Tuesday's Tirades and Tales

Coventry Health Care Inc of Bethesday MA Goes Back to Court

2011-06-28T16:33:00.000-04:00

The problem in not Anthony Weiner

Anthony Weiner, in and of himself, is not the problem. The problem is that we as a nation are willing to tolerate men like Weiner in office. How can it possibly be that Weiner is NOT going to be forced to resign? What kind of a populace do you have to have to tolerate Weiner’s sexual crimes, betrayal of his wife, betrayal of his oath of office, and his lying? Weiner is merely pathetic. A nation of people that permits men like him to continue to pollute the hallowed halls of their capitol is terrifying. The reason this country is going straight to hell isn’t because it contains men like Weiner. The reason we are going straight to hell is because we don’t respect ourselves enough to demand better of our elected leaders. A nation that thinks that it deserves to be ruled by lying, … is already dead.

~ Wethepeople.com, June 7, 2011

IN THE UNITED STATES DISTRICT COURT

FOR THE NOTHERN DISTRICT OF WEST VIRGINIA

Civil Action No.5: 10CV109

(STAMP)

CHRISTINE STENGER, Plaintiff, v. CARELINK HEALTH PLANS, INC. ("COVENTRY HEALTH CARE INC OF

BETHESDA MD") and PATRICK W. DOWD, Defendants.

MEMORANDUM OPINION AND ORDER

GRANTING THE PLATIFF’S MOTION FOR LEAVE TO FILE;

DENYING THE PLAINTIFF’S MOTION TO STRIKE DEFENDANTS’

MEMORANDUM OF LAW IN SUPPORT OF NOTICE OF REMOVAL;

GRANTING THE PLAINTIFF’S MOTION TO REMAND;

AND DENYING THE PLAINTIFF’S REQUEST FOR ATTORNEY’S FEES

I. Procedural History

The above-styled civil action is before this Court as a result of a notice of removal filed by the defendants in which the defendants assert that federal jurisdiction is pursuant to 28 U.S.C. $ 1331, 29 U.S.C. $ 1001, et seq., and 29 U.S.C. $ 1140. On October 15, 2007, the plaintiff, Christine Stenger (“Stenger”), commenced this civil action in the Circuit Court of Ohio County, West Virginia, asserting several state law claims against Carelink Health Plans, Inc. and its former President and Chief Executive Officer, Patrick W. Dowd (“Carelink defendants” or “defendants”), including discrimination, intimidation, intentional infliction of emotional distress, and negligent inflection of emotional distress. The defendants initially removed this case to this Court on November 16, 2007. On September 26, 2008, this Court remanded the action to the Circuit Court of Ohio Country, finding that the plaintiff’s state law claims were not preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. $ 1001, et seq., as the claims did not “relate to” an ERISA benefit plan.

On October 22, 2010, the defendants again removed this case to this Court, stating that the plaintiff filed “other papers,” specifically, her memorandum in opposition to the defendants’ motion for summary judgment and other related pretrial filings, which, for the first time, showed that the plaintiff intended to bring an action pursuant to ERISA. The defendants filed a memorandum of law in support of their notice of removal. The plaintiff then filed a motion to strike the defendants’ memorandum of law in support, in which they argue the memorandum in support is “redundant, immaterial, and impertinent.” The plaintiff also filed a motion to remand, in which the plaintiff argues that the defendants’ removal was untimely. The defendants filed a response to which the plaintiff replied. The plaintiff filed a motion for leave to file a supplemental memorandum regarding her motion to remand. (1)

For the reason set forth below, this Court denies the plaintiff’s motion to strike the defendants’ memorandum in support and grants plaintiff’s motion to remand.

And Judge Frederick P. Stamp continues in his arguments that will insure that Plaintiff Christine Stenger’s case be held in her hometown of Wheeling WV within the next 90 days.

This sweet victory comes at a huge cost to the plaintiff, but it is a monumental win for unsuspecting electorate that in the election of 2012 will be better informed as to the harsh reality about for-profit health care. The plaintiff will leave her small corner of the world a much safer place to raise the next generation of American citizens, whose disabled, should never again have to under go the travesty in the justice system that allows unconscionable delays and indignities unimaginable. As Father Jeremiah McSweeney, my spiritual director shared today when we met, “Penny, trillions of deo gratias.”

Coventry Health Care Fights for Life Two Auspicious Events

2011-04-26T07:22:00.000-04:00

Destiny

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.

Cordially,
Christine O Stenger

ENCLOSURE

Cc:
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.

TUESDAY'S TALE

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.

Postscript

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.

Coventry Health Care Inc A Time of Reckoning

2011-04-19T07:07:00.003-04:00

It's Time for A Reckoning

Forgive me if I stated this truism before. It bears repetition. Again. Again.

Most Americans have no access to the American justice system as it exists this day.

I now turn to the public arena to right personal wrongs.

A few moments ago I e-mailed West Virginia representatives in Congress and President Barack Obama a letter:

Re Christine Stenger v Carelink Health Plans of WV, First District Court of WV

I am a concerned Medicare recipient. Most significantly, I have irrefutable evidence about egregious deeds of the health care industry in West Virginia that will affect your future representation in our state. You might want to learn more about my extensive efforts in advocating for the mentally ill in our state.

For six long years my fight for rightful medical benefits from Fortune 500 health insurance company Coventry Health Care Inc of Bethesda MD, unfortunately, has been a secret. Former Vicar General of the Catholic Diocese in West Virginia, my spiritual director, Fr. Jerome McKenna in 2007, described what he had learned from my personal investigation as a "systemic evil in healthcare in West Virginia".

While politicians of both parties postulate for the 2012 election, evidence of wrongdoing to me and many Americans over the years, will speak truth to power.

FOR ACCESS TO ALL PUBLIC COURT DOCUMENTS SUBMITTEN IN THIS CASE, CONTACT:

Ohio County Courthouse

Brenda L. Miller, Circuit Clerk

1500 Chapline Street

City/County Building

Wheeling, WV 26003

Ph. 304-264-3611

Please...help the elderly and mentally ill in West Virginia, our state, begin to receive the compassionate help they need today.

I would like a personal response to this e-mail. A form letter will suggest a real lack of concern.

Be well.

Christine O'Brien Stenger

Coventry Health Care the Focus of Social Media Campaign

2011-04-12T05:33:00.001-04:00

Therefore, since we are surrounded by such a huge crowd of witnesses to the life of faith, let us strip off every weight that slows us down, especially the sin that so easily hinders our progress. And let us run with endurance the race that God has set before us.

~ Hebrews 12:1 NLT

Editor’s Note:

Since May 2005 Coventry Health Care, Inc, of Bethesda MD has robbed me of my sanity and quality life. And while Corporate attempted to silence me, they failed. They underestimated my Christian foundation. For me, every action I have taken thus far has been rooted in a compassion for a world that hungers for justice, human dignity and respect.

Most significantly, I believe in a “Big” God who moves mountains through ordinary, weak men and women. Men and women, who tremble, but are willing to say “yes” to desiring to make thier world a better place for generations to come.

I never intended to enter this fray. I was not a candidate for bold confrontation, but I am a woman of principles. I had no choice.

What I began to learn as I sought my rightful benefits with my former HMO, Carelink Health Plans Inc of West Virginia, beginning June 2005, is that there is a vast network of powerful and greedy for-profit insurance companies that continue to build profits on the backs of the suffering poor. God’s word instructs that one person in Faith can fight against such evil and win.

And so, always praying for the graces to be bold, to not be afraid of evil, and to trust that God is with me, I, a very weak and sick ordinary soul, did not remain silent. Today new light is shed on the health care industry by many, like me, who are choosing not to remain silent.

My bizarre this story will break. It will be soon.

One would have believed that the American court system would provide swift justice. One would think that others would understand how evil are the operations of health insurance companies who choose profits over people. One would think that our government and regulatory agencies would curb abuses. We think wrongly.

Today, I listen to wise voices in America who report that there is a deepening divide between the rich and the poor.

Common sense tells those of us who are willing to listen that anger is simmering across America.

Anger that will eventually break out into protests on a national scale.

Will these protests be peaceful, as many of us desire, or will there be violence with the realization that our financial markets, the oil and coal industry, our investment bankers and home lenders continue to make choices that harm?

What new story to be yet told will be that tipping point? With advent of social media, whatever it is, it will be broadcast by ordinary people across this country forcing unprecedented change in lightening time.

We poor, ordinary, good-hearted people, the majority of Americans, will soon recognize the power of our voices for change. Nothing else makes any sense. It is what fuels my passion.

IN THE CIRCUIT COURT OF OHIO COUNTY, WV

CHRISTINE STENGER, Plaintiff, v. CARELINK HEALTH PLANS, INC. and PATRICK W. DOWD, Defendants.RE: Civil Action NO 07-C-466, (Judge Martin J. Gaughan)

PLAINTIFF’S RESPONSE TO “DEFENDANTS’ MOTION IN LIMINE TO PRECLUDE PLAINTIFF FROM OFFERING ANECDOTAL TESTIMONY REGARDING THE INSURANCE INDUSTRY”

The prefatory and concluding paragraphs of defendants’ motion offer suffer from overbreadth and ambiguity. However, from the body of the motion it appears defendants believe the general public has turned against them and the rest of the health insurance industry due to misbehavior. While plaintiff does not deny this, it is not her intention to attack the industry generally for its unconscionable behavior – just Carelink.

This is not to say the power of the insurance industry and its critical importance respecting the lives and deaths of our citizenry, and the need that the industry not discriminate or intimidate, are off-limit topics. In this vein, punitive damages are prescribed to deter others similarly situated, and to the extent defendants believe plaintiff should be foreclosed from arguing the impact of the jury’s punitive damage across this country, they are wrong. See, Games v. Fleming Landfill, 186 W.Va. 656, 413 S.E.2d 897 (1991).

Moreover, should defendants continue in their counter-attack upon plaintiff, which portrays her as a narcissistic, would-be heroine, or should defendants in any variety of ways themselves open the door to Ms. Stenger’s views against the industry, then with Court leave, plaintiff intends to respond by presenting any and all of this type of evidence in meeting the defense.

WHEREFORE, plaintiff prays that the Court enter an order addressing this motion in accordance with the arguments set forth above.

Anthony Werner
Counsel for Plaintiff

PAUL T. TUCKER, ESQ.
W. Va. State Bar No. 5203
ANTHONY I. WERNER, ESQ.
BACHMANN, HESS, BACHMANN & GARDEN, P.L.L.C.
1226 Chapline Street
P O Box 351
Wheeling WV 26003
(304) 233-3511
(304) 233-3199 (fax)

FOR ACCESS TO ALL PUBLIC COURT DOCUMENTS SUBMITTEN IN THIS CASE, CONTACT:

Ohio County Courthouse
Brenda L. Miller, Circuit Clerk
1500 Chapline Street
City/County Building
Wheeling, WV 26003
Ph. 304-264-3611

Coventry Health Care Inc Fixation on Untruths

2011-04-05T04:39:00.007-04:00

The prayer of St. Francis

Lord, make me an instrument of your peace,

Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
where there is sadness, joy;

O Divine Master, grant that I may not so much seek to be consoled as to console;
to be understood as to understand;
to be loved as to love.

