Tuesday, August 5, 2008

An Arrangement Behind Closed Doors

Tuesday’s Tirade


A young philosopher once stated to his understudy: “The good man brings forth good things out of the good stored up in his heart, and the evil man brings evil things out of the evil stored up in his heart. For out of the overflow of his heart his mouth speaks.”

Pulitzer Prize—winning journalist and bestselling author Ron Suskind has written a new book, The Way of the World. The dilemma? Who is telling the truth about the reason the USA commenced the war with Iraq on March 20, 2003?

Mr. Suskind has written a startling look at "how America lost its way and at the nation's struggle, day by day, to reclaim the moral authority upon which its survival depends.” The reader must decide if President Bush and company told the truth to the American people in 2002 or if Mr. Suskind’s evidence describes a hidden agenda.

And that’s exactly where you and I are this day. Just who is telling the truth about how health plans perform their functions? Coventry Health Care, Inc. of Bethesda MD or Christine O’Brien Stenger?

Are you interested in tracking down the truth? The truth teller always points to the correct road. He moves people beyond appearances to facts that are confirmed by others and official documents.

Do Coventry records of financial success and happy customers speak the truth? Or do the accounts of my experience to which I link evidence, suggest something sinister?

Ultimately, you must choose and be correct. Soon. When it comes to quality health insurance, you better do your homework. Our world suffers while we choose to wait.

Why should you believe me? That is an excellent question. I am not an expert, but I have thoroughly investigated my former HMO, inside and out, for a long, long period of time. Future posts will take you inside corporate headquarters and inside Carelink and Customer Service where I was trusted by key personnel. We both trusted each other. That was then.

There are also many family documents that describe “what’s in my heart.” Here's a newspaper cliping of an interesting story. The text describes my family as being prominent in West Virginia history since the Civil War. It "has contributed doctors, lawyers, judges, and a newspaper editor." My son is the first of the fourth generation of O'Briens to join the honorable profession of law. My daughter is a doctor. http://www.freewebs.com/courageoffaith/O%27Brien%20Family.pdf

The second is a letter of recommendation signed by my friend, the former Bishop Bernard Schmitt of the Catholic Diocese of Wheeling Charleston http://www.freewebs.com/courageoffaith/Bishop%20Schmitt%27s%20Recommendation.pdf followed by an appointment I recently received from the Diocese. http://www.freewebs.com/courageoffaith/Disabilities%20Council.pdf

Then begin to look at the evidence. Question where it points. Which evidence is indisputable? And remember, while Coventry publishes a lot of information, do not be swayed by the sheer volume. Advertising and repetition do not create truth.

Web of Deceit
Each state and the District of Columbia has established an agency dedicated to regulating the business of insurance. The West Virginia Insurance Commission, Jane Cline, Commissioner, is responsible for monitoring the health insurance industry and enforcing applicable laws in West Virginia. As part of its monitoring and enforcement functions, the commissioner maintains a process by which physicians and patients can file complaints against health plans.

On September 28, 2005, I filed a formal Grievance with the West Virginia Insurance Commission against Carelink Health Care, Inc. of West Virginia, my HMO. This September marks my third full year of continual fighting against the the West Virginia Insurance Commission. My rights were violated as, shockingly, Jane Cline of the West Virginia Insurance Commission never enforced the Final Order 06-AP-024 that she signed on December 14, 2006. The same order the WV Consumer Advocate argued is essential to begin to clean up health care in our state. http://www.freewebs.com/courageoffaith/2007%208%2028%20Letter%20to%20Jane%20Cline%20re%20Carelink%20Defiance.doc

Future Tirades and Tales will detail the many twists and turns of my path to justice with the Insurance Commission. They will expose the sad plight of West Virginians and health problems relative to other states.
For today ponder these questions: Does this sound like corruption? Is there collusion between the Commisison and Carelink? Are their political contributions involved? Someday the truth will inform us.

To clarify, Carelink and Coventry challenged the ruling all the way to the Appeals Court in Kanawha County, West Virginia. Final Order 06-AP-024 mandates that Carelink review all initial inquiries, thoroughly review, to avoid the “egregious behavior” towards me being repeated again and again. Once the final order was signed, Carelink was obligated to follow the order. It was then that Carelink began a series of legal maneuvering to get the order reversed.

In a response to a civil lawsuit, Christine O Stenger vs. Carelink Health lans, et al on January 2, 2008, Carelink revealed a secret. Something happened behind closed doors at the Commissioner's office and Carelink dropped their appeal. That was my only notification that Carelink and the Commission had worked out a deal. A document. A copy of a document intended to present Carelink's position in my cival lawsuit.

