Tuesday, November 23, 2010

Mental Health Parity and Coventry Health Care Inc

“Courage! We must really act like men today if we are going to save our people and the cities of our God. May the Lord’s will be done.” 2 Samuel 11:12


It was Fr. Jerome McKenna, my spirtual advisor, who, several years ago, exhorted me to blog. I have written Tuesday's Tirades and Tales for over two years with significant results: 2,532 visits came from 25 countries/territories. People are making up their minds about the facts of this case. New visitors daily.

But there remain manyunanswered questions.

Why does the United States rank 49th in the world in overall life expectancy? ~Columbia University, September 23, 2010?

How is it that so many health care agencies are interested in reading Tuesday’s Tirades and Tales?
Over fifty agencies including insurance companies, hospitals, and lobbyists have visited my blog in the last two years.

Coventry Health Care of Bethesda MD, with 196 visits leads all insurance companies in visits to my site. Thjey have viewed an average of 3.2 pages and spent an “average” of 1 minute and 41 seconds each time. Here’s a breakdown by city.

1. Homestead PA    45 vistie  4.80 ave pages  00:01:10 average minutes on site

2. . Pittsburgh PA     34             3.97                    00:04:39

3. Cranberry Township PA     31 visits     3.10 ave pages visited      00:01:06 average minutes on site

4. Sewickley PA        16             1.00                     00:00
5. Harrisburg PA       13              1.38                   00:00:
6. Silver Spring MD   13              3.15                 :00:08

7. Downers Grove IL 11             1.73                  01:41 

8. Bethesda MD           7             1.29                 :00:24

9. Coraopolis PA         7              1.43                :00:53

10. Mc Kees Rocks PA  6          1.50                 01:50

11. Glen Allen             4              1.00                 00:00

12. Glenshaw PA        3             1.00                 00:00

13. Baden PA            1            1.00                  00:00

14. Broward County FL 1          1.00                   00:00

15. Opa Locka FL           1           2.00                 00:43

16. Tucson AZ               1            7.00                16:13 

I would be interested in knowing what the US Justice Department, the US Sergeant of Arms and Harwood Lloyd LLC find so interesting about my blog.

Can an Attorney represent someone he knows is guilty?
Attorney client privilege applies. Some say the lawyer can't represent someone because the defense would be a lie. That is not really true. Why? Because, the jury determines the truth. Not the lawyer, judge or defendant . A lawyer is required by the cannon of ethics to zealously represent a client. It is their job to force the prosecution to make the case. They must keep their client's secret unless failure to reveal it would place another person's life in danger. So, it is a lawyer's job to be quiet and allow the system to do it's job. They are not lying by doing so, in fact by forcing the system to do it's job correctly in the big picture by protecting the rights of the guilty, all of our rights are protected. This is our duty as lawyers and advocates and citizens.

Read more: What would a defence lawyer have to do, if their client was pleading not guilty but privately confessed to their lawyer that they were actually guilty?
Answerbag http://www.answerbag.com/q_view/363941#ixzz14Fysrbbg

The Law Firm of Spillman and Battle which represents CARFELINK (A Coventry Health Care Inc company) as defense in the civil lawsuit I brought against them on October 15, 2007 have visited Tuesday’s Tirades and Tales:

Charleston        222  visits     5.64ave pp.  01:09 7.ave minutes

St Albans                  26               4.58                03:59

Charleston             7               1.86                00:05

Institute                   2               1.50                 09:11

When can an Expert Witness be sued for malpractice?
There are two parties concerned with the performance of experts: the party that hires the expert to testify and the opposing party. Their goals are at odds. The hiring party wants effective testimony as measured by a beneficial effect on the judge and jury, while the opposing party wants the expert discredited and the testimony stricken. Dissatisfaction by either party, without more, is not evidence of malpractice. As in other malpractice actions, it must be found that the expert performed below the standard for the profession he/she represents, and that this substandard behavior caused the party's injuries ( my emphasis). Thus the party claiming malpractice must show both the standard for such experts and that, but for the expert's deviation from the standard, the party would have won. However, unlike other malpracticing professionals, the expert witness occupies a privileged place in the legal system. This is illustrated in the recent case, LLMD of Michigan v. Jackson-Cross.[1]

Here's one question for which I do have an answer: What has been the specific blog that draws these people back time and again?.

