Stalling Tactics To Avoid Appeal

Hi everyone!
     I hope you all are enjoying your holiday season. I know I have been doing my best to focus on family and friend gatherings and celebrations rather than typical daily life. However, I'm realizing that I can not simply stop working on important outstanding items so I'm rejoining the world today.

 It has been awhile since I've updated you about my insurance situation. When last I wrote, I spoke about ERISA and how the law is interpreted to give the client only 60 days to appeal a cancelation of benefits from long term disability companies. I also discussed how I sent in my appeal along with a second certified/signature required letter request for my entire case file to be sent to me within the month.

Yesterday marked day 20 of the insurance company signing for said letter and I have heard nothing. I decided to give them a call to check up on the progress of my request only to find out that although they had the letter in their system, and indeed signed for it 20 days ago, they did not have it marked as requiring any follow up. Therefore, for the last 20 days, the company has simply not been working on the request. According to the worker I spoke with (the one who signed the cancelation of benefits letter-- and sounded shocked to hear from me, but then smugly asked how my holiday was) they will send me all of the documentation I requested within 7-10 business days.  I'll believe it when I see it.

Just a reminder of why we need to follow up with companies even if we've gone to all the trouble to send certified letters requiring signatures.

This is not the first certified/signature required letter this company has actively avoided responding to, claiming it was mismarked in their computer system. Therefore, I'm 100% certain it's a common stalling tactic that they hope will cause the appeal to be sent in late, and allow the cancelation of benefits to stand uncontested.

I'm glad I sent the appeal in despite not having all of the information I requested, because at least the process has begun and I'm not panicking over when this box of documentation will arrive and if it will be complete. Let's say I receive the box of information at the 45 day mark-- what if it's not all there? How long would it take me or an attorney to accurately go through it?  Probably more than the week I would have left before I would need to send the appeal letter in and make sure it arrived before day 60.

At least this way, should this case go to court it is not an "easily dismissed on a technicality" situation now.

1974 ERISA Law

I've been thinking a lot about the 1974 ERISA (Employee Retirement Income Securities Act) law since I received my denial letter from the insurance company last week. (Which by the way,  yesterday I received the returned signature cards showing they received the certified letters for both the appeal and documents request).

The reason I've been thinking about ERISA is because it was noted in my denial letter and according to my research this law has been exploited by many insurance companies in order to no longer honor their obligations to policy holders. 

I found two articles/briefs that got me thinking about my own experience. Both are worth a read if you have some time. Specifically the second one that discusses exactly how this law is used against patients in insurance cases.

http://www.patientadvocate.org/index.php?p=443 

and

http://www.patientadvocate.org/pdf/ERISA.pdf

One thing I found surprising is in my own denial letter. The insurance company informed me I had 180 days to appeal the denial. However, with ERISA I really only have 60 days or a judge could throw out any future lawsuit regarding the case. 

I have a solid connection to a law firm willing to represent me, but I wanted to fully explore my options so I contacted a local firm that specializes in ERISA law. When I queried them I received a response back that this specific firm only represents the insurance companies with their knowledge of ERISA, not the patients. Of course large companies with large legal budgets are where the real money is, so from a financial perspective I understand that law firm's decision. I'm saddened though that this firm would use its knowledge to support companies known to abuse this law. 

The loopholes this law offers, I'm sure were unforeseen in 1974. However, over the years companies have discovered new exploitation methods using older laws. It's sad... and we're clearly at a point when these laws need to be changed. 

When I spoke to the insurance person who sent me the denial letter (before the denial was ever sent). He informed me this was "nothing personal"-- it was simply business. 

I would argue, "business" set up on loopholes and a year end bonus structure that encourages vilifying an honest policy holder, is very personal. Making up false claims about another human being in order to receive a year end bonus for saving the company money, is very personal. Trying to use intimidation tactics to harass a client because you know that client is not allowed a jury trial under ERISA, and you will never have to answer for that harassment, is very personal.

I am not a moral authority. I'm just an average human being whose integrity is being attacked by a company for the sake of money. And I'm wondering when the collective "we", as employees, stopped listening to our conscience and instead put all our trust in company policies meant to harm clients. 

I encourage anyone reading this to fully educate yourself on ERISA so you will have some basic knowledge should it ever be used as a tool against you. 

Denial Letters Without Using Facts

Earlier this year I posted a blog with a denial letter I received stating I was denied coverage, because.
http://themalformationofhealthcare.blogspot.com/2012/08/denial-because.html

No, I didn't forget to finish the above sentence. The denial letter I received said I was denied coverage "because." No further explanation.

It turned out the reason I received the denial was because of an inter-insurance-company problem having nothing to do with me. So when the insurance company didn't pay my claim, they had no reason for why it was denied, and therefore left the section blank. Leaving me to panic, call them, and wait until they cleared up their error and pay the invoice prior to me ending up in collections for something that should have been covered through insurance.

Ready for something to top not giving a reason for a denial.....

Drum Roll Please.....

