Ben Askren?

[Wrestej]

1 hour ago, scourge165 said:

I just don't get why the Insurance would not pay for the transplant.

There are a whole set of reasons they won't and the only possible one would be "experimental," or some type of non-authorized procedure.

All the rest...that I know of, medically neccessary, his ability to care for himself, be able to get care to support himself financially...comorbidities, none of those would be applicable. 

 

But whatever...Dana White is donating 300-400K from what I've read and the Wrestling community is... pretty good about taking care of their own, so whatever BS reason insurance won't cover it, I'm thinking they can make up the rest.

 

All the rest of the information is great and...the most important though. 

Pretty simple reason the insurance company or companies don’t want to cover the cost of a surgery.  They don’t want to shell out the money.  Companies are in business to make money, as much as they can.  People are their product and insurance companies want to maximize as much as possible from their product.  Right, wrong, just, unjust, all irrelevant.  What is relevant is the almighty dollar.

[scourge165]

9 minutes ago, Wrestej said:

Pretty simple reason the insurance company or companies don’t want to cover the cost of a surgery.  They don’t want to shell out the money.  Companies are in business to make money, as much as they can.  People are their product and insurance companies want to maximize as much as possible from their product.  Right, wrong, just, unjust, all irrelevant.  What is relevant is the almighty dollar.

 

An insurance policy is a legal contract. They cannot just refuse a legitimate claim because "they don't want to."

They can say this is "experimental," or not medically necessary, but that's why you have oversight. 

You can file an appeal or you can ask for a 3rd party arbiter. This usually involves the medical professionals familiar with the case making an argument for or against the the treatment. 

 

And insurance company denying a legitimate claim in a high profile case is going to end up costing them a lot more.

 

We all get insurance companies are shady, but they can't operate with impunity. I'm sure the Askren Family and Doctors are figuring it out, but if they're denying the transplant... I would hope it's not for a "valid" reason. 

[Wrestleknownothing]

21 minutes ago, scourge165 said:

 

An insurance policy is a legal contract. They cannot just refuse a legitimate claim because "they don't want to."

They can say this is "experimental," or not medically necessary, but that's why you have oversight. 

You can file an appeal or you can ask for a 3rd party arbiter. This usually involves the medical professionals familiar with the case making an argument for or against the the treatment. 

 

And insurance company denying a legitimate claim in a high profile case is going to end up costing them a lot more.

 

We all get insurance companies are shady, but they can't operate with impunity. I'm sure the Askren Family and Doctors are figuring it out, but if they're denying the transplant... I would hope it's not for a "valid" reason. 

You are assuming a frictionless world. But in reality they deny first and count on the insured not having the will, the means, or the knowledge to sue to enforce their rights. And they play the numbers. If they deny Ben, and everyone like Ben, then maybe Ben will sue and win, but the rest won't. Net win. It is a cynical, but effective strategy.

[scourge165]

Just now, Wrestleknownothing said:

You are assuming a frictionless world. But in reality they deny first and count on the insured not having the will, the means, or the knowledge to sue to enforce their rights. And they play the numbers. If they deny Ben, and everyone like Ben, then maybe Ben will sue and win, but the rest won't. Net win. It is a cynical, but effective strategy.

Yeah, I understand that. But in a case that's this high profile...really in any case in which someone needs a transplant, you have people at the Hospital who will help you with the Insurance.

 

For lesser things...even medications, they will deny, but this is on ESPN. I'm not expecting purity from Insurance companies, I'm expecting pragmatism. 

And I would think Ben's wife and all the people around him would be pressing and looking for questions. He has Dana White in his corner. 

 

So it's making wonder if they're using a legitimate reason to deny the claim. 

[BruceyB]

9 hours ago, Truzzcat said:

His infatuation with breaking news before Ben's wife does is rather insane.

I thought the same thing. Amy releasing her statement, and then undoubtedly giving one of Ben's closest friends, of over 20 years, the okay the use Flo's platform to provide a thoughtful, personal, and emotional account of what has been taking place for the last several weeks was undoubtedly the way this should have gone. Minnow trying to squeeze in was gross.

[BruceyB]

1 hour ago, 1032004 said:

$14 to ship a t shirt in 8 weeks, you’re killing me Rudis

 I just went back to check. I'll be curious to see who gets their's first.

[Wrestleknownothing]

2 minutes ago, BruceyB said:

I thought the same thing. Amy releasing her statement, and then undoubtedly giving one of Ben's closest friends, of over 20 years, the okay the use Flo's platform to provide a thoughtful, personal, and emotional account of what has been taking place for the last several weeks was undoubtedly the way this should have gone. Minnow trying to squeeze in was gross.

It is equally gross that people continue to give him information so that he can squeeze in.

