Think Progress

Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims. In April, Rosalinda Miran-Ramirez awoke and found her shirt soaked in blood. Realizing that her “her left breast [was] bleeding from the nipple,” she rushed to the emergency room.

Today, CBS-5 reports that this San Francisco Department of Public Health employee has had her claim denied because her insurance company, Blue Shield of California, didn’t consider her situation to be an “emergency.” Even though her doctor told her it was likely a tumor, Blue Shield said that Miran-Ramirez should have known it wasn’t:

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.”

Watch CBS-5’s report:

The sad truth is Miran-Ramirez is certainly not alone in having her claim denied by a major health insurer. The California Nurses Association (CNA), a nurses’ union and health care advocacy group, recently released a comprehensive study of claims denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted. The CNA twice successfully lobbied the California legislature to pass legislation that would establish a single-payer universal health care system in the state, only to have it vetoed by Gov. Arnold Schwarzenegger (R-CA).

Last week, in a congressional hearing titled “Between You and Your Doctor: the Bureaucracy of Private Health Insurance,” top insurance executives testified before Chairman Dennis Kucinich (D-OH) that the insurance company practice of denials can be fatal for its customers.

Indeed, such a denial cost 17-year old Nataline Sarkisyan her life in 2007, when Cigna denied coverage for a liver transplant until it was too late. Her mother, Hilda Sarkisyan, came to D.C. earlier this year to lobby for a public health insurance plan that would stop such denials. She told the press, “Insurance companies cannot decide who’s going to live and who’s going to die.”

Following the CBS-5 investigation, Blue Shield agreed to pay for all charges for Miran-Ramirez’s emergency room visit.



95 Responses to “Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’”

  1. belaccifer lacca says:

    I’m so glad that beuraucrats aren’t in charge of when I can see a doctor!

    Wait, what?


  2. evangenital says:

    The repiggie trolls will soon be on this thread telling us that we should all have medical degrees so that we won’t make the sort of stupid mistake that this poor woman made.

    It is shocking and disturbing how much of this sort of thing is going on today with the health insurance cabal.

    We need the Public Optiionl

    We don’t need the repiggie bullcrap.

    We don’t need more set-asides and sweetheart deals for the health insurance pirates.

    Screw the repiggies, and screw the teabagger trash.


  3. Xisithrus says:

    So you not only have to be bleeding you gotta go screaming haid on em?


  4. Wiz says:

    I am having a hard time seeing the difference between insurance companies and organized crime. Shaking down people, accepting premiums and then denying service is fraud and it needs to be treated like a crime.


  5. Hoodathunk says:

    Yes, when blood appears on the outside of the human body there is nothing to worry about. Evidently this woman’s body was just confused about the menstrual cycle and decided to migrate up.

    This is a common problem related to…profit?


  6. covered_10 says:

    Good work, TP. If you keep exposing these criminal atrocities maybe our country can enter the 21 century.


  7. Xisithrus says:

    Anthem pres: [into phone] I dont care if they are bleeding from BOTH nipples. We are not gonna pay on that stressless claim. Really? OMG our investments are down!! Oh. My God! This is an emergency! Raise premiums 20%!!


  8. Rich H says:

    aaronk, paging aaronk.


  9. dixie blood says:

    So Blue Shield of CA dropped the Blue “Cross” part of their name…how Christian. NOT!

    An insurance payment a day keeps the doctor away!

    They are a Shield without a Cross. A$$h0les.


  10. tom says:

    Now, if only we could find a couple wannabe muckraking hidden-camera “journalists” to expose the soft underbelly of these private health insurer atrocities, maybe we could raise these horror stories to the level of ACORN-hysteria.

    Nope. Little Seanie Vanity and Glenda BeckyBoy will never touch this story.


  11. Max Anax junius -1 says:

    .

    Ahhh…
    … Nothing screams “DEATH PANELS” louder than a denial from an Insurance Company.

    .


  12. smidget says:

    belaccifer lacca @ 1

    I can’t add anything more to what you just said.


