Tuesday, May 12, 2009

Dying for Lack of Insurance

Tuesday’s Tirade
Dying for Lack of Insurance

Americans want the right kind of health care reform, and they want their elected officials to deliver it NOW.

My personal journey through the health care system with former Fortune 500 Company Coventry Health Care Inc of Bethesda MD is frightening. It reveals a private for-profit network of choices that prey on consumers. Spinning the truth by employing a variety of tactics to fool the public into a false sense of security comes naturally.

Investigation of the health insurance industry describes companies who are willing to let a consumer die by denying a life-giving, rightful benefit. Daily it is reported that health plans intentionally deny quality life to someone. For example, Coventry delayed authorization of my medically necessary surgery for twenty-three months. Any real concern about my welfare? I had to fight (figuratively) every step of the way. I was my only advocate.

On the national front there is much discussion about health care reform. New ads appear daily promoting conflicting interests. Confusion results. I trust very few of these ads but I have learned a lot about the health care system from former Senator Tom Daschle who has devoted a lifetime to health care reform.

When Tom Daschle writes that “nearly 50% of all Americans don’t have the coverage they expect to have when they seek the care they need,” my anger explodes. I know this to be the truth. Tom Daschle knows this to be truth. Heck, my doctors admit to me that they do not tell their patients that a benefit may have been wrongly denied. Insurance plans know that the consumer cannot advocate for himself and the doctors have limited time to pursue a claim.

You and your family may be facing some hard times ahead. You have a 50-50 chance of receiving life-giving benefits. Are you comfortable with those odds? Let Tom Daschle speak to you directly about your options in his recent Newsweek article.

I have baseball on my mind: It is spring, the teams are on the field, the season has begun. It seems to me that winning the health-care debate is a lot like the Chicago Cubs' winning the World Series—it hasn't happened in forever, and some proponents are hearing the same old refrain of "Wait till next year."

This is usually a safe bet; we have never won the World Series of health care. The last time we even won a big game was in 1997, with the passage of the Children's Health Insurance Plan. Before that, you have to go back to 1965, when we won
Medicare and Medicaid.

Those were hard-fought victories, and the opposition then is familiar now. Our current debate has focused on whether reform should offer the choice of a public health-insurance plan. Many of the same arguments against a government-sponsored plan were used at that time, too—chiefly, that a public program will lead to a single-payer health-care system. The claim was nonsense, and nothing more than a shortsighted tactic. Fortunately, Congress didn't fall for it. Medicare is arguably one of the most popular government programs on the books today.

A growing number of Americans already get their health care from a public plan, including Medicare, Medicaid and the Children's Health Insurance Plan (the Department of Veterans Affairs, of course, also provides benefits). There are public-private hybrids as well, like state employee health plans where the government assumes the risk and insurance companies are responsible for the management. The use of a public plan as it is currently proposed is simply an extension of what we have already done in public policy during the last 50 years. We just have to circle the bases.

You get a free pass to first. Americans of all political affiliations overwhelmingly support a public plan. Part of the reason for this is because these plans have a proven track record of offering a far greater choice of doctors than private plans do.

Read the rest of the Tom Daschle’s article in Newsweek at http://www.newsweek.com/id/195672/page/2

Tuesday’s Tale
“Coventry Speak"

Over the past four years I have read many marketing pieces that Coventry has distributed, listened to countless positive messages on the phone while I awaited service, and, sadly, experienced Coventry in action, more correctly, in inaction. What has been my personal experience? Deception. Hypocrisy. Even fraud, it appears.

Here is a side of Coventry Health Care, Inc. that the public rarely, if ever, sees. Let’s begin with the following spin from Coventry:

Your Opinion Matters to Us

We work hard to provide the best care and service.

Our goal is to ensure our members receive the quality and service they expect from a health care insurer. To meet this goal, we annually survey our members to make sure they are satisfied with the quality of care and service they receive. We perform this annual member satisfaction survey through a third-party firm certified the National Committee on Quality Assurance (NCQA).

Member satisfaction is measured in two areas: quality of health care and quality of service. Health care quality is measured by overall satisfaction with health care, personal physician care, and getting needed care. Health care service is measured through satisfaction with the health plan, customer service, and claims processing.

Using the latest technology in processing claims, expanding our online capabilities to put more information at your fingertips and continuously enhancing our provider network are just a few examples of our dedication to quality.

Flashback to February 2005. I had been warned by my surgeon, Dr. Bernard J. Costello, of the University of Pittsburgh, that Coventry would initially deny my medically necessary surgery, counter to what the majority of health plans were doing at that time. Damn. Dr. Costello was right. Coventry was not telling the truth.

It took four appeals directed to the Appeals Department to address Dr. Costello’s request for reconsideration first transmitted in May 2005. Four appeals added to countless telephone conversations to locate an employee who cared about someone’s medically necessary surgery. Three months…long months, being led in circles.

It slowly dawned on me. Did Coventry ever have an intention of authorizing this surgery? It now appears that Coventry intentionally deceived me, hoping that I would go away. Providing the treatment Dr. Costello requested might set a costly precedent so the incentive was there to deny. Coventry kept building new walls and creating new excuses for the delays. But remember:

Your Opinion Matters to Us. We work hard to provide the best care and service.

Better yet, here a mission statement promoted online:

Coventry (Carelink) Vision Statement

We intend to revolutionize the health care industry in our markets through innovation, technology, quality performance, and commitment to our customers and constituents. Our aim is to offer products and services that will responsibly improve the quality of life of all we serve. We will conduct our business affairs in an ethical and financially prudent manner through employee development, involvement and empowerment, while demonstrating compassion to our members and setting a standard for all others to achieve.


“We deliver exceptional value every day, driving solutions that help people enjoy optimal health.”

Ugh! How can an insurance plan operate in defiance of its own governance regulations and advertising? It is one of the greatest injustices in health care.

Carelink is an H.M.O. The federal law E.R.I.S.A. prohibits the vast majority of legal claims against a Health Maintenance Organization. For over 60 million people who are insured under an HMO, Coventry and other H.M.O.s can claim to provide high quality care but in truth deny basic consumer rights and hide under the E.R.I.S.A. They smile all the way to the bank.

For what it's worth, you do have Coventry’s word on all this. Sleep well. They do.

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