For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life.

IN THE CIRCUIT COURT OF OHIO COUNTY, WEST VIRGINIA

CHRISTINE STENGER
Plaintiff,

v. Civil Action NO 07-C-466
(Judge .Martin Gaughan)
CARELINK HEALTH PLANS, INC.
and PATRICK W. DOWD
Defendants.

PLAINTIFF’S RESPONSE TO “DEFENDANTS’ MOTION IN LIMINE TO REMOVE PLAINTIFF’S BLOG DURING THE COURSE OF TRIAL”

Defendants’ fixation upon plaintiff’s blog is itself worthy of psychoanalysis. They contend that jurors will defy the Court’s standard directive against exposing themselves to the media for information germane to the case, they claim that those defiant jurors will be tainted against Carelink, and they claim that this risk justifies trammeling plaintiff’s constitutional right to free speech. They bolster their claim with the revelation that the blog has been accessed in Ohio County as many as 51 times over the last two years or so. To put it in perspective, in a county of more than 44,000 people, as many as 51 people (more likely than not, the same person re-entered the blog over and over again) opened the blog. This is hardly a chilling and dispositive statistic. Defendants even resort to claiming that, in resolving defendants’ initial motion to stifle plaintiff, the Court ordered plaintiff to cease blogging about the case. (See Def’s Mot, para. 3) However, the ORDER resolving that motion just simply, succinctly, and wholly denied defendant’ motion, devoid of this order which defendants mis-allege. (See, EXHIBIT A ) Meanwhile, posing an equivalent threat, if any, Carelink itself has as internet site on which, among other boasts, it touts its claims processing practices.

Inconsistent with defendants’ anxiety over the blog is the fact that they presented it all to their expert psychologist, Dr. David Clayman, for use in accessing and opining about Mrs. Stenger. (See Exhibit B, p. 3, item 35) They apparently wish to use the blog selectively to cross-examine plaintiff or to support their expert’s opinion, yet they decry its caustic effect.

Plaintiff proposes the following: She will refrain from blogging from the point of the Court’s ruling on this motion until the verdict is received. However, defendants have no right to an additional relief they seek. If the Court orders the blog to be removed or blocked 1, then Carelink’s own internet site should be similarly removed or blocked.

WHEREFORE, plaintiff prays that the Court enter an order resolving this motion in accordance with the arguments set forth above.

Respectfully submitted,
Anthony Werner
Counsel for Plaintiff

PAUL T. TUCKER, ESQ.
W. Va. State Bar No. 5203
ANTHONY I. WERNER, ESQ.
BACHMANN, HESS, BACHMANN & GARDEN, P.L.L.C.
1226 Chapline Street
P O Box 351
Weeling WV 26003
(304) 233-3511
(304) 233-3199 (fax)

1 Having insufficient computer knowledge, counsel for plaintiffs themselves do know how to carry out such an order.

NOTE:

PLAINTIFF’S RESPONSE TO “DEFENDANTS’ MOTION IN LIMINE TO REMOVE PLAINTIFF’S BLOG DURING THE COURSE OF TRIAL was submitted to the Court on October 13, 2010.

FOR ACCESS TO ALL PUBLIC COURT DOCUMENTS SUBMITTED IN THIS CASE, CONTACT:

Ohio County Courthouse

Brenda L. Miller, Circuit Clerk

1500 Chapline Street

City County Building

Wheeling, WV 26003

Ph. 304-264-3611

Coventry Health Care Corporate Brutality

2011-03-29T06:02:00.006-04:00

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy." —Martin Luther King, Jr.

IN THE CIRCUIT COURT OF OHIO COUNTY, WEST VIRGINIA

CHRISTINE STENGER                                                  Civil Action NO 07-C-466

Plaintiff,                                                                             (Judge Martin J. Gaughan)

v.

CARELINK HEALTH PLANS, INC. and PATRICK W. DOWD
Defendants.

PLAINTIFF’S MEMORANDUM IN OPPOSITION TO MOTION FOR SUMMARY JUDGMENT

I. The Factual Predicate

This is an action for discrimination, intimidation, and infliction of emotional distress by defendants during the course of plaintiff, Christine Stenger’s pursuit of a complaint to the West Virginia Insurance Commissioner. Plaintiff does not seek recovery of insurance benefits, but instead seeks recovery of compensatory damages for illegal treatment of her by defendants while plaintiff attempted to pursue her statutory right to seek redress from a public official. Because plaintiff’s complaint before the Insurance Commissioner involved the handling of her underlying claim of benefits, and the Insurance Commissioner’s ultimate conclusion in her favor, it is necessary to describe the events leading up to her complaint.

It is not disputed that plaintiff, Christine Stenger, was a beneficiary of a health care benefits plan marketed by defendant Carelink to Stenger Business Systems, an office supply company located in Wheeling, and owned by plaintiff’s husband. The plan was created by Carelink pursuant to the provisions of West Virginia’s Health Maintenance Organization Act, Code 33-25A-1 et seq.

For many years prior to 2005, plaintiff was treated for severe bipolar disorder. EXHIBIT A is Carelink’s payment history for plaintiff. It reflects payments beginning in 2000 to plaintiff’s treating psychiatrist, Mary N. Boren, and two of her therapists, Ann R. McGeary and Beth A. Andes, as well as pharmacy payment for psychotherapeutic drugs, including Zoloft, Lithium, and Clonopin. All these payments were for treatment of plaintiff’s mental illness. Although Carelink’s retained expert psychologist quibbles with the exact diagnosis, he agrees that plaintiff “appears to meet the criteria for several categories of personality disorders.” Her illness causes her to come across as “demanding, defensive, moody, and reactive.” He opines, “All of these behaviors have been demonstrated throughout her history and are part of a deeply enduring pattern that has led to ongoing problems in her life.” Finally, he concludes, “The history presented by Ms. Stenger does support the view that she will be more susceptible to emotional distress than an “average person.” The report of Carelink’s retained expert is appended to Defendants’ Motion for Summary Judgment as Exhibit D.

In the spring of 2005, plaintiff was also diagnosed with severe obstructive sleep apnea. For treatment of this condition, plaintiff was referred to Dr. Bernard Costello, Chief of the Division of Craniofacial and Cleft Surgery, University of Pittsburgh School of Medicine. Dr. Costello explained to Mrs. Stenger the potentially life-threatening effects of chronic, untreated sleep apnea. As described in his deposition:

Essentially when somebody has sleep apnea, they block off their airway multiple times during the course of a night. Individuals who have it more severely might do that 40, 60, 80, 100 times an hour where their oxygen level drops. That has been proven to be correlated very specifically with high blood pressure, which takes its toll on your heart and vasculature and puts you at risk for cerebral, vascular and cardiac events.

Dr.Costello deposition, page 46.

To eliminate these chronic health risks, Dr. Costello prescribed surgery known as Lefort osteotomy.(Note: 1. Dr. Costello actually prescribed five separate surgical procedures. For ease of reference, plaintiff will collectively refer to them as a “Lefort osteotomy.”) Dr. Costello’s office sought pre-authorization for the recommended surgery from Carelink, but coverage was denied by letter dated May 10, 2005, based upon an exclusion for cosmetic (orthodontic) surgery. (See Exhibit B). In its denial letter, Carelink encouraged the plaintiff to contact its Customer Service Department with any questions, and also advised plaintiff of her right to appeal the denial of coverage.

On May 16, 2005, Dr. Costello appealed Carelink’s denial, explaining in writing to Carelink (Exhibit C) that the surgery was not cosmetic surgery, and that this medically necessary surgery would eliminate substantial health risks, and the corresponding expense, in Mrs. Stenger’s later years. The success rate of the surgery in curing sleep apneas exceeds 85% (Costello deposition, p. 22). In the first instance of what was to become a recurring pattern, Carelink took no action on the appeal, and later claimed it never received Dr. Costello’s correspondence. As the administrative law judge ultimately found.

On June 6, 2005, (Dr. Costello’s nurse) again sent the May 16 letter with supporting materials to Carelink, this time by overnight UPS. Still no response was received from Carelink even in the circumstance of multiple unanswered phone messages. (Dr. Costello’s nurse) again sent the May 16 letter with support materials via fax on July 13, 2005. Carelink still did not respond despite multiple unanswered phone messages.

Recommended Decision of Hearing Examiner, p. 3. Appended hereto as Exhibit D.

Meanwhile, Carelink’s Customer Service Department computer logging records reflect telephone calls from both Costello and plaintiff inquiring as to the status of her appeal. A log appended as Exhibit E, reflects a telephone contact from “COSTELLO MD, BERNARD” about “STENGER, CHRISTINE”: in which Dr. Costello was told “Not showing receipt of any appeal, gave fax # for appeals and directed to Nancy Phillips”. On July 25, 2005, plaintiff herself called Carelink, and in a follow-up note dated July 29, 2005 (Exhibit F), Carelink’s records reflect, “AS PER NANCY NO APPEAL ON FILE FROM MEM OR PROVIDER…” This despite the fact Dr. Costello’s office had mailed, faxed, and overnighted the May 16 letter on three separate occasions prior to July 29. Recommended Decision, Exhibit D, p. 3.

Astoundingly, on the day of this entry, that is, July 29, 2005, the very Carelink employee who denied there was any appeal on file caused two letters to be sent to plaintiff. (Exhibit G and H). In the first, the Carelink employee, Nancy Phillips, states:

We are in receipt of your written appeal on July 29, 2005.Your appeal is currently being processed and reviewed…Please refer to the enclosed “Your Right to Reeview of the Plan’s Determination” for further explanation regarding your appeal rights with Carelink. You have a right to appear at the hearing before the Appeal Committee. Please notify within five calendar days from the date of this letter if you intent to participate in the hearing…

Exhibit G.

The second letter, dated the same day, states: We have reviewed the appeal of our decision to deny authorization of coverage for Lefort Graft surgery for Carelink member, Christine Stenger.Upon consideration of the information available to us as of July 29, 2005 and the information presented during the Appeals Process, Carelink is upholding our original denial of authorization,…We appreciate the opportunity to help you.

Exhibit H.

As later found by the Hearing Examiner, On July 29, 2005, Carelink’s Medical Director, Dr. Rodney D. McKinney, considered Complainant’s appeal of Carelink’s denial of the requested procedures…In conducting his review upon appeal Dr. McKinney did not consider the May 16 letter and supporting material from Dr. Cosgtello as it was not provided to him by Carelink
staff. Carelink claims to have never received the May 16 letter and material until well after the appeal was considered on July 29, 2005. This is just not credible.