  13. DRxJ says:

    Remember the pathetic concerns and outcries about supposed Death Panels, that will kill Grannie and Papa?
    Well guess what? They’ve already been created, and are regulated by insurance companies and their profit margins.


  14. Xisithrus says:

    Really, why would you need death panels when you got rescission


  15. Xisithrus says:

    BS EOL counseling motto. Your Outta Here.


  16. Badmoodman says:

    “I am like how can they say that it was not an emergency? Like, my breast was bleeding!

    – - Like, gnarly.


  17. smidget says:

    I suppose that the health insurance industry thinks that we should all have enough knowledge of medicine and pathology to be able to self-diagnose well enough to know what is wrong with us, so that we don’t waste their time and money on something silly like seemingly random bleeding from a part of the body that one does not expect to normally bleed.

    If I were to look in the mirror and discover my breasts were bleeding, you bet your sweet bippy I’m going to the ER. Even if I’m not in “acute distress” believe that the sight of something bleeding that shouldn’t be bleeding will put me in distress.

    BTW, Blue Shield HMO, acute distress can be caused by blood loss. I suppose she should have stayed home and risked bleeding to death, since she had no idea what the hell was wrong with her.


  18. Marie says:

    OMG — this is absolutely unacceptable. Insurance companies are the death panels! They operate with impunity against people who are most vulnerable. At the very least, BC/BS should lose their license in that state.


  19. USCKitty says:

    wait these insurance companies hire people with no medical background, no medical degree, yet they expect their victims to diagnose themselves?

    go figure…


  20. fletc3her says:

    If you ever do find yourself needing to go to the emergency room make sure that they admit you to the hospital. Even spending a couple hours in a hospital bed will help ensure that your visit is covered by insurance. If you walk back out the emergency room doors your insurance company can claim it was not an emergency.



  21. pags2 says:

    Every state has insurance regulators and these people are responsible for making insurance companies comply with state laws. Some of the state laws are very strict when it comes to denying claims and provide up to 3 times the amount of damage. We should be asking what our state regulators are doing to stop these abusive practices. If they are not enforcing the law, then we need to ask why. We cannot afford to wait for the feds to do anything.


  22. mary lacewing says:

    Customer on the phone with their insurance company:

    “You’re pretty sure my visit to the emergency room will be reimbursed? It depends on how distressed I am? Is being hysterical because my nipple is dripping blood distressed enough for you?! No? I have to be passed out on the floor from blood loss? But then how could I call you to get your approval?!”

    The new Catch-22.


  23. Politically Superior says:

    This comment has been voted down. Click to read.


  24. Pilotshark says:

    So once again just what dose the insurance company’s bring to the table again?

    yes thats right they bring the bureaucrats to the party.

    Wiz says:
    I am having a hard time seeing the difference between insurance companies and organized crime.

    me either


  25. dbadass says:

    Get on board the ignore Politically Superior bus. Do not vote up or down or respond. Let them be torn up by being denied the attention they crave.


  26. LibertyLover says:

    Here was her mistake… she didn’t call the back of the insurance card to the number to get pre-approved by a person with no medical degree whatsoever (but is armed with a computer and a phone headset and access to “the google”) to go to the doctor when she thought something was wrong with her.

    All you free-marketers that tout freedom, could you please tell me where the freedom is in having to get pre-approved to go to a doctor? Or to be required to go to one doctor in order to get referred to another doctor (all of which is designed to discourage you to going to the second doctor by the first doctor)?


  27. The Dogfather says:

    This is the most outrageous part of the whole teabagger summer that we just endured — there already are death panels in our health care system, and they go by the names of Cigna, United Health, Blue Shield, etc.

    So if we the patients hate the health insurance companies, and our doctors also hate the health insurance companies, who likes the health insurance companies? Oh yeah, silly me — any congresscritter with an (R) after their name…


  28. Politically Superior says:

    This comment has been voted down. Click to read.


  29. dbadass says:

    Politically Superior has nothing to offer and really doesn’t believe anything they post. It is about attention. Time to freeze them out. Let’s get the word out in the community and wave goodbye to this punkass kid


  30. LibertyLover says:

    dbadass says:
    Get on board the ignore Politically Superior bus. Do not vote up or down or respond. Let them be torn up by being denied the attention they crave.

