Coventry Healthcare Manuel Ramos, Jr., M.D. Denial of claims + potentially deadly medical directives = attempted murder for profit Newark, Delaware
My son had to go to the ER because he could not breathe. The diagnosis was cough variant asthma. Coventry healthcare is refusing to pay for this care stating my son only had a minor cough. My child could not breathe was red, then purple, then a purplish blue. This was far worse then a minor cough. They gave him a breathing treatment on at the hospital.
Manuel Ramos, Jr., M.D. is basically stating that because it was not medically necessary they will not pay for the costs incurred that night in treating my son. In his own response he indicated that if the pcp's office instructed us to seek the medical treatment we received then it would be paid. I had already provided cell phone records showing I had called my son's pcp. It was the nurse from that office that called for the ambulance to take us to the hospital.
Add to this, that a child that after 10 years of living suddenly can not breathe, what else is there to do in those circumstances but seek medical intervention. The denial of this claim, the statement that receiving medical care was not necessary, this is deadly dangerous. Some people are in such dire financial straits, they may heed Mr. Ramos' self serving heartless medical directive and put their or their children's lives at risk.
Mr. Ramos is violating the code of ethics by the AMA. A doctor is not supposed to put his financial interests above the patients. Mr. Ramos is doing just that by denying the payment of this claim. He should have his licensed revoked. It is not hard to imagine that should anyone follow his medical directive, they or their family could come to serious harm up to and including death.
Mr. Ramos is basically committing premeditated attempted murder, and should someone die it would then be premeditated murder for financial gain. I get that for him and Coventry Healthcare they rather see on of their subscriber's dead then pay for a legitimate medical claim. Why in the world are these people not being criminally prosecuted? The only subscriber's they want are healthy ones that have no need for medical attention. Should you need medical attention, then Mr. Ramos will be sure to discourage you from seeking it in the hopes that you ultimately die so that no claims ever have to be paid.
Mr. Ramos and Coventry Healthcare; in a word EVIL.
8 Updates & Rebuttals
JAFO
Atlanta,Georgia,
USA
Question
#9Consumer Comment
Sat, July 16, 2011
One quick question which could really help you. I ask because I did not see it mentioned in all your typing but apologize in advance if I just missed it. You state you provided cell phone records and/or told the ins. co. that your PCP told you to go to the ER. Have you had your PCP send a written statement confirming this to the ins. co. They are probably not going to take just your word and may be more cooperative if they had something in writing from your PCP.
JAFO
Atlanta,Georgia,
USA
Question
#9Consumer Comment
Sat, July 16, 2011
One quick question which could really help you. I ask because I did not see it mentioned in all your typing. You state you provided cell phone records and/or told the ins. co. that your PCP told you to go to the ER. Have you had your PCP send a written statement confirming this to the ins. co. They are probably not going to take just your word and may be more cooperative if they had something in writing from your PCP.
Jodi
Townsned,Delaware,
U.S.A.
Update...still being denied
#9Author of original report
Fri, July 15, 2011
Thanks for the support.
I have checked my coverage, and this is a covered item. I have appealed. In the first appeal, I explained the situation. I also told them that the pediatrician's office told me to wait for the ambulance and go to the ER. I even provided my cell phone records to prove this call took place. The Dr. that denied my appeal claimed this was a minor illness. In his letter he also stated that if the pediatrian's office had instructed me to take an ambulance it would be covered. How crazy is that, I already told him in my previous letter that is what happened and provided the proof.
I wrote a 2nd appeal letter. I pointed out his inconsistency in denying something that his last letter stated would be covered, just by the fact that I was instructed by the pediatrician's office to go via ambulance to the ER. I also restated all the pertinent facts, and provided the medical records to prove this was an asthma attack. The insurance company has chosen to just ignore that letter. I sent it certified, so I know it was received.
I will be sending the 3rd appeal letter tomorrow, certified mail of course. I will also be contacting the Delaware Insurance Commissioner regarding this issue. I will consider getting a lawyer if all else fails.
