Brain Dead Girls Court Case

[Minimalist]

Every time an insurance company agrees to insure a customer, they do a risk assessment to determine overall health and likelihood of an accident.

YOu have no idea what the terms of the policy are.  This was a minor which means she was under her parents' policy - probably employer based.

http://usnews.nbcnews.com/_news/2014/01/...rain-death

What is the cost of keeping someone brain dead alive?
With medical care, doctors and equipment required, it doesn’t come cheap. Caplan estimates it could be a staggering $7,500 per day.
And would insurance cover it?
No, because, legally, the person is considered dead.

[Easy Guns]

Every time an insurance company agrees to insure a customer, they do a risk assessment to determine overall health and likelihood of an accident.

YOu have no idea what the terms of the policy are.  This was a minor which means she was under her parents' policy - probably employer based.

http://usnews.nbcnews.com/_news/2014/01/...rain-death

What is the cost of keeping someone brain dead alive?
With medical care, doctors and equipment required, it doesn’t come cheap. Caplan estimates it could be a staggering $7,500 per day.
And would insurance cover it?
No, because, legally, the person is considered dead.

Agreed. We don't know the terms of the policy. But that doesn't have anything to do with how an insurance company determines your premium. However, as far as I can tell the general consensus is that the insurance policy is still covering the medical costs. There's no way in hell they would be if they weren't contractually obligated to do so.

And what point are you making when you say the insurance company wouldn't cover it? If the insurance company isn't paying for it and the parents are paying out of pocket, what point are you trying to make exactly?

The only point I'm trying to make is, if you're getting screwed by the insurance company, even if their excuse for screwing you is a set of delusional parents, the issue needs to be taken out on the insurance company.

[brewer]

Wow, this is fascinating. How long have you worked in the medical insurance field? Actuary? Underwriter? What do you base your statements on?

If you disagree with my statements, it works best to explain how your position differs from mine.

I'll start with background. 20 plus years in the health/medical insurance field. Did medical cost analysis for underwriters 15 plus years (among other things). Have been retired for 6 years so things may have changed, especially with Obamacare. But with Obamacare look at how many are going under (i.e. insurance gone) due to bad selection (underestimating the cost of medical care). With minimal health expenses this year my Obamacare premium increased 160% if I wanted to continue the same coverage.

Health/medical insurance contracts, and therefore the premium rate, typically run from year to year.

If this is an individual contract, the underwriters will look at the last years payout, make an assessment of the future year's potential payout and adjust the premium accordingly for the next year. I doubt the individual (parents in this case) could afford the premium.

Same for an employer group contract, it's run year to year. Same premium adjustment is done based on incurred and expected cost. Except in this case the premium adjustment is spread evenly through all of the members covered in that group. If the insurance premium adjustment is cost prohibitive, the employer will look for bids from other carriers that they can afford (the other carriers will ask for the prior years medical payout on the group prior to making a premium quote to limit risk) or discontinue coverage. With Obamacare, discontinuing coverage may not be an option. The option may be the employers close the doors. If discontinued the person(s) has an option to elect COBRA coverage that will last for up to 18 months. If medically disabled, after 18 months they become eligible for Medicare. The burden of paying is simply switched to the state/fed.

In any scenario I can think of for private insurance, the costs catch up to the premium within a year. Her condition has been going on for two years.

Most insurers will purchase "stop loss" insurance. It is a one year hedge against unforeseen medical expense and can work on an individual or aggregate basis. With the amount of her expenses, stop loss coverage would not be offered by any carrier in year two or, if offered it would be cost prohibitive.

If the parents have coverage funded through the state or fed, I can't comment.

OK, your turn. Justify your statements.

[Easy Guns]

If you disagree with my statements, it works best to explain how your position differs from mine.

I'll start with background. 20 plus years in the health/medical insurance field. Did medical cost analysis for underwriters 15 plus years (among other things). Have been retired for 6 years so things may have changed, especially with Obamacare. But with Obamacare look at how many are going under (i.e. insurance gone) due to bad selection (underestimating the cost of medical care). With minimal health expenses this year my Obamacare premium increased 160% if I wanted to continue the same coverage.

Health/medical insurance contracts, and therefore the premium rate, typically run from year to year.

If this is an individual contract, the underwriters will look at the last years payout, make an assessment of the future year's potential payout and adjust the premium accordingly for the next year. I doubt the individual (parents in this case) could afford the premium.

Same for an employer group contract, it's run year to year. Same premium adjustment is done based on incurred and expected cost. Except in this case the premium adjustment is spread evenly through all of the members covered in that group. If the insurance premium adjustment is cost prohibitive, the employer will look for bids from other carriers that they can afford (the other carriers will ask for the prior years medical payout on the group prior to making a premium quote to limit risk) or discontinue coverage. With Obamacare, discontinuing coverage may not be an option. The option may be the employers close the doors. If discontinued the person(s) has an option to elect COBRA coverage that will last for up to 18 months. If medically disabled, after 18 months they become eligible for Medicare. The burden of paying is simply switched to the state/fed.