    I suggest that this get applied to Quick vote me down as well


  31. LibertyLover says:

    I don’t know about you, but I get my insurance from my employer, I cannot switch insurance companies unless they do.


  32. texasrick says:

    This is EXACTLY the kind of story that should be on tonight’s news with CBS, ABC, CNN, Faux, NBC and MSNBC…but will it?

    Hell NO, because it may be a little uncomfortable when Limball and Beck calls them out for slanted journalism! They are too cowardly to tell the real story of atrocities being performed by insurance companies. My God, what is wrong with our elected officials?


  33. dbadass says:

  34. Oval12345678 aka James K. Sayre says:

    Republicans and their greedy private insurance companies are killing 45,000 Americans each year due to a lack of health insurance and a resulting lack of health care. What did the “compassionate” conservatives do during their eight year reign under the Bush gangster regime to help Americans get health care? They didn’t do jack-shit. Oh, they did pass some stupid health insurance savings program, that was basically worthless, especially to those that are poor.

    O/T: Praise the Lord and pass the Public Option. A robust, Day One, open to all Americans Public Option, that is…


  35. joe cantwell says:

    ***

    the level of stupidity ps has shown puts him over

    the top and into the mole troll category.

    *


  36. dbadass says:

    somebody needs to vote that pos back to zero


  37. PatrioticLiberalChristian says:

    But be sure you get to your physician immediately if you have an erection that lasts more than four hours.


  38. USCKitty says:

    The Republicans are the ones always criticizing others when they “play the victim card” yet when they feel like they’ve been unjustly dealt with, they become the whiniest set of “victims” you’ve ever heard…


  39. EugeneDebs says:

    PoliticallySTUPID.

    You are a soulless pathetic pile of dogshit. Did you know in first aid you stop bleeding BEFORE you restart breathing? My GOD you are so stupid it is just sad. You know trolling this site will do nothing to alleviate the misery of your sad life. You are stupid and always will BE stupid. No one is ever going to like you or respect you and trying to annoy people will not change that. You are pathetic and sad. Just STFU.


  40. dbadass says:

    Just ignore em. It is more painful to them then any words…


  41. LibertyLover says:

    Fred @ 21

    That is good news, but it shouldn’t have taken being exposed to the light in order for the Insurance Company to treat this woman like a human being.


  42. Hoodathunk says:

    “Hello? Preapproval? Yes, I am bleeding.”

    “Excuse me, ma’am, but is this from your vagina?”

    “Ah, no, it’s from my nipple.”

    “Is it copious?”

    “No, its my breast.”

    “Please hold while I transfer you.”


  43. USCKitty says:

    EugeneDebs says:
    PoliticallySTUPID.

    You are a soulless pathetic pile of dogshit. Did you know in first aid you stop bleeding BEFORE you restart breathing? My GOD you are so stupid it is just sad. You know trolling this site will do nothing to alleviate the misery of your sad life. You are stupid and always will BE stupid. No one is ever going to like you or respect you and trying to annoy people will not change that. You are pathetic and sad. Just STFU.

    He gets off from the sufferings of others…there’s no other explanation…


  44. EugeneDebs says:

    dbadass is right. He is a punkass troll begging us for pity. He isnt worth my time. I am through with him.


  45. Pilotshark says:

    Politically Superior says:
    So how many course you have to take to be this stupid?
    and sure wish you go back to what ever country you belong to as i know you are in no way a american.


  46. Hoodathunk says:

    “Hello…ma’am? There is nothing in your policy that covers bleeding tits. If your left eye were to suddenly pop out of your right knee, you are covered but…Have a nice day and thank you for calling for pre-approval.”


  47. misscoleopteramolly says:

    There seem to be an abundance of this type of horror story regarding private insurers — and the punchline often seems to be that they will back down and pay the claim whenever a strong enough spotlight is shined on them.

    Not surprising, when you consider that their profits depend upon two things — hiking premiums and denying claims. And they will do both as much as they can get away with.

