Tuesday, November 30, 2010

Coventry Health Care Inc Sick In America

Tuesday's Tirade

Carelink takes control of A Patient Bill of Rights!
A Reprint of Monday, August 11, 2008, blog.

                        “Hell hath no fury like a woman scorned.”

                                                                 ~William Congreve

        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: http://www.freewebs.com/courageoffaith/HMO%20Patient%20Bill%20of%20Rights.pdf (Note: Cut and paste this link.)

        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: http://www.freewebs.com/courageoffaith/2005%205%2016%20Dr.%20Costello%27s%20Appeal.pdf (Note: Cut and paste this link.)

        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.
http://www.freewebs.com/courageoffaith/Dr.%20Rod%20McKinney%20Testimony%2C%20139-140.pdf (Note: Cut and paste this link.)

        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:
http://www.freewebs.com/courageoffaith/Testimony%20Nancy%20Phillips%20pp%20110-117.pdf (Note: Cut and paste this link.)

        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:
http://www.freewebs.com/courageoffaith/Testmony%20Patrick%20Quinn%20pp%2086-89.pdf (Note: Cut and paste this link.)

"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:
http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf (Note: Cut and paste this link.)

        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:
http://www.freewebs.com/courageoffaith/2005%2011%204%20My%20Response%20to%20Patrick%20Dowd%27s%20November%20Letter.pdf (Note: Cut and paste this link.)

"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:
http://www.freewebs.com/courageoffaith/2005%2012%2021%20Wildman%20ultimatum%20to%20Quinn.pdf (Note: Cut and paste this link.)

         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

God's Providence

"As long as the king followed the paths of God, he prospered, for God blessed him"
                                                                                       ~ 2Chronicles 26:5

         Many, many months ago, there was some talk within Coventry of my suffering from a myriad of mental illnesses. Some appeared to think that I suffered with several personality traits including paranoia, narcissism, and histrionic personality disorder.

        I have received psychiatric treatment for almost twenty years. I have nothing to hide. Neither Dr. Steven Ward, Dr. Mary N Boren, nor Dr. Michael Thase diagnosed me with a disorder other than bipolar illness.

        Is Coventry Health Care Inc so backed up against a wall in this lawsuit that they must create facts? As I await the next stage of what has become a lengthy process, I am adding numbers to my supporters.

        One plus one always equals two, unless a person discounts the reality of “one,” falsely believing it to be a figment of the imagination. The “one” that Coventry obviously overlooked, in their assessment my honesty, is Dr. Richard J. O'Brien, my older brother.

        What do Rick and I share in common? We both have contacts throughout the world.

        My contacts are in twenty-seven countries that have sent visitors to my blog: 15 visitors from Brazil, 11 from India and the United Kingdom, 9 from Russia, 7 from Germany, 7 from Philippines, 6 from South Korea and 2,472 from the United States, among a few.

        Rick devoted thirteen years to research and education of tuberulosis in the world, first with the World Health Organization (Geneva Switzerland) and this past six years with Find Diagnostics in Geneva Switzerland.

        Hopefully, I can clear up some huge misunderstanding with Coventry personnel and others by directing you to the following information:

Head of Product Evaluation and Demonstration

Dr. Richard O'Brien

Dr. Richard O'Brien received his Bachelor of Science degree in Chemistry from Wheeling Jesuit University and his Doctor of Medicine degree from West Virginia University School of Medicine.

In 1970, following his internship in medicine at the University of Maryland Hospital in Baltimore, Dr. O'Brien joined the United States Public Health Service. He completed his residency in internal medicine and his pulmonary fellowship at Emory University in Atlanta and postgraduate training in epidemiology at the London School of Hygiene and Tropical Medicine.

In 1979, Dr. O'Brien joined the CDC Division of Tuberculosis Elimination (DTBE). From 1991-96, he was detailed to the WHO Global Tuberculosis Programme in Geneva. Following his return to CDC, as head of the TB Research Branch he expanded research on new TB diagnostics and oversaw the establishment of the TB Trials Consortium (TBTC) for therapy trials of new TB drugs.

In January 2004, Dr. O'Brien joined FIND as Head of Product Evaluation & Demonstration for TB. In this capacity he has primary responsibility for pivotal clinical trials and registration of new TB diagnostics.

        In the thirteen years of living abroad, Rick, as a respected scientist, travelled to every part of the world to work to eradicate tuberculosis. He recently returned to the United States where he will reside.

        Until this Thanksgiving holiday, Rick’s visits were rare and rushed. So it is not surprising that he knew next to nothing about my case against Coventry Health Care, Inc.

        At breakfast on Sunday, I handed Rick some “homework,” a thick folder with several documents that describe the incalculable evil in the health care system in America. I asked him to read these documents and call me to discuss the scope of my case.

        "After I read this," Rick retorted, "do you want me to pass them on to some of my colleagues?"

         My answer was brief: “It is your decision. I have been hearing for years that you are a social activist at heart."

         I smiled.

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