With 536 Pageviews and 314 unique views the most popular of Tuesday’s Tirades and Tales is Coventry Health Care Deceit and Indifference. For those who missed this blog, I reprint it today.

Monday, August 18, 2008
Coventry Health Care Deceit and Indifference

Tuesday's Tirade
Watch Out! Carelink is at the Controls

What you are about to read should alarm you.

Carelink Health Care, Inc. of West Virginia, and many of its sister companies, publishes a quarterly newsletter LivingWell, ostensibly to help advance quality health of its subscribers. In my mind the newsletter is just another tool of false or misleading advertising. Carelink's words conflict with its actions.

Unfortunately, too many Carelink subscribers believe these promotions. On paper Carelink is an ideal HMO. However, the web of deceit I describe here ought to shake anyone's confidence in Carelink and Coventry. For me, their promises were hollow.

The Summer 2008 issue of Livingwell describes Carelink's concern in improving their services to "meet the high quality standards." It invites the subscriber to participate in insuring these standards through registering complaints. Carelink's goal is "to focus always on quality issues of high importance." Carelink, on record, searches for problem issues.

One line bears repeating: Carelink's goal is "to focus always on quality issues of high importance."

Here's the link in the Summer 2008 issue of LivingWell entitled Giving You Quality Care at the bottom of page: http://www.freewebs.com/courageoffaith/LivingWell%20Summer%202008%20Q1.pdf

Hint: Just cut and paste this address into your web browser.

Shock is too tame an emotion to describe my response to opening this summer's LivingWell and reading the headline: Giving You Quality Care. It was a violent blow to me personally as I had struggled daily to receive the quality care from Carelink to which I was entitled. I remain outraged.

Today's Tirade will destroy any confidence one will have in Carelink's honorable intentions.

As an aside, assertions like this are made time and again in Coventry brochures and online tools. How can one not begin to doubt Coventry's motives after reading of my experience and those of many others who never lived to write a line of their trials?

Flashback: Tuesday, September 27, 2005.

The day was a crisp September day. The mail included an unexpected letter from a Carolyn Westfall, Quality Control Coordinator of Carelink Health Plans, Inc. of West Virginia. Westfall signed the letter and expressed an interest in investigating a claim about my concerns regarding lack of quality care. It was a computer generated letter. It may never have been mailed to me otherwise. Here is Westfall's letter: http://www.freewebs.com/courageoffaith/2005%209%2027%20C%20Westfall%20Complaint%20Registered.pdf

"What claim?" I quietly thought to myself. I had many more important concerns on my mind that September day about Carelink. Very serious concerns that I had expressed to many Carelink personnel and to Robin Aronberg of the legal department of Coventry Health Care, Inc.

How foolish man is to think that they are above the law and will never be held accountable. We all will face a higher power someday; know that the higher power seeks justice for the poor. Carolyn Westfall's letter is a testimony to a loving God who desires that the truth be set free.

It was urgent that I receive the medically necessary surgery that months earlier Carelink had denied. Why had the process taken three months? Is there not a regulation that demands speedy decisions especially when the doctor defines the medical necessity of the surgery? What happened to the other three appeals mailed to Nancy Phillips, Appeals Co-ordinator, that Phillips never processed? Why did Phillips lie to me and say thay "we have been working on this all day," when I knew the 4th appeal had only reached her on the afternoon of the day I was denied. How could a decision be made without consulting with my doctors?

Excuses. Excuses and more excuses, different words but the same intentions. And people continue to suffer and even die.

When I finally reached Westfall in late October 2005, she reported that Debi Kalorik, Customer Service Operation Supervisor of Coventry, submitted a claim in my name. Kalorik reported that during the appeals process, the Appeals Department did not respond to any of five phone calls placed to them by my surgeon, Dr. Bernard Costello.

