Tuesday, October 7, 2008

Coventry Health Care Subsidiary loses in Federal Court of West Virginia

Tuesday's Tale

Carelink, My HMO, Cannot Duck Responsibility

A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history. ~Mohandas Gandhi

Friday, September 26, 2008. A banner day.

“I’m ecstatic!” Paul Tucker, my attorney with Bachmann Hess Bachmann and Garden, P.L.L.C. of Wheeling West Virginia, exclaimed. Moments before Tucker had learned that Federal Judge Frederick W. Stamp, of the Northern District Court of West Virginia, granted my motion to remand my civil lawsuit, Christine Stenger vs. Carelink Health Plans, Inc and Patrick W. Dowd (former Carelink CEO) to Ohio County Circuit Court.

This is huge. If you visit unitedforjustice.blogspot.com there are links to copies of significant court documents that track a rare win against an HMO in the federal court.

Paul Tucker is beginning his preparation for the next legal battle against Carelink. I have no doubts that he will prove that Carelink Health Plans, Inc. gravely injured me as a part of a ruthless scheme to intimidate and discriminate against me. My voluminous records provide evidence of a widely corrupt system.

There is celebration but it is a sobering one. In America we consumers have rights, but there is no guarantee that we have affordable remedies. No remedy for the thousands of people with health insurance whose health plans will continue to do business as usual, denying and delaying their rightful claims.

Delaying is one of the many ruthless tactics employed by health plans. Delaying until it is too late for some. Dena Wildman, speaking with the experience of working for the West Virginia Insurance Commission once casually told me “that many times they (health plans) deny, deny and wait for appeal…hoping you will go away. Many,” Wildman believed, “do give up.”

Ours is not only a culture of deceit; it is a culture of greed. How can the conscience of health insurance executives be so twisted that they only hear what they want to hear? With the present financial crisis, it may be time that they begin to listen to the truth.

Did you happen to watch 60 Minutes on Sunday evening? Steve Kroft hosted an expose about the crimes of Wall Street:

Congress finally passed - and President Bush signed into law - a financial rescue package in which the taxpayers will buy up Wall Street's bad investments.

The numbers are staggering, but they don't begin to explain the greed and incompetence that created this mess.

It began with a terrible bet that was magnified by reckless borrowing, complex securities, and a vast, unregulated shadow market worth nearly $60 trillion that hid the risks until it was too late to do anything about them.

That chapter is not over, and there is much suspense and fear on Wall Street that there are other big losses out there that have yet to be disclosed…

Suspicions are being raised about all Wall Street companies who too often hide facts and avoid transparancy. Facts hidden from the public, from the stockholders, from federal regulators.

Coventry Health Care, Inc. of Bethesda MD has been described as the “darling of Wall Street.” Hmm. From what I have discovered of secret dealings, it would not surprise me to learn that Coventry may be the subject of a federal investigation in the future.

No. It would not surprise me one bit. For those of us who have a strong foundation in Faith, we need only turn to the many writings in the Bible, where God promises:

Then one day I went into God’s sanctuary to meditate and thought about the future of these evil men. What a slippery path they are on --- suddenly God will send them sliding over the edge of the cliff and down to their destruction: an instant end to all their happiness, an eternity of terror. Their present life is only a dream. They will awaken to the truth as one awakens from a dream of things that never really were. ~Psalms 73: 17-20

Public judgement lies ahead for HMOs. It may not be next week, but it may be next year. But until then, they will begin to live with doubts about their futures. About the future of their families. About the wrath and the anger of Americans who, for years, have had to pay a large price for their despicable actions. Much too high a price for many.

There has been a healthcare crisis in America for decades. My case is a very important step to holding managed care responsible for the major role they play in attempting to hide behind the federal law ERISA to deny quality care to the disabled in West Virginia.

But, I cannot delude myself. Our world is spinning out of control. My recent win against Carelink will be of little significance if others do not join together to demand reforms. The economic crisis is linked to the health care crisis.

We literally can no longer afford to stand still. Too much is at stake.

Today’s Tale
A Disastrous Result

Another costly delay by an insurance plan providing the consumer his rightful benefits. This man did not live to enjoy his benefits!

Using the Rev. Martin Luther King's fight for equality as a jumping-off point on what would've been his 79th birthday, members of a nurses' union staged a rally Tuesday in downtown Chicago decrying corporate interference in health care.

The rally organized by the National Nurses Organizing Committee and the California Nurses Association outside of Cigna health care's offices in the 500 block of West Monroe Street featured a Southland mother and daughter waging a battle against the insurance industry.

"While my dad fights, UniCare has failed him, and it has failed my family," Jody Polka told two dozen demonstrators on the frigid afternoon.

Polka's father, Cyril Strezo, 58, of Frankfort, suffers from esophageal cancer that was initially treated with radiation and chemotherapy. When the cancer spread to his liver last fall, his oncologist prescribed two drugs for his treatment.

UniCare declined to pay the cost of the drugs - about $3,000 per week - calling them "experimental and/or investigative," despite the drugs having been approved by the U.S. Food and Drug Administration in the 1990s.

But a recent article in the SouthtownStar spurred state Rep. Mary Flowers (D-Chicago) and the Illinois attorney general's office to bring pressure on UniCare, resulting in the insurer reversing its decision and agreeing to cover the cost of Strezo's drugs.

But the victory may have come too late. The family learned last fall that Strezo's cancer had spread to his brain.

Strezo's family criticized the insurance company for delaying his drug treatment, which they called a private matter.

"My dad's treatment had nothing to do with some lady in a cubicle (at UniCare) who does not have a license to practice medicine," Polka said, standing beside her mother, Terry Strezo.

"The treatment should be between him and his doctor. UniCare decides, based on their financial calculations, who should live and who should not. If you or I made decisions like that, we'd be serving a life sentence on Death Row."

The demonstrators also carried signs showing a photo of Nataline Sarikisyan. The 17-year-old California teen died last month after Cigna, her insurance company, refused to pay for a liver transplant. Cigna later reversed its position, but Sarikisyan was already terminally ill.

"How would you like it if you couldn't call the police because you're not insured?" Flowers asked the crowd.

"You pay your taxes, these are services you deserve. You are paying for your insurance. And if they don't want to be in the business of insuring, they should get out of the business."

Flowers is sponsoring House bills for a single-payer medical program and another that would allow patients to appeal denials of their health benefits by insurers.

Officials at Cigna could not be reached Tuesday for comment.

Polka said she hoped the rally would help publicize the struggle that many patients have with their insurance companies in getting the medical coverage they deserve.

"This is something that affects everybody," she said. "Everybody thinks they can sleep at night because they have insurance, but if you get sick it doesn't matter."

By William LeeSouthtown StarJanuary 16, 2008

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