Monday, August 25, 2008

Carelink Health Plan Member

Tuesday's Tirade
A Serious Matter: Nefarious Nancy

In their 2007 document on political responsibility, "Faithful Citizenship," the United States Catholic Bishops' Conferance declared:

In the Catholic tradition, responsible citizenship is a virtue, and participation in political life is a moral obligation. This obligation is rooted in our baptismal commitment to follow Jesus Christ and to bear witness in all that we do.

On November 14, 2007, the U.S. Conference of Catholic Bishops approved a new statement on Faithful Citizenship entitled: "Forming Consciences for Faithful Citizenship: A Call to Political Responsibility from the Catholic Bishops of the United States.

One of the issues discussed in depth at the 2007 conference was health care. "Quality health care should be accessible to every person as a part of basic respect for human life and dignity," stated Kathy Saile of the Officre of Domesitc Social Development in the bishops' Department of Justice, Peace and Human Development, in a commentary on healthcare and "Faithful Citizenship."

Cast of Minor Characters

In the real world, minor characters may play a major role in plot development. What begins as an innocent placement of an employee in a position within a small subsidiary takes on major significance as it creates a crack in what was thought to have been a strong foundation.

Unknowingly in the summer of 2005, it was Carelink Appeals Coordinator Nancy Phillips who began to seriously damage Carelink Health Plans, Inc. of West Virginia and its parent company Coventry Health Care, Inc of Bethesda MD. As you will learn, Phillips was incompetent for the position she held. While likely a good person independent of her role with Carelink, the unique circumstances of Phillips' job demanded more than she was able to provide.

Should Phillips be judged harshly? Documents do demonstrate deceit and negligence. And there is the serious question of perjury. However, I personally believe Phillips was an unwitting accomplice in a more sinister plot.

It has been often repeated at business seminars in leadership that if an employee fails, it is the responsibility of that employee's boss. Either the employee should not have been hired in the first place or the employee was not given the necessary training. Phillips was a sitting target.

Why was Phillips employed in a position for which, it appeared, she lacked the qualifications? As I searched the internet for a better understanding of how Coventry Health Care, Inc. of Bethesda, MD does business, I learned a great deal. The internet has much to teach each of us about health care issues.

Study this link to’s forum discussing Coventry Health Care. Then ask yourself, “Does Coventry desire to hire people with qualifications for the job they assume?” Note that many of the visitors suggest they have a working knowledge of Coventry Health Plans, Inc. The following comments raise serious issues:

Anonymous in Burlingame, California reports:
Coventry had a great job fair recently in Scottsdale Az. I was very impressed by their logistics, professionalism, approach etc.

However, I was most dissapointed by the fact that although I had an excellent screening, and was enthusiastically promised a follow-up interview, I have heard NOTHING. Worse yet, I had applied online for one of the positions, and received the thanks no thanks and all the jobs are filled form letter. Yet, all those jobs are STILL posted on their website. One hand not talking to the other apparently....

Darnell in Harrisburg, Pennsylvania 14 months ago
Be prepared to work and put your family second. It is a very fast-paced, highly competitive environment. The healthcare industry is forcing them to keep costs low, which translates into below average pay. Financially strong company though. Look at analyst stock reports.

Lisa in Etters, Pennsylvania 13 months ago
Below average pay (they display the salary range on the internal job postings, and pay at the lowest salary or below). Obviously not very good for morale, either. It makes you wonder what they REALLY think of you. -Job titles/descriptions are very misleading. You may end up doing something totally different than what you apply/are hired for.

David in Salt Lake City, Utah 13 months ago
I've been a business analysis manager at 2 fortune 500 companies, both with health care specialties, and have not been able to penetrate the Coventry hiring process. My decision was to just give up - sad because I'm good at what I do and I probably could have added value.

The Appeals Coordinator

In 2005, Nancy Philips worked in the Appeals Department of Carelink Health Plans in Charleston, West Virginia. As the Appeals Coordinator, Phillips investigated cases that consumers brought for an internal appeal following a denial of services. One might think that important credentials required for this position would include a working knowledge of medical terminology and an ability to deal with dissatisfied, sometimes irate, consumers. No so with Phillips.