In any scenario I can think of for private insurance, the costs catch up to the premium within a year. Her condition has been going on for two years.

Most insurers will purchase "stop loss" insurance. It is a one year hedge against unforeseen medical expense and can work on an individual or aggregate basis. With the amount of her expenses, stop loss coverage would not be offered by any carrier in year two or, if offered it would be cost prohibitive.

If the parents have coverage funded through the state or fed, I can't comment.

OK, your turn. Justify your statements.

First of all, you didn't explain how your position differs from mine.

Secondly, as far as I can tell you went on and on about how limiting an insurance companies ability to properly form a risk assessment costs them money, and in turn costs payers money.

If you want to discuss the ACA and how it's actually really bad for payers, we can do that and generally speaking I'll agree.

Maybe I didn't make my point very clearly and you misunderstood my intention.

Here is my point:

As far as I'm concerned, a person has the right to utilize their insurance policy to the fullest extent of their agreement with said insurance provider, and judging them for doing so just because you don't agree with why they're doing it is wrong. If the insurance company is losing money for doing so, it is the fault of the insurance company for putting themselves in a poor position to earn capital on that policy.

If my insurance company is charging me more money due to their poor investment decisions, then my issue is with the provider and not some crazy person that wants to keep their dead child breathing.

*edited for further clarity

[Minimalist]

If the insurance company isn't paying for it and the parents are paying out of pocket,

The news reports are that the insurance company is paying for it.  Unless they are wrong... in which case someone with deep pockets is footing the bill.  [ Always remember the Terry Schaivo case. ] 

Actually, the only reason I can see for the insurance company to continue paying is that they don't want to become the focus of the case.  They'd rather let someone else sit in the bulls's eye.  You can bet they are not displeased by the state court ruling.

[Ravenshire]

I'm quite flabbergasted that others think they have a say in what that family do.

I have no concern whatever for what they do, as long as they're not expecting others to foot the bill. This is not the case. They want to force an insurance company to do it, for a dead kid. Shit like this leads to higher premiums which affects everyone. They don't exist in a bubble.

As an outsider, the kid is still dead. For them to move on, they first need to let go.

[Easy Guns]

If the insurance company isn't paying for it and the parents are paying out of pocket,

The news reports are that the insurance company is paying for it.  Unless they are wrong... in which case someone with deep pockets is footing the bill.  [ Always remember the Terry Schaivo case. ] 

Actually, the only reason I can see for the insurance company to continue paying is that they don't want to become the focus of the case.  They'd rather let someone else sit in the bulls's eye.  You can bet they are not displeased by the state court ruling.

On the point of why the insurance company is still paying for it is pure speculation.

In any case, my opinion still stands that regardless of the reason for their poor investment decision, the burden of that decision still lands in their lap.

If they need to add a clause to their contracts that discerns eligibility for payouts based on medical condition, then so be it.

[brewer]

I'll start with background. 20 plus years in the health/medical insurance field. Did medical cost analysis for underwriters 15 plus years (among other things). Have been retired for 6 years so things may have changed, especially with Obamacare. But with Obamacare look at how many are going under (i.e. insurance gone) due to bad selection (underestimating the cost of medical care). With minimal health expenses this year my Obamacare premium increased 160% if I wanted to continue the same coverage.

Health/medical insurance contracts, and therefore the premium rate, typically run from year to year.

If this is an individual contract, the underwriters will look at the last years payout, make an assessment of the future year's potential payout and adjust the premium accordingly for the next year. I doubt the individual (parents in this case) could afford the premium.

Same for an employer group contract, it's run year to year. Same premium adjustment is done based on incurred and expected cost. Except in this case the premium adjustment is spread evenly through all of the members covered in that group. If the insurance premium adjustment is cost prohibitive, the employer will look for bids from other carriers that they can afford (the other carriers will ask for the prior years medical payout on the group prior to making a premium quote to limit risk) or discontinue coverage. With Obamacare, discontinuing coverage may not be an option. The option may be the employers close the doors. If discontinued the person(s) has an option to elect COBRA coverage that will last for up to 18 months. If medically disabled, after 18 months they become eligible for Medicare. The burden of paying is simply switched to the state/fed.

In any scenario I can think of for private insurance, the costs catch up to the premium within a year. Her condition has been going on for two years.

Most insurers will purchase "stop loss" insurance. It is a one year hedge against unforeseen medical expense and can work on an individual or aggregate basis. With the amount of her expenses, stop loss coverage would not be offered by any carrier in year two or, if offered it would be cost prohibitive.

If the parents have coverage funded through the state or fed, I can't comment.

