Friends,
Because "Sicko", Michael Moore's new documentary about the health care industry does not open until June 29th, I have not seen it yet, but I have seen the trailer and watched online an Oprah interview with Moore that showed some clips. I got angry just watching the trailer. It featured a Dr. who used to work for one of the insurance companies, testifying to Congress how her job was to routinely deny payments to insured clients, many of whom were cancer patients, in order to increase profits for the company. Insured patients died as a result of the denials.

When I was diagnosed with Stage IV base of tongue SCC in 2002 and was scheduled for the routine treatment plan of 5 weeks of radiation concurrent with 4 chemo treatments (cisplatin and taxotere) at M.D. Anderson (the number 1 or 2 cancer hospital in the world) I was shocked to learn that my insurer was attempting to deny paying for part of my treatment by characterizing the chemo portion of the treatment as "experimental" (which, according to the Moore interview, is one of their common tactics).

M.D. Anderson and my insurance agent battled them for me and eventually the insurer did approve payments for the chemo. This was not the kind of aggravation that I needed as I was preparing to go through treatment to save my life. Fortunately I am a lawyer and have lawyer friends and was in a position to protect myself, although at the time, treatment was imminent and I did not have time to screw around.

The moral of the story, is to keep fighting these people and get a lawyer if you need one. All the insurance companies care about is the bottom line and the best way to insure their profits is to pay you less. They also know that if one of these cases ever gets before a jury, they will lose. I was fortunate to have disability insurance as well, but dealing with two disability carriers was no pleasure either. A fraud investigator, who "just happened to be in my part of the country" wanted to come by and meet me so he "could put a face with the name". One of my former partners represented me for free and instructed the guy to meet me at his office and did most of the talkiing for me. By this time I was already beginning to feel badly from the radiation and might have already been on the feeding tube.
Later on the other company sent its former cop, fraud investigator, and then accountants to go through my records. Their medical staffs were constantly picking over the required monthly reports that my doctor and I were required to fill out, suggesting, then alleging that I was fully ready to go back to my work in my specific occupation as a "trial lawyer." Sure I was ready.... 20 pounds underweight, living on a liquid diet, with a sore throat, fatigue and a very hoarse voice, taking vicodin, concentration lacking, wondering if I was going to survive, I was ready to go pick a jury and begin a murder trial! Fortunately my health improved eventually and I quit receiving the disability payments, but not until I was ready to begin doing trial work again.

Just remember, the nice guy that you grew up with or the friendly neighbor down the street who sold you an insurance policy is not the same guy or lady that you have to deal with when the time comes to make a claim.

Give 'em hell!

Danny G.