Insurer Denies Claim: Bleeding Breast is Not An Emergency

As rumors and misstatements continue to swirl about death panels and government limitations on insurance coverage, these are the stories insurance companies do not want you to hear. They are stories of insurance companies, their own death panels, and their own health care rationing. Would any woman out there, waking to a shirt soaked with blood and blood coming from their nipple, not rush to the ER?

To put it in a context men might understand, would any men out there not rush to the hospital if you woke to underwear soaked with blood and blood coming from your penis? Exactly.

That is the health insurance horror story faced by Daly City, CA resident Rosalinda Miran-Ramirez. She awoke one morning in April to find her left breast bleeding from the nipple, and the shirt she had been sleeping in was saturated with blood. So her husband took her to the ER at Seton Medical Center. Common sense, no?

Initially, the doctor believed it was breast cancer, but after the growth was removed and biopsied, it was benign. End of story? Not according to her insurance company, Blue Shield of California HMO.

The insurance company, which had initially approved the claim for the ER visit, changed its mind and sent her a bill three months later requiring her to pay the total charges for that visit: $2,791.00. The reason? Blue Shield states that after reviewing the case they believed that Miran-Ramirez "reasonably should have known that an emergency did not exist."

Really? She is not a doctor, so how is she supposed to know that? Even the original doctor thought it was breast cancer. This makes no sense to anyone sane! It's basically an excuse to not pay.

Here's what an attorney interviewed by CBS5 said:

"If you reasonably believe it's an emergency, it's an emergency. They don't have the right to second-guess you. 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."

"Bad faith" is defined as "Intent to deceive. A person who intentionally tries to deceive or mislead another in order to gain some advantage."

And people wonder why we need a "public option" for health insurance, or even better, a single-payer system like Canada.