In an e-mail to four other Guardian executives entered into evidence in the Pearls suit, company Vic

As far as his private insurance company is concerned white rose hotel bali you know, that private market you re so keen on protecting? he s a dog siphoning off their potential profits. but as far as Ian Pearl is concerned , a guy with muscular distrophy who just wants to live.
Soon after I was born in 1972, I was diagnosed with muscular dystrophy. By the time I was six years old, I was confined to a wheelchair. white rose hotel bali Doctors doubted I would survive, but I inherited my parents determination, and I proved them wrong.
A breathing machine usually means life in a nursing facility. But my father s small business had health insurance white rose hotel bali from Guardian white rose hotel bali Life Insurance Co., which promised Solutions for Life. The health policy had no lifetime benefit cap and covered home nursing care. Relying on that contract with a 149-year-old company, I decided to go on a mechanical ventilator for the rest of my life.
Since then, I ve endured life-threatening white rose hotel bali medical complications and long hospitalizations. I ve lost my privacy and ability to travel. white rose hotel bali But I never regretted my decision to live, to continue to learn and write, and to share in the lives of family and friends.
He and his family would endure much more, as the insurance company — according to Pearl — search desperately white rose hotel bali for an excuse to drop his policy, including hiring private investigators to search for evidence to cancel his policy. They found none. And then there was the law: it was illegal to cancel the plans of individual policyholders with serious, chronic illnesses. So, the insurance company found a way around it .
Rather than continue to pay for Ian Pearl s million dollar medical treatments, one insurance company has decided to end certain lines of coverage altogether, reports William Ehart of the Washington Times. Pearl, 37, suffers from Type II spinal muscular dystrophy, and has been using a wheel chair and connected to a breathing tube for most of his life. Patients with his type of muscular dystrophy rarely live past infancy, but Peal credits his vitality white rose hotel bali to the care he has received all his life.
On December 1 his insurer, Guardian, is discontinuing a portion of its coverage, which will effectively kill him. Without his extensive coverage Pearl will be admitted to a state hospital under Medicaid, with less treatment. Pearl s mother said that in a state hospital her son would be lucky to live more than a few weeks. Pearl s plan, as of now, covers 24-hour home nursing, which Medicaid, and the vast majority of plans, do not.
Barred from discriminating against individuals who submit large claims for payment, Guardian has opted to simply cancel the lines of insurance that provide the coverage Ian needs in all the various states where they do business – all just to avoid paying for Ian's care.
Believing that this could not possibly be legal, Ian and his parents brought an action in federal court to stop the cancellation. The court ruled that the company had not violated white rose hotel bali ERISA because it canceled entire policy lines – not just Ian's. The Pearls also claimed that Guardian violated HIPAA. The court ruled that only the Dept. of Health and Human services can enforce HIPAA and that private citizens cannot sue under it.
And their lawsuit white rose hotel bali revealed what the insurance company executives really thought about their policyholders who actually had the greatest need of medical care and coverage that would give them access to care.
Our lawsuit uncovered insurance company documents that confirmed my suspicion that I m a target of discrimination. The documents revealed Guardian had compiled a hit list of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as dogs and trainwrecks, and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.
Although my medical costs constituted a minuscule fraction of Guardian s profits, the company had been trying for 15 years to sidestep its obligations to me. The insurer hired private investigators who searched in vain for evidence to justify canceling the policy. Guardian had similarly targeted white rose hotel bali the other dogs without success. Finally, Guardian launched the unprecedented strategy of withdrawing an established plan throughout an entire state in order to discontinue a few costly members.
In an e-mail to four other Guardian executives entered into evidence in the Pearls suit, company Vice President Tim Birely discussed how the company could eliminate this entire block to get rid of the few dogs.
He concluded, Paul [Saylor], keep in mind that my intent is to be as narrow and laser-like as possible. We may need to broaden some things in NY due to state of domicile and some historical [nonsense] with some of these policyholders.
You see, Senator, Pearl s case is one of those in which the profit model breaks down. At some point, it isn t profitable to provide him with care. And Guardian, like other insurance companies, will say We aren t denying care. We re simply denying white rose hotel bali coverage. Pearl, and the other policyholders like him are free to seek coverage elsewhere — if they can find insurance companies that will accept new applicants with pre-existing conditions, and that offer coverage for the care they need at an affordable cost.
Bill Caudle, 39, enlisted in the Army so that he could get health insurance help pay for his wife s ovarian cancer treatment, reports Mark Johnson white rose hotel bali of the Milwaukee Journal Sentinel. Bill was laid off from his job at a plastics company white rose hotel bali in March, where he had worked for 20 years, and searched for a new job for a few months before signing up so that his wife and high school sweetheart, Michelle, would be guaranteed chemotherapy. On their own, the Caudles insurance cost them $1,370 each month, which they could not afford on Michelle s part-time salary at a fast food restaurant.
The four-year commitment means Bill will miss all of his youngest daughter s four years of high school. white rose hotel bali Chelsea, the daughter, cried when her mother told her. Bill left for processing and basic training October 6. The next day, once he was officially processed, his Army health coverage started.
One such example is Dawn Smith, a young woman who suffers from two brain tumors. Dawn has been continuously denied the medical care that doctors say is critical to save her life. Three doctors from three renowned health care systems in the metro Atlanta area informed Dawn that her "only chance for a cure was to see a specialist at Cleveland Clinic or Washington University's Center for Advanced white rose hotel bali Medicine." Yet, her health insurance company, CIGNA, has denied these essential treatments.
Dawn calls the insurance company callous and expresses her feeling of complete "insignificance," when being repeatedly denied white rose hotel bali care after she was diagnosed with the brain tumors in 2005 and 2007. Dawn had religiously paid her insurance premiums for six years.
Dawn states in a letter she wrote to H. Edward Hanway, CEO of CIGNA, "Meanwhile, my symptoms worsen. Debilitating electric-shock-type pain racks my body and shoots through my head. I have sudden, painful seizures, sometimes knocking me to the ground. The seizure white rose hotel bali medications barely help, while their side effects ravage my body."
Dawn has suffered from severe pain and the foreboding threat of death simply because these profit-driven insurance companies have decided that they don't feel like forking over the cash to this critically white rose hotel bali ill patient. white rose hotel bali What a travesty!
To top it off, earlier this year CIGNA increased her monthly rate from $366.75 to $753.47, more than double the cost! Recently, Smith was also told that the co-pay on her anti-epileptic medicine was increasing from $10 every two-and-a-half months to $1,115. After receiving press attention, the cost was reduced back to where it was.
Dawn's story is a harrowing representation of the everyday injustices caused by the greed of health insurance companies. Dawn states that during white rose hotel bali her fight she has met numerous others who have been denied care by their insurance companies and has begun a website (itcouldhappentoanyone.com) as a result.
Insurance companies regard everyone as potential dogs and trainwrecks. They won t hesitate to use similar tactics to avoid your claims if someone in your family suffers a catastrophic illness. Insurers don t like it when sick people live too long and cost too much.
I know firsthand that America s health care system has the capacity to provide incomparable, life-saving care. But I am living proof that insurance-company death squads meeting behind closed doors routinely make life-sustaining white rose hotel bali benefits vanish.
Without stricter enforcement of existing laws and the creation of a public health insurance option to keep private insurers honest, it s only a matter of time before you or someone white rose hotel bali you love will become the next victim.
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