Tuesday, April 26, 2011

Coventry Health Care Fights for Life Two Auspicious Events


We can always “prove” that we are right, but is the Lord convinced? ~Proverbs 16:2

American author James B. Stewart appeared on The Charlie Rose Show ton April 25, 2011, to promote his new book "Tangled Webs: How American Society Is Drowning in Lies". Stewart dedicated his book “To all those who seek the truth.”

As a seeker of truth myself amidst the many lies Coventry Health Care, Inc of Bethesda MD have advanced, I found much of Stewart’s convictions thought-provoking:

1. False statements by corporate America are undermining America.
2. Perjury and false statements are reaching a crisis proportion…
3. …near epidemic in part because such prominent people are doing it…
4. “I have to say lawyers have a lot to answer for in all this because each of these people had a lawyer at their side at the time they committed these lies…these aren’t common lies. (my emphasis)
5. Isn’t there a legal responsibility …that lawyers can be in trouble if they know their client is lying?(Q) Well, I went to law school…unfortunately, professional responsibility is limited to official proceedings before a judge…(Stewart's resonse)

Ironically, BASS BERRY & SIMS PLC of Nashville TN visited Tuesday’s Tirade and Tales yesterday. Who are Bass et al? Just visit their site and one’s understanding of justice expands:

At Bass, Berry & Sims we are making a name for ourselves as one of the nation’s premier firms. We represent more than 30 publicly traded and Fortune 500 companies and have been involved in some of the largest and most important business and litigation matters in the country. From coast to coast, mega-firms turn to us for high-stakes matters and consider Bass, Berry & Sims their blue-chip partner.

One-on-one relationships are at the heart of our client interaction, yet we maintain a cohesiveness and sense of community inside our walls that encourage a team approach.

Coventry Health Care Inc of Bethesda MD is listed as a client of Bass et al. Of interest to the “team” was the following blog written in August 2010.

Coventry Health Care Insurance Scams  - August 2010

"In a time of universal deceit, telling the truth is a revolutionary act."~George Orwell, English essayist, novelist, & satirist (1903 - 1950)

On October 27, 2005, I placed a phone call to the Customer Service Operation of Coventry Health Care Inc. Despite being told "countless times" that "your appeal rights with Careilnk regarding your request for a lefort graft have been exhausted," I uncovered a flawed system. My plan guaranteed my benefit, medically necessary surgery. After many delays lasting 22 months, Carelink authorized my surgery on April 19, 2007.

The authorization for medically necessary surgery occurs much later in my story. Prior to October 2005, both my surgeon and I had contacted the Appeals Departmant many times without receiving a phone call from the Appeals Department. This evidence is part of Final Order 06-AP-024, a ruling against Carelink Health Plans by Insurance Commissioner Jane Cline, following a hearing before Judge Jack DeBolt of the WV Insurance Commission on August 10, 2006.

On October 27, 2005, Ruth Simpson, CSO, answered the phone. She listened to my account and offered to relay a message to Mr. Patrick Quinn, who oversaw the Appeals Department. I told Simpson that I hoped Quinn woulntact me and I mentioned that I was writing a blog about my journey with Carelink.

163 Bello Vedere Avenue
Wheeling WV 26003

November 4, 2005

Mr. Patrick W. Dowd, President and CEO of Carelink Health Plans, Inc.
Virginia Street, East, Suite 400
harleston, WV 25326

Dear Mr. Dowd:

I received your letter dated November 1, 2005, and I am most happy to be able to clear up any misconceptions any representative of Carelink Health Plans may have. I thank you for this opportunity.

Your records indicate, as do mine, that a phone call was made on October 27, 2005, from my home phone to a Customer Service Representative of Carelink Health Plans, Inc. This CSO had promised on October 19, 2005 to look into a matter for me and contact me about her findings. On October 27, 2005, I believed I had been patient enough and had a right to contact the CSO about this matter. I did not intend nor did I express myself in any way that would suggest I was impersonating Ms. Dena Wildman, Wv Insurance Commission.

In your letter, Mr. Dowd, you stated that "based on the information you (Christine Stenger) gave her, and the way you (Christine Stenger) expressed the purpose of the call" left the CSO with the "impression" that "she was speaking with Dena Wildman." Let me clearly state that I did no such thing. Additionally, I did not provide any information nor did I intend to provide any information, that could reasonably be interpreted as misprepresenting myself as a public official. Nor did I express myself or intend to appear in any way that could be reasonably interpreted as impersonating Ms. Wildman.

Throughout this lengthy process to insure I receive treatment that is medically necessary per Dr. Bernard Costello my surgeon, and is covered by Carelink per the terms of my contract, I have sought to obtain records regarding my case. I have received a portion of those records that I requested, and I can assure you that my 28 pages of records of conversation with employees of Coventry Health Care Inc, are much more detailed that those I received from CSO. Regarding the above noted "impression" of the CSO, I want to state emphatically that the "impressions" of the CSO are in direct contradiction with my records.

Finally, referring to your statement that "we have informed you...that your appeal rights with Carelink...have been exhausted," I take this opportunity to advise you of two concerns of which you may be unaware. There have been several times in this lengthy appeal process where I have the "impression" that I received false information from employees of Carlink Health Plans Inc and outside agencies, information that appears to contradict what you are saying. I have been told that I have not exhausted my appeal rights. Surely, a person of your stature must understanbd my quandry.

I do greatly appreciate your involvement in furthering the truthregarding my case. Neither of us have anything to hide nor fear as we continue to act in fairness and with consideration.

Thank you.