Recommended Decision, p. 4 (Exhibit D),

It is important to note that the policy exclusion relied upon by Carelink in its appeal denial – 7.1.35 for “orthongnathic surgery” Exhibit H. is a different exclusion than that relied upon in its original denial – 7.1.67 for “oral surgery which is part of an orthodontic treatment program” (Exhibit B). The Hearing Examiner castigated this behavior in his Recommended Decision. “It is equally important that Carelink not be permitted to abandon grounds for initial denial and substitute other grounds for denial upon internal appeal.” Exhibit D at page 8. The Insurance Commissioner adopted this finding, as she did all of the Hearing Examiner’s recommendations.

II. Defendants’ Campaign of Discrimination and Intimidation Began When Plaintiff Complained to the Insurance Commissioner

Upon Carelink’s denial of plaintiff’s internal appeal, on July 29, 2005, Carelink also placed the Insurance Commissioner on written notice of plaintiff’s complaint. Exhibit I. As advised by Carelink, plaintiff contacted the Insurance Commissioner’s office as to the appropriate procedure to be followed, and on September 28, 2005, she filed her formal written complaint on a form provided her by the Insurance Commission’s staff. Exhibit J.

In the meantime, there were two levels of concern for the plaintiff. First, the document sent to her by Carelink¸tited “Your Rights to Review of the Plan’s Determination” (Exhibit G, pp. 2 and 3) spoke of two levels of internal appeals in certain cases, and of an external review panel other then the Insurance Commissioner in others. Aware of her need to exhaust her internal appeals, and still naively believing that Carelink might actually recognize its responsibility to cover her surgery, plaintiff wanted to be certain she had complied with all of Carelink’s internal appeal requirements. Thus, on August 18, 2005, plaintiff telephoned Carelink’s Customer Service Office and spoke with customer service representative Lorrie Moore. As Carelink’s log records reflect, plaintiff called “asking how many levels of appeal there are”, and she was told by Ms. Moore, “adv that Appeal has 2 levels for mbr’s.” (Exhibit K) Later, however, on August 22, 2005, a log entry was made by Carelink employee, Nancy Phillips, “Member was advised of this when she was called on appeal decision.” 2 (Note: Not surprisingly, no one from Carelink ever actually called plaintiff concerning the appeal decision. There is no record in Carelink’s logs of such a call being made, and plaintiff will testify she learned of the decision when she received both ot the July 29 letters (Exhibits G and H) on the same day.) (Exhibit K) Not surprisingly, the truth is that no such telephone call was ever made. There is no record in Carelink logs of such a call, and plaintiff will testify she learned of the appeal decision when she received both of the July 29 letters (Exhibits G and H) on the same day. Then, on September 1, 2005, a supervisor instructed in Carelink’s logs, “Pls sent (sic) mbr correct letter for this 1st level of appeal.” (Exhibit K)

Thus, as Carelink’s computer logs plainly reflect, when plaintiff made reasonable inquiries as to whether another level of internal appeal existed, she was given conflicting answers with each call. Different Carelink employees gave different information¸ forcing plaintiff to continue to inquire until it was clear her only redress was to the Insurance Commissioner. One can safely assume that, had plaintiff failed to pursue the proper course, Carelink would later have contended she failed to exhaust her remedies.

A second level of concern for the plaintiff arose from Carelink’s advice, in its appeal denial letter, that she has a “right to request documentation related to your appeal”. This advice was reinforced by the document “Your Right to Review of the Plan’s Determination”Exhibit G, and again naively, plaintiff took it to heart. On August 17, 2005, plaintiff asked for copies of records concerning telephone calls between her and Carelink. Carelink’s call log reflects, “adv that she had req copies of call doc from CSO and was adv that she would have to have her lawyer do this and her son is an Attorney…adv that this req needs to be in writing and sent to P O Box 7103”. Exhibit L On August 22, Carelink’s log reflects that Carelink employee, Lorrie Moore, called the plaintiff on this subject, “followed up w/Christine on 8/22/05 apologized (sic) for miscommunications regarding access to her records, adv a form to be completed for this req will be mailed to her today.” Exhibit M

Hence, Carelink’s records reflect legitimate inquiries by plaintiff concerning matters related to the processing of her complaint to the West Virginia Insurance Commissioner. Here again, Carelink responses are inconsistent and unhelpful. Initially, Carelink recommended that plaintiff request the documentation she need, but when she did so, she was told it would only be provided in a written request from an attorney she did not yet have. Then, Carelink changed its mind and said she actually needed to fill out a form they would send her. Believing she had a 60 – day window to file her written complaint with the Insurance Commissioner – another piece of faulty information provided by Carelink – plaintiff filed her written appeal without most of the documentation from Carelink.

The truth of the matter is that during this time, Carelink was not happy that plaintiff was pursuing her complaint to the Insurance Commissioner. It knew that is had completely botched the appeal process through repeated failures to respond to Dr. Costello’s letters and telephone calls, and through its failure to process the appeal in a remotely timely manner – both conclusions later reached by the Hearing Examiner. It knew that sending a denial letter on the same day it sent a letter inviting plaintiff to participate in the appeal hearing was not going to sit well with the Insurance Commissioner. Finally, it knew, as the Hearing Examiner later found, that its practice of fishing around for exclusions, none of which ever truly applied to the requested surgery¸ meant it had no chance of prevailing on the merits.

Carelink also knew that the plaintiff was mentally ill. Carelink’s call logs note her diagnosis of bi-polar disorder, (Exhibit N, for example) even though that diagnosis had no relation to the sleep apnea surgery that was the subject of the appeal. Carelink understood that plaintiff was “more susceptible to emotional distress than an ‘average’ person.” (Clayman report appended to Defendants’ motion as Exhibit D). So, it undertook a campaign of behavior specifically designed to exploit its knowledge of plaintiff’s mental illness, and avoid the Insurance Commissioner’s scrutiny of its own behavior, by blaming the plaintiff. In so doing, it knew it was attacking an emotionally fragile person, and it hoped that by demeaning her character, it would ultimately cause her to give and go away.

When, on September 7, 2005, Carelink’s Quality Improvement Committee, having been advised of repeated unanswered telephone calls¸ asked the Appeals Department, “Please address the issue of calls not being returned on the appeal request” (Exhibit O), the Appeals Department blamed the plaintiff. In response, the Appeals Department wrote, “Member has demonstrated several times with Robyn and Debi K. of CSO that she has forgotten when called and sometimes forgets and has had memory loss. Nancy has been asked about this and is unaware (sic) of any member or provider calls that were not returned. We have also asked the member to supply any evidence of this and has not been provided.” 3 (Note: One might reasonably wonder how someone is supposed to produce evidence that a phone call was not returned.)

(Exhibit O).

This excuse was 1) patently false, and 2) an obvious attempt to exploit plaintiff’s mental illness.
From this point on, Carelink personnel engaged in a pattern of behavior designed to discredit plaintiff based upon her mental illness. As noted earlier, Nancy Phillips falsely claimed the plaintiff was given information “when she was called on appeal decision” – a call that was never made. Exhibit K. The Chief Executive Officer of Carelink was enlisted in an effort to get plaintiff to go away. Defendant Patrick Dowd has testified that sometime in October 2005, he was approached by Carelink staff and asked to intervene:

And that had reached a point where they felt like every time they turned around there was another e-mail, there was another phone call¸ there was another inquiry on this, and that it was really distracting to their work and that it was basically ¬ it was really difficult. And so that was my assessment of the situation. And the specific request was that at my level something needed to be done and that needed to so something.

Dowd deposition, p. 58.

It did not matter to Carleink staff that plaintiff had every right to ask for the information she was requesting; indeed, that Carelink had encouraged her to do so. Instead, Carelink took advantage of plaintiff’s mental illness in an effort to divert attention from its own failures. Again, the appeals staff mislead Dowd about their interactions with plaintiff, “What Mr. Quinn told me is that he had spoken to your client on numerous occasions, and explained to her what the circumstance was…” Dowd depo., p. 53. In fact, defendants have been unable to produce a single log or telephone record documenting that Patrick Quinn ever spoke to the plaintiff¸ and the Hearing Examiner specifically found evidence of “multiple unanswered phone messages.” Exhibit D, p.3.

Then, Carelink representatives upped the ante by falsely claiming the plaintiff attempted to impersonate a representative of the Insurance Commissioner’s Office. On October 27, 2005, plaintiff placed a call to Carelink’s Customer Service Office seeking information needed to pursue her complaint with the Insurance Commissioner. The call log for that contact is appended hereto as Exhibit P. That document plainly reflects “Contact from: STENGER, CHRISINE”, meaning the caller specifically identified herself as Christine Stenger. The recipient of the call, Carelink employee Ruth Simpson, has testified she underwent an eight-week training course to learn how be to be a customer service representative. Defendant Dowd has testified that for a customer service representative responding to a telephone call, “The first thing would be the member’s name and ID card to confirm who they are talking with”, and that it is important that customer service representatives record information accurately. Dowd depo., pp. 34-6. Yet, despite the fact Carelink’s records plainly and unequivocally demonstrate the disputed call was from the plaintiff, they nonetheless concocted the story that plaintiff misrepresented herself as a representative of the Insurance Commissioner.

Carelink then set about to spread this falsehood as widely as possible. It sent an e-mail to the General Counsel of the Insurance Commissioner’s Office accusing plaintiff of misrepresentation, and contending, “We will be sending a termination notice to the member today.” Exhibit Q. Mr. Dowd sent a threatening letter to the plaintiff, with copies to Insurance Commissioner staff, contending she had engaged in criminal behavior and advising her “We have handed this matter over to the State for investigation.” Exhibit R.

Mr. Dowd now acknowledges he never saw Carelink’s call log concerning this telephone call, and never knew until the day of his deposition it plainly showed the call was from the plaintiff. Dowd depo, p. 75. Mr. Dowd brazenly admits he did not care whether or not the accusation was true, “So, it’s not really an argument about whether she was doing an impersonation act or not. It was an argument about, we can’t help you. That was the point.” Dowd depo, p. 82. He sent the letter in an effort to get the plaintiff to go away, “So what I hoped was that after these repeated phone calls and requests to reconsider something that had already come to a dead-end, that perhaps your client would understand that there really isn’t any option and that repeated calls couldn’t really go anywhere. And so by doing something, I thought that a letter might be a good way to go about it.” Dowd depo, p. 69.

In short, Mr. Dowd sent an accusatory and threatening letter without bothering to inquire whether Carelink’s own direct record of the call collaborated or refuted the accusation. He did so not because he cared about the truth of Carleink’s accusation, but because he was hoping this would intimidate the plaintiff into dropping her complaint. In the process, Carelink undertook to cast the plaintiff in a bad light with the Insurance Commissioner and to divert attention from the merits of the plaintiff’s complaint. Indeed, a subsequent communication from the Insurance Commissioner’s Office to Carelink referred to plaintiff as “the complainant who contacted your office claiming to be me.” Exhibit S. Carelink undertook these actions knowing that plaintiff was emotionally fragile, and specifically hoping to exploit her emotional illness by frightening her.

