Mark Gendernalik just wishes he could focus on being a dad instead of having to constantly fight insurance company red tape to get the medical care his daughter needs.

Mark’s 2-year-old daughter Sidney started having seizures when she was three months old. Ever since, he has been fighting insurance company bureaucracy and a series of frustrating delays in the authorization of his daughter’s care.

Excessive insurance claim delays and denials were the subject of a House Oversight and Reform subcommittee hearing earlier this month. The hearing featured testimony by Mark about his family’s experience, along with testimony from a pair of former insurance company executives about industry practices that often put profits before patients' needs.

Mark’s testimony was particularly poignant and helped underscore why health care reform is so urgently needed:

“The toll it took on my family will never be forgotten," he testified. " The constant hassle of getting referrals for the correct services. The run-around to get the needed tests. The over a week recovery time lost to my daughter while we languished waiting for her meds. The months lost to an inaccurate diagnosis. The battle to get the medication approved…Consumers should not have to endure this kind of life and health threatening hassle. I hope Congress will find better ways to ensure that insurers deliver on the care they promise.”

The hearing and Mark’s testimony were featured in stories on CBS Evening News and ABC’s Good Morning America.

Families like Mark’s need better protections to ensure that claims are handled fairly and in a timely manner. That’s why Consumers Union is urging Congress to make sure that health care reforms include provisions that will expedite appeals when claims are denied, among other reforms.

comments (18)

Comments

1 Posted by Nick at 09/23/09 04:01 AM

I did a blog entry a few days ago that was critical of an exploitative insurance product called "GradMed", and since then they've spent six hours on my site, almost reading it twice over -- all during working hours. (You can read my entry at this link)

Insurance companies are designed for marketing, collection of premiums, denial of care, and legal self-protection -- these are the most profitable skillsets for an insurance company.

We won't get anything better until we have a strong public option, to force private industry to use the government's standard -- the good of society and of the American citizen.

2 Posted by Ken McConnell at 09/23/09 12:41 PM

Yes, we definitely need health care reform, starting with Tort reform and universal health plan portability throughout the US. The proposals currently in Congress will never work, nor can we afford them.

3 Posted by Andrea Infinger at 09/23/09 02:00 PM

I agree that the country can't afford the public option nor would it be good to let the government manage healthcare.

Tort reform must be passed. Too much money is wasted due to the trial lawyers and the multiple lawsuits.
My daughter had a side effect due to one of her medications. It had to be corrected surgically, but it was listed in the possible side effects. I now see where they are filing a class action in reference to this medication, but I don't feel the need to sue the drug manufacturer.

Insurance portability is very needed as well a method to cover those with pre-existing conditions. I don't think the insurance companies should be mandated by the government to do this.

4 Posted by E. R. Hager at 09/23/09 02:41 PM

While it is clear that changes must be made to present medical care, it is also clear that most of us will have to pay MORE and NOT LESS due to the bills presently in the congress. Example: CU's analysis of the Medicare changes proposed House bill state that Medicare Advange costs will be reduced by cutting benefits. Obviously, this will increase costs (probably by at least 14% to those of us who are presently covered by this program.

5 Posted by Jim Peterson at 09/23/09 07:00 PM

I lived in Canada for 8 years and worked for a canadian Company for another 5 years. The best boss I every worked for died while on a “Waiting List” for about 2 years. He needed a kidney transplant which was readily available in the US but because he smoked the Canadian system kept moving him back on the list until he died.

Anything that ends up changing our current system with “rationing” as in Canada is a very bad deal for American Citizens and many many other nationalities that benefit from the progressive medical procedures and treatments that only seem to be developed here in the US. I have visited every continent 4 or 5 times per years and know what we have is better system than what I see in other countries. My Canadian Doctors office tools were pretty much limited to tongue depressors, thermometer, stethoscope, Otoscope and a blood pressure cuff pretty archaic compared to what the standard US doctor’s office has.

6 Posted by Nick at 09/23/09 08:13 PM

Hi, Jim.