OK, your turn. Justify your statements.

First of all, you didn't explain how your position differs from mine.

Secondly, as far as I can tell you went on and on about how limiting an insurance companies ability to properly form a risk assessment costs them money, and in turn costs payers money.

If you want to discuss the ACA and how it's actually really bad for payers, we can do that and generally speaking I'll agree.

Maybe I didn't make my point very clearly and you misunderstood my intention.

Here is my point:

As far as I'm concerned, a person has the right to utilize their insurance policy to the fullest extent of their agreement with said insurance provider, and judging them for doing so just because you don't agree with why they're doing it is wrong. If the insurance company is losing money for doing so, it is the fault of the insurance company for putting themselves in a poor position to earn capital on that policy.

If my insurance company is charging me more money due to their poor investment decisions, then my issue is with the provider and not some crazy person that wants to keep their dead child breathing.

*edited for further clarity

You made a comment about execs getting rich on payers. Not in this case, not a valid point.

I agree that the insurance company will take a hit in the first year. Fine, get all the benefits you can during the first year. But not after. You don't seem to be able to grasp that point. This kid will be going into the 3rd year.

Medical contract premium rates last for 1 year, then they go up based on experience. Either the parents are paying (unlikely) or the others in the group are paying through increased premium (other payers). It's unlikely any private insurance company will be out any money after that first year. The insured's will. You stated that "That contractual agreement has nothing to do with other paying customers". In the second year that is not correct. The point is that the cost is shifted to the payers. If it is/was a group, it was shifted to other payers. If the premium can't be afforded by private funds it will be shifted to the state/fed. Are those not "other payers"?

A quick search shows that care is being paid through an award through the Terri Schiavo Life and Hope Network. That kind of sounds like an "other payer" to me. 

It appears that your position is mainly opinion with little to back it up. Fine, OK. We can agree to disagree.

[Easy Guns]

First of all, you didn't explain how your position differs from mine.

Secondly, as far as I can tell you went on and on about how limiting an insurance companies ability to properly form a risk assessment costs them money, and in turn costs payers money.

If you want to discuss the ACA and how it's actually really bad for payers, we can do that and generally speaking I'll agree.

Maybe I didn't make my point very clearly and you misunderstood my intention.

Here is my point:

As far as I'm concerned, a person has the right to utilize their insurance policy to the fullest extent of their agreement with said insurance provider, and judging them for doing so just because you don't agree with why they're doing it is wrong. If the insurance company is losing money for doing so, it is the fault of the insurance company for putting themselves in a poor position to earn capital on that policy.

If my insurance company is charging me more money due to their poor investment decisions, then my issue is with the provider and not some crazy person that wants to keep their dead child breathing.

*edited for further clarity

You made a comment about execs getting rich on payers. Not in this case, not a valid point.

I agree that the insurance company will take a hit in the first year. Fine, get all the benefits you can during the first year. But not after. You don't seem to be able to grasp that point. This kid will be going into the 3rd year.

Medical contract premium rates last for 1 year, then they go up based on experience. Either the parents are paying (unlikely) or the others in the group are paying through increased premium (other payers). It's unlikely any private insurance company will be out any money after that first year. The insured's will. You stated that "That contractual agreement has nothing to do with other paying customers". In the second year that is not correct. The point is that the cost is shifted to the payers. If it is/was a group, it was shifted to other payers. If the premium can't be afforded by private funds it will be shifted to the state/fed. Are those not "other payers"?

A quick search shows that care is being paid through an award through the Terri Schiavo Life and Hope Network. That kind of sounds like an "other payer" to me. 

It appears that your position is mainly opinion with little to back it up. Fine, OK. We can agree to disagree.

My comment about execs getting rich was oversimplified, and you are right, in this case not worth very much for the topic at hand. But I do believe that in a free market, customers have the power to minimize corporate profits and maximize their own dollar value if they're smart enough to collaborate and unify. Again, not the topic and a useless, oversimplified comment for me to make.

I'm not disagreeing that the cost is being shifted to other payers, there's no doubt that is the case. I'm heavily involved in the finances of a corporation (albeit, not an insurance provider) But I do know there are two primary ways to maintain and/or increase revenue: increased cost to customer or decreased cost of compensation to employees. Customers are always first, and when that's not possible, you short change employees (starting at the bottom and then moving up). Compensation, after all, is typically the #1 expenditure (although I can see how that may not be the case with an insurance provider) but that doesn't change my moral standing.

At the end of the day, I still believe a company is responsible for its own financial decisions. If their poor financial decisions are costing me additional money as a customer, I place blame on them and not the recipients of their decisions. I'm content to agree to disagree on that.

[Thumpalumpacus]

It seems settled that her treatment won't be covered, meaning that if the parents have their way, they'll have to pay themselves, or the costs will be shifted to the taxpayer.

Am I missing something?