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Michael says Americans have to remember that Karen's low denial rate doesn't include claims that are only partially paid. In Stewart's case, insurance would only cover $150,000 of his bone marrow transplant based on the limit listed in his policy, which would leave him with thousands of dollars in additional bills.

"You should explain that the insurance company counts that as a claim that they approve," Michael says. "If my car gets in a wreck, you pay for the car. Why don't you just pay for the whole operation?"

When deciding how much to allot for a procedure, Karen says insurance companies contract with hospitals that are considered "centers of excellence." "If you needed a bone marrow transplantation, you would not go to the facility down the street," she says. "You would go to the best place to get the bone marrow transplantation. You would go to a center of excellence. That's what we negotiate. They do it for a rate that we negotiate."

Since Linda's testimony in 1996, Karen says the industry has taken steps to change what's wrong with the system, but they still make mistakes. "Is everything going perfectly? No. No system public or private does everything," she says. "Can we do better? Yes."

Karen and Michael agree that no one should ever lose their home or go bankrupt because of mounting medical bills. "It shouldn't happen here, and there are ways to address that," Karen says. "We should have a helping hand to subsidize working families who can't afford it. There's no question about that. ... We have to find our way through this a uniquely American solution that balances public and private. I think that's what people want."
FROM: Sick in America: It Can Happen to You
Published on January 01, 2006