People die waiting for kidneys all the time -- 4,500 people died last year in the United States while waiting for a kidney. We have a limited number of donor kidneys, so we ration them -- it doesn't have _that_ much to do with what health care system a country uses.

Rationing is, in all societies including ours, an unfortunate fact of life. Why would we entrust it to for-profit insurance companies rather than public organizations that are responsible to voters?

7 Posted by Ken at 09/23/09 09:47 PM

In response to Mr.Peterson,
It is certainly a tragedy anytime someone is placed on a waiting list and does not receive a organ in time however I can tell you Jim that I as a Insurance Agent selling Health Insurance that rationing goes on everyday in America as 97% of all private plans require prior approval before surgeries or transplants are done and many die because they are denied the approval and a small example of this can be seen on sickforprofit.com.
Opponents will tell you that if a Public Option is passed that the Government will be between you and your Doctor however Insurance claims reps are already between you and your Doctor.
I am forced to tell people daily that of the 5 Insurance Companies I represent that none of them want or will except their business however these same companies want these people denied the opportunity of another option.
I was a Republican supporter and frequent viewer of Glen Beck and Sean Hannity until this Healthcare debate began and I can tell you for a fact that the things that they are telling the American people about Healthcare Reform are lies and they know that they are lying but this appeals to their group of listeners who in large numbers do not realize how bad this situation is.
A recent study by Eastman-Kodak is as follows:
WASHINGTON--(BUSINESS WIRE)--“Business Roundtable members commend Senate Finance Chairman Max Baucus for continuing to advance the goal of passing effective health care reform legislation. As the results of yesterday’s Business Roundtable report show, if health care costs continue on the current path, the cost to employers for providing coverage will triple, exceeding $29,000 per employee over the next decade. Simply put, the cost of inaction on health care is unsustainable and could put millions of workers at risk.
This is certainly one of if not the most important issues facing this Country in our lifetime.

8 Posted by Bubbiesue at 09/23/09 10:20 PM

I believe there are two major problems with health care in this country: insurance and the law.

I echo Nick, #1 above, that we absolutely need a public option. We also need more regulation of the industry.

In the ideal world I'd like to see a single-payer system, but I'll settle for a public option, to improve insurance company honesty and to provide for people whose employment--or self-employment--currently makes insurance unaffordable.

9 Posted by JR in Florida at 09/30/09 09:11 PM

Someone who is fully appreciative of how capitalism-based business succeeds, of the fact that government programs suffer gross waste of resources and tax money as a matter of habit, that proper regulation means proper checks and balances, and that government involvement ought to be limited to oversight through a balance of legislation and judiciary would never say something this naive and, frankly, socialistic: "Why would we entrust it to for-profit insurance companies rather than public organizations that are responsible to voters?"
Folks like Nick here don't get capitalism as all. It's the regulation of health coverage that has failed us, just as it failed us in the financial markets. Why blame business and not government, for that matter? Where has government recently proven itself trustworthy with your money?

10 Posted by Gail at 09/30/09 09:30 PM

I agree with the comments in #1 and #8. I have worked in Human Resources for a large corporation for many years and strongly support a public option. The large corporation does not want to provide health insurance because it cannot control the cost of doing so - a large corporation likes to be able to predict and manage its costs. The insurance company keeps proposing creative ways to reduce coverage and pass on increased costs to the employee. This is a form of rationing and "tax increase" that is not talked about by those supporting the status quo. A public option would allow for more equity in our current system, and create a more competitive environment in the existing health insurance marketplace.

11 Posted by JFK at 10/03/09 04:59 PM

We do need health care reform but the proposed Socialist health care does not work in countries using that kind of system. Those countries see many people who can afford it leave for treatment in the US. If we go by the socialist system where will we get medical attention? Waiting lines will be like those in Canada. AARP and Consumer Reports better get their heads out the sand!

