Melanie Shouse crusaded for her two political passions; medical care for all as implemented by a vibrant public option such as the Conyers-Kucinich bill, HR676 (aka Expanded Medicare for All), and electing a little known Illinois Senator, Barack Obama, president. Nationally known as a grassroots healthcare activist; she has been the modern-day equivalent of a female Moses, working to bring medical care for all--home.
Melanie had insurance, not the "cadillac' type enjoyed by congress, but the individual policy for catastrophic illness, replete with a mandatory five thousand dollar deductible. No benefits kick in, until the five thousand is paid. As an individual, this was the only type of insurance open to her. Who among us can afford five thousand dollars before any benefits become active? It is wage slavery.
Melanie plainly stated this fact at a healthcare rally this past November. She probably knew this would be her epitaph.
""we need to take on the big insurance monopoly and liberate American families from the SLAVERY of skyrocketing insurance premiums and cancelled coverage, which leave millions of us in a state of perpetual fear and insecurity"" --Melanie Shouse, activist.
Melanie's care was delayed by deductibles and co-pays expensive enough to bankrupt most of us. In addition, her policy was "rescinded' after beginning her third round of chemo. Though her treatments were approved by the Siteman Cancer center, a premier research institution considered one of the top centers in the world; her provider Anthem (under the umbrella Wellpoint), rescinded or cancelled her coverage. Fortunately, for Melanie, she had coverage by the PUBLIC PLANS OF MEDICARE AND MEDICAID (after a 2 year waiting period), by that time. Without the public plans of Medicare and Medicaid; Melanie would have died much earlier. Wellpoint had sent her the equivalent of a death sentence.
I wanted to better understand how insurers can defraud so openly and found five major practices working in an orchestrated manner to steal our money and deny medical care. They are as follows: the use of pre-existing conditions, gender rating, post-claims underwriting, retroactive policy rescission and the rewarding of employees for successful post-claims discovery.
Pre-existing conditions are used to block coverage either by making premiums and deductibles beyond reach financially, or as justification to deny coverage at any price. No one ever asks why any pre-existing condition should serve as the roadblock to medical care. Unless you never become ill--all of us will eventually have a "pre-existing condition.'
Gender rating is institutionalized discrimination against women by pricing premiums approximately 47% higher than those for men.
Post-claims underwriting and rescission go hand in hand. Post-claims underwriting occurs when an insurer investigates ancient medical records looking for any minor hint of a pre-existing condition, for the express purpose of cancelling the policy when medical care is most needed. The cancellation is also known as policy rescission. The fraud lies in the fact that this investigation occurs AFTER a policy has been written and accepted. Once someone has been "rescinded', they are unable to obtain health coverage anywhere else. Wellpoint has a list of some 1400 different conditions that will trigger such post-claim investigation. (http://www.huffingtonpost.com/richard-kirsch/biggest-health-insurer-ad-)
Anecdotal accounts, including those recorded in official testimony before congressional committee chaired by Rep. Bart Stupak documented accounts of patients losing coverage a few weeks before major medical procedures such as double mastectomy, due to some odd note in an old record which was misinterpreted by the clerk. http://www.votesmart.org/speech_detail.php?sc_id=474236&keyword=&phr
Insurance executives like Braly regard post-claims underwriting and policy rescission necessary fraud prevention practices.
Frankly, it is hard to imagine a sane person wanting to suffer from any life threatening illness so they can defraud insurance companies. Such thinking begs the question; why should anyone ever be denied medical care for legitimate medical need? Regardless of pre-existing conditions; medical care is a human right.