Yesterday, the insurance policy I have held since I had to stop working due to my arteriovenous malformation and chronic myelogenous leukemia sent me a letter listing off several reasons why they have decided to stop honoring their obligation to my claim. They included not hearing back from my doctor (although my doctors name was spelled completely incorrectly and I can only wonder if she even received the documents she was asked to fill out). Partial information from a report done by a doctor who in a video taped interview stated he did not treat either condition I have. Video taped surveillance showing me go into a local business for 3 hours (without mentioning it was a dental office)...And the piece de resistance....

 because my oncologist informed the company that I was in complete remission from AML.

You can imagine my relief to hear I was in complete remission from a condition I was never diagnosed with.

Here's the portion of the letter:

Yes, this denial letter stooped so low as to deny my claim using completely false information.

AML is Acute Myeloid Leukemia. It is a really terrible blood cancer that is difficult to control. I have known two young adults who have battled this disease. One survived it and one did not.  AML is treated with aggressive traditional chemotherapy and often a bone marrow transplant.

I have Chronic Myelogenous Leukemia-- a completely separate condition that currently has no proven "cure" outside of a bone marrow transplant. Fortunately for me, as long as I take a daily chemotherapy pill my chronic leukemia is kept at bay in the body. It is not a traditional "remission" as suggested by this letter. It is a conditional cytogenetic response to a daily chemotherapy drug.

I sent in the appeal letter today correcting their misinformation and requesting my policy to be reinstated. Should this company deny the claim a second time my only recourse is to hire an attorney.

Health Care and Religious Freedom

Can we stop all the shrouded discussion on this topic and call it what it is? The reason religious freedom is being brought up with regards to the new health care law is because of the issues of women's fertility and money. With that I mean contraception, abortion, and the cost to care for the sick.

This is article I read this morning: http://firstread.nbcnews.com/_news/2012/11/26/15456408-supreme-court-opens-door-to-universitys-health-care-challenge?lite

In the article Liberty University is contesting the individual mandate for health insurance due to their belief that because most health care policies allow for abortion and contraception Liberty University's religious freedom is being trampled on (fertility). They are also contesting the section of the bill that states employers must provide health insurance or pay a penalty (money).

You might be wondering why this is coming up again since the individual mandate issue was already discussed and decided on earlier this year by the Supreme Court. The answer is there will always be someone, or a group of someones, who look for ways around decisions. I'm not saying this from a liberal or conservative perspective, I'm saying it from a historical perspective. Our country was built on disagreements and loopholes (example- all men are created equal, but slavery is fine).

The Supreme Court's decision about the individual mandate, earlier this year, was in relation to state's rights.  Liberty University is a private institution and often times private institutions do not have to adhere to certain state or federal laws. Loophole.

I suppose what bothers me about what Liberty University is doing here really comes down to the issue of money being wrapped up in a religious cause. When I think about spiritual principles in health care, I think about caring for the sick, and the poor. I don't think about legal battles to deny coverage for the sick and the poor using convenient loopholes in man made policies.

I feel like there is a disconnect between what the law is intending to do and some religious reaction to it.

Here's an example of what that disconnect can do (note: this happened outside of the United States).

 http://www.reuters.com/article/2012/11/23/ireland-abortion-idUSL5E8MN7YM20121123

A woman visiting Ireland died of blood poising after being denied an abortion when she was already miscarrying. There was no saving the fetus at the point when the woman asked for the termination. However, because of Ireland's anti-abortion law, she was denied the medical assistance necessary. The miscarriage lasted for three days, which presumably caused her body to become septic and she passed away. Abortion in this case would have been used not for the ending of a life, but the saving of life. Which is why I become frustrated when some believe abortion is a cut and dried issue.

We need to reconnect to the human side of health care. If we boycott coverage for medical procedures and people on the premise of religious freedom and an otherwise healthy individual dies because of that boycott--- who is at fault?

I would argue unexamined principles. When we fight so hard against something often times we become blind to the full picture. We focus so intently on the rabbit, that we miss the lion about to pounce.

Thanksgiving for Non-Profit Groups!

Thanksgiving is this week and I'd like to take a moment to thank all of the advocacy groups out there dedicated to helping those struggling with health care.

Groups like

The Patient Advocate Foundation:  http://www.patientadvocate.org/about.php?p=901 
that has an online web-chat to answer specific questions a patient may have regarding insurance access, job retention, and medical debt.

P.S.I/ Patient Services Incorporated: https://www.patientservicesinc.org/how-we-help/default.aspx
that offers co-pay assistance to some patients on extremely expensive medications.

Sy's Fund: http://sysfund.org/
that encourages young adults battling cancer to also pursue their artistic/ life goals outside of their health  battle.



There are so many wonderful organizations out there that I would be remiss to try and name them all. However, I am happy to update this post with additional references if you simply comment below with the name of the organization and what it focuses on.



Blessings to you and yours during this holiday season!

Basic Tips on Working With Health Insurance

As many of you are aware The Malformation of Health Care book just became available on Amazon.com

 http://www.amazon.com/dp/B009V37CXU

In the book I detail several tips and tricks on how to navigate through our very complex and often times confusing health care system.

