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.

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!

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.

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.

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.

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 :) 

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.

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.

"-isms"

Today I went to an International Women's Day event to hear a friend speak. Little did I know the event was being sponsored by a rather militant political group. (sigh). What did I take away from the experience? NO GROUP HAS IT EXACTLY "RIGHT."

I speak about health care in this country knowing there is not one magic "cure" to all the problems that exist. I think sincere dialoguing is the way to discover ideas to help move us towards a positive outcome. If we choose an idea and close our minds off to everything else, we lose the opportunity to discover ideas potentially (and most likely) better than our original thoughts. Plus, we cement our feet and everyone else's feet to prevent forward movement towards any possible better outcome.

Systems of government (and every other gathering of people for a common cause) all have positives and negatives. When people become militant about one ideal or another, the goodness tends to leak out and leave the junk (of whatever system) stuck there to defend itself. People hold onto the "system" for what it could be, and not for what it is. Pick an "ism" any "ism" and you will find corruption just like you'll find the original ideal. So can we please stop already with the "this 'ism' is the only correct path" nonsense?

What we need to do is clean up the "isms" by cleaning up our individual consciences. When people as a whole stop lying, cheating, stealing, intentionally harming, etc... then maybe we would have a better handle of which "ism" really best aids society---however, at that point, maybe the label of an "ism" wouldn't even be necessary.

Until then, "everything in moderation" never rang so true.