Children Denied Coverage for Serious Medical Conditions Under Obamacare, Hospital Sues Government

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Seattle Children’s Hospital has filed suit against the government over the failure of Obamacare to provide essential coverage to children.

Specifically, the insurers in Washington state’s Insurance Network are excluding major hospitals from their networks. They then deny payment for essential medical care for serious medical conditions when patients need the kind of care that only these hospitals can provide.

Seattle Children’s Hospital is ranked as one of the best hospitals in the United States. It ranked in the top twenty hospitals for 10 specialities, including a number six ranking for children’s cancer treatment. A number of Obamacare insurance providers are denying coverage for treatment at this hospital.

It seems to me that for an insurer to refuse coverage for care at hospitals like Seattle Children’s Hospital is tantamount to saying that their plan does not provide full coverage. Plans that only provide coverage for every day illnesses at second and third tier institutions should not be allowed to market themselves as full insurance coverage.

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  • SisterCynthia

    Seattle Children’s is a truly great hospital. I have many friends/acquaintances back home, whose kids went there. Not every kid has won their battle, but the parents have never had a single bad word to say about the care, and most have had positive outcomes, from cancer to meningitis to severe (and I mean SEVERE) brain trauma. For seriously ill kids, there’s no other hospital in NW that comes close. And they are great advocates for their patients (why parents tend to love them!), so if they are suing, I trust that this situation is even worse than I suspected. :( I hope they are successful!

    • Bill S

      I trust that the hospital knows that they are suing the insurance companies and not the federal government.

      • http://outsidetheautisticasylum.blogspot.com/ Theodore Seeber

        Sounds more like they’re suing Washington State, but with Obamacare, the insurance companies have become de facto nationalized.

  • http://ashesfromburntroses.blogspot.com/ Manny

    Now can we repeal this disaster? Obama’s single signature achievement has destroyed the healthcare system. We had a good healthcare system. It wasn’t perfect, but 80% of the country found it worthy. Now we’ve turned the system upside down and made things substantially worse. When will government beurocrats realize they can’t construct a system for hundreds of millions of people from scratch? There is no humility in the government, just a bunch of pampered, over rated mediocrats (not you Rebecca) who have to feed their ego by putting their name on signature legislation. Can you finally see why I am a Conservative?

    • Dave

      I don’t think we had a good healthcare system, but now with Obummercare, it has gone from perhaps a 20 on a scale of 1 to 100 to a 3 on the same scale.

      • http://ashesfromburntroses.blogspot.com/ Manny

        There was a poll done before Obama pushed his plan through Congress, and something like 80% of the American people were personally happy or better with their personal healthcare.

        • oregon nurse

          Very few people realize how much the problem of uninsured healthcare and bad debt in the system is close to toppling the entire system and how many physicians and hospitals have closed their practices and doors because of it. I think if people knew how much of every healthcare dollar they spend goes to cover the cost of other’s uncompensated healthcare they might not be so happy. You can include medical bankruptcy and it’s ripple effects in the economy in those costs.

          I don’t claim that obamacare is the answer but I do know the answer involves getting more people paying into the insurance (or some healthcare system) pool and frankly obamacare is the first actual step in that direction.

          • http://ashesfromburntroses.blogspot.com/ Manny

            I think some reforms were in order, but I don’t see how any of Obama’s reforms even address the problem. If anything they make it worse. And he just created a whole bunch more problems. No one can design a system this complex. Obama refused to make incremental adjustments. He went for the whole ball of wax because he has no humility in the face of complex problems. He believed he was a diety. Incremental adjustments preserve what is working while striving to help the problem areas. Like I said, 80% of the people had good insurance. Now when Obamacare takes full effect, maybe 30% do. And those are the richest 30%. The more Liberals try to address inequality, the more they create inequality.

            • oregon nurse

              Obamacare is inferior precisely because it didn’t go far enough and that’s why it’s so complicated and messed up. Too many insurance co. lobbyists were writing the legislation so they could stay in what is a very profitable game. You want simple, you go single payor. But much like our tax code, we have far too many people making money off the dysfunction and unfairness of the system to make the changes that are really needed.

              • AnneG

                Oregon nurse, I’m a nurse, too. The way the system works now with the insurer being the customer is a large part of he problem. But, single payer will make it worse. I’ve lived in places that have single payer. First, there is overuse by some and backlogs for others. Kids in the UK can wait 7 months to see an ENT for chronic otitis media and 2 years for myringotomies with pe tubes. In some places cataract surgeries are rationed to one eye and only done when the patient is legally blind. It gets worse from there. There is rationing and you avoid it by buying private insurance that covers stuff rationed by state health services. That is not a solution unless you consider utilitarianism preferable. That is why you see what you do in Belgium right now.