12 Posted by JR in Florida at 10/04/09 01:42 PM

I have no reason to be anything but suspicious of a debt-ridden, culpability-free (financially -- they can run up a deficit, I cannot, companies cannot, for long) government telling me they will lower costs by buying out an industry, which is in effect what I figure the current top leadership of the US has for an end game. They can dance around the words al they want, I don't buy the rhetoric. The dollars tell the story, not the rhetoric.

The social security system is upside down. In health care, the actual burden of costs, from malpractice insurance for doctors to indirectly funding R&D for drugs from every American pocket, needs to be reduced. We cannot absorb the costs while other countries benefit from it more than we, in effect, suffer financially for it.

The proper change is what I want, and further government involvement is not it. Regulate, don't dominate.

13 Posted by JR in Florida at 10/04/09 01:50 PM

Ken, you said:
"I was a Republican supporter and frequent viewer of Glen Beck and Sean Hannity until this Healthcare debate began and I can tell you for a fact that the things that they are telling the American people about Healthcare Reform are lies and they know that they are lying but this appeals to their group of listeners who in large numbers do not realize how bad this situation is."

Can you please provide some of these lies? I am NOT a frequent listener (rarely, at best) to those two folks you note, but I know they have large followings. I'd like to follow up on that.

I don't appreciate lies from either side, which there have been, or at least, half-truths that I've caught. Obama is sadly leading that effort with his horribly inaccurate health tragedy examples, etc. And, in making it about the thing that, sadly, is is never REALLY about: people. I wish this were truly about people, but it is about money. It is about cost. Without the cost of things, all things would be possible. The costs are the issue.

14 Posted by Bill Bloomfield at 10/05/09 12:10 PM

Ken,

LIES?? Sit back down, be quiet, don't touch anything, and drink your Kool-Aid like a good little boy.
Obama loves you.

15 Posted by Jon at 10/05/09 03:13 PM

Mark's story is certainly painful...and unfortunately, it's not an isolated experience. But there are some insurance companies out there - non-profits that provide public-sector health care like Medicaid - that seem to get the issues relative to private insurance run-around. Check out this blog:

http://www.ourhealthcaresource.com

And check out this specific blog entry about how this company empowers their customer service reps to make the tough decisions (as opposed to having to filter everything up the hierarchy of the organization) on behalf of its members.

http://ourhealthcaresource.com/2009/08/24/what-starts-on-the-front-lines%E2%80%A6stays-on-the-front-lines/

This company seems more dedicated to their members first...not profits...than your typical commercial insurance company. These are the types of companies that stand to thrive in a new era of health care.

16 Posted by Scott at 10/06/09 03:56 PM

The original story starts with an individual fighting with insurance companies to get coverage for his daughter and somehow this translates into the public option being better. My daughter is considered disabled and is therefore covered under Medicaid. She is now two years old and we still can not find the case worker assigned to her.
though I am grateful that there is a safety net in place for her, the idea that a governmental solution is better than a private solution is preposterous. With a private solution, you or your employer or, if necessary, your attorney do have leverage when it comes to getting responses. No one can reasonably expect to have an efficient, clear response from a government bureaucracy.
I am very surprised at the biased stance of Consumer Reports which runs contrary to the premise of the organization - to present the facts in order for the subscribers to draw their own conclusions.

17 Posted by Richard at 10/07/09 11:11 AM

OK, I'll bite at Bill's silly comment (#14). How many hours of Fox news do you watch a day? You still boil this all down to an attack on Obama? Beleive it or not, many of us see a problem with Health Care. Maybe you do not. Some of us believe a public option may be the only real way to counter-act some aggregious acts by Private Insurance companies. But, I'm open to tort reform and better regulation if that really makes the difference.

So, before you do the old 'Liberal, Obama' rant, just stick with debating the issues. That works better for all of us.

18 Posted by howard mulcahey at 11/04/09 10:20 AM

You have to be kidding. The Obama's health care plan is a disaster. A vote for that plan is an ignorant vote, because anyone that knows the facts would vote NO.