Healthcare part 1, How the american healthcare system works (from Sicko 2007)

out there this is Adam he had an accident he's one of nearly 50 million Americans with no health insurance but this film isn't about Adam so this is the table saw they was spinning that way this is Rick but I grabbed it I hear and it hit or not he sawed off the tops of two of his fingers zipped and it is that quick his first thought I don't have insurance how much it's gonna cost I'm gonna have to pay cash for this these three thousand dollars more and still doesn't have health coverage so the hospital gave him a choice reattached the middle finger for sixty thousand dollars or do the ring finger for twelve thousand it's an awful feeling to just try to put a value on on your body being a hopeless romantic Rick chose the ring finger for the bargain price of 12 grand the top of his middle finger now enjoys its new home in an Oregon landfill but this movie isn't about them it's about the 250 million of you who have health insurance those of you who are living the American dream it's moving day for Larry and Donna Smith they've packed everything they own in these two cars and are driving to Denver Colorado to their new home in their daughters storage room look at all that yeah we will what do we do as a computer it stays so this is where this is where Heather talked about we might have to put our foot bump it I see what she's talking about yeah it wasn't supposed to end up like this for Larry and Donna they both had good jobs she was a newspaper editor and he was a union machinist they raised six kids who all went to find schools like the University of Chicago but Larry had a heart attack and then another one and then another one and then Donna got cancer and even though they had health insurance the co-pays and deductibles soon added up to the point where they could no longer afford to keep their home I have somebody had told me ten years ago this was gonna happen to us because of health care I would have said you're it's not possible not in the United States we wouldn't let that happen to people like this I do early in the morning the first thing I do is this I clean it at age 79 Frank our deal should be kicking back on a beach somewhere but even though he's insured by Medicare it doesn't cover all the costs of the drugs that he and his wife need being that I'm an employee here my medicine is for free so that's why I gotta keep working until I die there's nothing wrong with that I don't really know how this happened that the trunk kind of came forward into the back seat Laura Burnham was in a 45 mile an hour head-on collision that knocked her out cold paramedics got her out of the car and into an ambulance for a trip to the hospital I get a bill from my insurance company telling me that the ambulance ride was not gonna be paid for because it wasn't pre-approved I don't know exactly when I was supposed to pre-approve it you know like after I gained consciousness in the car before I got in the ambulance or I should have grabbed my cellphone off of the street and called while I was in the ambulance or I mean it was just crazy I applied for health insurance for Jason they rejected him because of his height and weight Jason six feet tall and 130 pounds I applied for healthcare through Blue Cross Blue Shield and they told me that my body mass index was too high from 5-1 I weigh 175 pounds I always thought the health insurance companies were there to help us so I posted a note on the internet asking people if they had had any similar stories about problems with their insurance company within 24 hours I had over 3700 responses and by the end of the week over 25,000 people had sent me their healthcare horror stories some of them decided not to wait for me to get back to them like Doug know who took matters into his own hands without my permission his daughter Annette was nine months old when they discovered she was going deaf his health insurance company Cigna said they'd pay for an implant in only one of her ears according to the letter they sent it's experimental for her to hear in two ears if a cochlear implant is good for one ear well didn't make any sense that it wouldn't be good for the second ear especially when a child is just starting to learn how to talk she has to learn from both sides of her head that's when he sat down to write Cigna a letter this is two segments noted filmmaker Michael Moore is now in the process of gathering information for his next film I've sent along information concerning signas lack of caring for its policyholders is your CEO ever been in a film before before he knew it he received a call on his voice mail from Cigna headquarters comeback and a decision to overturn the previous to know the special is approved the appeal for the second implant thank you obviously all this worked because Annette is going to get her second implant in July dear Mike I work in the industry I worked for an aged about I started to get hundreds of letters of a different sort from people who work inside the healthcare industry they'd seen everything and they were fed up with a system health insurance companies suck flat suck like Becky malke II who was in charge of keeping sick people away from one of America's top insurance companies I work in a call center so people call in and they're asking for insurance rules is there certain pre-existing conditions basically interests