Anyone know how to get this story on the national news?

@cranky1950 I guess having battled health insurance companies over and over, including having them refuse to finish my reconstruction after one of my breast cancers (and despite federal law requiring them to do so - calling it vanity surgery), refusing to honor their continuity of care when my health insurance changed and thus delaying chemo #3 by nearly a month with a different cancer because of that, having them deny tests for cancer #1 for 4 years - yes years - until the tumor was 5.5cm, I don’t have much sympathy for health insurance companies.

I am not so sure how he would be viewed as a laughing stock though. Yes there was major stupidity in how he lost his hand but now that he has lost it, he will pay for that for the rest of his life. If he needs something other than a “Captain Hook’s hook” to be able to manipulate stuff for his engineering classes, to play his musical instruments again… it seems to me he should be able to have that. This is, after all, why we spend years paying for insurance even if we don’t use it - so that when bad stuff happens it is there for us. Heck until I got nailed with 3 major cancers in 7 years I was generally a major profit center for insurance companies. Of course then I ran up $170,000+ (negotiated rate) in one year alone which sort of wiped out their profits on me LOL. But his hand costs far LESS than just ONE round of chemo had cost for me. Should I have been denied that chemo because it was expensive?

I do agree though that he’d likely get it faster if he started a gofundme. Took me nearly 5 years win one battle with health insurance.

I wish him luck, but more than likely moms and dadums are going to have to pay for his stupidity. Quite frankly an Industrial engineer only needs on hand to use a stop watch.

@Kidsandliz How long does this prosthesis last? What about the next prosthesis? And the next? And the next? What about when the next new innovation in prosthetics comes around? Do they pay for that one too?

I sympathize with the guy and might even throw a bit his way in a gofundme if he made one but this strikes me as expecting the insurance company to go above and beyond. They haven’t complained that the insurance company didn’t pay for the emergency room visit, amputation, all of the follow ups, having a prosthesis fitted, physical therapy to learn to use it, etc. At what point do we draw the line? The insurance company must keep paying out until he’s at 100%? It would never end.

Don’t get me wrong, I hate insurance companies more than anything. Similar to you my mom paid into for over 20 years and then my dad fell off a ladder and it was a fight to get them to cover things. But in this case they’ve done as much for this kid as I think can reasonably be expected. Yeah, he faces limitations compared to his pre-accident state but it’s a condition many people live successful, happy lives with. Never mind the whole did it to himself factor.

@cranky1950 I think this fails the “medically necessary” test. If he had lost both hands they would have paid for one. And people blame drug companies for the high cost of insurance.

@Kidsandliz I think that law about breast reconstruction is ridiculous. You can get as many surgeries as you want until you’re happy, and they are required to do the unaffected breast too so they match. Bullshit.

@sammydog01 Somehow I doubt that there are a ton of breast cancer survivors lined up for multiple rounds of frivolous surgery.

@Pantheist I bet you’re wrong.

@sammydog01 I thought that too. The electric hands have not been out long enough. Usually the insurance agreement has language about prosthetics.

@sammydog01 What the law says is that insurance companies are required to cover breast reconstruction, including if it takes multiple surgeries (which in my case it did due to complications). I gave them copies of the law, etc. but because the dead tissue was on the area where they took the donor tissue (had a tram flap done) they claimed they weren’t required to fix that mess since it finally had a scar and taking off the excess scar tissue (even though it was pulling on other skin and adhered to the muscle under - lost tissue about twice the size of my hand) was vanity surgery rather than related to breast reconstruction. Umm wouldn’t have had that mess if I hadn’t had reconstruction done and needed that skin. Same company in a different state had no problem with covering this but then I didn’t have money to pay my share of it. So still not done.

@sammydog01 As far as breast cancer patients lining up for surgery - of the people I know and the yahoo group I belong to - almost no one with a lumpectomy does anything at all to try to make things match. Those who have a mastectomy generally don’t go back to get the other side to match. By the time you get to that point you have just had enough of having to even deal with the medical system.

Many folks don’t even get the final steps done in a reconstruction (nipple reconstruction and the tattooing). I had a failed nipple reconstruction on one side and quit, never even bothered on the other side (mastectomy there too due to 5 tumors). Some day I might get things to match and finish it but I STILL can’t deal with more surgery, more scars… emotionally, not to mention can’t afford the co-pays. (especially since I now have one of the incurable non-hodgkin’s lymphomas as paying for that has to take priority).

@Kidsandliz Are nipples medically necessary? It’s a whole separate surgery right? And it’s covered? And they’re not even any fun because the nerve endings are shot, right?

Lumpectomies exist because they don’t require reconstructive surgery. If they have to take too much tissue the just do a mastectomy.

Implants are a fairly easy reconstruction but often require the other breast lifted. That’s what I was talking about.

TRAM flaps, on the other hand, are medically difficult and have a high failure rate.

Scarring- yes, it’s an issue. Who gets to decide how much is too much?