                • oregon nurse

                  Hi AnneG,
                  I agree that single payor can be abused as well. It’s just that buying insurance leaves too many people out of the healthcare market, a market whose costs are higher for everyone precisely because of bad debt. We really have very good models for single payor in Medicare and the Veteran’s Administration (not coverage for military which stinks). They are not without fraud and waste, but they actually do a very good job – better I think than our private insurance system and I’ve worked in the insurance system.

                  Maybe a hybrid is the answer. Open access for basic and preventive care (instead of just emergency and catastrophic care) and private insurance for the rest. We’ve actually had a kind of rationing system in Oregon under Medicaid and I think it did pretty well in assigning coverage based on level of need. I don’t think gov is responsible for providing cadillac care, just for making sure people get good solid basic care and timeliness of treatment is definitely part of that.

                  • AnneG

                    VA isn’t bad, but there are a lot of holes. But most of the bureaucracy has skin in the game, so they are sorta responsible. But, some VA clinics are pill factories. Medicare is a mess. People were mostly happy with Medicare Advantage, but ACA did away with that. Every year there is a freeze on allowances that Congress overrides and raises. Other payers base their reimbursements on what Medicare pays. And, it is going broke. There needs to be means testing and a sliding scale. I’m in favor of HSA’s that carry over, nontaxable, then catastrophic policies for low risk or people who don’t mind paying out of pocket expenses. Locally controlled and funded basic care clinics with a sliding scale for care and advanced care referrals would be great. But everybody should pay something, even if it is only $2. And stop trying to cover stupid stuff like pediatric dental screenings. The poor are not compliant in those things, anyway. Maybe a dental clinic with same conditions would be ok.
                    I think a lot of the problem is that health care is an industry, but making it a federal government department or agency will only make it worse.

                • Fabio Paolo Barbieri

                  And it did not occur to you that the disaster in the UK has been caused by corruipt Thugcherite governments (that includes the Tory Blur, too) saddling the NHS with mountains of unnecessary expense and long term debt under the guise of “creating an internal market” and “harnessing public and private partnership”? Do you know how many doctors and nurses have been sacked or not hired in order to make space for administrators? Do you have any idea how many billions of pounds have been stolen by Tory contractors who felt that the money would look so much better in their pockets than paying for nurses and wards? If you don’t understand that, you don’t understand anything about the NHS – or, for that matter, about the financial and social catastrophe forced on the United Kingdom from above in the last forty years. Meg Thug and her wretched successrs/imitators have been worse for the country than a lost war, and their hold on the corrupt media is so strong that nine people out of ten still honestly believe Meg Thug to have been a “great leader”.

                  • AnneG

                    Mostly, that’s what happens when you have a command economy rather than a demand economy and a government bureaucracy that cannot and has no incentive to run things well. Btw, people used to get care they needed here. Not deluxe, but adequate and lots was given for free. But, when you have a govt bureaucracy managing things, the whole system breaks down. Corruption just makes the whole thing worse.

                    • Fabio Paolo Barbieri

                      Did you even TRY to understand what I was saying? You are talking exactly like Meg Thug and her imitators – command economy blah blah blah – government bureaucracy blah blah – nanny state blather blather. It has been the repeated attempts to force the NHS into the wonders of the free market that have wasted trillions of taxpayers pounds and helped only crooks and other contractors. And people like you still imagine there is some special magic about the free market. Will you ever, ever, ever learn?

                    • AnneG

                      Fabio, it isn’t magic. I’m not going to discuss Thatcher or UK politics. Different system.
                      Btw, helping somebody who needs help is called Caritas, I believe. And subsidiarity is of prime importance along with solidarity. That is not the government. Our government tends to get involved in anything we let it and exceptions are only made when you make political donations to the right politician. Different system from what you are used to. Bureaucrats have rules and laws and policies that they have power to enforce but they don’t do their jobs. I’m talking about in the US. We do better with less regulation and government restraint. Not what we have now.

                  • AnneG

                    That’s what happens when you have a command economy rather that a demand economy. Our health care is excellent. Most people, 85% were happy with what they had. So, what’s Belgium’s excuse?

              • http://ashesfromburntroses.blogspot.com/ Manny

                No way in hell will I ever support single payer. Pure mediocirty and government control. Free the market and let individuals buy their insurance, like car insurance.

                • FW Ken

                  Canadians by and large disagree with that assessment. They are quite happy with their care. Of course, Canada has about the population of California.

                  My own opinion is that single payor is not right for the U.S. Better to have medical savings accounts, catastrophic insurance, and a public system for the indigent, as well as some forms of Medicaid and Medicare.

                  • http://ashesfromburntroses.blogspot.com/ Manny

                    Because they’re used to it and don’t know any better. All I know is that Canadians come here for services that take too long to get there, including a recent politician.