Sadly, Carelink’s campaign of character assassination did not stop there. When the Insurance Commissioner finally appointed a Hearing Examiner to take evidence concerning plaintiff’s complaint, Carelink immediately undertook to poison this as well. Upon being advised of a hearing date, and before an attorney had been appointed to represent the plaintiff, Carelink’s General Counsel wrote the Hearing Examiner, “(D)ue to certain concerns we have regarding this matter, we request an opportunity to hold this Administrative Hearing telephonically.” Exhibit T. Attorney Frank Hartman, the Consumer Advocate appointed to represent the plaintiff, was later told Carelink contended plaintiff was too dangerous for Carelink’s witnesses to be in the same room. Attorney Hartman objected to a telephonic hearing.

Exhibit U., the Hearing Examiner agreed, and the evidentiary hearing occurred without incident.

During the course of his several months of representing the plaintiff, Attorney Hartman observed numerous respects in which Carlink discriminated against the plaintiff because of her mental illness. His testimony, in part, is as follows:

Q. And you said that you thought that this discrimination – there was discrimination against Mrs. Stenger based on her mental condition?

A.. That’s my – yeah, I think so.

Q. Well, upon what do you base that?

A. Well, I base it upon the way things kind of went down, between this kind of phantom allegation –

Q. Well, let’s start there. Well, go ahead. I’m sorry. You finish.

A. No. I’m saying between the phantom allegation of this alleged fraud, and then that she’s somehow dangerous – and I think that that’s the leap or this perception that you can’t be in the same room with her or that she’s just too annoying to deal with ¬–I think those are all manifestations of her mental illness, the fact that people didn’t want to deal with her.

Q. Does that necessarily have anything to do with her mental illness?

A. I think it’s entirely about her mental illness, that she behaves the way she behaves because she is mentally ill.

Q. Who do you think knew that?

A. I think anybody who had access to her records, who was covering her mental health benefit.

Hartman depo., p. 61-62, appended to Plaintiff’s Motion for Partial Summary Judgment.

In summary, defendant’s behavior following referral of this matter to the West Virginia Insurance Commissioner discloses a pattern of discrimination and intimidation. Defendants knew that plaintiff was bipolar, and they knew that persons with bipolar disorder are aggressive demanding, and difficult. Because of her mental illness, and consistent with patients diagnosed with bipolar disorder, plaintiff was persistent in her request for information from Carelink and in her insistence of the rightness of her cause. Careink did not like that, so it set about to exploit plaintiff’s mental illness by falsely accusing her of not remembering telephone conversations¸ of impersonating a public State official, and of being a danger to Carelink’s witnesses. All of these accusations were made because of plaintiff’s mental illness, and were undertaken in the hope of improperly influencing the outcome of her complaint to the Insurance Commissioner; or better yet, getting her to drop the whole thing.

Finally, Carelink undertook this behavior knowing, as its retained expert has opined “that she will be more susceptible to emotional distress than an ‘average’ person.” Exhibit D to Defendants’ Motion for Summary Judgment. Carelink knew its behavior would be particularly distressing to the plaintiff; indeed, it counted on it. This campaign of character assassination did, indeed, cause the plaintiff severe emotional distress for which our law demands compensation.

III. Argument

Nothing more persuasively demonstrates Carelink’s continuing obsession with insulting and discriminating against a person with a mental illness than the shockingly snide opening remark of both its motion for and memorandum in support of summary judgment. According to Carelink, “By all appearances, this case is an unfortunate outgrowth of Plaintiff’s apparent, longstanding mental illness.”

What Carelink continues to misapprehend is that any claim for discrimination based on mental disability is, by definition, the “unfortunate outgrowth” of the victim’s mental illness. As far as Carelink is concerned, the whole notion that folks with mental disabilities have a right to bring discrimination claims is an outrage. Carelink’s brazenly offensive remark, itself a manifestation of discriminatory intent, is merely another in a seemingly endless litany of insults Carelink has unleashed at the plaintiff because she had the temerity to insist on her contractual and statutory rights. Virtually every witness whose deposition has been taken in this case has been asked whether the witness knew that on one occasion Christine Stenger danced in front of her television. 4 (As an example, at page 47 of Frank Hartman’s deposition, defense counsel asked, “ Did you know that she once danced in front of the television in some sort of state of something?” Not surprisingly, that subject had not come up during Mr. Hartman preparation of his client for the Insurance Commissioner hearing.) And counsel for defendants simply could not restrain himself from mentioning it one more time in his Memorandum in Support of Motion for Summary Judgment.

fn1.

Yes, Christine Stenger is mentally ill. And yes, Carelink has known from the beginning that Christine Stenger is mentally ill. Carelink has known how to goad her into behaviors it later decries, and it has known just what buttons to push to get the strongest reaction out of an emotionally fragile human being. Then, when plaintiff behaves the way Carelink expected she would, says, “See, we told you so. She dances in front of television sets.” For Carelink, nothing about the proceeding before the Insurance Commissioner concerned the merits of its coverage denial. Knowing it had no substantive leg to stand on, it chose instead to exploit plaintiff’s mental illness by characterizing her as a violent liar; a woman who can’t remember what she’s been told; a dishonest, persistent sort not worthy of the Insurance Commissioner’s time. And now, Carelink continues its discriminatory crusade of personal affront to the final throes of this “unfortunate outgrowth of Plaintiff’s apparent, longstanding mental illness.”

The vast majority of defendants’ Motion for Summary Judgment is based on a repeated assertion that there is no evidence to support one or another of plaintiff’s claims. There are, of course, weight-of-the-evidence arguments that rarely have applicability in a deposition motion setting. This court is well aware of the standards applicable to consideration of motions for summary judgment, and plaintiff will not belabor them. There are, however, more specific consideration sto be applied in the context of discrimination cases.

Our Supreme Court has been careful, and consistent, holding that, in the context of discrimination cases, an inference of discrimination is sufficient to overcome a summary judgment effort. In Conaway v. Eastern Association Coal Corporation, 178 W. Va. 164, 358 S.E.2d 423 (1986), a case involving alleged age discrimination in the workplace, our Court held:

Because discrimination is essentially an element of the mind, there will probably be very little direct proof available. Direct proof, however, is not required. What is required of the plaintiff is to show some evidence which would sufficiently link the (defendants’ actions) and the plaintiff’s status as a member of a protected class so as to give rise to an interference that the (defendants’ action) was based on an illegal discriminatory criterion. This evidence could, for example, come…by the elimination of the apparent legitimate reasons for the (action)…

358 S.E.2d at 439-30.

Conaway’s holding, that a mere inference of discrimination is sufficient for a prima facie case, was expanded upon in two important, and unanimous, opinions written by Justice Cleckley in the mid-1990’s –Skaggs v. Elk Run Coal Co., Inc., 198 W. Va. 51, S.E.2d 561 (1996) was a disability discrimination case; while Barefoot v. Sundale Nursing Home, 193 W. Va. 475, 457 S.E.2d 152 (1995) involved a claim of age discrimination. In both cases our Supreme Court grappled with the weight of evidence needed to make a showing sufficient to overcome summary judgment, and in both cases our Court held that an inference of discrimination was sufficient.

In Skaggs, Justice Cleckley cited with approval the rationale behind the Third Circuit Court of Appeals in rejecting a direct evidence requirement:

Gone are the days (if, indeed they ever existed) when an employer would admit to firing an employee because she was a woman, over forty years of age, disabled  or a member of a certain race or religion.

Further elaboration on the prima facie case was offered in Barefoot.At the outset, we note some confusion about the prima facie case may have developed from the third prong of the analysis we set forth in Conaway that “(b)ut for the plaintiff’s protected status, the adverse decision would not have been made.” Use of the “but for” language in that test may have been unfortunate, at least if it connotes that a plaintiff must establish anything more than an inference of discrimination to make out a prima facie case…To further clarify, we now hold the
“but for” test of discriminatory motive in Conaway is merely a threshold inquiry, requiring
only that a plaintiff show an inference of discrimination.

457 S.E2d at 161 (citation omitted).

For all of these reasons, our Supreme Court has cautioned that summary judgment should rarely be used in discrimination cases, “In Hanlon v. Chambers, 195 W. Va. 99, 464, S.E.2d 741 (1995) we cautioned circuit courts to be particularly careful in granting summary judgment ( ) discrimination cases.” Tiernan v. Charleston Area Medical Center, Inc., 212 W. Va. 859, 864, 755 S.E.2d 618, 623, (2002).

Plaintiff asserts that the recitation of facts indulged above presents compelling, direct evidence of discrimination on the part of defendants, as well as more than sufficient evidence to defeat summary judgment on the remaining counts of plaintiff’s Complaint. Certainly, when only an inference of discrimination is required, plaintiff has demonstrated that summary judgment in defendants’ favor is not applicable.

Defendants do raise one legal issue in their Memorandum that warrants discussion. That is the applicability of the West Virginia Human Rights Act’s preclusion of discrimination in places of public accommodations.

To begin, defendants wrongly assert that, “A place of public accommodation is a physical location.” Memorandum in Support, p. 13. There is no West Virginia law to support this assertion, and indeed controlling authority plainly rejects it. The definition of “place of public accommodations” contained in the Act is found at W. Va. Code Section 5-11-3:

The term “place of public accommodations” means any establishment or person, defined herein, including the state, goods, facilities or accommodations to the general public…

W. Va. Code Section 5-11-3(j) (emphasis added)

If, by explicit statutory definition, a place of public accommodations can be a “person”, then it is specious to suggest that only physical locations qualify. According to the statutory definition of “person”, either the Insurance Commissioner or Carelink or Patrick Dowd, can be places of public accommodations. W. Va. Code Section 5-11-3(a)

In Israel v. West Virginia Secondary Schools Activities Commission, 182 W. Va. 454, 388S.E.2d 480 (1989) our Supreme Court considered the meaning of the “place of public accommodations” in the context of a female high school student who was denied the right to try out for the boys’ baseball team on the basis of her sex. No physical location was implicated. As the Supreme Court framed it:

The threshold question presented is whether the SSAC is a “place of public accommodations”
under the Human Rights Act, W. Va. Code, 5-11-1, et seq., and thereby subject to the provisions of W. Va. Code, 5-11-9(f)(1).

182 W, Va, at 462, 388 S.E.2d at 488.

Our Court had little hesitance in reaching the conclusion the SSAC was a place of public accommodations based on the statutory definition cited above, and the fact, “The SSAC undeniably falls within the definition of ‘person’ which is found in W. Va. Code, 5-11-3(a)….”

fn. 19.

