This Week In “Insurance Company Rules”: Forced To Raise Funds For Sick Friends

Bill Scher

Insurance Company Rules were in full effect this week, from New Orleans to Pennsylvania to The Hamptons, as communities rallied to raise funds for ill friends.

AmeriCorps volunteer Mark Smith has a hospital bill of more than $90,000, after relocating to help rebuild New Orleans, then getting shot in the abdomen and arm trying to stop a car theft. But the New Orleans Times-Picayune reports that his insurance company will only pay one-ninth of his medical expenses.

Despite the insurance company rules, the Friends In Need Foundation has organized a benefit this Sunday at the Mid-City Lanes Rock ‘n’ Bowl (one of the coolest places on earth, by the way) to help raise money for Mark’s care. More information here.

The Chamersburg (PA) Public Opinion reports on Kathleen Angotti’s struggles recovering from Lyme disease after her insurance company refused to pay for continuing treatment. She’s become severely debilitated and wracked with symptoms. Her family is now soliciting donations to cover their costs. The Public Opinion reports:

After the diagnosis, Kathleen was treated with antibiotics, but they didn’t help her condition. A doctor in Staten Island, N.Y., who specialized in Lyme disease, tried a different antibiotic. But that didn’t help, either.

A different tack was tried — antibiotics administered intravenously through a “pic” line inserted into her arm each day. Kathleen’s symptoms improved with the treatment, but her insurance company refused to continue to pay for it.

The line was removed and her condition deteriorated.

A month after she was taken off the IV, her memory worsened and her pain returned.

At 24, Kathleen can’t walk far and uses a wheelchair for longer distances.

She hasn’t been able to ride a horse in more than a year, her mother said, adding that Kathleen sleeps 18 to 20 hours a day. She has developed other health problems, including lupus, and she has a small tumor on her pituitary gland.

The tumor causes her to have seizures. Plans have been made to have the tumor surgically removed later this month.

Recent tests revealed she still has Lyme disease and she’s also been diagnosed with Rocky Mountain spotted fever, which is also contracted from a tick bite.

The family is concerned about funds to pay for their stay in Washington, D.C., while Kathleen undergoes surgery for removal of the tumor on her pituitary gland.

Gas cards or checks may be sent to Michele Angotti at 2821 Woodstock Road, Chambersburg 17201.

Mega-tony East Hampton, NY is losing family doctor Robert Semlear. Because of insurance company rules, he can’t afford to stay. The East Hampton Star reports:

“I can’t afford to stay,” he said last Thursday. “It’s a comment on the state of medicine today, and I’m not the only one having problems financially.”

“Insurance companies are denying claims. We’re rejected constantly,” Dr. Semlear said. “We spend hours of staff time and our own time to get authorization for tests, consults that they say are not medically necessary. Then why did we go to medical school?”

Often he suspects something is wrong and wants to order a test, but the insurance company says no, he said. “It’s not fair to the patient or the doctor. The H.M.O. C.E.O.s are raking in millions and the rest of the system is falling apart.”

And that’s how Insurance Company Rules work.

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