Today I want to take you inside the book and give you some basics of where to begin. Although some of these may seem obvious, they are often things that are overlooked when thrown into a stressful situation.

Checklist for Health-Care Rights and Service

Know your benefits: Get a printout from your insurer and know your deductible and out-of- pocket maximum. This way, you can track what you are responsible for. Be an educated consumer.

Ask for a case manager. This is a contact person within your insurance company who will know your case and be of real benefit to you if it is a complicated one. If your insurance company says you can't have a case manager, keep asking. Once they see all the claims coming in, most likely the company will change its mind.

Keep all of your insurance claims and bills/booklets, which you can usually do online. Keeping hard copies is probably a good idea, just in case your computer or backup drive dies.

Appoint an organized family member/friend to help you with all of this because it can be overwhelming␣especially if you're sick.

Reach out to a hospital social worker or to local nonprofit organizations (such as the Cancer Legal Resource Center, the Leukemia & Lymphoma Society, etc.) for ongoing help or support. They will know of good resources to help you if you're in trouble and can save you a lot of legwork.

Write down the name of anyone you speak with at your insurance company every time you contact your provider or your provider contacts you. Make sure you record the full name, date, and a detailed synopsis of the conversation.

Follow up!

If you are denied coverage, do not be afraid to appeal. Jump through all the hoops the insurance company asks of you, and document everything. If, at the end of the appeals process, you need an attorney, you will have something to give him or her.

Learn all you can about your condition. A lot of times, insurance company workers know little about your condition.

Check with your insurance company about its fertility policies. I include this advice because many young adults are diagnosed with serious illnesses that may require heavy medications and treatments. At the point of diagnosis, someone who is in their late teens may not be thinking about future plans for a family.

Have a relationship of open communication with your doctors, who can help to advocate for you. Know that there is creative coding for blood tests and other procedures you may require to facilitate your health. A test that might not be covered if coded in one particular way may pass muster with your insurance company if coded in another way.

Know your out-of-network benefits! Sometimes you may be referred to specialists who may not be in your insurance company's network␣ What is the percentage and how does your out-of- network benefit work with your deductible? Do any of the company's in -network doctors offer the same care as the out-of-network specialist to whom you have been referred? If not, most policies have provisions to cover out-of-network providers when no in-network doctor has the same capability.

Try to connect all of your doctors, so that each knows about your health in relation to the other physicians providing your care. If you can start a group dialogue among your doctors, your care will be better.

The Malformation of Health Care (Chapter 25) Copyright Erin Havel 2012

November is National Caregivers Month

In case you missed it...

http://www.whitehouse.gov/the-press-office/2012/11/01/presidential-proclamation-national-family-caregivers-month-2012

President Obama issued a proclamation that November is national caregivers month.

I'm really glad there is beginning to be a larger recognition of the people that so many of us are grateful for every day.

Caregivers are the unsung heros in illness.

The patient is called often times called "strong" "survivor" "amazing"
but these words absolutely also describe the caregivers behind the patient. Caregivers are the ones who hold everything together when the patient doesn't have anything left. Caregivers are often the ones who make sure the patient is getting to their appointments, fighting with insurance, managing the household. Caregivers are the ones who put on a brave face and offer encouragement and support.

Caregivers are simply the greatest advocates patients have during a battle.

I for one, want to take this moment to say THANK YOU!!! to all the amazing/supportive/unstoppable caregivers in our lives.

"Obamacare is the law of the land"

"Obamacare is the law of the land"

That was one heck of a quote this morning from John Boehner, Speaker of the House.

Did we all know the Affordable Care Act "happened"?  Sure.

Did many people think if Mitt Romney became president that law would be gone? Yup.

So today hearing the top Republican concede that "Obamacare" is here and will not so easily be done away with, was fascinating.

Now he also quickly added that Republicans remain committed to repealing the law, but I don't know if the American public will be pleased if the next two years are spent with constant attempts to simply do away with the law rather than working to improve it.

There is no easy way out on this topic... these two very different parties are going to have to come together and actually work for the common good.

This will get interesting.

Tomorrow Will Preface History

Is anyone else excited about the presidential election tomorrow?

I can't help myself. Election day is very exciting for me. I love that the majority of our country is waiting to hear who will take the reigns of America for the next four years.

I love the passion shown from both sides during the campaign.

Watching the trend of some good presidents and some less than good-- the day before the election leaves us with uncertainty of what is to come so it offers cautious optimism about the future.

We don't know how well or not well the nominees will do once they hold the coveted position... but we have hope whomever it is will do amazingly wonderful things for us and our future.

Here's to hope!

Please get out and vote tomorrow! Be a part of this incredible process!

Arteriovenous Malformations--AVMs

Arteriovenous Malformations are incredibly rare. They are among the list of conditions that most doctors don't know anything about. I was born with an AVM so I have been "medically fascinating" to most doctors I've come in contact with for the majority of my life.

This is good and bad.

The good is that I am relatively well spoken and I don't mind answering questions because I want more doctors to be aware of AVMs and what they do.

The bad is that there are still doctors who do not know how to treat these conditions but want to "try."

