For More Of My Blogs: Please Check out The Huffington Post

Hi All!
   If you've stumbled upon this blog for the first time, or if you've been reading for awhile,

I wanted to let you know I've begun blogging for the Huffington Post.

You can check out my HuffPo  pieces at the below website:


http://www.huffingtonpost.com/erin-havel/ 


Thanks for reading!

Statute of Limitations Medical Bills?

Maybe part of the reason Americans have a difficult time healing after a traumatic medical event is because of the potential non-health related aftermath.

As some of you are aware, I was in active monthly treatment for an arteriovenous malformation (AVM) from 2005-2010. Since that time my doctors are in a holding pattern, watching the condition with annual MRIs. Although those annual tests do remind me of the rough patch I've been through regarding those treatments, I usually try and not think about them. They were a huge financial burden, physically/emotionally draining, and although there are residual issues from the built up scar tissue etc... I really try and focus on my life now rather than living in the past.

Focusing on the present is difficult, however, when just yesterday I received a statement for one of those treatments done in May of 2008!

I'm not sure why a single bill from almost 5 years ago, that should have long ago been paid by my primary and secondary insurance (from that time), would just now resurface. Looking at the statement it appears my 2008 insurance companies were only first billed this past November (2012). That doesn't make any kind of sense to me though.

It's possible I still have an EOB (explanation of benefits) somewhere in the stack of paperwork I tossed into a file cabinet so many years ago--- but to be honest with you, the idea of having to dig through all of that to find one single piece of paper sounds like a punishment I wouldn't wish on anyone.  Don't get me wrong, if I have to do it I will do it. However, the fact that this is even a topic for discussion seems inherently incorrect.

Perhaps I'm wrong, but by this point if there was an unpaid charge wouldn't the hospital have written it off on their books?

I live at the exact same home address since before this billed treatment and I never received a bill until now for it. I also haven't received a bill for any of the other treatments I had done within that year. So why this bill? Why now?

I am not the only one who has received medical bills for a surgery/treatment years after the fact, but I do not understand how this occurs. No one can tell me with a straight face that the hospital simply "forgot" I had a treatment and only remembered 5 years later.

No wonder Americans (particularly-because we are the only ones with an insurance system like ours) often times are unable to pick themselves up after a medical trauma.  How can someone completely move on when they are unexpectedly reminded of it again and again years after the fact?

...Or You Could Pay $4,150.00 Out Of Pocket

Every new year I go through the same game of trying to get my leukemia medication.

The game goes something like this:

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-approve it for the new year.
The insurance re-approves it (which usually takes a week or two)
     However, they only re-approve it for the first month
I pick up my medication
     However, I need to have my doctors fill out more forms and fax them in over the month so I can hopefully get my medication the next month without any hassle.

This year the game was changed up on me.

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-aprove it for the new year.
The insurance re-approves it (which took about a week and a half) BUT ONLY IF I RECEIVE MY MEDICATION FROM THEIR MAIL IN SPECIALTY PHARMACY

"Okay, Fine." I think to myself

So I call the specialty pharmacy who tells me they do not have my prescription and need my doctor to re-fax in all of the information including my co-pay assistance card.

My doctor faxes in all the information, insurance/copay cards in on Wednesday of last week and I am assured by the new pharmacy that everything will be ready to go within 24 hours.

On Friday morning I call, because I haven't heard anything and I figure I better check in.

I speak to a woman who informs me my copay is $4,150.00.

I tell her my co-pay assistance card helps with that and she tells me they do not have my co-pay assistance card on file. Frantically I give her all the information over the phone and she tells me she has put an "emergency" note on the file to get this shipped out to me.

I hear nothing.

So Monday morning I call to check back and am told they have all the information in the system and to check back at 4pm (Pacific Time) to make sure the medication goes out tonight.

I call at 3:50pm (Pacific Time) and a new person tells me it will take another 7 Business days for them to "verify" my co-pay assistance--- OR I COULD JUST GIVE THEM $4,150.00 AND THEY WILL SHIP IT OUT TONIGHT


I hope each and every one of you has that kind of money laying around for one month's worth of medication--- but I'm guessing I'm not the only one who does not.

