Monday, August 11, 2008

Tuesday's Tirade
Carelink takes control of A Patient Bill of Rights!

How has the brazen disregard for insurance law and humane treatment of HMO subscribers been tolerated for so many years? Where is our outrage? What are we doing to promote reform? Alas, too little and too late for many.
For years Carelink Health Plans Inc, of West Virginia was my Health Maintenance Organization (HMO). At its best a HMO works with its subscribers to insure that they receive quality health services. Carelink, as an HMO, is expected to follow published rules of Governance as well as adhere to A Patient Bill of Rights. While Coventry Corporate excels at making profits, its behavior can be repugnant. Simply stated, for me it stinks.

In the latter part of the twentieth century, health care organizations began to adopt what is today known as a Patient Bill of Rights. It’s a statement that defines the rights a HMO ought to provide a subscriber.

“The dramatic growth of health maintenance organizations (HMOs) has prompted calls to give patients a stronger voice in decisions about which medical procedures will be covered by insurance.” (Washington Post, Politics: Heath: Patient Bill of Rights)

Here's a link to the Patient Bill of Rights published by my HMO, Carelink Health Plans, Inc. of West Virginia:

Coventry Health Care, Inc of Bethesda MD, the parent company of Carelink, is a business, a big business. Theodore R. Marmor, professor of public policy and management and political science professor at the Yale School of Management noticed a significant "change in the amount of lives" for which health insurers are responsible. "I think the big story in health insurance is its big business, as you see in the options given to key executives," Marmor says in 2007. That is three years after there appeared published accounts of Coventry’s CEO Dale Wolf's earning an obscene salary package of $32 million. "Thirty years ago nobody expected to get rich that way in the insurance business,” Marmor continued.

Carefully reread Carelink's HMO Patient Bill of Rights (linked above), which is an industry standard for treatment of subscribers by health plans. Coventry Health Care, Inc, a Fortune 500 company, ought to have adopted this standard in each of their dealings with the subscriber.

Instead, Coventry blatantly disregarded this standard time and again in its treatment of me. My treatment was rife with conflicts and intrigue. I was not treated fairly. Period. I fought hard to receive authorization for my rightful benefits according to my plan. Period. I am angry. Period.

Carelink's Patient Bill of Rights includes the following guidelines:

Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care.

On July 29, 2005, Nanci Philips of the Appeals Department of Carelink ruled against my appeal. Earlier that day Philips had received what was the 4th appeal for my medically necessary surgery. In a rush to send in the paperwork while I had Philips' attention, I overlooked including Dr. Costello's documented appeal. This essential document was required to make an informed decision. No other appeals were logged into the system by Carelink.

Here's the link to Dr. Costello's appeal:

This is the first of four appeals either Dr. Costello or I mailed to Carelink in the spring of 2005 to the Appeals Department that described the medical necessity of this treatment. This document was not reviewed by Dr. Rod McKinney, Carelink's Medical Director, as part of the appeal review process.
See this link to Dr. McKinney's sworn testimony at the August 10, 2005, hearing before the West Virginia Insurance Commission, page 139 lines 15 - 24 and page 140 lines 1 -7.

Nanci Phillips, former Appeals Coordinator, denied my appeal in a very short period of time, without the required medical justification. As governed by law, I received a notice from Carelink advising me of my rights to have my physicians be a part of the appeal process. Unbelievably, the notice is dated July 29, 2005, the same day as Phillips ruled on my appeal.

Link to Nanci Philips' sworn testimony:

This testimony is but a small excerpt from Philips’ sworn testimony in a court of law. When compared against the partial sworn testimony by former Appeals "Manager" Patrick Quinn, it raises serious questions and doubts.

Link to Patrick Quinn's sworn tesitimony:

Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you.

There were many instances in 2005 when I was treated with disdain and discrimination. Reread Carelink’s former CEO Patrick W. Dowd’s letter to me dated November 1, 2005.