For further support for its conclusion, the Court referred to its earlier decision in Shepherdstown Volunteer Fire Dep’t v. West Virginia Human Rights Commission, 172, W.Va. 627, 309, S.E.2d 342 (1983), in which the Court concluded volunteer fire departments were places of public accommodations. The result as based, in part, on the conclusions:

First, we found our public accommodations definition to be broader than its federal
counterpart. Second, we reiterated the liberal construction of the Human Rights Act
which is required under its terms. 5 (In footnote 21, the Court cited W.Va Code
Section 5-11-15 which provides, “(t)he provision of this articles shall be liberally construed to accomplish its objectives and purposes.”)

182 W.Va, at 462, 388 S.E.2d at 488.

Given our Court’s conclusion that West Virginia’s concept of places of public accommodations is broader than its federal counterpart, it is appropriate to consider whether cases interpreting the federal statute have held an insurance company to be such a place. In Msarques v. Harvard Pilgrim Healthcare of New England, Inc., 883 A.2d 742 (R.I. 2005) the Rhode Island Supreme Court was confronted with interpretation of the Americans With Disabilities Act, 42 U.S.C. Section 12101 et seq. (“ADA”) , and in particular that Act’s prohibition of discrimination in places of public accommodations (Title III). Plaintiff has been denied a health insurance policy due to the fact he suffered from Arthrogryposis and Crohn’s Disease. The Court was therefore called upon to determine whether an insurance carrier can be a public accommodations under the ADA.

The next preliminary issue that must be addressed is whether or not HPHC-NE is a “place of public accommodation” within the meaning of Title III of ADA. The pertinent mandate within the provisions of Title III of the ADA is the following:

“No individual shall be discriminated against on the basis of disability in the full and equal
enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of
any place of public accommodation by any person who owns, leases ( or Leases to) or operates a place of public accommodation..” 42

883 A.2d at 748.

Against the insurance carrier’s claim that a place of public accommodation must be a physical place, the Court held:

In our judgment, the term “public accommodation” is not limited only to physical places. In Carparts Distribution Center, Inc. v. Automotive Wholesaler’s Association of New England, Inc., 37 F.3d 12, 15, 19 (1st Cir. 1994), the United States Court of Appeals for the First Circuit, in reversing a grant of Fed. R. Civ. P. 12(b)(6) motion to dismiss, held that the
term “public accommodation,” as used in Title III of ADA, should not be limited to “actual physical structures.”…The First Circuit went on to hold that “(t)he plain meaning of the terms (of the statute) do not require ‘public accommodations’ to have physical structures for persons to enter,” Id. We are in agreement with the First Circuit’s ruling in that case.

883 A.2d at 749.

To similar effect is Pallozzi v. Allstate Life Insurance Co., 198 F.3d 28 (2nd Cir. 2000). There, an insurance carrier denied a life insurance policy based on its underwriting standards to a mentally disabled applicant. The Second Circuit characterized the issue, and its conclusion, as follows:

Allstate contends that Title III of the ADA does not reach the underwriting practices of insurance companies. Plaintiffs, marshalling the test of the statute,.. argue that Title III does regulate insurance underwriting practices. We believe the text of the statute confirms Plaintiffs’ position,…Allstate argues that Title III defines the term “public accommodation” to include “insurance office(s),” not insurance companies. This choice of words, the carrier maintains, suggests that Congress intended the statute to ensure that the disabled have physical access to the facilities of insurance providers, not toprohibit discrimination against the disabled in insurance underwriting. Furthermore, Allstate contends¸because insurance policies are not actually used in places of public accommodation, they do not qualify as goods and services “of (a) place of public accommodation.”

We find those arguments unpersuasive. Title III’s mandate that the disabled be accorded “full and equal enjoyment of the goods, (and) services…of any place of public accommodation,” suggests to us that the statute was meant to guarantee them more than mere physical access. We believe an entity covered by Title III is not only obligated by the statute to provide disabled persons with physical access, but is also prohibited from refusing to sell them its merchandise by reason of discrimination against their disability.

198 F.3d at 32-3 (citations omitted).

Thus, given West Virginia’s law that the federal definition of “place of public accommodations” is more restrictive than our State’s definition, it is plain that our statute applies far beyond physical locations, and applies to the underwriting and policy-issuing practices of insurance companies generally.

Indeed, just earlier this year, our Supreme Court held the provisions of the West Virginia Human Rights Act to be applicable to claims handling practices of insurance companies. In Michael v. Appalachian Heating, LLC, __S.E.2d___,2010 WL 2346274 (W Va. 2010), our Court considered this certified question:

Does the West Virginia Human Rights Act prohibit discrimination by a tortfeasor’s insurer in the settlementof a property damage claim asserted by a member of a protected class under the Act?

In answering the question in the affirmative, our Court rejected an argument by the insurance carrier defendant phrased in terms remarkably similar to defendants’ arguments in this case:

State Auto contends that, under the UTPA, the Plaintiffs’ sole remedy is to file an administrative complaint with the Insurance Commissioner. In addition, State Auto submits that there is no common law cause of action for third-party claimants who allege discrimination by a tortfeasor’s insurance company. Additionally, State Auto argues that the rules of statutory construction support its interpretation of the relevant statutes. State Auto opines that, if this Court allows the instant action, it will open a flood of baseless litigation which the Legislature has already prohibited. According to State Auto, this action is simply a third-party bad faith claim disguised as a Human Rights claim.

After engaging in a thorough discussion of the applicable provision of the West Virginia Human Rights Act, the Court analyzed the issue as follows:

To analyze the applicability of the foregoing holding to the circumstances presented in the instant case, we first consider whether the statute is applicable to an insurance company….The term “person” is broadly defined in the Human Rights Act as “one or more individuals, partnerships, associations, organizations, corporations, labor organizations, cooperatives, legal representatives, trustees, trustees in bankruptcy, receivers and other organized groups of persons.” W.Va. Code Section 5-11-3(a) (1998) (Repl. Vol. 2006).
This plainly worded definition clearly indicates an insurance company, as an “organization” or “corporation” within the meaning of the term “person.” …Therefore, an insurance company is included within the meaning of the term “person” as used in W.Va. Code Section 5-11-9(7)(1998)(2006).

Based on its reading of the statute, our Court held, at Syllabus Point 7:W.Va. Code Section 5-11-9(7)(A)(1998)(2006) of the West Virginia Human Rights Act, prohibits unlawful discrimination of a tortfeasor’s insurer in the settlement of a property damage claim when the discrimination is based upon race, religion, color, natural origin, ancestry, sex, age, blindness,
disability or familial status.

Although the Michael case was not decided upon the basis of an interpretation of “place of pubic Accommodations, its conclusion that the Act applies to the claims settlement practices of an insurance company provides compelling support for the position asserted by the plaintiff here.

In the present case, plaintiff’s claims for discrimination and intimidation are not limited to those for access purely to the Insurance Commissioner herself, or the offices of the Commissioner, or to Carelink itself, or to Patrick Dowd. Instead, plaintiff contends the discrimination occurred, as her Affidavit says, “during the course of the administrative proceeding before the West Virginia Insurance Commissioner.” This means any aspect of her access to the complaint mechanism established by law whereby a policyholder may seek redress for misbehavior of an insurance carrier. It includes her access to Carelink’s records as they may be necessary to pursue her complaint; it includes her right to a clear explanation of her appeal rights, and it includes her right to pursue her complaint in a fair, equal and non-discriminatory manner.

The complaint mechanism of the Insurance Commissioner is a statutorily created mechanism that is open to all citizens of this State. W.Va. Code Section 33-2-13. Careink, as a health maintenance organization, is a creature of statute, endowed with unique regulatory and legal protections designed to promote the goal of low¬-cost health insurance. Code Section 333-25a-1 et seq. Fees are imposed, by statute, on health maintenance organizations that are to be placed into a special fund to be used “for the operation of the department of insurance” Code Sections 33-25a-22 and 33-3-13. Thus, Carelink partially funds the complaint mechanism through which plaintiff sought redress, and it does so in exchange for unique statutory protections accorded by the Legislature to health maintenance organizations.

Defendants should not now be heard to claim they are not part of a place of public accommodations when they clearly fit within the statutory definition of that term, and are an integral part of the complaint mechanism during which the complained of discrimination in a “place of public accommodations” provides a viable avenue of relief to the plaintiff against these defendants.

Finally, it should be noted that defendants’ argument disputing the applicability of Code Section 5-11-9(6) has no applicability to plaintiffs’ alternative theory of recovery under the Human Rights Act contained in Paragraph 9 of plaintiff’s Complaint. Whether or not the “place of public accommodations” provision is applicable, there is no dispute that the Human Rights Act’s broader prohibition of discrimination contained in Code Section 5-11-9(7) remains a viable claim. As to that claim, defendants’ sole argument is that plaintiff’s have presented no evidence of discrimination. The extensive discussion contained in the earlier portions of this Memorandum will have laid that assertion to rest. Likewise, as to the remaining Counts of the Complaint, defendants’ weight-of-the-evidence are unavailing.

For all these reasons, Defendants’ Motion for Summary Judgment should be denied in its entirety.

Anthony Werner
Counsel for Plaintiff

PAUL T. TUCKER, ESQ.
W. Va. State Bar No. 5203

ANTHONY I. WERNER, ESQ.
BACHMANN, HESS, BACHMANN & GARDEN, P.L.L.C.
1226 Chapline Street
P O Box 351
Wheeling WV 26003
(304) 233-3511
(304) 233-3199 (fax)

IN THE CIRCUIT COURT OF OHIO COUNTY, WEST VIRGINIA Civil Action NO 07-C-466

CHRISTINE STENGER Plaintiff,                                                        (Judge Martin J. Gaughan)

v

CARELINK HEALTH PLANS, INC., and PATRICK W. DOWD Defendants.

CERTIFICATE OF SERVICE

Service of the PLAINTIFF’S MEMORANDUM IN OPPOSITION TO MOTION FOR SUMMARY JUDGMENT was had upon defendans via fax transmittal a true and complete copy thereof this the 13th day of October, 2010, as follows:

Eric W. Iskra, Esq.
Grant P. H. Shuman, Esq.
Spilman¸Thomas & Battle, PLLC
P. O.. Box 273
300 Kanawha Blvd.m, East
Charleston, WV 25301

Anthony Werner
Counsel for Plaintiff

PAUL T. TUCKER, ESQ.
W. Va. State Bar No. 5203
ANTHONY I. WERNER, ESQ.

