Tuesday, February 24, 2009

Tuesday’s Tirade
Is U.S. News and World Report Misleading the Public?

“If you're sloppy or you're unethical and you're exempt from so many of the regulations, it's easy to cover your tracks for a while. But sooner or later, these things come out.”
~Paul Nelson, Philosopher and Scientist

Corporations are unraveling with astonishing quickness around us. Today, Coventry Health Care, Inc. of Bethesda MD, former “Darling of Wall Street,” sees its empire crumbling. Sadly, while Coventry is fighting for its life, it still falsely portrays itself as an “Excellent” insurance plan. Is U.S. News and World Report involved in this false advertising?

I met Carelink Health Plans, Inc., a Coventry subsidiary, in 2005, when Carelink denied me a medically necessary benefit. I made a choice then to investigate. My discoveries are shocking.

Judge Jack Debolt presided over my administrative hearing before the WV Insurance Commission against Carelink in August 2006. He was outraged by the evidence. Judge Debolt and the West Virginia Insurance Commissioner signed the fourteen-page Final Order 06-AP-024 against Carelink in December 2006.

It is concluded that it is appropriate for the Commissioner to issue a cease and desist order to Carelink under the provisions of 33-25A-23(4)(a) of the code to require it to consider all aspects of a claim both upon initial consideration and upon internal appeal (my emphasis).

In 2007, three personal physicians requested treatments for me from Carelink. Each request was denied on the spot! Unlike the honorable insurance commissions in Kentucky, Alabama, Kansas, and Delaware who enforce final orders, the West Virginia Insurance Commission refused.

But nothing prepared me for the knowledge that Carelink received an “Excellent” accreditation from a regulatory agency NCQA in early 2008. What! How? Why? In the face of evidence that proves that Carelink is anything but honest and law-abiding, their reward was an “Excellent” rating.

Are you sitting down?

NCQA was organized in 1979 by trade associations for managed care (HMOs). NCQA was founded to counter government’s attempts to oversee the HMOs, like the fox guarding the hen house!

Big mistake made in West Virginia. Not only is there the public record of my administrative hearing and the Final Order that discusses “egregious” deeds by Carelink, there is also a civil lawsuit pending with evidence that Carelink discriminated against and intimidated me.

It only gets worse. NCQA uses “voluntary information” from the health plan that requests accreditation. It is grossly outrageous and intolerable that U.S. News and World Report relies on NCQA’s evaluation to determine its top health plans each year.

Cost plays a large role in plan choice, of course. But data analyzed by NCQA and provided to U.S. News about hundreds of plans permit quality to be considered as well. The rankings, at health.usnews.com/healthplans, show how well plans do at preventing and treating illness and providing consumer services to members.
~U S News and World Report

While Coventry’s empire continues to collapse and U.S. News and World Report promotes health plans using volunteer information, decisions are being made about real lives by, what I believe to be, a phantom corporation. These real lives are suffering.

“Sooner or later,” Paul Nelson writes, “these things will come out.” Hope sustains me as the unraveling continues.
Tuesday’s Tale
The Legislative Branch: Making Laws to Protect Us
~John Adams

There is a deep sorrow that comes from knowing about the injustice of Carelink Health Plans, Inc. of West Virginia, my former HMO. For four years my goal has been to make the public aware of the potential for deceit and harm to health care consumers in West Virginia.

Last week I participated in the Catholic Diocese of Wheeling Charleston’s days of lobbying our West Virginia legislators at our State Capitol in Charleston, West Virginia. While it is sometimes difficult to fight the status quo, it was as if I was led by some divine force to meet two legislators of courage, integrity and honor.

I first introduced myself to Delegate John Frazier. “It’s gotten ugly,” I announced as I began to discuss real concerns about Carelink and the health insurance regulatory agency NCQA. Delegate Frazier, a former judge of twenty-five years and a church elder, focused intensely on my words as my truth impacts all health insurance consumers in West Virginia.

My message was obviously powerful for when I prepared to leave, Delegate Frazier stood up and looked at me directly as he stated: “I am on the insurance committee. We might be able to discuss this issue in committee.”

Later, I wandered into the office of Delegate Larry Williams, the Chair of the Senior Citizens Issues Committee. He was very busy but when I opened my mouth, I caused a response. “You mean to say that the same company that owns Carelink Health Plans owns the Medicare supplementary company that is administered by WV PEIA?” “Yes, sir,” I smiled inwardly.

Delegate Williams discussed the West Virginia “PEIA mess” with me. Too many of his constituents have called for an investigation. They are alarmed as are the many others with whom I spoke at the Capitol. No one was amused as we share a heavy burden.

The West Virginia legislature has the power to create and amend laws, to study significant issues facing citizens. My presence made a positive impression on both Delegates Frazier and Williams.

“I will investigate this,” Delegate Williams promised me.

Lobbying was fun and I proved to be a natural advocate. Once I had someone’s attention, I kept it. I have only begun to explore this avenue to secure justice, to hold Coventry Health Care, Inc. and associates accountable for corporate wrongdoing. I will demand it of those in authority. It’s such a bizarre tale of abuse and corruption.

What does this mean? One person, dedicated to a great cause, can bring about positive change. It takes time and perseverance and a Faith that believes that all things are possible with God. You, too, can make a difference. Your voice is needed. Now.

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