[1032004]

1 minute ago, BruceyB said:

I thought the same thing. Amy releasing her statement, and then undoubtedly giving one of Ben's closest friends, of over 20 years, the okay the use Flo's platform to provide a thoughtful, personal, and emotional account of what has been taking place for the last several weeks was undoubtedly the way this should have gone. Minnow trying to squeeze in was gross.

Bader mentioned there was a group text and did say Ben asked for wrestling results (which Minnow said but Amy’s post didn’t), guessing he somehow got one of the guys on that text chain to share with him

[1032004]

Reminder of how Minnow and Askren feel about each other.  Of course, Askren’s feelings were justified but then Minnow got butthurt

 

 

[HokieDave87]

41 minutes ago, BruceyB said:

I thought the same thing. Amy releasing her statement, and then undoubtedly giving one of Ben's closest friends, of over 20 years, the okay the use Flo's platform to provide a thoughtful, personal, and emotional account of what has been taking place for the last several weeks was undoubtedly the way this should have gone. Minnow trying to squeeze in was gross.

Minnow was posting rumors from the MMA board after Tom Ryan publicly said "Amy shared with me that the family is requesting prayers but choosing privacy at this time" - ruining HS kids announcements is one thing, this makes him a genuinely bad human being.

[BarSeries]

[billyhoyle]

2 hours ago, scourge165 said:

Yeah, I understand that. But in a case that's this high profile...really in any case in which someone needs a transplant, you have people at the Hospital who will help you with the Insurance.

 

For lesser things...even medications, they will deny, but this is on ESPN. I'm not expecting purity from Insurance companies, I'm expecting pragmatism. 

And I would think Ben's wife and all the people around him would be pressing and looking for questions. He has Dana White in his corner. 

 

So it's making wonder if they're using a legitimate reason to deny the claim. 

Maybe he doesn't have insurance and just chose not to get it because he's self employed? I don't think you can even get an organ transplant unless it is medically necessary because they are so rare to get (many die on the waitlists).   It also doesn't make sense that he wouldn't have insurance though because he has an entire family.

Edited 18 hours ago by billyhoyle

[scourge165]

22 minutes ago, billyhoyle said:

Maybe he doesn't have insurance and just chose not to get it because he's self employed? I don't think you can even get an organ transplant unless it is medically necessary because they are so rare to get (many die on the waitlists).   It also doesn't make sense that he wouldn't have insurance though because he has an entire family.

Yeah...he had that hip done, that would have been a few hundred K...or you pay 1600 a month for your family. 

I'd be shocked if he didn't.

And of course, it has to be medically relevant, I was just listing reasons it could be denied and... it being experimental or low risk was the only plausible one I could find. 

The rest, he takes care of himself, he's got the resources to follow up on a post-transplant regiment, he has a support system. Basically, without knowing any of the details, you can check off the majority of reasons they could decline. 

So medically necessary, experimental are the two I don't know about...BUT, his wife certainly made it seem necessary. 

[1032004]

30 minutes ago, billyhoyle said:

Maybe he doesn't have insurance and just chose not to get it because he's self employed? I don't think you can even get an organ transplant unless it is medically necessary because they are so rare to get (many die on the waitlists).   It also doesn't make sense that he wouldn't have insurance though because he has an entire family.

Zero chance he doesn’t have insurance with a family.  Besides, Bader pretty much said only the lung transplant was the issue.  He’s been in the hospital for weeks, if he had no insurance at all I’d guess the hospital stay could cost more than the lung transplant.

[cowcards]

52 minutes ago, scourge165 said:

Yeah...he had that hip done, that would have been a few hundred K...or you pay 1600 a month for your family. 

I'd be shocked if he didn't.

And of course, it has to be medically relevant, I was just listing reasons it could be denied and... it being experimental or low risk was the only plausible one I could find. 

The rest, he takes care of himself, he's got the resources to follow up on a post-transplant regiment, he has a support system. Basically, without knowing any of the details, you can check off the majority of reasons they could decline. 

So medically necessary, experimental are the two I don't know about...BUT, his wife certainly made it seem necessary. 

As someone that lives in a rare disease space, insurance companies don't need a legit reason to deny you. They just will because they don't want to pay for it. They are there to make money and nothing else. They hope you don't continue pushing for it and just deal with it. I can't tell you all the things I've seen denied that are basic medical necessities. 

[scourge165]

42 minutes ago, cowcards said:

As someone that lives in a rare disease space, insurance companies don't need a legit reason to deny you. They just will because they don't want to pay for it. They are there to make money and nothing else. They hope you don't continue pushing for it and just deal with it. I can't tell you all the things I've seen denied that are basic medical necessities. 

Yeah, no, I get that. I'm saying if you push back, they can't deny you and they're certainly not going to deny you in a high profile case that's on ESPN.

I worked in health care for a period of time. I understand how corrupt it is. They still can't just deny a legitimate claim... 

So whereas I understand they may deny treatment for normal people from time to time, they need to have a valid reason for denying a transplant as Askren is certainly going to have the resources to challenge the Insurance company.