Nafarious actions? Heinous Crime? Who knows? No one notified me of this key meeting. Don’t know but I believe that Jane Cline never had the intention of enforcing Final Order 06-AP-024 from the beginning. The web of deceit broadened. See last page 4, first paragraph: http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

In the summer of 2007 three different physicians requested three different procedures for me. Each was denied on the spot. http://www.freewebs.com/courageoffaith/2007%2011%201%20Dr.%20Rogers%20Complaint%20%40%20Claim%20Dismissal.pdf (I have linked to one of my doctors complaints. There are two more doctors who details their complaints as I describe.) It only takes this one instance for Carelink to be in definance of Final Order 06-AP-024.)

No thorough investigation as required. Had Carelink done an investigation as ordered by Final Order 06-AP-024, they would have authorized a procedure for me, a $3100 procedure to treat my severe sleep apena, much less than the costly surgery they have authorized. Most importantly, they would have learned that Dr. Bernard Costello, my surgeon, advised me a year ago that because of the continued stress in my life due to dealing with Carelink, he will not perform the surgery. Too risky. And so I wait.

Now I live from day to day knowing that I must have medically-necessary surgery. I know that the West Virginia Insurance Commission by WV State Code must intervene. I know that three different attorneys, inside and outside state government, have warned me of the corruption within the commission. And I know much more about the web of deceit in my state.

Tuesday’s Tale

Consumer Horror Stories

Reported on the site: www.bluecrosssucks.com

I recently watched the movie "Sicko" at home. It really lit a fire under my butt. I am so grateful that somebody has finally taken the time and effort to "out" the medical system in this country. It is about **** time!!! I worked in the allied healthcare industry for over ten years, up until I became disabled as the result of an auto accident. That's when I became a victim to this horribly dysfunctional and corrupt system I was witness to for so long. I am currently carrying COBRA coverage through Blue Cross / Blue Shield of Texas (HMO). And, let me tell you that they are absolutely wretched. I have been in the Emergency Department of my local hospital with horrible abdominal pain, swelling, constipation and nausea several times this week. Earlier today, I noticed a large amount of dark black blood in my stools. Accompanied with a low grade fever, lightheadedness and yet more abdominal pain, I reported once again to the Emergency Room. The doctors there said they wanted to call in a gastroenterologist for an endoscopy. After several hours and some blood work, they returned to my room and stated that they were discharging me home. Feeling no better at all, I asked them the reason for this and they stated my blood pressure and hemoglobin were fine, and that my HMO would not authorize an endoscopy unless I had lost "a lot of blood," or my hemoglobin was low. Now, I don't know how all of you feel about this, but the half-pint I found in my toilet this afternoon was quite alarming. I voiced this concern to the ER staff, only to hear, "well you really need to follow up with this referral we are giving you." Unfortunately, my HMO doesn't recognize referrals from the ER doc, only from my primary care physician, who I have phoned many times only to hear that he is not available to see me for several weeks. I can't see anyone else because my HMO won't cover them. I can't even explain how horrible this is, to know something is horribly wrong with my body and to be hung out to dry like some menial financial liability.

Comments: Blue Cross/Blue Shield of Georgia has repeatedly refused to cover my medicine, my office visits and my doctor ordered brain and heart tests. Now I can't log in and when I call the 800 number they say it's after hours and they hang up. I have surgery tomorrow and they won't pre-certify me! Blood-suckers!

Comments: My 16 yr. old son was taken by helicopter to nearest trauma center due to a motorcycle crash. B/C ppo will not pay e.r. bill. Stating it was an out of network hospital. I had no choice which hospital he was taken to, state law says in a life and limb situation he must be taken to nearest trauma. He had lacerated his pancreas cost for 8 day stay is 78,900. Only for room and board. BC has a special circumstance clause they are not following....What to do. Denied appeal. Karla


Although it wasn't blue cross, but SRP that is really making me steamed. Husband was in a bad car accident, and the lady who hit him and was 100% at fault had very minimal insurance--AllState--so our health insurance covered his emergency surgery. Now, they want us to pay them back, even though we paid health insurance premiums for years! And paid all our deductibles and co pays as well. We haven't gotten a settlement or any money from our car insurance, Allstate only paid for my husband's car to be totaled out (which was under $2000) and that's it. We didn't get some huge million dollar settlement, and my health insurance company wants to be paid back!? Then why do I pay for health insurance in the first place?

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