@sammydog01

No lumpectomies exist because it is traumatic to lose your entire breast, there is less tissue damage and the cancer outcomes are the same as a mastectomy. Plus clothes then still fit right - which they do not do with a mastectomy and no reconstruction.

Implants aren’t permanent either - they usually need replaced every 10 years or so.

Where I got my free tram flap done (MDAnderson Cancer Center) their failure rate is low (less than 2%) and their surgeons are skilled. I wouldn’t let a local, non specialist surgeon do that. Ever. It takes a vascular surgeon to have the right skills. Maybe if a butcher does it or a general surgeon the failure rate would be higher… I have had more problems with the fucking implant on the other side (you can only get a free tram done once - had I known the future I would have had both cut off and had a free tram done on both sides at the same time).

There are many reasons why people choose to reconstruct their nipple. And no they have no feeling. But that isn’t why one reconstructs them.

Scarring - I’d say a scar around 2-4" wide and about 10" long that is adhered to the underlying tissue and contracted needs fixed. BCBS of Idaho said it was vanity surgery. When I had an abdominal biopsy for the lymphoma that guy was floored they wouldn’t fix it so he chose to separate it from the underlying tissue (which helped) and didn’t include a dx code to have me billed for it. Scar is still pretty wide though.

Prosthetic eyes aren’t medically necessary either. Nor is plastic surgery on the face to repair damage instead of a general surgeon. Yet that is routinely approved.

@Kidsandliz you had a disease that should have been covered. He blew his own hand off. There’s a difference. The insurance company doesn’t pay for it their customers do.

Maybe he should have had AD&D insurance.

@unksol Roll two D20 to see if you’re covered?

A giant litch emerges…

@unksol I don’t judge the kid for that- we all do stupid stuff. Should you refuse emphysema treatment to smokers or cancer treatment to anyone who’s obese? It’s a matter of where we spend health dollars- people think we have infinite money to do all these nice things for everyone and then scream about health care premiums rising. Life doesn’t work that way.

@cengland0 And you are why everything is so expensive. The best Pentair Sand Dollar is $380. The lateral assemblies run under $100. So instead of using the insurance for what it’s made for (catastrophic failure of a furnace or major appliance), you sued for a few hundred dollar pool part. I sincerely hope they cancelled your policy after your little stunt.

@Rus They cannot cancel my policy because I paid for the whole year at once. But I didn’t renew with them and that was my choice. I decided after a year that nothing else was going to go wrong and the price for insurance will probably exceed the out-of-pocket costs to fix something.

Do you think I misused the court system for a company that refused to provide me a service that I paid for? I didn’t care about the dollar amount. Even if it was only $10, I would have done the same thing. It was all about principle and getting what I paid for. I paid extra to have the pool covered in my policy so I expect them to pay when something goes wrong with the pool. Why do you have a problem with me expecting the insurance company to do the right thing?

The insurance company had a lawyer drive all the way from Tampa to Jacksonville area two times. I’m sure they paid their lawyer more money than the lateral assembly would have cost. I gave them plenty of opportunity to pay but they kept refusing – even through the arbitration phase. So after going in front of the judge, they paid out the nose. It is their loss, not mine.

If you let companies get away with ripping you off, they will continue to do it to you and to other people too. You have to fight for your rights and keep doing it. Don’t let big corporations scare you into thinking you have no rights.

@cengland0 Damn straight!

@Rus so how are things going for you down at the insurance company? That big promotion come though yet?

@cengland0 Well, good for you. In the meantime, the next guy who wanted a pool insurance policy had to pay an extra $1000 to cover their loss on your frivolous claim. Also, you are going to get a very rude awakening to pool ownership if you think $100 in laterals are worth the time and effort to file a SCC case. Enjoy.

@Rus

Wrong.

And I know people had recent very successful careers high up in the insurance industry. They would also say, “Wrong”.

I don’t mean to oversimplify the issues associated with insurance.

And if you choose not to make small claims, fine. There’s a decent logic to that. As well as a decent logic to other approaches (both from the consumer and the industry’s POVs).

@Rus You’re trying to equate a small home warranty policy with “regular” home insurance.

These little home warranties are more often than not very hard to collect upon. But they are specifically for these types of minor appliance repairs.

“Regular” home owner’s policies should be only used for catastrauphic losses.

@Rus Oh so we are supposed to buy insurance and then never use it for its legitimate purpose? We are not DONATING to insurance companies. They have sophisticated risk assessment tools and set their premiums based on that and whatever else they can determine by records, data mining, etc. I went years and years and years of never even using my health insurance that I paid for. Then I probably have gotten back more than I paid in in just a 2 year period - but I would have been perfectly happy for that to have never happened.