    But what about government-administrated health insurance? Why aren’t we hearing an equal number of horror stories about Medicare and Medicaid refusing to pay claims for things like bleeding breasts? You would think that with so many people claiming that government programs are inefficient, poorly run, and just plain awful, we’d be getting stories like this daily to justify those claims.

    Maybe — just maybe — Medicare doesn’t screw people in this manner just to improve their bottom line? It’s amazing how not having a stock price to worry about can change things.


  48. Exit Stage Left says:

    Rich H says:
    aaronk, paging aaronk.

    Burritos for lunch?


  49. LibertyLover says:

    Remember your little brother? How he liked to just poke you to get a rise out of you? Didn’t your mom tell you to just ignore him?

    That’s what PS is doing to you. Politically provoking you to get a rise out of you. dbadass is correct. Ignoring is a fate worse than insurance death panels to them.

    PS isn’t even one of our brighter trolls. Not worth the effort or the venom.


  50. dbadass says:

    Glad to see you onboard EugeneDebs. Whereas Pat Pomery is one in the same let us work to organize the community such that those with reasoned opposition who seek discussion are welcomed while the negative attention disruption seekers are frozen out.


  51. Perry logan says:

    This is all going on, and you can tell: the Republicans don’t care. They are past pretending to care.


  52. dbadass says:

    Indeed LibertyLover. Seems we have gotten a chain going. Let’s keep it moving throughout this community.


  53. MCMetal says:

    Even though her doctor told her it was likely a tumor, Blue Shield said that Miran-Ramirez should have known it wasn’t

    Nice to see that Blue Shield knows Miran-Ramirez has an extensive medical background ………..When , apparently , she herself doesn’t recall it……..


  54. MCMetal says:

    Politically Superior says:

    ——————————————————————————–

    September 25th, 2009 at 4:59 pm

    Yeah , because switching insurance companies is logically the 1st thing on everyone’s mind when they are bleeding from a tumor , you fu(ktard……..


  55. AMcG312 says:

    The repiggie trolls will soon be on this thread telling us that we should all have medical degrees so that we won’t make the sort of stupid mistake that this poor woman made.

    You are aware that this woman did not make a mistake, right?


  56. Johnsnottoodistracted says:

    Most people do not understand that the insurance companies have full force teams to find loop holes and not pay claims.
    Life insurance as well.
    Their law teams do what ever they can to avoid payment.
    Again may we be reminded: when you go to anycity usa who owns the largest buildings? Insurance and banks. Now to make it more sick, these companies have none of their own money….only your money!
    Study the “rule of 72″ and get the picture what these guys do with your money.
    And they are sooooooo greeeeeeedy even while making a killing with your money they will refuse to pay out on any claim when they can find a way.
    Time for a change or two.


  57. dbadass says:

    McMetal with all respect. They aren’t worth it…


  58. Pilotshark says:

    Politically Superior
    switching insurance companies

    yes like that would not be consider a per-exciting condition so moving to another insurance company is probable out of the question.


  59. dbadass says:

    Pilotshark
    Can I ask for your support? I will owe you a solid…Thanks and best-


  60. Cats r Flyfishn says:

    The insurance industry death panels continue with their death sentences to their premium payers. There is something very immoral about taking insurance premiums and then denying coverage.


  61. lcdrrek says:

    “Last week, in a congressional hearing titled “Between You and Your Doctor: the Bureaucracy of Private Health Insurance,” top insurance executives testified before Chairman Dennis Kucinich (D-OH) that the insurance company practice of denials can be fatal for its customers.”

    Oh, but wait. I thought all that talk from the loons on the right was that they didn’t want the government running healthcare and placing them between you and your doctor.


  62. just the bleepn facts says:

    Politically Superior says:
    This woman still has the feedom to switch insurance companies if she doesnt like it. Obamacare wouldnt allow that.

    I guess you missed the part about pre-existing conditions and costs in the current system that would prevent her from switching?

    Obama/Congressional approaches improve the opportunity to switch, they don’t reduce it.