                • Fabio Paolo Barbieri

                  Manny, you will find out when a member of your family suffers from an expensive long-term disease. I am a poor man, but since I have been on the net I have helped with my own money no less than four people who had been taken near death by refusal or foot-dragging from their wonderful private insurers. Now, let us see whether you can guess what country every single one of those deceived and beggared free citizens belonged to. A hint. They were not Canadians. They were not British.They were not German, Italian, French, Japanese, Israeli, Dutch, Swedish or Spanish. NO, they weren’t Portuguese either. Which supposedly rich country leaves its sick citizens to beg for money on the internet as they are in danger of their lives?

                  • http://ashesfromburntroses.blogspot.com/ Manny

                    I’m not saying that there will be no insurance. Of course we’ll still have insurance and in the US the employer contributes toward the insurance payments. That money will be handed over to the employee for a no net change in the employee’s cost of insurance, and with time and larger pools of insured the costs should come down relative to current prices. The 8 to 10% of uninsured would still be a problem, but Obamacare hasn’t solved that either.

  • http://outsidetheautisticasylum.blogspot.com/ Theodore Seeber

    Let me guess. Bronze level plans. And they said there wouldn’t be rationing.

  • http://outsidetheautisticasylum.blogspot.com/ Theodore Seeber

    The neurosurgeon that did my son’s spinal surgery is running for Senate because of stuff like this.
    http://oregoncatalyst.com/25511-dr-monica-wehby-alternative-obamacare.html

  • Bill S

    Obamacare is intended to provide more coverage, not less. The fault is with the insurer not the national healthcare program. I’m sure that’s who is being sued. It’s disingenuous to say that Obamacare is being sued. You can’t sue a statute.

    • hamiltonr

      Of course you can sue a statute Bill. It happens every single day.

      That said, I have no idea how these people are framing their lawsuit. What I read sounded as if they were suing the government, based on how the statute which has created this mess is written. But I don’t know for sure.

      If the insurance companies are in compliance with the law, it would be fruitless to sue them.

    • http://outsidetheautisticasylum.blogspot.com/ Theodore Seeber

      “Obamacare is intended to provide more coverage, not less.”

      No, Obamacare is intended to force people who didn’t previously give insurance companies money because their illnesses were too great, to become customers of the insurance companies. Rationing under socialized medicine is necessary and inevitable. It is indeed a very poorly written law.

    • AnneG

      Bill, the intention of ACA was to insure the uninsured and get rid of “substandard” policies. So, about 5 million people who had policies they were happy with had those policies terminated and are forced into a system that covers things they don’t need, costs more and has higher deductibles. Only about 500,000 people have been signed up who were truly uninsured. Medicaid doesn’t count, since they are usually enrolled at point of service when eligible and they are routinely non compliant. The real goal, stated by a lot of supporters, from Pelosi, Obama, Clinton to Emmanuel is simply single payer.
      I’m pretty sure Seattle Children’s has competent attorneys suing the appropriate parties. Washington’s system is part of ACA as they adopted it and function as part of the exchanges.

      • FW Ken

        The last I read, Obamacare will, when fully implemented, leave 29 million people involved.

  • FW Ken

    I am in favor of universal health care, particularly for children’s services. My county hospital district taxes I pay cheerfully. No, really.

    Obamacare is a nightmare. A few years ago, Children’s Hospital in Dallas took care of Egyptian twins joined at the head. It was months of uncompensated, or not fully compensated, charity care that brought joy to this area. What would Obamacare do for them?

  • Allison Grace

    This terrifies me. I have a 19 year old son with cystic fibrosis whose preventative medications cost $12,000 every single month. He has a new plan under the marketplace and will be ordering his next month’s supply next week. We have no idea what will happen.

    • hamiltonr

      Prayers for you and yours Allison.

  • oregon nurse

    Honestly, choice of hospital is not a new limitation although perhaps Obamacare has taken away some additional freedom to choose. I’m not an expert on obamacare, but I am somewhat of an expert in medical insurance policy and especially HMOs and PPOs.

    In every large metropolitan city there are hospitals which are acknowledged experts in certain types of care. When my children were little I knew which hospital I wanted them to be at if they needed inpatient care (and which ones I did NOT!) and I selected an insurance policy and a pediatrician accordingly. Access to hospitals has always been (for several decades anyway) controlled by the insurance company you belong to and their participating provider clauses. In many cases access is realistically controlled by who your doctor is and which hospital(s) your doctor has admitting privileges at. Exceptions usually had to be initiated by a doctor who would verify that needed treatment could only be obtained at an out-of-network facility and seek approval from your insurance company. People were also limited by the insurance plans offered by an employer and very few could afford to independently insure if they didn’t like the employer choices. So I actually think some of this is a bit trumped up as if these limitations never existed before.

  • Fabio Paolo Barbieri

    In other words, Obamacares preserves and advances all the most admirable features of American health lack-of-care.
    By the way, could you ask Patheos why I can leave snarky comments here but not on your previous entry (about a friend taking her baby to you)? I just wanted to make a stupid joke about politiicians kissing babies.


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