AVMs as I discuss in my book

(The Malformation of Health Care http://www.amazon.com/dp/B009V37CXU)

show up when a fetus is developing. In order for the gestational period to do what it is supposed to do, extra blood vessels show up to help grow the fetus. Usually these extra blood vessels do their job and then reabsorb in the body. However, for one percent of the population, those blood vessels think they still need to work so they become tangled and complex in a body that isn't supposed to house them long term.

I didn't find a doctor who knew how to treat my AVM until I was in my mid-twenties. Prior to then, I had a doctor who tried to "cut" my AVM out. This caused the AVM to grow more rapidly and out of control. I of course didn't know that at the time.

We tend to put faith into our doctors. The point of this blog is to encourage those dealing with an AVM or a child with an AVM to seek out a second opinion with a doctor who really understands and actively treats this condition.

My particular AVM should not have been cut into. Ethanol embolization treatments ended up being the way to go for me.


Here's an article on my doctor. He's one of the top docs a person with an AVM can see. I highly recommend Dr. Wayne Yakes as a second opinion if a person is questioning how to treat an AVM.


http://www.denverpost.com/popular/ci_19016626


I also highly recommend http://www.avmsurvivors.org/ if you want to talk to others dealing with the same condition.

This Drug is More Expensive---Therefore It's Better

I read this article the other day:

http://www.bloomberg.com/news/2012-10-25/novartis-cannibalizes-gleevec-to-boost-new-cancer-drug.html

Basically what it comes down to is that a drug company who makes a very expensive medication to save lives of those living with Chronic Leukemia is about to have their patent run out. Therefore, before the patent runs out and the drug is allowed to be made generic, they are attempting to raise awareness of their second line drug which has a longer patent in place.

I have no problem with making patients aware of another drug available to treat the same condition. What I struggle with is that the first drug (that is about to go generic) is a powerhouse that has saved hundreds if not thousands of people from an early grave.  What this company is doing, in order to make sure their profits continue to soar is they are attempting to sway doctors to the more expensive drug by saying that first drug is less effective.

Both of these drugs have been around for a decade. I feel like money is driving care in this scenario, and that makes me uncomfortable.

Truthfully, if a person is unable to take a generic for whatever reason then their options are limited--- but if there is an option to save your life by paying $500 a year for a medication that used to cost $5,000 a month prior to generics. My vote is save yourself from bankruptcy and stress--- stick with what works, and don't play health games over profits.

What do you think?

Who Will Make Insurance Companies Happy?

With the 2012 Presidential election just a little over a week away I can't help but wonder the fate of the Affordable Care Act.  I also can't help but wonder who some of the heavy hitting health insurance companies are hoping will win.

I read an interesting article today:

(http://www.huffingtonpost.com/2012/10/28/insurers-nervous-obamacare-repeal-romney_n_2033580.html?utm_hp_ref=business)

The article began by saying the health insurance companies are afraid of a Romney win because he has guaranteed to overturn the law--without saying how. The fear is the insurance industry would lose the potential profits to be made from the individual mandate.  Along with the fear of not knowing what a Romney administration would do with health care because there has been no plan laid out for when they pursue repeal.


However, I can only imagine the uncertainty of an Obama win. Keep in mind the health insurance industry was not happy about this new law, they found ways to work with it, but they weren't fans.

I think deep down the industry, and most of us understand

This law is not in its final form. It is a starting point.

There's no putting the genie back in the lamp. Health Care IS a topic that will be addressed and addressed again over these next several years.

For now we all must vote for who we believe will do the best with our country and then sit and wait to see what will happen. If I were to guess, I don't think the health insurance market is too eager for either candidate to win this election. Their situation is on shaky ground.

The Book is Now Available on Kindle!

Big News!

As of this week, The Malformation of Health Care is now also a book! 

If you have enjoyed reading this blog so far, I encourage you to learn more by downloading the Kindle version via Amazon.

Here's the link:

http://www.amazon.com/The-Malformation-Health-Care-ebook/dp/B009V37CXU/ref=sr_1_1?ie=UTF8&qid=1351105974&sr=8-1&keywords=the+malformation+of+health+care

Feel free to share it with anyone you think may be interested in delving more into a discussion about our current American health care system.

Thank you for your continued support!

On A Personal Note

Many of you know that there are four states (Washington, Maryland, Maine, and Minnesota) that have referendums or initiatives on the election ballot for November regarding equality. 

I usually keep this blog relatively specific to the public situations of health care. 

This year has been a real journey for me, however. 

I think I've been afraid to speak up about my sexuality and spirituality where backlash was potential, for a long time. Speaking about my health care journey at the Seattle Women's Choir Equality rallies and shows was easy because the supporters outnum

bered anyone who might disagree. 

Playing my music at GLBT affirming clubs and churches was never a problem, because everyone understood. This year particularly I've had to make some choices. I was conflicted about discussing sexuality and spirituality in my book about health care, even though both are huge parts of my life. I ultimately decided I needed to be honest and tell it all. I'm not ashamed to be a spiritual, faithful, believer in God. It's not a contradiction to love and believe. This year has been filled with baby steps that I didn't even realize I needed to take.