Christine O Stenger


Ms. Mary Jane Pickens, General Counsel, WV Insurance Commission
Ms. Robyn S. Aronberg, Legal Department, Coventry Health Care Inc.
Ms. Carolyn Westfall, Quality Control Coordinator, Coventry Health Care Inc.

In the First Circuit Court of Ohio County Paul Tucker, my attorney, intends to prove that Patrick W. Dowd was aware that I suffered with bipolar illness when he knowingly mailed me "the" letter dated November 1, 2005, falsely accusing me of fraud.

Within minutes of receiving Dowd's letter, I contacted my son, an attorney. The rest is history.


Dr. David Clayman, Forensic Examiner for Carelink Health Plans, Inc. of West Virginia

" At Clayman & Associates, our goal is to provide reliable, comprehensive and objective evaluations that exceed all professional guidelines set forth by the American Psychological Association and other affiliated organizations. For us, the ethical guidelines are the expected standard -- not merely an aspiration."

Don't Expect A Fair Report

"While some IME doctors are highly professional, and seek to actually provide an objective evaluation, a great many doctors know that they are being paid by the defense, and that the insurance companies which pay their bills expect that the position of the defense will be improved as a consequence of the IME report. Accordingly, many IME doctors appear to skew their reports in favor of the defense. A subset of IME doctors have a very poor reputation for fairness or accuracy, and will present whatever medical opinion the insurance company desires… The problem is, these insurance industry physicians are not “independent medical examiners” by any sense of definition, and can actually add to the controversy of medical impairment bydrawing conclusions, writing reports, and providing testimony that is clearly biased in favor of the insurance company." ~The Independent Medical Examination by Aaron Larson, March, 2005

Dr. David Clayman is aware that I have kept thorough notes of any dealings with Carelink. Not surprisingly we are worlds apart in presenting truth versus presenting lies. But that's for future blogs, today I record my notes of the interview with Dr. David Clayman and Dr. Stacy Waller on May 10, 2010 as I experienced it.

May 26, 2010

The day of my forensic exam by Dr. David Clayman, forensic “expert” I awoke as usual. It was natural to consider the upcoming questioning as to the history of my mental health, but I frequently remembered that my Faith would ultimately prove that Carelink et.al are fools.

I did experience a challenging moment as I drove to meet Paul Tucker. I was shaking and felt light headed; I ate a nutrition bar and moved through it. By the time to face the interview, I was strong and inwardly angry that what I believe to be a farce continued.

Clayman brought along his co-worker Dr. Stacy Waller “to take my history of drugs and alcohol…” That took all of about twenty minutes and did not require a second psychologist. Clayman is more that capable to deal with all the questions. An attempt to pit two peoples’ statements against mine? Time will tell.

Prior to this interview Judge Gaughan had asked Paul to advise me to be direct with my answers. As the interview continued through some questions that triggered a lot of pain, I suddenly was direct with Clayman stating that I could not trust him, that he is not who he says he is. I was brutal, bringing up the near bankruptcy. I mentioned that one article described his having 30 years experience in forensic psychology while another, in contractiction, stated it was more like 20 years. Dr. Calyman dismissed the inaccuracies as nothing. I mentioned several people told me that he is not a forensic psychologist. I hit hard on how hard he works at creating image.

I did not plan this conversation. It came out of nowhere although I do have serious doubts about Clayman. I had mentioned the use of the record and the coerced signed consent – Naturally, Clayman had no knowledge of that. “That is standard procedure.” Clayman took several minutes of what he termed earlier as valuable time to discuss the evidence that led me to my conclusions. I believe it was I who called him back to the reason for our being there for this forensic interview. It was not time to continue discussing my concerns about him.

At the end of the interview, there were several minutes left as Dr. Clayman was preparing to end the session. Suddenly he asked a lengthy question that basically asked me which of the areas under my suspicion would be the one that might be the most problematic to him. I told him that I had no answer, but added that he should forgo image building on the web.

While most of the questions posed appeared to be legitimate areas for a forensic psychologist to bring up, there was an unsettling realization after discussing the facts, specific facts…”who said what”, that Clayman was abusing his privilege to evaluate my emotional state…I felt like I was being grilled about the evidence of my case. He dismissed this complaint also, saying that he had to do this to try to understand what caused an emotional meltdown. Clayman also admitted he would be reading all my written documents which includes this blog. It was I who called it quits to this line of questioning, stating that he had enough info and I would not answer any more. I was emphatic.

Unlike the last session where I shook very clammy hands, Dr. Clayman was relaxed. Dr. Waller was more reticent, a noticeable change in her when I was direct with Clayman.

It, in retrospect, was like, “I have the pieces of the puzzle…I know I can produce a report in 30 days that will satisfy Carelink.”

Earlier in the afternoon, Paul Tucker walked me to my interview with Dr. Clayman and Dr. Waller. Paul shared that he had been working hard on my case, reading document after document. “They really botched it,” Paul told me. I thanked Pauk for sharing his assessment at this time as I would face my interviewer with the image that these people are fools.


As we were preparing to leave the examination, I asked Dr. Clayman what he thought about the BP disaster. He genuinely assessed the source of the problem to be lies associated with regulatory bodies. Dr. Waller shook her head, describing how media distorts the truth. “Who are you to believe? Which person is telling the truth?” There is real irony in these statement as Carelink has demonstrated time and again that they have no honor. Is Dr. Clayman a hired assasin? An ignorant fool with a tragic flaw?

This is not pleasant, nor is reading a twenty-nine page report that was fabricated to support Carelink's case.

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