Philips and I connected on the afternoon of July 29, 2005. A fateful day. Phillips denied my doctor's request for medically necessary surgery and sealed her fate. In the spring of 2006, Phillips left Carelink's Appeals Department to work at Carelink as an outreach coordinator for Medicare. Our time together, though brief, was not pleasant, especially for Phillips.

On July 27, 2005, CSO representative Sherry Salopek processed my third appeal to Phillips. In her naivety, Salopek believed Carelink would address any wrongs committed against me. What follows is my account of the events that led up to Carelink's denial of my medically necessary surgery, my conversation with Phillips and my attempt to unsuccessfully reach a department that would address my serious concerns:

There is no doubt in my mind that Nancy Phillips was not qualified for such a critical position in a health plan. My records of a few of the conversatons I had with Phillips on July 29, 2005, follow:

Phillips, despite telling me that she checks her mail messages regularly, never returned one of five phone calls placed to Dr. Bernard Costello’s office. Patty Conrad, Dr. Costello’s receptionist, testified before the West Virginia Insurance Commission in August 2006, to having records that prove Phillips lied.

Dr. Costello's first a
ppeal would have reached the Appeals Department in May of 2005, but it was never stamped. Documents show that neither the second or third appeal was stamped by Appeals. The third appeal was the appeal CSO Salopek personally faxed to Phillips on the 28th of July 2005. The very next day Phillips contacted customer service to state that she had never received an appeal from Dr. Bernard Costello.

Phillips evaded answering my questions and misled me to thinking Patrick Quinn, Appeals Manager, would speak with me at the time.
Phillips rushed through the denial process and was not on top of the necessary paperwork required to make a decision.

Negligence. Incompetence. Deceit. Just keep adding up the one accusation after another. Am I jumping to conclusions? Time is now on my side and I'm willing to patiently wait for public opinion to persuade others.
Does it not raise suspicions that four appeals must be sent to Phillips before she stamped one as entered? And how about the lie that "we have been working on this all day", when CSO Salopik did not fax the fourth appeal to Phillips until mid-afternoon on the 29th of July? Or the letter that was mailed to me the same day as the denial that offered me an opportunity to have qualified specialists discuss my issue with Carelink as is the regulated procedure?

In Carelink's own words: Carelink Awarded EXCELLENT NCQA Accreditation 12/07 FOR IMMEDIATE RELEASE Contact: Mary Sandridge, Public Relations Manager434-951-2433Charleston, WV – December 10, 2007 –-

Carelink Health Plans, Inc. today announced that it has been awarded an accreditation status of Excellent by the National Committee for Quality Assurance (NCQA), an independent, non-profit organization that assesses and reports on the quality of the nation’s managed care plans.

Carelink’s accreditation status – the highest possible level – is based on voluntary review of how a health plan ensures that its members are receiving high quality health care. The Excellent Accreditation applies to Carelink’s HMO/POS plans until September 2010.

“Earning ‘Excellent’ Accreditation reflects a health plan’s ability to work with their members and their physicians to improve the quality of clinical care. It shows that they are building the kind of partnerships that are critical to delivering great care and great service,” according to NCQA President Margaret E. O’Kane.

“We are an organization committed to continuous quality improvement so we are extremely proud of the results of Carelink’s first NCQA review,” said Carelink President and CEO Cosby M. Davis, III.

On August 10, 2006, Nancy Phillips appeared at my formal hearing before the West Virginia Insurance Commission against Carelink Health Plans, Inc. of West Virginia. All my many imaginings and conflicted images of Phillips came together as I met her for the first time in person.

Far from being a "corporate suit" as one might expect, Phillips appeared fearful, feeble, and nervous. She was noticeably shaking while under oath, especially when she acknowledged that she did not remember 'Penny Stenger'.

My husband Tom broke the tension in the air. He nudged me and said, a little too loudly Judge DeBolt thought, "Nobody forgets Penny Stenger!"