BACHMANN, HESS, BACHMANN & GARDEN, P.L.L.C.
1226 Chapline Street
P O Box 351
Wheeling WV 26003

(304) 233-3511
(304) 233-3199 (fax)

NOTE: FOR ACCESS TO ALL PUBLIC COURT DOCUMENTS SUBMITTEN IN THIS CASE, CONTACT:

Ohio County Courthouse

Brenda L. Miller, Circuit Clerk

1500 Chapline Street

City/County Building

Wheeling, WV 26003

Ph. 304-264-3611

Gently Closing the Door ...I'll Leave the Light On For You

2010-12-26T09:50:00.062-05:00

An aside: Happily, today is my last blog in this series. I have so enjoyed knowing that people from over twenty-five countries have visited the blog. I know that nothing leaves the internet so more visitors will come. I invite you to contact me at pennystenger@comcast.net if you are interested in learning of the outcome of my lawsuit against Coventry or of any other positive developments. If you have any insights to help me as I continue to advocate for the mentally ill. If you just want to stop by and say, "God speed."

With many leave-takings there is often some final words; I desire to share a few stories. The first story is of a wise priest who many years ago shared his belief that someone from Carelink would testify in my defense by the time my case came to trial. I have always wondered who that would be as I had no doubts that this wise priest was anything but right.

What has remained a secret to a very few until now is the identity of that "whistleblower," the Carelink employee who must have sent shockwaves throughout Coventry Health Care and the law firm of their defense attorneys. Meet Mr. Patrick Dowd, defendant and former CEO of Carelink Health Plans, Inc. of West Virginia who revealed his sad self in his deposition while testifying in August 2010 under oath.

The crux of my case is that Mr. Dowd falsely accused me of fraud, of impersonating an official of the West Virginia Insurance Commission, of never indicating my real identify in that phone call. My claim is that Dowd knowingly discriminated against me, a person with a disability, thus violating a law of the state of West Virginia.

In questioning Dowd, Mr. Paul Tucker, my attorney, revealed records that indicated that a policy of Carelink Customer Service requires the Coventry agent to ask a call-in consumer for the insurance identification number which verifies the name and address of the caller. Mr. Tucker provided evidence that Carelink records show that Christine Stenger placed the phone call in question to CSO in late October 2005.

Shocking news. It mattered not to Dowd that his hands were caught in the cookie jar during the deposition. Rather than admit his wrongdoing, he attempted to justify it by saying in effect, "I don't care. She was bothering my employees and wasting valuable time with all her questions... Writing that letter was the only way..."

And so the 2nd motion to remove my case to federal court followed. More delaying tactics causing me more emotional pain. But ultimately, Coventry will lose in the first Circuit Court of Ohio County. Those close to the case know this.

I honestly pity defense attorney Grant Shuman as he must explain to a jury of my peers why Dowd committed such a ruthless deed.

“And Humpty Dumpty fell off the wall and all the King's men and all the King's horses could not put Humpty Dumpty together again.”

The same priest, a modern-day prophet, predicted that I would do extraordinary things as I pursued my right to hold people accountable for ruthless actions. Know that I am determined and have persevered at great cost. But I do so, gladly and with eyes now wide open, with an understanding that injustice and grace can empower an ordinary citizen to help, with others, create positive change.

The most remarkable reality of my five year journey is that I am ordinary is so many ways. While my roots are rich in heritage, I have lived through the suicide of my father, a respected local attorney who suffered from bipolar illness at a time when it took a pharmaceutical company twenty years to produce an ordinary salt, lithium, a wonder drug for treatment of bipolar illness because there was not much profit in producing this drug. Tragically, using eminent domain my father lost his beloved camp following what was reported by a respected family member, an attorney, as a call having been made by a local coal company to the White House. I believe that that coal company is now owned by BP.

Sadly, I had to live through more injustices until it was my turn to make my own decisions to bring Carelink to court. Up until this case, it was my husband who made the decisions about our experiences with injustice.

Today, because of the earlier injustices, my family's net worth went from .5 million dollars in the 1980s to living on the brink of bankruptcy for decades. We sold our 70 year old family business last year and are using the proceeds to pay off a sizeable debt. We sold the company real estate this year and our net proceeds were zilch. At that time, due to the need for an SBA loan seven years ago, the bank had a lien on our home and we lived for years with the reality of losing it at any time. A tragic situation that too many other Americans face today,

So, I do know pain that comes from the knowledge that despite being named the number one copier dealer in our division for two straight years in the US market in the 1990s, despite being respected for integrity in our market locally for decades, despite many incentive trips to places like Japan, Greece, Rome, we were unable to bring the guilty to court because they had deep pockets. Twice my husband cut his losses and moved on, hoping to save his family business. Ultimately, that could not happen, although he did save all his loyal employees jobs – a valiant effort.

Although some would think living on two social security checks would be painful, it is not. After a year of our son’s working with our local bank, a deal was reached and the lien to our home cancelled. We own our home and we are free.

Real miracles have happened in our lives during our travels these last five years. I now advocate for the mentally ill who would have no chance to receive the justice I will receive in the U.S. court system. To the holy men, my friends, who have accompanied me on this painful but just journey, Fr. Jim O'Brien, Fr. Michael Greb, Fr. Jerome McKenna, Bishop Emeritus Bernard Schmitt and Fr. Jerry McSweeney, may I say that we all owe you a debt of gratitude, for together we are shedding light on evil. Our efforts will soon be rewarded.

Be well, my friends.

"People grow through experience if they meet life honestly and courageously. This is how character is built." ~Eleanor Roosevelt

This year I came home for Christmas.

In the wee hours of a wintry morning last week, I lay somewhere between dreaming and awakening. I heard a soft voice, “You have won, Penny!” And from that moment on there was an indescribable peace. I sensed that I no longer must play games.

In 1982, in a state of emotional and physical pain from living with a mental illness that would take years to diangose, the highs and lows of bipolar illness, I committed to becoming the healthiest Penny I could become. My goal was simple: I desired to be a healthy, happy active 92 year old. And I began to exercise, to study the Bible, to develop positive thoughts, and to learn how to pray and be grateful.

And then, in 1998, driving 55 miles per hour on a heavily traveled interstate, I fell asleep at the wheel. When I awoke I had crossed the median. I somehow slowed the car, turned the car around, and drove back onto the highway. I did not look to see if I there was any traffic.

Something was very wrong. It took me 14 years, five doctors, including specialists, a Complaint against my former HMO,Carelink Health Plans Inc of West Virginia, and 8 sleep studies to have my health restored... Until I met a man of integrity, Dr. Robert Rogers, DMD, of Wexford PA, who designed an oral appliance to successfully treat my apnea.

It was Dr. Rogers wife, Mary Ann, who contacted my former HMO to receive authorization to treat my apnea, with this less invasive, far less costly procedure than surgery. Carelink Health Plans Inc of West Virginia denied this benefit on the spot though there existed Final Order 06-Ap-024 that ordered them to first investigate the need for a requested benefit to insure thoughtful consideration. Highmark Blue Cross Blue Shield of Pittsburgh quickly authorized this benefit.

A denial of a $3000.00 has brought Carelink and me to today. Neither of us would have wanted to be in this place in this time about to face each other in a courtroom after five long years of costly efforts. How sad. How so very sad.

But let's return to 1998 when I could have kiiled someone. There were so many cars on the highway that day as I slipped into a spot that may not have been there. It was this memory that drove me to fight for medically necessary surgery to treat severe sleep apnea in 2005. It was the severe sleep apnea and my dream to be a healthy 92 year-old that brought me to Carelink Health Plans Inc of West Virginia, my former HMO, for help.

These last five years, 2005-2010, fighting for my rights, have taught me much about law, justice, family, church, evil, and myself. I had to lose everything to discover that I had a voice, and that I need no longer play games.

While I like games, I have not enjoyed the persona I had to create to deal with the reality that our justice system is oftentimes a travesty as it has been for me personally. I believe there is little justice for the mentally ill. No speedy trials. No compassion.

But there is integrity within me and there will always be.

I began writing blogs in 2005 as I had been frustrated to learn that while Coventry promised to promote health, they ignored my serious health condition. I learned that a federal law E.R.I.S.A. protected them from a law suit for damages. They could, in effect, and did, ignore me, violate every commitment in their rules of governance, even promote themselves falsely as “excellent” and the law protected them.

I did not know that when I placed a phone call to Carelink’s Customer Service in late October 2005 that E.R.I. S.A. protected Patrick Dowd et al. I only wanted to have my surgery before I suffered a stroke or heart attack. I wanted to live to be 92. I only asked for a benefit that was rightful at that time but would take me, a disabled person, 22 months to receive.

That late October day I spoke with Civentry Customer Service, a concerned agent, Ruthie Simpson, who promised to speak with her boss. All I wanted at that time was an apology and a willingness to look into my case. I told Ruthie that I would be writing a blog detailing my journey with my former HMO.

Four days later I received a ruthless letter falsely accusing me of fraud. Former CEO Patrick Dowd thought he would be able to use this letter to convince the West Virginia Insurance Commission that Carelink had the right to terminate my coverage. He could not. And the rest is history, tragedy at its most intriguing,

On Veteran’s Day 2005 I began writing my first blog Untied4justice, I would write for well over a year. Recently, I reread a few of these first tales. There was no anger. No games. I quietly told the truth, believing that this blog would help me receive my medically necessary surgery.

With for-profit insurance companies, there are far too many games. Games supported by deep pockets. So, at the insistence of my spiritual director, Vicar General Fr. Jerome McKenna,of the catholic Diocese of Wheeling-Chraleston (WV) I began Tuesday’s Tirades and Tales in June 2008.

What started as an attempt to speak the truth, which I did with honor from the first blog to this final blog, became my catharsis. For five years, other than regularly seeking wisdom from holy people, my family was in so much pain, so frightened for my mental and emotional health, that they silenced me.

They loved me so deeply that they had to distance themselves from this issue. And so to deal with deep emotional pain I entered Carelink’s game, blogging so I could live.

And, I admit that I did have fun. With so much evidence against Carelink and Spillman Thomas Battle, the Charleston WV law firm that represents them, it was all too easy to attack their positions.

But I am tired of games. The persona I created as I wrote each blog is so far from the truth of who I am and who I have become that it is time to silence that person. Her role is over. This act ended.

It’s time to put this wonderful friend to rest. It is time for you to meet my true self.

Will I win my lawsuit against Coventry Health Care Inc of Bethesda MD? I have no idea. But I no longer care. Justice is not found in the court systems. It is no longer available in this blog.

But I remain more hopeful than ever. In the last five years I have met many people like myself who are working for reform of health care. They have each quietly supported me, waiting for the moment to join together.

That moment may well begin with a bus trip to Washington D.C.

I just learned that for under $20 I can travel directly from Pittsburgh PA, an hour away from Wheeling, to Washington, D.C. roundtrip on Megabus. I can reconnect with my cousin Tony Ames who is the head percussionist with the National Symphony. I can visit the headquarters of organizations that support the mentally ill. I can visit my representatives in Congress, one of whom I once called "Friend."

When you have lost everything, freedom results. When you suffer deeply, your spirit can rise from ashes.