I thought I was "out" but I was only "safely out." Sometimes we have to speak up even when we're uncomfortable, even if we're scared--- because the only way things can be better for all people is when individuals come forward and tell the truth. Domestic Partnerships are separate and not equal in health care and many other ways. I know this, not from research, but from my own life and the lives of my friends.

These votes are not about my relationship. They are about all relationships. It's hard to know what life would be like to not have to fight for something like this. It's hard to know what it would feel like to not have groups dedicated to making sure others look at me as an abomination. It's hard to know what it would be like to meet someone, fall in love, and simply start planning a wedding with no legal barriers.

I'm less thinking about myself and more thinking about the children who come after me. Wouldn't it be nice if they never had to feel like their love was "less than." Wouldn't it be nice if everyone understood that God is love, and therefore real love, can never be "less than".

Link to my speech about Health Care and Referendum 74

http://www.youtube.com/watch?v=au-dXE7L6jQ

Link to something else that touches my heart:
http://www.youtube.com/watch?v=hlVBg7_08n0&feature=share

The Power of Your Words: Phonebanking

We aren't all lucky enough to find a public platform to share our personal experiences with large audiences.... however...

This week has been eye opening for me.

I've been blessed several times this past month to talk a bit about my health care journey in conjunction with the Seattle Women's Chorus during some of their performances. Due to this exposure, I've been freely given the immediate feedback of kind faces, and gentle hands placed on my arm as soft words thanked me for my courage to speak up.

I like face to face interactions. I like the power they have. I like the energy in the room.

Then last night a friend told me a story about phonebanking.

I will 100% admit I'm uncomfortable with phonebanking. Despite the good I've been told it does, I've always looked at it similarly to telemarketing---which actually caused me to disconnect my house phone awhile back.

I'm bugged when I get political phone calls on my cell phone where someone asks me if I have time to talk and then asks me one question. When I answer the question in a way they weren't hoping for, they don't continue the dialogue they simply say thank you and hang up. What is the point of that?

A little background before I begin the story:

My friend now lives in a wonderfully diverse urban setting. Her entire family, however, lives in small town rural America. From the stories she's told me, many of that family just simply hasn't been exposed to as much of the diversity that my friend has, and this has caused frustration, confusion, and even all out angry fights.

There is nothing wrong with these people. There is nothing evil about these people. There is nothing hateful about these people. It is simply a matter of exposure. When you never meet an actual person that falls into a category others tend to criticize, how would you know anything other than the critical words?

As my friend was at work on Friday she received a phone call from her mother saying she had made a decision to support a local referendum. A referendum my friend was certain would not be supported by anyone in her family. This, quite frankly, FLOORED my friend.

She immediately called her mother to find out what had changed.

Turns out, another small town community member was a part of phone bank that day and happened to be the one who called my friend's mom. He was polite and genuine and simply had a heartfelt discussion with this woman.

After the call ended, my friend's mom changed her mind on the referendum... because she took the time to really think about her vote. She realized how much power her vote had in the lives of "others" she's never even met.

While I am glad to be able to share my story with the crowds of people I've spoken to, I've really had more of a "preaching to the choir" effect. The people in the audiences do have reach to others, but mostly those listening already understand my point of view.

This one phone banking person, on the other hand,  was able to reach the unreachable.....

now that's saying something.

Saying Thank You!!!!

This is not your average blog post.

When you are passionate about a project and you have no idea how to accomplish it, you "get by with a little help from your friends," as the Beatles song says. 

I am so incredibly thankful to everyone who is helping me achieve my goals.

 Today however, I wanted to give a shout out to a very special group who helped me along the road these past couple months.

Special Thanks to:

Anna Koopman

Cordae Wright
Matt and Colleen Fuller

Laney Williams

Carol Zaura

Joshua Caniford

Sean McLaughlin

Dayna Sweders

Brigette Menoni Brankin

Linda Stanley

Bobbie C.De Baca

Mary Jo Braun

Jon Grigalunas

Katie Vadnais

Cathy

andrew rasmussen

Ruby Dee and the Snakehandlers

Mori Marchany

Amy Petersen

Aaron Cassara

Jill Sunderbruch

I-Wei Feng

Kate Wehr

Cheryl Jacobs

Shari Rosner

Lauri Boren

Rosemarie Coy

Nicole Simon-Burton

Tim Bruhn

Diana Roger

Beverly Lippe Terlep

Peg Pedersen
Betty DeBace

Jane Healy Brown

RIchard Hein

Khanh Doan

Leslie McQuade

Chad Jessup

Elaine A. THEUS

Anthony Elizondo

Justin Kreitzburg

Travis Mccauley

Kathleen Wake

Stephanie Nguyen

Joleen Schultz

Amber McGuire Lemar

Sue Kolasinski

Jessie Oettinger

Carrie Walsh Engberg

Thomas Dunham

Nicole DeBace-Rech

Justin Ozuna

Judith L. Miller

Ande Harwood

Martha Plummer

Jennie Gustafson

Katrina Lehto

Betsy Bruce

martha Luna

Anna Bevens

Tiki Naccarato

Jody Mayer

Daniel Rech

Jacinthe Assaad

Cassandra Brackmann

Elizabeth Granger

Carol Baker

Caro Horsfall

Duane Cuthrell

Darbie Whitman

Mary Jo Weaver Larson

Julia Colson

Matthew Browning

Claire Mouflard

Jenni Thibedeau Redman

Ruthy Lewis

Kathryn Doane

Jane Maranhas Kruse

Emily Sharp

 Nancy Balderas

Ric Firmino

Joel Duldulao Agpaoa

Peggy Gilmer

Nancy Bent

Mary Jelinek

Brian George Kerr

Selina Emlen

Kory Riley

Cheryl Cristello

Geneva Harwood

Eric Larson

Scott Welch

Bruce and Mary Claire Havel

Denial Because...

I couldn't make this letter up if I wanted to. Therefore, I decided to post it for you.

If you read the letter you will see that the insurance company will not pay for the prior authorized visit to a doctor I went to "because"

Sincerely,

Claims Department

That's right, they didn't say why, they just said "because."

It's okay to laugh. I did after I got over the shock of getting a denial letter for a prior authorized appointment.

The company is based in Florida and if this was my first rodeo with an insurance company in Florida I might think "oops, someone sent this by mistake." However, attached to this notice of denial is also my EOB (explanation of benefits) reiterating the fact that my insurance company (that I faithfully pay every month) will indeed not cover this appointment they authorized me to go to.

The truth of the matter is Florida has lax regulations on insurance companies. They're not the only state with these lax regulations, but you have to question why so many of these companies avoiding their obligations are based in certain states and not in others.

In general American's don't like "regulations"--- there is a fear that "regulations" will lead to a communist system. I think that's a bit of extreme thinking and there is no way our country would move briskly to a non-capitalist society based on regulations for companies who are clearly not working for the best interest of their consumers.

All regulation means (in this case) is the loopholes, games, and tricks these companies play to gain the most profits based on denying coverage would be accountable to review. I personally think that would only improve our health care system.

Or maybe we will all begin to accept letters without question that say "We will not cover your care, because."

Political Platform to Prevent Coverage

I don't know if you all saw the story of Jackie Curtiss, the 22 year old Republican who voiced her concern over the new party platform on abortion.

(http://www.buzzfeed.com/zekejmiller/meet-the-22-year-old-young-republican-who-challeng)

Here's what that article says:

"Curtiss made waves in the committee when she objected to an amendment to the platform banning medication "that terminates human life after conception." The amendment was aimed at RU-486 and other so-called “abortion pills," but Curtiss warned that it could potentially include the “morning after pill.”

"Nevertheless, the amendment passed and found its way into the party’s 2012 manifesto."

That is one slippery slope folks...

The reason I'm raising concern is not because I'm anti-Republican or because I'm voicing judgement on abortion at all-- but rather because I am pro- life for people who have cancer, RA, and other major illness.

Most chemotherapy medications have warnings that state women may experience spontaneous abortion while taking the medication.

This platform doesn't differentiate between drugs, it just bans all medication that "terminates human life after conception."

I understand what the Republican Party is trying to get at, but if we aren't incredibly clear when we document our ideas unintentional problems can and will arise.

Health Care or Political Football?

When you're getting ready to buy a car, it happens. When you're trying to have a baby, it happens. And apparently when a presidential election is about to occur, it happens.

You see what you want EVERYWHERE.

Perhaps you decide on a Honda. Guaranteed you will see more Civics on the road than ever before. Want to have a child? Your office will flood with pregnant women. Want health care? Every political discussion will taper back to your topic.

While I knew health care was going to be one of the political footballs used for punting in this election, I still find myself frustrated.

For the kick off -the political ad about the man who lost his job and then his wife passed away from cancer. The return- if that patient had lived in Massachusetts she wouldn't have died. The tackle- the person who put the Massachusetts law in place wants to repeal the federal equivalent. New line of scrimmage-- the little girl's father whose company let him go because his daughter needed a transplant.

These stories are hard to hear, and they seem to fire up both political parties. However, they are not new, they're not even unique. They happen every day, in every state.

Why is it that we are only interested in hearing about these horror stories when an election is on the horizon? We should be outraged and concerned even when political ads are not invading our favorite evening television program.

Did you hear the one about the 90 year old in the nursing home? How her coverage ran out? Probably not. It's not as powerful when we're talking about Grandma.

These political teams pick and choose the most effective stories to "expose" and while it is supposed to serve as an example of what is going on in our country, it seems like we as viewers get tunnel vision.

"This is the story I heard about, it's a fluke."

The "fluke" is that we are only hearing about a very small number of people struggling daily and until we decide health care is not a political football and make sure everyone in this country is adequately cared for, we just keep playing a game.

http://www.kickstarter.com/projects/1139799717/the-malformation-of-health-care

November, 2012!!! Vote for--- Medicare?