The only way to get any of my Daily Leukemia Drug for the month of January is to have them over-ride the system and allow my regular pharmacy to go ahead and fill the prescription.

I ask them to do this--- and they tell me they are only open for another half hour so I need to call my local pharmacist, have her try and run the prescription through the system, get a denial number, call them back with that denial number, and THEN they can release it to her so she can order the medication for me to receive before February 1st.

I hate to make assumptions--- but isn't it convenient that the insurance company doesn't have to pay anything for January if they can't have the drug approved until February?

My local pharmacy originally tried to re-fill the prescription on January 10th. The December prescription ran out on January 14th. Today is January 28th.

Anyone else see a problem here?

Health Insurance and Profits: Capitalism is not to blame

Today I read this article in the NY Times:

http://www.nytimes.com/2013/01/09/business/health-care-and-pursuit-of-profit-make-a-poor-mix.html?pagewanted=all

For those who read this blog and The Malformation of Health Care book http://www.amazon.com/dp/B009V37CXU  you already understand my position on what this article says (the author is preaching to the choir).

I find it fascinating that no matter how many discussions, articles, programs, books, take on this topic; these companies still have the audacity to continue acting in bad faith.

What will it take for incredibly high powered, well lobbied, excessively wealthy companies to become accountable for bad practices?

I'm sickened to say, probably "nothing".

Despite the claim that corporations are people, corporations (especially on this high of a financial level) do not have an internal moral compass. Most people who work for these companies are at the mercy of this corrupt system just as much as the customers who pay their premiums each month in hopes their policy will cover them should tragedy strike.

This is not capitalism. This is greed.

The reason I say this is because I know what the ideals of capitalism are, I grew up on them. My family owned a small hardware store for over 100 years. The reason the company lasted for 100 years was because of the pride taken in our services and products. We didn't force anyone to shop at our store, but we gained loyal customers, based on our integrity.

We offered competitive prices and guaranteed our products and our work. If a customer came in to the store and said a product was faulty and we didn't either exchange the product or fix the issue, we would have been run out of town. No customer would have shopped with us.

When a health insurance customer comes to the provider with a problem, many times they are ignored, avoided, or told of a previously undisclosed "loophole" that frees the insurance from all coverage obligation.

Capitalism only works when those servicing the population understand that first and foremost they are performing a service for the community. Profits come when that service is performed well. If that service is performed poorly, profits should be reflected.

That is capitalism.

That is not what is going on currently within our health insurance system.

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.

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

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.

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."

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 :) 

Mental Health or Mental Illness?

Yesterday morning in Seattle a man shot and killed several people in two different locations. When he was found, several hours later, walking down the street and confronted by police, he then shot himself. According to ABC news, his brother was interviewed after the incident and said it was "no surprise" to his family and friends. Apparently the shooter was struggling with mental-health issues.

The reason I'm writing about this today is because I live in Seattle and yesterday was terrifying. No one knew where, or who this man was. They didn't know his motivation. They didn't know if there was more than one person involved. This was a completely random incident.

The question for me is if so many people were aware of this man struggling with mental health, what were the reasons behind him not getting the medical help he needed?

As a country we tend to brush off mental health issues. I don't know if it's because of shame, or societal expectations.  I don't know if it has gotten worse over the years, or if we just hear about it more now thanks to the media. What I do know is there are entirely too many people with mental illness who are not being treated.

The National Collation for the Homeless published a study showing mental illness in the top three causes for homelessness. I don't believe this particular shooter in Seattle was homeless. However, according to another story from Miami this week about a naked cannibal eating a man's face, that man was homeless and drug addicted which may mean he also was dealing with some mental illness. My point is, mental illness happens in every category of people, and not every category of people has the coverage to be treated for it.

Homeless people have little access to health care. Part time employees have little access to health care. Full time contractors, small business workers, some retail employees, all have little access to health care.  That's a problem.