you why that will not be covered diabetes heart disease certain forms of cancer that if you have these conditions you are most likely not going to get your health insurance how long is this list of conditions that we make you ineligible be really long list it could wrap around this house let's meet some of these happy insured customers Maria has blue shield and Diane horizon Blue Cross BCS insures Laurel and Carolyn has Cigna and it's a good thing that they're all fully covered I ended up being diagnosed with retroperitoneal cancer rank two more breast cancer brain tumor on the right temporal lobe because they were insured they got the red-carpet treatment at the doctor's office she requested for me to see a neurologist the way they were going to treat it was to remove it surgery was scheduled for December 9th there is a test that you can take that will show whether or not you actually would benefit from chemo oh they got their treatment all right but not before battling with their insurance companies they were investigating whether or not this was a pre-existing condition it's not medically necessary they claim that it's experimental we don't consider that life-threatening Diane died from her non-life-threatening tumor laurels cancer has now spread throughout her body her experimental tests proved that Carolyn needed chemo while vacationing in Japan Maria became ill and got the MRI that BlueShield of California had refused to approve the doctors in Japan told her that she had a brain tumor BlueShield had said repeatedly she didn't have a tumor dr. linda peeno was a medical reviewer for Humana she left her job because she didn't like their way of doing business I was told when I started that I had to keep a 10% denial and they were actually giving us reports on a weekly basis that would have all the cases we reviewed the percent approved and the percent denied and our actual percentage denial rate and then there would be another report that compared me to all the other medical the doctor with the highest percent of denials was actually going to get a bonus really it means so what you as a doctor working for the HMO if you denied more people health care you got a bonus that was the way they had set the system up any payment for a claim is referred to as a medical loss that's the terminology the industry uses I mean when you don't spend money on somebody you deny their care or the you you make a decision that brings money in and you don't have just been it's a savings to the company this is Tarsha Harris Blue Cross didn't deny her her treatment and actually approved her operation but then they discovered that in the distant past she had had a yeast infection apparently it's common men women can get a yeast infection so was prescribed the yeast infection cream general cream and it went away she later applied for health insurance and that's what you're supposed to be disclosing serious ailments the yeast infection was independent and it's not a serious ailment there was nothing else she could have done it wasn't until if they were gonna have to spend money that they looked if they take in five minutes beforehand and wanted to clear up the yeast infection they could have looked at her medical records they could have talked to her doctor because of the undisclosed yeast infection BlueCross dropped Tarsha Harris she thinks she's put this behind her and then BlueCross changes their mind tells the doctors we're taking the money back go get the money from Tarsha the fact of the matter is it was a yeast infection that's all it was I'm still a little bitter because I don't trust insurance companies now to me there it seems they're always going to be looking for a way out you know what happened to help in the person that sick don't make their problems worse this is Lee einer if they weren't able to weed you out in the application process or deny you the care your doctor said you needed and somehow ended up paying for the operation they send in Lee their hitmen his job is to get the company's money back any way he can all he has to do is find one slip-up on your application or a pre-existing condition you didn't know you had we're gonna go after this like it's a murder case and I mean the whole unit dedicated to going through your health history for the last five years looking for anything that would indicate that you concealed something you misrepresented something so that they can cancel the policy or jack the rate so high you can't pay them and if we couldn't find anything you didn't disclose on the application you can still get hit with a pre-existing denial because you don't even have to a sought medical treatment for it in some states it's legal to have what's called a prudent person pre-existing condition and that's a mouthful I know but what that says is if prior to your insurance kicking in you had any symptom which would incline a normally prudent person to have sought medical care then the condition of which that symptom was a symptom is excluded I know it's it's labyrinthian isn't it but that's how it works they're supposed to be fair and even-handed but with an insurance company it's their friggin money so it's not unintentional it's not a mistake it's not an oversight you're not slipping through the cracks somebody made that crack and swept you towards it and the intent is to maximize profits

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