My records are thorough as I daily recorded any conversation I had with Carelink and Coventry personnel. Unlike Carelink's records, my records are not "generic." Read this link to my records which describe a shocking, sinister reality: http://www.freewebs.com/courageoffaith/Westfall%20Investigation.doc

My complaint was sent from Quality Control to Patrick Quinn, the former "Manager" of the Appeals Department for review before he chose to send it to corporate legal in Bethesda MD. Legal returned the original claim to Kalorik, the supervisor who reported the "problem" that Coventry says in its published documents it wants to resolve. The entire incident was meant to vaporize with these actions. But the computer kept kicking out timely responses. Technology at its finest.

Carolyn Westfall never contacted me as promised. She likely thought that she could run from the truth. There was a conspiracy to withhold information from me, an intentional, underhanded plan to deny me access from the same company who broadcasted each chance they had their stellar practices. This truth is highly disturbing.
Today Quinn no longer works for Carelink, but then he was a central figure in my complaint. It was he who had ultimate responsibility for the department's insuring appeals are processed in a timely manner. It would be a few more months before I heard that Patrick Dowd, Carelink CEO, had left his position. Dowd had been Quinn's immediate boss. More intrigue? Definitely.

Westfall's grossly offensive admission to me in the spring of 2005 greatly alarmed me. Westfall answered the phone that day and responded to me, "I thought you were gone." There was tension in the air. The conversation brief. It was all too obvious that Westfall wanted off that phone. Before hanging up, her final words were, "Mrs. Stenger, I have taken this as far as I can."

It was only a few short weeks following Westfall's letter, that I received a survey requesting my thoughts about how Carelink does in providing me care. And I received a second survey. The next day the trash was taken out as usual.

One more twist of fate. Carelink has a satellite office in Wheeling, West Virginia, my home town. Just down the street. How might Westfall react to a surprise visit? Most likely, like Quinn and Phillips under oath, "I don't remember Penny Stenger."

The more interesting question: Will Debi Kalorik, Robin Aronberg, and Westfall receive the same fate as Quinn, Phillips and former CEO Dowd?

The pendulum of justice swings. Justice remains on our sides.

Tuesday's response: Guilty as charged

The complacency and actions of Coventry employees who contribute to this type of scheme must be renounced. Every time someone turns his back when he is part of an injustice, our health care, a basic right, will be diminished. Greatly diminished at times, especially for the most vulnerable, the elderly and the mentally ill.

When the quality of health is at stake, there is no excuse for being involved in questionable acts. How do these people sleep at night? How much more salary does Coventry CEO Dale B Wolfe, have to draw to live his quality life?

To help you remember something I never will forget, here's an interesting link to an article by the Washington Post: http://www.freewebs.com/courageoffaith/Rich%20Rewards%20Corporate%20Elite.pdf

There needs to be an accounting soon of Mr. Wolfe’s business practices. Waiting another minute is not acceptable. Our collective conscience must move us together towards justice in the name of all those who have been harmed. Forever.

Tuesday's Tale

My Father’s Legacy: Voices for Justice

My parents: Dick and Mary Kay O'Brien, 1960

When did I first sense that I would write a book? It was in the 1980's. I had begun to record my thoughts daily in a journal and developed a physical and emotional regimen to prepare for a successful future. "Why not write a book about this journey?" I asked my self. This question turned into a statement in 2005.

My dear friend, Fr. Michael Greb, O.F.C. directed me to write a book. With surprise, I responded, "About what?" Fr. Mike gently spoke, "About your great faith."

As of today I have written about 60 pages of a powerful story that will touch lives. It begins with the following Prologue that sets its tone. For not only is my book about faith, it is a story of how one person can fight against injustice and make a difference. With patience and perseverance, the way will be lit and the impossible happens.

My Father’s Legacy: Voices for Justice


The day began as the day before it and the day before that one. A black hole, so deep he wondered if he could climb out of bed. ‘I’m only a shadow of myself,’ he thought. Was this just an evil trick of his brain or had he changed so much? When did his present struggles begin? His mind raced upon awakening. No stopping the noise. Now he was afraid of himself.

This day would be different, he reminded himself. He had plans. He knew there was a way out.

Dressing for the day, he chose a blue suit with white shirt and a favorite red tie. It was too obvious that he had lost weight. He didn’t dare stare too hard in the mirror. The reflection suggested worry and weariness.