    Your lies just prove you are either uninformed or a liar.


  63. Hoodathunk says:

    ah yes, PS, switch insurance companies. Pay ridiculous premiums to a company that is supposed to offer coverage and when the don’t switch to another that makes the same promises as the las except they don’t do pre-existing so hunt for another who say the same, and another.

    Isn’t competition wonderful?


  64. dbadass says:

    63
    Politically Superior is not here for the right reasons which is exactly why they should be frozen out. I hope you will consider doing so. Thanks for your consideration of my suggestion.


  65. just the bleepn facts says:

    sounds like a plan dbadass. But using that approach shouldn’t all of the trolls be frozen out? ;)


  66. Pilotshark says:

    dbadass says:
    Pilotshark
    Can I ask for your support? I will owe you a solid…Thanks and best-

    Support for???

    if its for dont feed the trolls then yes you have it.


  67. dbadass says:

    66
    That is always a tough balance. I think that those who come in a sincere sense I discussing should be welcome. Those that are obviously not are a different matter. The collective conscience of the community usually can distinguish the two


  68. rsalier says:

    Any one and every one who has insurance and is denied should immediately report it to 1) their state’s insurance commissioner, 2) then call the newspapers, tv and radio. After awhile, there will be so many calls to media, the state house that something will be done. The Repuglicans are fearful of the Govt. making life and death decisions when their buddies in the insurance industry is doing it every day and people are dying. So what’s the dif? Lets inundate the bastards till they scream uncle.


  69. nellieh says:

    Unfortunately, the state didn’t step in. It is when obvious semantics are used to deny, the state should contact them to reverse or lose their privilege of doing business in their state.


  70. conservative guy says:

    This comment has been voted down. Click to read.


  71. ElBruce says:

    While we’re busy arguing about trying to make sure a public option gets in there, we also need to remember to make sure that the specific prohibitions against these kinds of scams don’t get amended out of the health care reform proposal. There are a lot of balls to keep our eye on.


  72. just the bleepn facts says:

    conservative guy says:
    Keep government out of health care.

    So you think we should deregulate it further so more people can be rejected and allowed to die?

    That’s an extremely radical and insane proposal – you’re definitely a Republican! ;)


  73. BaPo says:

    conservative guy, are you stupid or just a thug? The time has come for someone to shame people like you for your viscious stupidity. there need to be more smackdowns such as the gDOp has been getting.


  74. Leftside Annie says:

    Bleeding from anywhere in your body that you’re not supposed to be bleeding from IS an emergency. Period.

    I can tell you right now that if I woke up and found my shirt soaked with blood and my breast bleeding, you bet your a$$ I’d be in the car on my way to the emergency room is 6 seconds flat.


  75. OutstandingInMyField says:

    conservative guy says:
    Keep government out of health care.

    Keep the profit motive out of health care.


  76. EugeneDebs says:

    ConservaTROLL

    Kill yourself. Get your disgusting existance out of our world


  77. windfrost says:

    Insurer Denies Woman’s Claim: She Should Have Known That Her Bleeding Breast Was Not An ‘Emergency’

    ~replica watches~buy replica watches online~cosplay costumes~StarCraft CD Key


  78. flight says:

    Health care for the sake of health care is a very good thing.

    Health care for profit is an abomination. The capitalistic system puts profits ahead of peoples’ health and well being.

    After 30 years of our little experiment, capitalism was not the magic bullet that fixes everything! Sorry Republicans, Reagan was very wrong, hope you are having a nervous breakdown!


  79. Jess Wonderin says:

    ya think if Bruce Bodaken, Chairman, President & Chief Executive Officer was bleeding from his dick, he’d call to make an appointment or just mosey down to the ER????


  80. bluesunflower says:

    conservative guy says:

    ——————————————————————————–

    Keep government out of health care.

    I agree. Get rid of Medicaid. Those damn senior citizens should stop sitting on their fat asses and WORK to pay for their insurance, instead of making me pay it for them.

    /sarcasm


  81. cd says:

    “Her Bleeding Breast Was Not An ‘Emergency’”?

