links are submitted by members of the Fark community.

  2. When community members submit a link, they also write a custom headline for the story.

  3. Other Farkers comment on the links. This is the number of comments. Click here to read them.

  4. Click here to submit a link.

Report