Finally, Eleanor Roosevelt has been my mentor throughout this ordeal. Her “chutzpah.” Her love for the downtrodden. For boldness and eccentricitiy. So much more. Mrs. Roosevelt helped me find my voice.

Know that I am not bitter. I have no hatred for those who continue to inflict pain on me. Only concern for others who have no knowledge of the games for-profit health insurance companies play this very moment.

I have invited Grace into my life. How could I not with so many holy men honoring my courage, my "chutzpah." And outside of a few hours each week, when I sort through justice issues, I celebrate the ordinary things of life, the beauty around me. The simple, ordinary things of life.

I have won. I am home.

Former OVMC CEO Sues a Wheeling Hospital

2010-12-24T05:42:00.002-05:00

Headline: News Register
Brian K Felici sues OVMC
December 23, 2010

An aside:

It's is early Christmas eve. I was surprised to read the local headlines yesterday, as I hold many secrets about OVMC as well as other health care instituitions in the Ohio Valley. I chose to speak out. And, likely, my comments will stir a few people as both my husband's Tom and my families are well-known and respected in the Ohio Valley.

For four and a half years I have had to keep a secret, a nasty tactic to intimidate me and thwart justice. Carelink Health Plans, Inc. of West Viriginia, a subsidiary of Fortune 500 Company Coventry Health Care Inc of Bethesda Md, personnel told a WV judge that I "may be dangerous." The reality is just the opposite. They are dangerous as is everyone connected with them. Ironcially, I guess I am dangerous....to their continued success as an "excellent" health care provider.

Former CEO says he was guaranteed full salary in contract

December 23, 2010 - By SHELLEY HANSON Staff Writer

WHEELING - The former chief executive officer of two local hospitals is suing the facilities' parent company for alleged breach of contract and fraud.

Brian Felici, former CEO of Ohio Valley Health Services & Education Corp., the parent company of Ohio Valley Medical Center and East Ohio Regional Hospital, filed a complaint in Ohio County Circuit Court against the corporation and American Healthcare Solutions, which is the company hired to shore up the hospitals' finances.

In the complaint, Felici claims the corporation breached its contract by not paying him after he resigned April 7 as CEO. The corporation, he claims, agreed to pay him $303,000 a year for a three-year contract - Oct. 1, 2009 to Oct. 1, 2012 - plus bonus compensation of up to $100,000 for each year of the contract.

"The contract states 'that in the event that Mr. Felici's employment is terminated by OVHS&E without just cause or by Mr. Felici for good reason, Mr. Felici shall be entitled to receive the total compensation due to him under the then-current term. Such compensation shall be paid to Mr. Felici in a single payment, due 30 days after the date of termination,'" according to the Nov. 23 complaint.

Hospitals spokeswoman Shayna Varner said she is aware the complaint has been filed in circuit court.

"OVHS&E denies the allegations of the complaint filed by Mr. Felici in the Circuit Court of Ohio County, West Virginia, and intends to vigorously defend against that complaint," Varner said.

Felici could not be reached Wednesday for additional comment. However, he notes in the complaint that after the hospitals' board of trustees hired American Healthcare Solutions he was informed that he would be replaced as CEO.

"OVHS&E informed the plaintiff, Brian Felici, that it would honor the terms of the employment contract and asked the plaintiff to gracefully resign so that the move would garner favorable public relations for all parties involved," the complaint states.

The complaint claims the corporation notified Felici July 8 that all payments and benefits would cease. It also claims American Healthcare Solutions "intentionally interfered" with Felici's contract.

Felici's suit also claims the defendants intentionally inflicted "severe emotional distress" because they knew Felici "was relying on the payments and benefits" in the contract.

In addition to lost wages, Felici also is suing for loss of earning capacity, lost benefits such as life insurance, pension savings plan, automobile allowance, vacation and more. He also is suing for mental anguish including aggravation, annoyance, inconvenience, anxiousness, fear and humiliation, along with attorney fees and costs.

Felici, who recently was hired as CEO at Wetzel County Hospital, is demanding a jury trial.

My posted comment, Post 6, December 23, 2010:

This day, a young, brilliant, beautiful woman fights for her life. Again and again. My friend of nine years suffers from a debilitating illness, bipolar illness. It was under Brian Felici’s administration, that my husband Tom and I met with Brad Schnarr, the former Director of Hillcrest, to tell a troubling story.

Hillcrest director, Brad Schnarr, did not listen to the evidence. OVMC’s wrongful treatment brought a life of hell to a trusting young adult and her good, loving parents. The hell continues this day.

My friend has been hospitalized for over one month at two different psychiatric centers – never again to be Hillcrest. Doctors have little hope. If we cannot bring her back, I must no longer keep my mouth closed.

Brian K. Felici is aware that to effect change sometimes one must have the courage to sue. But what he does not know is that he is responsible for the poor conditions at Hillcrest and the lack of professionalism of some of its staff. And that may be criminal.

25th Comment Posted December 24, 2010

Christine, I'm so glad you saw my post. I lost my only unborn baby when I was 40. My troubles began shortly after. 3 day migrane headaches, mood swings, the whole nine yards. As I said, after 7 doctors my angel came in the form of Dr. Kenneth Allen when I came back home to West Virginia. He put me on something called Parladel. I am completely recovered as far as I know. Even the late Dr. Anderson didn't know what was wrong. Maybe it is your answer. I pray it is.

26th Comment Posted December 24, 2010

Skunky, Thank you for your concern.

Please Google "Christine O'Brien Stenger" and, if you carefully read, you may begin to understand that the problem goes much deeper than the operation of one hospital. As Fr. Jerome McKenna, my former spiritual director, told me before leaving Wheeling a few years ago, "There's a systemic evil in the health care in West Virginia." At the time Fr. Jerome was the Vicar General of the catholic Diocese of Wheeling-Charleston, a man calling for social justice. I have personally learned that this deceit extends into many other health care institutions in the Ohio Valley. Carelink Health Plans, Inc. would like you to think I may be violent and dangerous. That’s a story for 2011 that will hit the front pages of the newspaper if they have the courage to cover it. May the truth set us free so that we can all begin to live the Hope the season of Christmas brings.

~Christine O’Brien Stenger

A Child is Born Again

2010-12-23T10:36:00.001-05:00

As I have begun to be more vocal about man's inhumanity to man, I ponder the light of Christ that shines in the hearts of so many good people during this season of hope. I return to a blog I first published on Christmas Eve 2005. There is a calmness and peace in my writing that has not been present for many years.

A Child is Born

December 24, 2005

It is December 24, 2005. Nana has wrapped a multitude of gifts that our daughter Beth, Santa's helper, had dropped off earlier. No bows this year. Just a little something to place under the tree.

Santa's helper has worked miracles with the money and lists. She bought the best of the bargains, stretching the dollars so that the fun of unwrapping would last and last.

Family gathers. Cameras are ready. Alas. Something is amiss. Clothes do not fit. Wrong colors. Wrong ideas. Oops! There is one young man who failed to give Santa's helper a list. Naughty! Naughty! Cash from returns reaches our pockets in April...

Fast forward. It is Christmas 2005. My husband Tom is more firm than ever: "We're only sending gifts to those in need." So this season we are buying a heifer at www.heifer.org in the names of family and friends. While we hope all will agree that this is our best Christmas gift ever, there are more than a few "bah humbugs".

I ponder Christmas. It's become so messy this year dealing with corporate injustice which is nothing new to our family. Our response to past injustice was to develop a stronger Faith,

It is in Faith that we celebrate the coming again of Jesus into our world, a world that needs the light to shine in its darkness. A coming of the Child Jesus with abundant graces for those who seek to know Him.

We know it is He who leads us through troubled days. He renews our confidence that we will make a difference, that justice will once again reign in our small corner of the world as we become peacemakers.

May each of you open Jesus' gifts for you this Christmas as you remember that with God all things are possible. May you enjoy a blessed Christmas Season. And may God bless us all with Liberty and Justice.

COVENTRY HEALTH CARE EXECUTIVE ON TRIAL IN WEST VIRGINIA

2010-12-17T09:27:00.004-05:00

Tuesday’s Tirade

Redemption

Note: I am publishing my December 21, 2010, blog a little early. It’s time to begin preparation to celebrate the coming of Christ in Christmas. It will be the first time in five long years that both my husband and I will be home…in body, mind, and spirit. We have much for which to be grateful.

"You never really understand a person until you consider things from his point of view - until you climb into his skin and walk around in it." ~Atticus Finch, To Kill a Mockingbird, by Harper Lee

WikiLeaks founder Julian Assuage was released from jail yesterday on bond. In an interview, Assuage softly told the press that the isolation he experienced in jail has resulted in increased dedication to exposing truth. He hints that the obstruction of justice, which he recently experienced, goes ultimately to the White House.

Until suffering through my own fight for justice, my own victimization and isolation, I would never have considered that Julia Assuage might just be a hero.

Today I invite Coventry attorneys Robin Aronberg and Grant Shuman, whose law firm Spillman, Thomas and Battle, PLLC, represents Defendants Carelink Health Plans Inc and former Carelink CEO Patrick Dowd in a civil lawsuit soon to be heard in the First District Court of WV, to listen carefully to what I have to say.

I invite them to walk in my shoes.

I suggest Mr. Dowd also ponder what I am about to say before he takes the stand in his defense.

There is evidence that Patrick Dowd attempted to wrongfully terminate my health insurance coverage on November 1, 2005. To terminate a consumer by law, Dowd had to accuse me of fraud. The letter accusing me of misrepresenting myself as Dena Wildman, WV State Insurance Examiner, on November 1, 2005, was the beginning of the end for Carelink as they operate today.

Who really knows what drove Dowd to connive so ruthlessly to defeat a mentally ill person?

What I do know is that once Carelink denied my medically necessary surgery in May 2005 (Finally, after 22 months of suffering, Carelink authorized my benefit), I had no choice but to pursue all rights afforded me under law. Both Dr. Shelley MeQuone, of West Penn Hospital in Pittsburgh and Dr. Bernard Costello of the University of Pittsburgh, my surgeons, advised me that I had a very serious health problem that could result in a heart attack or stroke. I personally heard a death sentence were I not to act immediately.

Dr. Costello asked for my assistance as he understood it may be difficult to receive the benefit from Carleink even though their sister company had frequently authorized the surgery in Pittsburgh. Hmm.

It took several months before I understood that Carelink was playing games with my health. I had no intention of contacting Robyn Aronberg, at Coventry Legal in Bethesda MD in late summer 2005. A customer service representative told me that I must first speak with Coventry Legal to process my request for a copy of my records. I was only following instructions.

Why was I told to go to legal? With a lot of suspicion I spoke with a Coventry attorney at the Bethesda office and I asked if the reason Legal had to release the records was for Coventry to have an opporutnity to edit them. That attorney was honest and told me that's the procedure. However, among Aronberg's first words in an e-mail to me, "We do not edit customer records." Hmmm.