Tonight Mitt Romney chose a running mate. (drum roll please)...Paul Ryan, of Wisconsin. I'm not surprised he chose Mr. Ryan whose plans to phase out Medicare and Medicaid were widely publicized recently.

In order to distance himself from "Romneycare" it only makes political sense to find a running mate who has put significant time and focus into plotting out ways to rid our country of safety net health care, for the elderly, the sick and the poor.

Perhaps this decision will boost the health care dialogue for November. In that sense, I'm thrilled with Mr. Romney's choice. My concern is the PR "spin" this new campaign will put on the topic of health care. They will talk about all the money wasted on caring for those who have no other health support.

It is important we listen to the message behind the words that will be spoken regarding Medicare and Medicaid. We must remember these are not "programs" to be cut, these are "people" to be cut.

Passion for Purpose

As many of you know, last year I connected with a group of people on a mission. The mission was to discover our passions and how they could translate into purpose.

I have many passions. I am passionate about music, I am passionate about my family, I am passionate about making a difference. Before this journey I would not say I was "passionate" about health care. I was just struggling to work through a system that was not easy. The best way to describe my relationship with health care was persistence, but not passion.

However, I had a fire in my stomach for social justice and this system stoked that fire more and more. I believe we are given recurring themes in our lives that build and shape us to become warriors for good, if we're willing to accept the challenge.

Over this last year I have accepted my desire to help others so they may not have to struggle the way I did. I have recognized how that ties into health care, and how ultimately that really is the clearest passion for purpose path I've been given.

I am educating myself daily to try and build my understanding of this passion. I am recognizing there is no "one right answer." I am learning from people I agree with and those I disagree with.

Passion for purpose is not an easy road--- but so far it is rewarding.

What unexpected passions do you have? How can you use them for a greater purpose?

"Obamacare"

I find it completely fascinating how so many people in our country are anti "Obamacare," not the Affordable Care Act. It seems many have latched on to the catchy phrase and divorced its meaning.

I don't know who convinced anyone that calling the law by its proper name equated to supporting socialized medicine... but there are some who believe this.

The Affordable Care Act, no matter what name you want to call it, has some good and some bad, but it is most certainly not socialized medicine. Last I checked, socialized medicine didn't have anything to do with privately held insurance companies being allowed to step in and charge. That's maintaining a capitalist system.

There are people who like President Obama and don't like the Affordable Care Act, just as there are people who can't stand President Obama but appreciate some of what the Affordable Care Act will do for them.  This is not a simple "Obamacare is socialized medicine" situation, and I'm offended by those who believe it is. 

Health care in this country should not be about who is president, and it should not be about catchy words. Health care should not be based on which party is in office.

In my mind health care should be about a sick person going to the doctor, paying for the service, and leaving with recommended treatment.

Currently that system is not what we have. 

Some people have the above scenario and others have this one:  

A sick person checks with their insurance company to see if their doctor will even see them based on accepted rates, goes to the doctor and listens to what treatments they need but may or may not be covered by their policy, the patient then appeals to the insurance company to please allow them to have the treatment their doctor prescribed, hires an attorney to step in when their final appeal is denied because paying for the treatment would cut into the insurance company's bottom line, and the patient potentially goes bankrupt while all of this goes on, because they are forced to decide between life and money.

I would like to refer individuals who believe "Obamacare" to be socialized medicine to a book by Wendell Potter called Deadly Spin. In the book he talks about how Public Relations companies and PR executives used the words "socialized medicine" any time privately held insurance companies looked like they would have to start being accountable for their actions. 

Don't buy in to catchy phrases... educate yourself and decide on your own what the catchy phrases are masking.

Kickstarter and The Malformation of Health Care

Have you thought about ways you want to change the world?

This blog and its facebook group counterpart ( https://www.facebook.com/groups/352009698155992/)

works diligently to try and do just that.  

I've found that the more we tell our stories about pivotal life experiences, the more others learn and the more positive change we can create!

With this in mind I have decided to launch a kickstarter campaign to further share my health care journey. In my book, I discuss some of the pitfalls in the American health care system, I offer tips on struggling through the system, and offer encouragement for others to use their experiences to help create positive effective change in our world.

Please take the time to view my kickstarter pitch here:

http://www.kickstarter.com/projects/1139799717/the-malformation-of-health-care

If it strikes a chord with you, please share it so the campaign will have the potential of going viral and doing the most good.

Together we can do incredible things!!! Here's a small step :) 

Gun Control or Mental Health Care? Aurora, Colorado

The shock of today's mass shooting in Aurora, CO has reignited the on again/off again debate about gun control. Apparently last year Aurora was listed as one of the safest places in our country to live.
Then this happens, and guns are the main topic of conversation.

Is it the correct conversation though?

Might I propose that a city is only as safe as it's most mentally unhealthy and untreated member?

Folks, the kid that did the shooting was described in numerous media outlets as a "normal" 24 year old who was active in his mainstream church. So far as we know, he wasn't into gangs, or drugs, or any other lifestyle that might endanger his stability.

If this man was as he is being described, then clearly there were mental health issues lurking.

