From Pine View Farm

We Need Single Payer 0

Life insurance has been described as a wager: You bet that you are going to die, the life insurance company bets you won’t, and you hope that they win the bet.

Of course, you know the death rate is the same everywhere, as Mark Twain observed: One per person.

Nevertheless, the gag points out what gets forgotten: insurance companies don’t want to pay claims; they want to pay the bosses’ country club memberships. Their business model is founded on not paying.

The Philadelphia Inquirer details the attempt of a severely crippled 27 year old woman–one whose hands and legs are too weak for her to maneuver herself–to get a modern wheelchair.

It took months, and three appeals of her insurer’s denials, to get the wheelchair she now uses in her family’s small home in Gibbsboro, Camden County.

People who evaluate and fit patients for wheelchairs say cases like hers have become more common in recent months. They say many requests for the kind of chairs that patients like Lorey use – expensive, motorized units with multiple custom features – are being denied because insurers and Medicare officials are worried about high costs and fraud. Doctors, physical therapists, and patients must appeal the decision, or else the patients give up and accept lesser chairs.

“It’s gotten to the point where words are not enough to convince the medical directors” of insurers, said assistive technology professional Robert Townsend of Jeff Quip, a Boothwyn company that supplies complex chairs.

Experts said patients who fight – especially those who appeal in person – often can get the chair they need, but during the bureaucratic battle, they must make do with loaner chairs or lie in bed.


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