From Consumerist, which broke the story yesterday, the details of what happened in the woman's own words:

On Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn't necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong! On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, "We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it." WTF!!!??? I asked her, "Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o'clock in the morning?" It was then, I think it clicked in Jane's mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn't have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway? Mind you we have had Blue Cross and Blue Shield of Kansas City for less than three months, they have denied every claim we have submitted to them. EVERYONE!

Wow.

Just...wow.

She goes on to explain that nothing she did could have possibly been construed as an elective act:

I just got off the phone with the hospital and was told that the claim was not miscoded. The billing clerk told me that the wording clearly stated that I had had a spontaneous miscarriage and not an elective abortion. I was also informed that this is common practice with BCBS of Kansas City to deny miscarriage clams as an "elective abortion." For those that wondered, I didn't not have a D&C. The miscarriage was complete before I arrived at the ER.

Welcome to Blue Cross/Blue Shield's America. Where your basic health is not nearly as important as their profits. This may not be an act of Murder by Spreadsheet - but it is still a horrific, sick, and inhumane act.

What's more important is that this is, as noted by the victim and by those at the hospital she went to, a standard business practice on the part of BCBS. They make their money not by providing health care, but by denying you health care. They are in business to make you sick.

Last week, bonddad explained that this is fundamental to private health insurance. Because they are public companies, traded on the stock market, they have to deliver profits to their shareholders. That means they are under pressure to take your premiums, pocket it, and then find bullshit reasons to screw you out of the health care that you have paid for via that premium.

The question is, faced with such despicable practices - and despicable people - what can we do to fight back?

Consumerist - one of the best and, I'd argue, most important sites on the web, specializes in finding ways to fight back against crappy corporate customer service. Today they have a post from a BCBS claims rep explaining how the victim can fight back and appeal the claim. It's useful information, but as the details make clear, the system is rigged against the victim. You can't fight back alone - in such a massive market failure, governmental help is needed.

What about our presidential candidates? The Big 3 (Hillary, Obama, Edwards) have now offered their proposals. Would any of their plans help this victim?

The short answer is "no," with a qualified "maybe" for the Edwards plan. Allow me to explain.

Both the Hillary and Edwards plans rely on private insurance to somehow deliver health care to Americans. Both have a so-called "individual mandate" where people will be forced to buy insurance, either private or public. Obama's plan also relies on private insurance, but he does not have an individual mandate.

None of their plans, however, mention the more important problem of denied care. Michael Moore's SiCKO was full of stories like the one offered in this diary. Moore, like bonddad, pointed out that the problem isn't that people lack insurance, it's that they lack care - that health insurances does NOT guarantee health care. All three of these candidate plans, then, fail because they do not address this problem.

I did say Edwards rates as a "qualified maybe." That is because, although he does not propose any detailed regulations to prevent these repugnant practices on the part of BCBS, he does offer support for a patient's bill of rights.

A patient's bill of rights is intended to give victims like the woman who was told her miscarriage was an "elective abortion" some legal methods by which they can more easily contest these claim denials. Edwards is, based on my own initial research, the only of the Big 3 candidates to support a patient's bill of rights, although he regrettably does not give any details (if Hillary and Obama have gone on record supporting it, let me know and I'll update; and if not, we need to lobby them to include it).

The problem, though, is that a patient's bill of rights doesn't prevent someone like BCBS from pulling this kind of crap. It only helps you after the fact. And often you have to spend time and possibly money, neither of which you may have, to get justice against these evil insurers.

Relying on private insurance is a recipe for disaster, as it will simply witness the endless repeat of horrible stories like this one. And though some will say that the "public insurance option" that Hillary and Edwards offer would guarantee avoidance of this problem, that comes with its own concerns, especially that private insurers will dump the sick onto the public option by routinely denying their claims, causing the costs of the public option to soar, necessitating either an uncompetitive and unaffordable rise in the public option's premiums, or a politically damaging bailout. And the existence of a public option wouldn't help victims like this woman, who are already insured and are denied care as a matter of course.

What will it take for us to start demanding action from our Democratic politicians? When will we stand up and say "you need to go back to the drawing board" and craft plans that will actually address the core problem? How many more people must have their claims denied, must be victims of murder by spreadsheet, before we say "enough is enough"?