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Woman wakes up with bleeding breasts, insurance company claims "no emergency"

Merc

Problematic Shitlord
V.I.P.
When Daly City resident Rosalinda Miran-Ramirez woke up one morning in April to find her left breast bleeding from the nipple, she panicked. The shirt she had been sleeping in was saturated with blood. So her husband took her to the emergency room at Seton Medical Center.

"In my mind I know something serious is going on," said Miran-Ramirez. "I need to see a doctor."

Doctors found a tumor and initially told her she had breast cancer. A biopsy later proved that assumption false; the tumor was benign.

But Miran-Ramirez said the real shock came when her insurance company, Blue Shield of California HMO, which had initially approved the claim for the emergency room visit, reversed course and sent her a new bill three months later requiring her to pay the total charges for that visit: $2,791.00.

Why? Documents from Blue Shield indicate the company had reviewed the case and determined Miran-Ramirez "reasonably should have known that an emergency did not exist."

"I am like how can they say that it was not an emergency? Like, my breast was bleeding! I am not a clinical person but if your breast is bleeding, for me that's an emergency," she said.

So she appealed. And she was denied again This time Blue Shield told her she hadn't been in "any acute distress."

But an attorney interviewed by CBS 5 Investigates doesn't believe insurance companies can do that in California.

"If you reasonably believe it's an emergency, it's an emergency. They don't have the right to second-guess you," said attorney Arnold Levinson, who works on insurance denial cases. His take? "They're clearly looking for a way to deny a claim here, when it's clearly unreasonable to do that, that's the definition of bad faith."

Miran-Ramirez's coverage came through her employment with the San Francisco Department of Public Health. City Supervisor Michela Alioto-Pier told CBS 5 Investigates she's curious as to whether any other city employees' claims could be affected.

Absolutely, I think that is a big concern and that is something we should be looking into," Alioto-Pier said.

"What happened to this woman in my opinion, it's reprehensible," she said. "It seems like they're nickel and diming her. They should be thanking her, in my opinion, for walking into that emergency room and getting it taken care of."

Miran-Ramirez said she feels like she's being punished for getting sick. She said in her home country of The Philippines, people going to emergency rooms don't have to worry about getting a $3,000 bill after the fact.

But there is good news: after CBS 5 Investigates asked Blue Shield about Miran-Ramirez' case, the company said it was reviewing the case again and has now agreed to pay all charges for the emergency room visit.
Source

So yeah, thankfully these bastards paid up but once again I challenge you GF with the question, why does the government want to give these guys so much power? We forget that they are running a business, meaning they're going to dodge as much liability as possible and that does not sound like a good healthcare idea to me in the slightest.
 

Blueyes

Registered Member
that's insane....and people wonder why i despise the insurance companies on a daily basis. I have to deal with this sort of crap of denial although thankfully i only deal in peds so this hasn't happened yet lol
 

CaptainObvious

Embrace the Suck
V.I.P.
I agree with Arnold Levinson, clearly an example of bad faith. Enact much tighter regulations for the handling of these claims and enact legislation that punishes insurance companies for acting in bad faith, having them liable for extra-contractual liability with statutes outlining the penalties.
 
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