HEALTH PLANS: Looks like Empire has caved

So judging from the comments in the post on this subject below, it looks like Empire BCBS has decided that the headache of not paying for the young teenager’s surgery exceeds that of appearing on CNN in a negative light. Very understandable, and something that more health plans need to consider, especially when they are asking for more than 10% rate increases for the 5th year in a row.

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  1. we have been told since he was 12 we must wait until he totally finishes growing – ins. or not — We have again become aggressive about finding a surgeon that will do his surgery. I wasn’t expecting ins. to pay — from what I’ve known of past—-Sooooo, I am glad you guys fought your way through to get them to do what they should do. I hope Kevin is doing fine — My son knows it will be tough –but boy is he ready. We have an appt. in California next week. We were in San Antonio today — that Doc doesn’t have enough experince in PC surgery. Did Kevin have the Ravitch procedure????

  2. Kevin is doing great and the surgeon did a wonderful job. The was a first for the Wilimington Hosp. There were a few things that happended that caused the kid pain..but..after The Dr’s setting things straight..will not happen agaim. 🙂
    so he has a brand new looking chest and everyone is extremely happy..of course Kevin has us all bet in that department. 🙂
    Grandma Dee

  3. June 21, 2005
    new interview from wway3
    Insurance Company Reverses Decision, Covers Teen's Surgery
    Jun 20, 2005, 8:42 PM
    It's an unbelievable turn of events for a Wilmington teenager and his family. Fifteen-year-old Kevin Dick just found out that Empire Blue Cross Blue Shield will pay for an operation to help him breathe. Over the past month, the insurance company had repeatedly denied coverage for a surgery Kevin's doctors said he needed.
    "I called my husband right away, and he was in shock. I called my father, I've called everybody, and it's just a huge relief for us," Kevin's mother Carla told NewsChannel 3. For the past year, she's been on an emotional roller coaster. As her son's unusual chest deformity grew more pronounced it began to restrict his breathing.
    Doctors said the condition could be fixed through surgery, but then Empire Blue Cross Blue Shield refused to pay for it. After an emotional series of appeals, and our extensive coverage, insurance company executives have changed their minds. "It's been painful for him and my family," said Kevin's little sister, Hannah. "I'm still pretty mad at them, but I'm glad they finally came through."
    Kevin is going to need some extra T.L.C. after the surgery. Doctors will completely reconstruct his chest cavity, and it will take about three months for him to heal. But after that, he has a lot to look forward to. "I'm just happy. I didn't think it was actually going to happen, I was just glad it was approved," said Kevin, shortly after getting the news from Blue Cross Blue Shield in New York.
    "He's going to be able to have a normal life. He's going to be able to start playing basketball again, which he loves so much, and he's going to be able to breathe easier and hang out with his friends at the beach and do all these wonderful things that he deserves to be able to do," said Carla.
    Dr. Don Nakayama will perform Kevin's surgery at New Hanover Regional Medical Center on Tuesday morning. Kevin's extended family had flown into town for his original surgery date earlier this month. They won't be able to fly out again on such short notice, but they, along with a lot of other people, will be with Kevin in spirit.
    Empire Blue Cross Blue Shield says their decision to cover Kevin's surgery has nothing to do with all the TV coverage. During the second appeal, another physician the insurance company hired to review Kevin's case finally agreed that the surgery was indeed medically necessary.
    — Reported by: Ann McAdams

  4. It has been 3 hours since Kevin went into surgery. Ron,(my son) said last night that the Doctor will cut cross ways on his chest.Then cut through the chest bones and repair them. Then will place a metal bar brace and sew him back up. That will be in place for about a year. He will be on best rest for about 3 months. This is a five hour long surgery.
    I do agree with Gadfy..people do get apathetic because they think they cannot win. I hope that this cause will give them hope that they can win. I do not wacth reality shows..there is enough true drama in real life.
    Have a good day.
    Grandma Dee

  5. // “what is the use’..no one can every WIN AGAINST big corporations//
    What depresses me is that people tend to get apathetic because they think the little guy can’t win. Worse, I think people have more fun commenting on why the little guy loses than cheering for the little guy: they’ve become accustomed to wisely commenting on why so-and-so got voted off the island in Survivor. Perhaps there’s something comforting in being able to explain it all and issue judgments on how foolish other people are for trying. It really does my heart good to see someone who managed to get the help it requires to make big corporations do the right thing.

