Sue Them To Get Your Treatment
Posted 05 April 2007 - 06:12 PM
Well, I found at least 5 cases where patients needed a procedure... ironically, in 4 of them it was a stem cell transplant. The insurance company said..."no no no experimental." The patient died or sued and won multi millions of dollars.
So..... there is a precedent (very important for lawsuits) that courts don't like insurance not giving treatment.
Don't listen to any lawyers that say you have no case. Just the way you shouldn't listen to DR's who say you have 3 years to live. Or "stop reading that fancy innnernyet"
Get a lawyer who wants to do pro-bono work. Go to your legal aid office. Run an ad in the local paper or a trade magazine. You will find a good and dedicated lawyer. Don't break out the yellow pages
Then go for it. This is just me talking out of my ear as I'm not a lawyer (but I play one on TV). But I can't imagine the insurance company that wants to risk a multimillion dollar lawsuit to fight the cost of a stem cell transplant for something as rare as Scleroderma. If they let scleroderma stem cell transplants hit their approved (and consequently costly to the company) list it's really not that bad. 10...20... 100 procedures a year. Really nothing. It's not like breast cancer or something like that.
But if they lose the lawsuit. Yikes that can cost quite a bit. And the punitive damages in one case I saw were 77 million. Ooooooh that's alot of stem cell transplants
Also juries and judges to a lesser degree do not like it when you pay for health insurance when you're healthy... and then you get sick... and the insurance company says... oh sory we won't help you. It just isn't easy to swallow...even if the fancy contract says so. One thing I've learned in court over many years (i'm a landlord) is that it doesn't matter who's right or what the contract says. It only matters what the judge or jury feels.
Good luck everyone. Fight back.
Michael in Florida
Posted 06 April 2007 - 04:42 AM
Thanks for this information. I think there will be several on this board that feel a bit better after reading it.
Play a lawyer on TV huh?? My my we have a celebrity amongst us.
Posted 06 April 2007 - 01:06 PM
Founder and President
International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099
The most important thing in the world to know about scleroderma is sclero.org.
Posted 06 April 2007 - 05:16 PM
I hope you guys know I was kidding about the "play one on tv". Remember the funny ads where the doctor from a soap opera would tell you how great some pain reliever was, and he'd say "I'm not a doctor, but I play one on Tv"
Also I think the progressive nature of Sclero lends itself well to a lawsuit. Every day of delay could potentially be a day of damage to one's body. And as we know any permanent damage to your body equates to big legal damages. So instead of suing for them to cover the procedure, include suing them for damage you incurr while fighting for your procedure. Plus legal fees.
Remember the old lady who burned herself with hot coffee from McD's. Multi million dollars in damages.
One could argue that a drop in lung function or heart function which would unlikely be reversed by a successful stem cell transplant was worth millions. I'm thinking of pitching my idea to some lawyer friends I have. I'll let you know what they say.
Michael in Florida
Posted 06 April 2007 - 06:54 PM
Don't forget to mention the role STRESS plays in disease progression and we all know how STRESSFUL dealing with insurance companies can be, not mention a lawsuit!
I like it.
Posted 07 April 2007 - 02:55 PM
I just want to say thanks for all the research you do on all the topics and then post what you find. Many thanks!