Tuesday, March 10, 2009

Fighting Coventry, the Darling of Wall Street

Tuesday’s Tirade
On Being an Underdog

"I never expect to lose. Even when I'm the underdog, I still prepare a victory speech." ~Author H. Jackson Browne

Flashback: August 16, 2005
My husband Tom and I arrived home from visiting our son Allen, who lives in Washington D.C. I had a lot of downtime during the visit, so I used it well, searching the internet for information about my HMO, Carelink Health Plans, Inc of West Virginia, as well as other available resources related to my investigation of Carelink.

I located a sizeable volume of pertinent data. Of interest is that there are many sites linking to Carelink that are no longer available (AWOL). Very suspicious. Maybe the truth hurt just a little too much. I suspect there was manipulation. Funny though. Nothing is ever lost on the internet. I have learned ways to retrieve all the files.
This project has begun to take on the dimensions of writing a research paper. A critical paper on the health care crisis. My internet sources will provide the body of the paper; my sizeable evidence will be noted as addendums.

During our visit at Sunday liturgy that weekend, the homilist shared his perspective on HOPE. Hope means trust that God will do his sizeable part. I choose to hope. As the woman in the biblical story who never gave up seeking a cure for her daughter, God will reward me for my persistence. That's His promise.
What occurs to me today is that I am dealing with real people who must have hearts and concerns about office procedures, but mostly people in the lower ranks of the organization, maybe with little post high school education. Do they care about justice? Yes, many do, but most excuse Carelink’s policies as they must have no idea of the grave injustice done to consumers at the other end of the phone.

Do some fear for their jobs? Are they permitted to ask questions? Do they ever stand up for the consumer? Afraid not. Good people turning their backs on wrongdoing. Where is our moral conscience?
What does this all mean? I am the underdog. The good news is that underdogs can operate under the radar and tools exist to help me. One of these tools, I thought, is URAC, an accreditation agency of health plans. I was sadly mistaken.

URAC, is purported to be an independent, nonprofit organization that is well-known as a leader in promoting health care quality through its accreditation and certification programs. A vast number of health insurance companies are accredited by URAC. In my case, I have a right to file a complaint with this agency against my health plan to be investigated by them. It "appears" that the investigations are to meet high standards. Wrong again.
Yet another roadblock. In 2005, I wrote to URAC asking for direction in filing a complaint against Carelink. No response. Do they have the same problem as Carelink in losing records of communications?

I later learned that an executive officer of Carelink’s parent company, Coventry Health Care Inc of Bethesda MD, was co-director of the Board of Directors of URAC at that time I sought assistance. Bernard Masheim, M.D. was the Executive Medical Director of Coventry. Coincidence? I think not, but who knows? Conflict of interest? I believe so.

Times change and events happen. Someday I will no longer be the underdog. A role reversal will occur. Carelink will become the underdog.
Update as of Tuesday, March 10, 2009

I have increased the scope of my investigation against Coventry in the last three and a half years. I am confident that I will write that victory speech someday. For today, I present yet another indictment of a system that needs more regulation and transparency to insure consumers receive justice.

The following is the current description of a “person of interest” who now chairs the Board of Directors of URAC:

Bernard Mansheim, MD named chairman

Washington, D.C. May 28, 2008 - Today URAC announced that Bernard Mansheim, MD, has been elected to serve as chairman of URAC's Board of Directors.

Mansheim has served on URAC's Board of Directors since 2005. He is a physician and is board certified in internal medicine and infectious diseases. He worked in academic medicine for three years and then in private practice for another decade, and has worked in medical management for more than 15 years.

Where is the mention of Mansheim’s long affiliation with Coventry Health Care, Inc. of Bethesda MD as the former Vice President of Coventry Health Care? Who are these people trying to fool?

We know the answer. It is the many physicians, consumers, and legislators, who do not have the time, the knowledge or the passion to investigate organizations whose marketing plans somehow fail to tell all the truth.

Here’s a juicy link to the make-up of the Board of Directors of URAC today. Just how many people are part of Carelink’s grand scheme? Ponder my rejection by URAC in 2005. Ponder the policies that might just be adopted by URAC because people who have invested interests in their own health plan benefits are members of a governing body. Ponder why I am the underdog.
URAC Board of Directors

Tuesday’s Tale
Justice Delayed

Few people know that I live with a serious medical problem which left untreated could cause a stroke or heart attack at any moment. As justice continues to elude me, my treatments have been delayed.

On , December 14, 2006, the West Virginia Insurance Commission enacted Final Order 06-AP-024, that ordered Carelink to authorize my medically necessary surgery to treat my severe sleep apnea . Following one Carelink delay in court after another, I received Carelink’s authorization on April 19, 2007.

Prior to this, on January 23, 2007, my specialist contacted Carelink to request an alternative treatment, one that neither required invasive surgery nor cost Carelink much. Records indicate that the specialist's representative Sarah Hamilton spoke to Lewis T, a customer service rep with Carelink. Hamilton was told on the spot that this was not one of my benefits. Just like my surgeon Dr. Bernard Costello was wrongly told in May 2005 and later proved to be an error.

Final Order 06-AP-024 also mandated that each requested procedure be thoroughly investigated by Carelink before a decision. Justice was delayed once again January 23, 2007. I am still waiting. Did the West Virginia Insurance Commission enforce the order so I could avoid life threatening effects? No. Justice delayed.

On May 17, 2007, I met with Dr. Bernard Costello, the surgeon who was to perform my authorized, expensive procedure of maxillofacial surgery to treat my medical problem. We discussed the great stress under which I was living, chiefly due to my relationship with Carelink. Dr. Costello advised me to delay the surgery until these difficulties were behind me. He ordered another sleep study. Again, I wait for delayed justice.

Justice now awaits the prosecution of my civil lawsuit against Carelink and former CEO Patrick Dowd for alleged discrimination and intimidation that will take place in two to three years in Ohio County, West Virginia. Ohio Country jurors have the distinction of awarding the highest damages in the U.S. Not necessarily a coveted distinction, but …

Will I live to witness the final victory? Who knows? I have always suspected that Careink would rather I die so I’ll go away, like Ivyl Garnes, Tracey Pierce, Dale Fausset, and Nathan Crabtree. Whether present or not, my evidence is my condemnation.

I begin to outline my victory speech and it feels sweet.

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