Link to Patrick Dowd's letter:

Within the hour my son, an attorney, dictated a formal response to Mr. Dowd in response to his ruthless behavior.

Link to my letter to Patrick Dowd:

Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Chapted 33 of West Virginia code established a code of behavior for all health maintenance organizations doing business in the state.

A part of this declaration is a statement about including physicians in the process:

WV State Code 33(8) The HMO shall have physician involvement in reviewing medically related grievances. Physician involvement in the grievance process should not be limited to the subscriber's primary care physician, but may include at least one other physician;

Additionally the grievance process is to be completed in a reasonable period of time:
(6) The HMO shall process the formal written subscriber grievance through all phases of the grievance procedure in a reasonable length of time not to exceed sixty days, unless the subscriber and HMO mutually agree to extend the ...

In the fall of 2005, Patrick Quinn, former "Manager" of the Appeals Department at Carelink, received a letter from Dena Wildman, the Grievance Examiner with the West Virginia Insurance Commission. I had filed a formal Grievance complaint with the Commission on September 28, 2005, and Examiner Dena Wildman reminded Quinn of my complaint in a letter.

This letter was revealed at the time of my hearing on August 10, 2006. The testimony of Wildman is serious and damaging to both Carelink and the West Virginia Insurance Commission.

There was too much discussion between the Commission and Carelink. Discussion which suggests in this letter that in Dena's mind, I had indeed impersonated her. Discussion about the conversations Carelink must have had as to what to do about me. It took 3 1/2 months to resolve the grievance. Where are my privacy rights? Where are my rights to have a quick response because of the urgency of Dr. Costello's request? Should not this letter be considered a grave indictment of a systemic evil that West Virginians confront?

Read Wildman's letter:

Wildman's incriminating letter is a significant piece of evidence.Wildman oversaw a grievance process that began on September 28, 2005, and lasted 3 and 1/2 months. A time when my integrity was once again called into question before the West Virginia State Examiner. I am incensed by the games Carelink continued to play together with the West Virginia Insurance Commission. Games that have cost me dearly.

Sad statement about the dark abuses in West Virginia.

Did I sit quietly and allow this injustice? No. I contacted and re-contacted Carelink headquarters, Supervisor Debi Kalorik. I contacted corporate headquarters, attorney Robyn Aronberg. I contacted the Office of West Virginia Insurance Commission Examiner Dena Wildman. Not one person would take my call. From late October 2005 until January 2006, I was fully blocked from receiving my rightful benefits as a subscriber of Carelink Health Plans, Inc of West Virginia and a citizen of our "wonderful and wild" West Virginia.

There will be a lot of evidence to come that will indict Coventry Health Care, Inc. of Bethesda MD and the West Virginia Insurance Commission and Commissioner Jane Cline. Additionally, there are others who conspired in fraud. Others who created obstables to justice. Others who turned away with indifference.

I am not remaining quiet. My conscience moves me out of my complacency.
Tuesday's Tale
And Who is Telling the Truth, all the truth?

My evidence about my treatment by Coventry Health Care, Inc. is convincing. It will move people to action.

While others wait, ponder this story.

Link to Coventry's Denial of Kansas City Man who now is dead:

In a press release, Coventry made a statement saying, "All of us at Coventry share a deep concern for Nathan Crabtree and family..." Go back to the evidence in my case. Ask yourself, "Could there be a pattern here? Would the same Coventry who lied to Christine Stenger, a Coventry health plan subscriber, boldly lie again?"

Tracey Pierce died. Lee Crabtree may still have a chance but he was robbed of valuable time. Evil impersonating as a good.

Coventry will someday learn that they made the wrong "business" decisions with Tracey Pierce, with Nathan Crabtree, and with Christine Stenger.

There will be justice. Given the opportunity, I will testify under oath that “There was no deep concern demonstrated by Coventry to Christine Stenger.”

Mark my words. Another episode of my story will be played out in a courtroom in this country. And I will bring my own experts to testify. And others who suffered at the hands of Coventry will be in that courtroom with me.

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