His financial problems began when he left the family law firm. It appeared to be a positive move, founding another firm with two of his friends. But something snapped. His life was a whirlwind of activity and creative ideas. He was empowered and moved mountains, spreading joy to those he met. Or so he thought.

But then he suddenly fell into a dark chasm of depression. No choice but to go to the hospital for psychiatric care. Six long weeks. People shuffling around like zombies most of the day. Sleepless nights. Gray days. Too dark to move.

His doctor prescribed medication that would bring him back to reality. That’s what the doctor had said. Only he had to be patient. “It takes time for medication to work,” the psychiatrist told him. “It takes time for the medication to be effective. But it will be better…someday.”

And so he waited in darkness for three months. Despair. Deep despair. His thoughts drifted to “what-ifs.”

What if he could return to his family’s law firm? What if he did not have such deep financial problems? What if the State Road Commission of West Virginia had not seized his beloved camp of 20 years though eminent domain, in his eyes an abuse of power that took a slice of his heart? What if his new law partners would allow him to come back to the firm now instead of waiting for a complete recovery? No, No. No…This is madness.

Breakfast was simple: a bowl of shredded wheat, milk, O.J. He had little appetite of late. Nor interest in conversation. He said nothing to his wife. His three children had already left for school. He sat and remembered. He cried within. No one understood his pain. No one understood his behavior. There were snickers and hushed talk on the rare occasions he left his safe house.

He kissed his wife goodbye that Monday morning. The signs of spring were in the air as he drove his Chevrolet up the avenue. Instead of turning left as was his routine of late, he turned right. The car knew the way. Although he might be missed at the bank where he did routine legal work for half a day, people would know: it’s another bleak day.

There was no flash of better times, no signs of new life that he saw out his window. There was irony. Springtime is a time of new beginnings, of hope, of desire. In his depressed state of mind spring reminded him of the what-ifs, and he continued driving without thought, only darkness.

Many factors triggered his gloom. He had begun to deteriorate rapidly. He fought to save his Camp as best he could in his crippled mental state. Camp was not only home to him; it was respite from the ills he experienced daily, the imbalance in the legal system he had so proudly represented. He wept at the injustice done to many and rejoiced in the success of a few. Camp was his piece of heaven, where he enjoyed peace and solace.

Justice was on his mind that Monday morning. He was obsessed with visiting the Camp one last time before it was torn down for the new Interstate. Justice? There had been a last minute maneuvering, a change in routes for the planned Interstate. The State Road Commission of West Virginia chose a second option, one that would destroy Camp. He no longer had the energy to fight, but he had plans.

It was a late Monday morning when he drove off the country road and onto his property. Camp appeared sad and naked. Everything had been removed the day before except for a few items. He felt empty as he thought back to November. He had taken a stance: Justice in the guise of a stop sign. He impaled the sign in the ground in a futile attempt to stop people from trespassing. Or was it a futile attempt? Maybe it was an act of defiance by a deeply troubled but just man. Someone had removed the stop sign. He had no voice.

He proceeded into the now empty house and walked with purpose to the closet. A “what-if” came to his mind. What if the family had not left the guns yesterday when they cleaned out the Camp? Sick in mind, body, and spirit, he slowly walked up the steps to the attic. With no more thought he aimed the gun at his head and pulled the trigger. He found his way out. He quit.

On a dreary Monday in March 1965, he left a legacy. A rich legacy. One that continues as his spirit rises from ashes and guides others today. It’s quite simple. Stop: it’s time for all of this to change. It matters what we leave behind. Justice is attainable. Our lives do make the difference.

Now it’s my turn for I am my father’s daughter. I am involved in a legal battle against a giant in the insurance industry, who made the big mistake of neither understanding my roots nor appreciating that one determined, faith-filled individual can accomplish great good. Additionally, I have filed a claim against the WV Insurance Commission for one million dollars damages for obstruction of justice. No time for “what-ifs.” In West Virginia we are “Open for business.” Well, I have business to do, too, as I have discovered that just maybe West Virginia is a little too open to business. Dad’s stop sign is now replaced with this book. My work is words and the truth will set us free.

Posted by Christine O'Brien Stenger at 4:22 PM

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