    Someone doesn’t like women.


  82. USCKitty says:

    Conservative guy – Pro profit or pro life? Every Republican should be asked this question, every church that refuses to support universal health care, etc.


  83. Rodeskawler says:

    So part of her policy was that she was suppose to get a medical degree and diagnose herself?


  84. bsober says:

    Hey Politically Superior @ 24, Now if she had a CUT on her nipple I might not think you are TOO disgusting an individual. After all, I’m sure your wife has cut her nipples a time or two while shaving her chest; or maybe you have while shaving your chest for a rendezvous at an airport men’s room; but come on. Oh I get it, it’s the” I’m a tough guy conservative talk”! Why don’t you and your TOUGH GUY buddies all go watch a Chuck Norris movie marathon to lather yourselves up for the man-love orgy to ensue shortly there after!


  85. dbadass says:

    That pos multiple personalities homebound freakshow should be ignored…


  86. kingjack says:

    wow… what is going on here…. America is ALL business no heart no brains… ONLY money… how can you deny a woman’s claim who obviously has an emergency, what do you call a bleeding nipple?? this makes me very angry.

    electronic cigarette


  87. ElBruce says:

    just the bleepn facts says:

    conservative guy says:
    Keep government out of health care.

    So you think we should deregulate it further so more people can be rejected and allowed to die?

    That’s an extremely radical and insane proposal – you’re definitely a Republican! ;)

    Wingnuts need more Americans to die at a faster rate so that their lord and master Satan will have more souls before the Rapture comes.

    I’m not sure if I’m even kidding any more with this stuff. Every single thing supported by a wingnut seems literally directed to killing as many Americans as possible, while leaving the rest of us all broke, homeless, sick and embroiled in scores of wars against the rest of the world while being universally reviled by mankind.

    If you wanted to literally destroy America and made a laundry list of how to go about doing it in every way possible, you would come up with an exact copy of the conservative agenda today.

    .

    kingjack says:

    this makes me very angry.

    I know it’s a serious topic and all, but I totally read that sentence in Marvin the Martian’s voice…


  88. Mugsy says:

    Someone please explain to me what the point of having insurance is? People pay in thousands a month, then when they go to use it, the insurance company denies the claim and sticks them with the bill… which they could of paid if they hadn’t spent that money buying insurance.


  89. kwsventures says:

    That is one expensive band aid.


  90. Mr.Duke says:

    The following medical conditions are some of the possible causes of Bleeding nipple. There are likely to be other possible causes, so ask your doctor about your symptoms.

    * Benign breast tumor (see Breast lump)
    * Breast duct cancer (see Breast cancer)
    * Breast cancer
    * Breast duct papilloma – typically a bloody nipple discharge
    * Breast abscess
    * Paget’s disease of nipple – can cause a bloody nipple discharge
    * See causes of nipple discharge, breast pain, breast lump, or other breast symptoms
    * Breast feeding
    * Piercing

    I am not a doctor. But I did stay at a Holiday Inn Express last night.


  91. marlow says:

    Pay or die insurance = Murder Inc.


  92. ElBruce says:

    kwsventures says:

    That is one expensive band aid.

    You are stating that if your nipple were bleeding for some unknown reason that you would not seek medical treatment.

    Is that correct?

    kwsventures says: “if I woke up and my nipple was bleeding for no reason, I would not seek medical treament.”

    I’ve got that right?

    Because if you don’t seek treatment, that gets us into this problem over here.

    Either way, your call. Either you don’t get help, in which case you might die, or you do, in which case you might be stuck with a big bill. But no matter what you choose, the Republican party is against you.


  93. KayInMaine says:

    It’s a known fact that uninsured right wingers know how to do emergency triple bypasses on themselves and other surgeries to avoid paying hospital bills. Right trolls? Spit.


  94. dwilli1 says:

    I know you guys are gonna shout me down on this, but I almost don’t believe this. Why? Because of the prudent layperson standard: “Consumers have the right to access emergency health care services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity — including severe pain — such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.” The lady should keep appealing and file a complaint with her Dept of Ins.



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