Study Nancy Phillips' testimony linked here, page 108, beginning lines 24 through through page 118 line 24. Note that there are four pages of transcript to each page:

In the spring of 2006 when both the West Virginia Insurance Commission and Coventry became aware of the serious nature of my issues, several people were removed from key positions. Phillips was one. In her mind, one is permitted to forget any details of my case because she no longer had access to any records.

Did Coventry intentionally move three potential witnesses from positions who might incriminate Coventry in the future in a court of law? Both the CEO Patrick Dowd and Appeals Manager Patrick Quinn “left” Carelink’s employ in the spring of 2006, just after I filed my formal complaint with the West Virginia Insurance Commission. Phillips was moved to another office within Carelink at the same time.

Three people with potentially damaging testimony, no longer must remember any details as they no longer have access to company files. Would a jury believe them? When does a coincidence become a tactic? I am no lawyer, but I know right from wrong.


An intimidated Nancy Phillips testified under oath at my hearing in August 2005. Her conflict must have been huge. Tell the truth and face intimidation by Coventry or tell a lie and face penalties. The verdict is out. Will Phillips still have a job with Carelink when the verdict comes in?

As you review the conversation Phillips and I shared on July 29, 2005, consider the irony of Coventry's "tactic" of promoting their image while a consumer is on hold on the telephone. As I awaited recognition by CSO that yet a 4th appeal would be necessary, I heard glowing descriptions of my health care plan. My fury and frustration mounted.

With the passage of years and new knowledge at my fingertips from internet searches, I experienced an intuitive insight recently. Counter to Coventry's advertisement, Carelink, it appears, hires people who will accept low wages and may likely not have the moral courage to do the right thing.

There's dramatic irony with this plot. Nancy Phillips may have been hired to contain costs. Contrary to this intention, her participation in deceit and possibly illegal activities may cause a disastrous outcome for Coventry Health Care, Inc., the "darling of Wall Street."


Tuesday’s Tale

Albert Einstein

"The most important human endeavor is the striving for morality in our actions. Our inner balance and even our very existence depend on it. Only morality in our actions can give beauty and dignity to our lives. " ~Albert Einstein

It has been a very difficult road challenging a giant in the health care industry. I have encountered selfishness, egotism, elitism, indifference, fear, corruption, cronyism and ineptitude. It is the wisdom of the men and women of past generations who speak quietly to me. It is these heroes who remind me that I have no option but to continue my fight. Remind me over and over that truth and justice ultimately will win.

It was Carelink’s sales agent who renewed my spirit in early August 2005. My persistence and perseverance paid off. Nancy Phillips had used several faulty justifications to make her determination of a denial. One stated that my huband's employer had not purchased the necessary rider to cover this surgery.

At this point, it's wise to consider that in Coventry's eyes, we are just numbers. Statistics. Or so they think. Pulling a justification out of the hat of tricks may have worked in the past. Not today.

In early August 2005 I learned from Michelle Gill, Carelink’s sales representative that, "There is no rider." Surprised? Gill and I certainly were, for despite a rider's being printed in the document of coverage as required, there is no such rider. More lies.

So bizarre. No riders. No appeals. No phone calls. Few records. No medically necessary surgery. Are you beginning to appreciate how people die without ever receiving their rightful benefits? Doesn't this alarm you?

From 2005 to the present, my HMO has not acted in "good faith." How many other health insurance companies operate this way? If you cannot trust a Fortune 500 company who prides themselves in providing an excellent service to subscribers, who is deserving of our trust? Puzzling to ponder your options.

My HMO's ruthless attack on me is not happening in isolation. I will repeat: this is not happening in isolation. It truly is an invisible evil, one that would have aroused Einstein's fury.

Here are published "alarming" facts:
Finally, next month begins my fourth year of blogging. While my blog has changed form in the last few years, the principles behind blogging remain the same. I blog to persuade, to help shape public opinion about an invisible evil. I am angry. That's good as the angrier, nastier blogs are growing the fastest.

Spread the word. Help us out here. We're in this together. Inform others of this blog. They, too, are likely in the dark.

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