@Kidsandliz This instance is the equivalent of buying health insurance and then running to the emergency room because you got a cut on your finger. The purpose of these home insurance policies is to protect you against major repairs and unforeseen expenses. Replacing $100 of parts in a pool filter is not the intention. The OP was able to get a court to see his side of the case, and get the insurance to pay for it; good for him. That is not how insurance is supposed to work.
If one set of mini blinds in the house he bought quit working, should he get those replaced under warranty too? What if the fill valve on a toilet wears out (approximately $20)? There is a point where the homeowner is expected to take care of some repairs and maintenance in the course of action of owning the home.
The OP got a simple repair covered, so every policy written after that will go forward under the assumption that the customer is going to try to get every sand filter lateral, miniblind, and fill valve covered under the policy. This is what drives up the cost of all insurance: the abuse and misuse of claims to avoid taking any responsibility for one’s own actions and property.
This is NOT to say that insurance companies are altruistic, or that you shouldn’t get appropriate claims covered by that insurance. The problem is when people want insurance to cover every little thing because they feel they are owed it. Insurance is a voluntary collective; when someone abuses it or defrauds it, it costs each and every one of us in the form of higher deductibles (or purchase prices in the case of the OP). Rampant fraud and abuse of these systems is exactly why claims rejections keep going up so many more cases have to be fought. It isn’t fun, and it isn’t fair, but as usual, bad eggs have ruined it for everyone.

@Rus Isn’t that partially what deductibles are for? To prevent smaller claims from being submitted?

I had to use a home warranty that was included for my house a long while back. The warranty company contracted out all of their jobs, and any repair had a $75 service fee (deductible). Repairs were done, issue persisted, and the repair guy had to come back and do some more work, twice (since it was the same issue, I only had to pay the $75 once).

The actual parts for the repair were probably < $100, however had I had to pay a plumber out of pocket, I’m sure it would have been $500+. There was also a disclaimer about them not covering any items that have been repaired, or attempted to have been repaired by the home owner or anybody else not dispatched by them. So if I had tried to fix it myself, got to a point where I was over my head, then called the warranty company, I’d have been screwed.

@pajamma Yeah they are a nightmare. So is CIGNA.

@pajamma PS and both companies serve as the processor for self insured companies, also have a side business dealing with referrals and out of network approvals. I had a nightmare experience with UHC when they controlled approvals when I had state BCBS. Then one day suddenly things were much easier. Turns out they lost the bid to renew. And cigna I had to take to the state insurance commission to get them to pay my legitimate claims. The attorney who dealt with them said she never ever wanted to deal with cigna again. Umm neither do I.

@Kidsandliz

So among health insurances companies, who sucks somewhat less?

Is a company like UHC sometimes ok in one state and horrible the next state over?

What about when the insurance company is merely the administrative agent and approval/claims processor for a corporate self-insurance company health policy? Then how much does the patient experience vary in dealing with them, compared to a regular insurance company policy?

@f00l I have no clue. BC sucks in Idaho, is OK in Mississippi (although heaven help you if where you are going doesn’t use the identical dx code on everything regardless of what since the approval is on the dx code and not on the visit. Administered by BC is was OK once they got rid of cigna as the gatekeeper. United health care sucks in MS (my kid has that - it is the universal denial machine).

@f00l I’ve been reasonably satisfied with Aetna, but I’ve never had a major claim. I like their wellness initiatives. I continued my expensive high deductible policy with the City, along with dental and optical, when I retired because I was afraid of exactly what is happening with national health care. I’m unlikely to ever actually use it (I think the deductible came down from $5,000 to $3,000 this year), but it’s there in case of catastrophic injury or illness. I’m fortunate in that the City’s plan comes with free access to the employee wellness clinics, which staffs physician’s assistants and can do most anything within their scope. I put $100 a month into an H.S.A. to cover any medical costs I might have, so far just dental and optical.

@ekw I am really surprised where this went. All I was hoping was that someone might help this kid, or at least sign his petition. United Health Care’s favorite word is no at least in my state and the state of someone else who posted on this list. It does not seem unreasonable to me that he wants a hand that functions like a hand. Apparently some here feel he doesn’t deserve that. Personally I hope they never end up in the kind of situation this kid is in, where I and some others have been. Or maybe if they did they’d develop some compassion. I was sort of taken aback with some of the attitudes/opinions expressed here.

@Cerridwyn I would agree. And I guess when I see things like this I try to do something about it partly because I can’t do anything about my mess, but maybe, just maybe I can contribute in a small way for someone else’s problems being solve. Nothing will ever put his life back to where it was and he has to learn how to live with that reality, but certainly it is possible to help him be in a better place that where he is now.

I guess I think things like this matter; that as a society we have a responsibility to/for others; that there is a place in life for empathy, and the “I’ve got mine due to all my hard work, you don’t have your’s because you are too fucking lazy, stupid (fill in the blank)” rather than understanding sometimes bad shit just happens (and yes this kid did something stupid thing, but he is also young enough that his frontal lobe still has years to finish developing thus the ability to anticipate the future with respect to decisions made now is still underdeveloped), is the epitome of being a self-centered jerk. Clearly this country has a number of people who have had a empathy lobotomy - Just look all the attempts in DC to prevent some people, including the most vulnerable, from any having health care.

@djslack I don’t know what all the options are but he needs to contact his state insurance commission and let them help him deal with it. The one time I finally resorted to getting their help they actually came through for me.