Who knows, maybe he talked to a professional at some point about his inclinations, but my guess is he didn't. People in the psychiatry world would have to report someone who was a danger to himself or others.

If we start examining how mental health is treated in this country we will see a trend. Often times when those who need mental health support look into that support, they find pitfalls.

Insurance companies have largely avoided solidly covering mental health for years. At a higher co-pay, after the correct code is entered, if a patient is referred, records that are returned to the military... Pick a hoop to jump through.

Say the person decides help is worth all the struggle that is required by a company or policy---that person needing the help may receive four or six sessions with a professional. If they need more than that, most policies will re-evaluate from that point forward but there's no guarantee they won't cut a person off. Mental health isn't a broken ankle. Some people need a few sessions to help them through a tough situation, and others need long term care.

Why isn't there a huge unstoppable uproar when it comes to caring for these people? Why does the uproar only happen when someone doesn't get help and tragedy strikes?

The Affordable Care Act is taking a step by bringing parity between mental and physical health and that's great. We as a society need to go further though and stop vilifying the people who get help before a disaster occurs.

Personally, I would much rather demystify and de-shame the policy of going to a mental health professional than watch another shooting take place.

So sure, we can keep talking about guns and gun control. I 100% agree that the right to bear arms wasn't intended to include "oozies", but is that really the conversation this tragedy should spark?

Fighting Against Health Care... And Fighting For????

Am I the only one frustrated with politicians fighting against health care continuously?

I understand those who believe the Affordable Care Act does not go far enough. I even understand those who feel the Affordable Care Act has too much government involvement. What I do not understand is the lack of other suggestions that may spark a dialogue to help improve our health care system.

Today the House of Representatives voted to repeal The Affordable Care Act... for the 33rd time. Normally at this point I would say "that's an exaggeration, it wasn't really 33, it was____." Unfortunately, there is no exaggeration in this case. On 33 separate occasions the House has wasted valuable time and money to beat the proverbial dead horse.

This latest repeal effort (again) has no chance of passing through the Senate to arrive on the presidents desk. Even if the president did see this repeal, he would not sign it. From every news source I've seen today, the general consensus is this was yet another political stunt to avoid fighting FOR something helpful... perhaps the Jobs Bill... (just a suggestion).

Rather than grandstanding, can you imagine the positive accomplishments these very powerful people could instead be celebrating?

Fine.

If everyone is so hung up on this health care law that no other bill can be considered, why not present positive suggestions to improve the bill? Fight for clear and specific ways to be more efficient and offer more security for the common man/woman. Don't junk the good and the bad of the law, work on it! Be the champion of a well cared for healthy society.

This bill, no doubt, will be massaged over the decades just as Medicare and Social Security were. Many great minds have worked on those projects. I challenge the members of the current House who continue to fight against health care to instead make their mark as the newest great minds who history will remember for helping a nation heal its people.

Supreme Court Health Care Decision

At the end of this month the SCOTUS (Supreme Court of the United States. for those who may have not seen the acronym before) will be deciding on the Affordable Health Care Law's mandate to require every US citizen to buy health insurance.

Is it wrong to say I'm conflicted?

In one sense the mandate must stand because it will help fund all of the positive features of the new law. People have been struggling with insurance for many years now (in my opinion more so since health insurance companies were allowed to become publicly traded businesses). These positive features in the law really should not have been something "new" or a "kindness extended" to those purchasing policies. These are common sense practices that slowly were removed from policy holders over years. The law attempts to partially regulate an industry that has derailed with greed. Having this law remain in tact will send a signal to the insurance companies that they are now being monitored and can not simply deny someone's treatment to improve profits for their investors and pay enormous bonuses to medical directors who deny coverage and save the company the most money. There are at least some checks and balances. Any change is better than no change.

In the other sense, I'm completely disgusted that the law does not have a public option. The mandate to purchase policies from private insurance companies (who no doubt will find ways around following the law as it is intended) gives these publicly traded companies more business than they deserve. Capitalism was founded on the basis of providing the best products at the best prices so as to compete for buyers. When a whole system is set up with good intentions to do the best for clients, capitalism works. Unfortunately, this is not what we are dealing with in this instance. One health insurer is not any better or worse than any other health insurer. Some policies that your employer may set up have fantastic coverage, but that changes from employer to employer, from access to access.  The publicly traded insurance companies, from my vantage point, seem to be in cahoots. Each is offering less and less while charging more and more. There is no real competition. There is no real capitalism. They are not worried about the consumers, they are worried about the investors.

I understand the law would not have passed at all with a public option because the well paid lobbyists for insurance companies and their interests worked over time at convincing voters in congress that a public option equalled government interfering with capitalism. I'm bothered that some of our congressmen and women fell for it. I'm bothered that they didn't have the bravery to speak to all types of their constituents and see the problems before voting. I'm grieved to know these companies have had months to find loop holes so no matter what the outcome of the Supreme Court decision, policy holders will still suffer.

I am conflicted because the point of the law was to provide positive consistency of care for everyone in this country, and financial interests have corrupted that good will.

There is nothing socialistic about wanting capitalism to work without corruption.