  6. Yes, they really did cover the story on CNN..It was seen by my other son and his friends. I have hunted and hunted and put into the search every which way..no luck. I have e-mailed CNN and asked them to send link.
    LOL..Ron..you are pobally right..1000 blogs plus.
    I am getting e-mails from others asking for help. I am sure they will learn alot from Matt site.
    I ALWAYS THOUGHT “what is the use’..no one can every WIN AGAINST big corporations. That is of course untill it struck home.
    I hope that this will help others…atleast try to fight and find some champions( like all of you ..esp…matt..:) & don’t let go …until what is right …is done.
    I am going to keep my ‘ghost site updated.
    Now, that he is going to get his surgery..he had donated all the blood himself. But, all but one… is not too old. Hopefully one of the parents will be able to donate.
    I am scared for him..they have to cut all the rib cage..just like in major heart surgery. It will be a 4 to 5 hour operation and a very painful recovery.
    I will of course keep my blog updated.
    Did you pay your BUCK? LOL

  7. I don’t think CNN did run a story. When I searched the doctor’s name and Kevin I only get the two blogs and the Channel 3 TV station. Did CNN not use the Surgeon’s name?
    So it wasn’t like a bunch of blogs were involved either. The TV station is taking total credit but I don’t buy that. I think the power of the 2 blogs had something to do with the prompt attention.
    Don’t tell Matthew because he will raise the cost of advertising here. Google AdSense doesn’t pay enough.
    Knowing Granma D though, it another month this story would have been on 1000 blogs.

  8. ME TO. lol..you should pay the buck anyways. lol
    I have e-mailed them and asked for the link to view.
    I missed it.
    Because, I am getting private e-mails wanting to see kevin chest. They, also have sons, daughters and themselves, They have this Pectus Carinatum. or the other kind….and are being refused coverage by there Insurance companies.
    I hope that I will be able to..I have No experience..only heart & determination & loads of frustration at insurance companies that would cause any human being to living life deformed.
    Grandma Dee

  9. Darn it. I don’t think I have to pay unless Matthew agrees to the bet. And he might be disqualified for waiting too long.
    Is there anyway to see this CNN story? I would be interested in what was reported.
    TV is great for stories about sick people, it can be so visual.

  10. Don’t be so humble Matthew. I will bet you a dollar that CNN doesn’t do anything about this Empire BCBS story. It might of helped that she said CNN but I doubt it. CNN has nothing to do but try and fill up air time and they are not running stories like this.
    I’m sure someone at “Empire Central” checked out the blog and thought, “We don’t need this.” Or maybe Empire was contacted by BCBS National because other BCBS plans were complaining that if one BCBS looks bad, all of them look bad. The public doesn’t know that they are all independent, kinda.
    Does BCBS have over 10 million people covered just in Michagan and Florida? I have always said that there needs to be a law that no insurance company should have more than 1 million people in any particular state. Then no one would have to discuss the word, monopoly.
    Downsizing is an art. When monopolies are broken up and income drops you better have good people in charge or everthing could unravel. These Empire people reacted pretty quick so they might do an excellent job of controlled downsizing if that’s what happens.
    You’re correct that health insurance premiums go up. It’s exactly like my wife’s age, it can’t be stopped. It goes up faster than normal inflation for a bunch of reasons. Ive seen projections on how group health employee plans will cost $17,000 to $25,000 per year, per family, by 2010. That’s another reason I tell people that many families have HSA insurance for $250 a month. Don’t pay $1,000 a month, that’s excessive. And besides, which premium would you want to double with inflation, $1,000 per month or $250 per month? Getting the proper health insurance is much like an IQ test. I also tell them to stash their savings in a tax free HSA, with a mutual fund option, for optmum savings.