The only problem is, lawyer's charge over $250 an hour and it is highly unlikely you would be reimbursed for such expenses. Even if you go to court and prevail, many judges do not like to reimburse you for your legal fees. So the legal fees can cost more then the original bill. If the insurance company continues to refuse payment of my valid claim, I will check with a lawyer to see if I can hire him and make sure I can get reimbursed my legal fees.
It is just outrageous to have to go to such lengths to get a legitimate claim paid. When they collect their monthly fee, they do not have to chase me all over to get it. So why should I have to fight endlessly with them to get a legitimate claim paid?
When our new healthcare law was passed, we should have criminalized such behavior by the health insurance companies. What a missed opportunity.
hartdaniel
bear,Delaware,
United States of America
Where to go?
#9Consumer Suggestion
Fri, July 15, 2011
A lawyer would want to hear your story. Pretty sure you have a case there, but I am not a lawyer myself.
Acute asthma attack is indeed an emergency, and requires immediate intervention. Even ore so in children as they can bottom out faster than adults. I know you did the right thing going to the ER.
Jodi
Townsned,Delaware,
U.S.A.
Not a stretch or drama queen...facts
#9Author of original report
Mon, June 13, 2011
The FACT is that BREATHING is essential to living. The FACT is that an asthma attack is restricted breathing. The FACT is that an astma attack can turn deadly very quickly. The FACT is that it is medically irresponsible for a doctor to tell a parent not to seek treatment for a child that can not breathe. It is also a FACT that when insurance company does not pay a claim that is more money they keep for themselves.
This particular quack works for the insurance company, his SOLE job is to find excuses to deny claims...and to discourage people from seeking medical treatment no matter how necessary. In doing so he is making sure to increase profitability. It is easy to foresee how someone following his medical directive to not seek medical treatment under such circumstances can suffer grave harm if not death. So yes, this is attempted murder and murder for profit.
I have reviewed the policy and this is a covered event. In addition, the quack in his own denial letter stated that if my son's pcp instructed us to take an ambulance to the hospital, the event would be covered. I have provided this moron with my cell phone records that prove I called the pcp's office. That no other calls were made after that call. Proving that the pcp's office even called for the ambulance.
He chose to ignore all the evidence, up to and including the ER report that showed the diagnosis as asthma, and he is still denying the claim.
Always nice to hear from someone with an obvious biased viewpoint in favor of the insurance companies...but Ken I would like an intelligent response from someone that understands BREATHING is essential to living. And that understands that a doctor that dispenses medical directives telling someone not to seek medical intervention for such a serious problem in the name of profitability for their company is putting lives at risk for profit. According to the AMA it is against their ethics for a doctor to dispense medical advice to enhance their own profitability. Which is clearly what the doctor for the insurance company is doing in this case. I have reported him to the Delaware Medical Review board in the hopes that his medical license is yanked before his medical directives cause serious harm.
Ken
Greeley,Colorado,
USA
MURDER???
#9Consumer Comment
Mon, June 13, 2011
Murder would seem to be a bit of a stretch here. What would a claim refusal have to to with murder or attempted murder?
Being a drama queen doesn't really help your cause.
If this was medically necessary and your policy covers it, you should send the insurance company a letter and a note from the doctor stating the care was a medical emergency and due to time of day, holiday, availability of medical personnel, etc. could not be handled in any other way.
Chill, back off and take a new look at your policy and options.
mr rik
miami,Florida,
USA
What a
#9Consumer Comment
Mon, June 13, 2011
grade a piece of s***!
Stacey
Dallas,Texas,
U.S.A.
Suggestion
#9Consumer Comment
Mon, June 13, 2011
File an appeal with your insurance company asap. If (and I hope you did) take your child to his ped ask him/her to verify this condition. Please understand I do not know this Physician but they only write down what they think is the correct diagnosis and the billing department logs those codes according to the Charge Master that the hospital uses. Good luck to you and your child.