Here's a bigger problem, most health insurance policies don't cover very well for mental health. Premium policies may have catastrophic coverage up to a million dollars if a person finds him or herself in a terrible accident. However, in the same policy they may only  cover (with a high co-pay) a few sessions of therapy for the mentally ill. Considering the cost of antipsychotic drugs, the policy's coverage might be lacking there as well.

My frustration is when a mentally ill person who has not been adequately treated, causes the catastrophic coverage to kick in for someone else.  Wouldn't it make more sense to not cut corners on mental health coverage and potentially avoid a catastrophic incident? Mental health is not separate from physical health and it should not be treated separately.

Cancerversary: Celebrating 5 years since rebirth

The first time I heard the word "cancerversary" I remember thinking it was so clever, albeit a little morbid. I was fairly certain no one celebrated having cancer. Why would anyone celebrate having cancer?

Once I was inducted into the cancer community though, the word made more sense to me. No one was celebrating cancer, they were celebrating life. Life with cancer, life without cancer, life in general.

Cancerversaries are sometimes set as when people finish their treatment, or eradicate their disease. 

For me,  I count my cancerversary as the day the doctor came into the hospital room and told me I have leukemia. Since my leukemia is chronic, I don't get to celebrate the day my cells went back to normal and the leukemia vanished from my body. 

I do however, have the opportunity to celebrate my rebirth. 

There was a jolt. I felt like my body and my spirit were separate. At one point, that night of diagnosis, I felt claustrophobic within myself. My spirit "I" was at odds with my physical "I." The spirit "I" didn't want to deal with the physical "I's"drama. 

In that moment, when I separated from myself, I could see things much more clearly than ever before. The love handles on my form that caused me to wear a larger size of jeans didn't matter. They hadn't mattered all along, my physical "I" just didn't know love handles didn't matter.

My conflicted relationships with others weren't conflicted at all. There were people I had to let go of, and there were people I had to pull closer. In that moment when I separated from myself, I knew exactly where each relationship fit.

Passion for music, love, creativity, spirituality, assisting a greater cause, and leaving a legacy far outweighed the amount of money I had squirreled away in the bank. 

I was clear. 

In this, my fifth year of cancerversaries, I am reminded of my rebirth.  The clarity of that first day isn't as searing now. However, the ability to prioritize, is still strong within me. 

I am celebrating today the love in my life, the passion in my words, the deeper understanding of self, and yes, five years of living with cancer.

Happy Cancerversary to me, and to anyone else who has been given the gift of deeply understanding the importance of living.

Chronic Cancer

"So when are you done with treatment?"

That's a question that until recently had a fairly solid answer for most cancer patients. Many chemotherapy treatments have a beginning date and and ending date for each cycle.  A three month cycle or a six month cycle with an option for further treatment (if necessary) addresses the above question. There is no confusion because it is a solid timeline that people are used to hearing.

You can imagine the confusion when someone asks me that same question and I'm forced to say-"Never."

The problem with the question is that it doesn't allow for the current advancements in medicine.  Many cancers are now being treated differently than before. Chemotherapy in the traditional sense isn't the only treatment option being exercised to care for patients. New medications are being developed to help target specific cancer and cancer cells rather than attacking an entire body to reach a small section.

For me, I am on a daily TKI (Tyrosine Kinase  Inhibitor) that helps to manage my CML. The condition is chronic, it is not temporary, and unless someone attempts an ideally successful bone marrow transplant, currently there is no proven cure. I will take this TKI for the remainder of my life, as long as it continues to work, I don't develop a resistance to it, or the cancer researchers discover a cure through clinical trials.

Do NOT feel badly for me though. Prior to the early 2000's CML was almost certainly a death sentence. Traditional chemotherapy had little effect on the disease. With my TKI, I have a chance to live with my cancer and not die from it.

Don't get me wrong, my first thought when I was diagnosed was -"Get it out of me!" It's not an easy acceptance process when cancer is chronic, but still being alive three years past when I would have expired without the TKI, really helps.