And Robyn Aronberg understood that I was only following CSO's insturctions. She also knew that I had experienced major problems in my pursuit of my benefits. More and more games. Only this matter is too serious for games.

While Aronberg's e-mails reminded my constantly that I could return to dealing with Carelink Customer Service, speaking directly with legal was critical to my success. Or so I believed.

While Aronberg would always remind me in many, many e-mails that I had exhausted my rights with regard to my appeal, I believe Aronberg knew that Carelink botched the appeal and that I had never received a just appeals hearing. More games. More delays.

Carelink does play too many games. Period. Unfortunately, like Julia Assuage, I am angry. I am angry because so many other people, like my 87-year old friend Nancy Tsien, about whom I wrote in an earlier blog, are at risk. You or a loved one may also be at risk when dealing with for-profit health insurance companies.

I was so angry with all the games that I entered the fray early on. I played games, too, asking lots and lots of questions that when answered frequently revealed lies as employees gave conflicting answers. There was no way that once I was given permission to speak with Coventry Legal I would let go of this unbelievable opportunity to gain deeper access to the reality of the game.

Today, December 17, 2010, in a season of love, let’s assume that it is Robyn Aronberg’s husband who is placed in my position and must walk in my shoes. Let’s assume that it is Grant Shuman’s father, who develops severe sleep apnea, and must walk in my shoes. If you live in West Virginia, a state with one of the highest rates of obesity, a cause of severe sleep apnea, you would be out of luck if your health insurance carrier were Carelink.

Would not Grant Schumann use all his skills and knowledge to fight for his dad’s life? I am told they are very close friends. Would Aronberg not do everything possible even to the point of becoming obsessive and bothersome to do everything within her rights? If either of these people answer, “No,” they would be lying.

Surely, even Mr. Dowd is loved by someone?

Tuesday’s Tale

My Unsent Letter to the former Governor Joseph Manchin, today US Senator Joseph Manchin

September 16, 2008

Dear Governor Manchin,

Tuesday’s Tirades and Tales is my blog about the corruption in our health care system in West Virginia. I have been investigating Carelink Health Plans, Inc. of West Virginia for three years. They would not be in business today if your administration were doing right for the citizens of West Virginia.

Please carefully read my blog located at www.tuesdaytiradesandtales.blogspot.com. I hope you will be shocked by what you read, but, somehow, I am afraid that you will not be surprised.

And I am saddened for I believed you offered so much hope to West Virginia when you took office on January 17, 2005. Also, I am discouraged that the many young people who look upon you as their hero may become disheartened. Your administration has let them down.

While I have been very much alone in my fight against injustice, it’s been the Catholic clergy and my doctors who called me to persevere. They know my story and they know the significance of the systemic evil in health care in West Virginia. What they did not know until I began my journey is the names of so many “Christians” who are part of the problem. When one chooses to do nothing, one is part of the problem.

Accountability is everyone’s mandate.

What am I hoping to accomplish with this letter? A miracle.

Admission of wrongdoing and a willingness to clean up our state. Yes, I may be naïve as you are a powerful politician, but I cannot believe that you personally knew of the horror stories of people who did not receive their rightful benefits from Carelink and their parent company, Coventry Health Care, Inc. of Bethesda, MD. While pride and greed injure one's conscience, I believe in redemption.

I have a few questions:

1. What was your relationship with former Carelink CEO Ted Cheatham prior to your naming him Director of WV PEIA on September 22, 2006? What did you think when Coventry Health Care, Inc., the parent company of Carelink, was awarded a lucrative contract by PEIA within months Carelink's former CEO's appointment? Were you concerned at all at the appearance of impropriety knowing Coventry was the highest of three bids and the award went out-of-state?

2. With all the fine candidates for Chairman of the West Virginia Public Service Commission, why appoint an attorney on August 15, 2007, who had represented the utilities prior to this posting? These are very same utilities that Chairman Michael A. Albert is now called to regulate and do so independently.

3. Will you recognize a troubling pattern here, a little like eyes closed and mouths shut? My blog describes the continued injustice by the West Virginia Insurance Commission in regulation of insurance companies in West Virginia and the West Virginia Human Rights Commission operating in the same way.

4. In 2007, why did you replace Mr. Frank Hartman, Director of the West Virginia Office of Advocacy, with a person outside the agency when you had a candidate desiring the position who had four years experience within the Office of Consumer Advocacy? And I am told you asked the more experienced candidate, during his interview, to define his role in government. His response was immediate: “I would help pass laws more supportive of West Virginia citizens. It’s a little too unbalanced presently.” I am told that your response was just as immediate: “We cannot do that. At least not this year.” I may be wrong, Governor Manchin, but it is appearances again. It appears that you did not want to change insurance laws during an election year. Am I right?

Know that my bizarre tale of intrigue will reach a wider audience in time. Tuesday’s Tirades and Tales blog has reached over nine hundred visitors in a little under three months. There’s my recent appointment to the Diocese of Wheeling Charleston Disabilities Advisory Council. And I am writing a book about these events of national interest entitled My Father’s Legacy: Voices for Justice.

I cannot sit still. People are dying needlessly. Somewhere out there is a man or woman with a conscience who will finally recognize the extent of the evil and the role they play. Somewhere there is a man or woman who will recognize that God forgives even the gravest of sins. I hope that someone will be you, Mr. Governor.

Please pray about your future role and do right for our poor state. You will have my continue prayers.

Sincerely,
Christine O’Brien Stenger
Wheeling, West Virginia

"Never separate the life you live from the words you speak." ~Paul Wellstone

Coventry Health Care Inc Loss of Moral Compass

2010-12-14T11:10:00.001-05:00

Tuesday's Tirade
The Lessons of Bernie Madoff

“The people said, ‘Let His blood be upon us and upon our children.’ At that, he (Pilate) released Barabbas to them. Jesus, however, he first had scourged.” ~Second Sorrowful Mystery of the Holy Rosary

Startling news this week. And, yet, not so startling to those of us who fully understand how a family member’s indiscretion and/ or ruthlessness will haunt generations to come. Mark Madoff, eldest son of Bernie Madoff is dead. At his own hands.

The sins of the disgraced father were passed on to his sons.

I frequently ponder why people are so ruthless in the health insurance industry? Coventry Health Care, Inc is much more cruel and uncompassionate than Bernie Madoff ever was. Madoff never preyed on the poor and helpless. What makes these tyrants behave as they do? Are they are so arrogant that they never think that they will be caught?

And then the unthinkable happens.

What is about to happen in a court of law in small city of Wheeling West Virginia (Christine Stenger v Carelink Health Plans, Inc of West Virginia and Patrick Dowd) has serious implications for many others across our great nation. What is about to happen in Wheeling West Virginia is that a systemic evil in the healthcare industry will be revealed to a jury of my peers. Peers who are likely sick of the rich becoming richer at the cost to our poor, to ourselves.

Some day, sooner and not later, the truth will begin to set us free. Daily there are hints that something is being stirred within the ranks of the common people across this country. We are all beginning to reach our limits and realize our obligation and power to confront evil. We must.

Sadly, on that day, there will be mothers and fathers, sisters and brothers, spouses and children who, like Mark Madoff, will feel betrayed and be disgraced, people whose lives will turn upside down as did the world of Mark Madoff.

When one loses one’s moral compass, deceit enters. Only truth will shatter that deceit. We must pray for the many innocent who will suffer. We must pray for those who committed the egregious deeds, as they will have to live with the knowledge that their loved ones will suffer unbearable heartache for the rest of their lives.

For power and money. At what cost?

Would Bernie Madoff want to change history if he could have Mark’s life back?

Tuesday’s Tale

West Virginia Insurance Commissioner Jane Cline: A Shameful Situation

The world is a dangerous place to live, not because of the people who are evil, but because of the people who don't do anything about it." ~Albert Einstein

The state government of West Virginia is allowing a large health care insurer to rip off the public. West Virginians suffer at the hands of this improperly rated "Excellent" company. We live with the highest rate of depression and obesity, among many other ills.

The Offices of the West Virginia Insurance Commissioner's website states they “offer a variety of services for both the consumer and the insurance industry to ensure that quality coverage exists throughout the state.” It is the duty of Jane L. Cline, Insurance Commissioner, to insure health plans provide quality service to West Virginia consumers. For Cline, however, injustice has become the law over an unsuspecting public.

On December 14, 2006, Cline signed Final Order 06-AP-024 that regulated Carelink Heath Plan Inc's future dealings with processing consumer requests for benefits. In making this judgment Cline judged after a legal proceeding that Carelink had committed "egregious" deeds against me. To prevent this from happening in the future to others, Careink was ordered to carefully review each incoming request of its consumer to insure proper processing.

Cline willfully abused her office to, in effect, support the healthcare industry. Carelink ignored the order.

As the West Virginia Insurance Commissioner, Cline is a member of the National Association of Insurance Commissioners (NAIC). As such, Cline has a duty to follow NAIC’s Codes and Bylaws, which include the following:

• A state regulator's primary responsibility is to protect the interests of insurance consumers, and the NAIC helps regulators fulfill that obligation.

• The mission of the NAIC is to assist state insurance regulators, individually and collectively, in serving the public interest and achieving the following fundamental insurance regulatory goals in a responsive, efficient and cost effective manner, consistent with the wishes of its members.

• Conflict of Interest Policy: In furtherance of the Mission of the NAIC, it shall be the policy of the NAIC that all member (i.e., Commissioners, Directors, superintendents or other chief insurance regulatory officials) shall act in a manner that reflects the highest standard of ethical conduct and members shall avoid any activity or situation where their personal interest could conflict, or give the appearance of a conflict, with their fiduciary duties to NAIC. All members shall follow this Conflict of Interest Policy unless subject to a more stringent state policy.

• NAIC members are obligated to avoid “any activity or situation where their personal interest could conflict, or give the appearance of a conflict, with their fiduciary duties to NAIC.” Return to my tirade dated October 14, 2008: West Virginia Insurance Regulation AWOL.

So what do we think about Cline? Cline frightens me.

Our state government is infested by evil. Many times in the last three years I have heard the outcry, “the West Virginia Insurance Commission is owned by the insurance industry.” And now Cline's poison maybe infesting yet another regulatory agency, NAIC, an agency that is formed to provide protection to the consumer.

And, herein lays a perplexing problem.

In an improbable twist of fate, Jane L. Cline was the President of NAIC for 2010. Yes, a Commissioner who refuses to enforce a significant final order she signed in 2006 to regulate how HMOs must now do business in the state of West Virginia, wields her power and control over a national body of regulators. This alarming news has dreaded ramifications.

Many months prior to Ms. Cline's becoming president, I wrote the then President of NAIC, Ms. Sandy Praeger, a certified letter requesting an investigation of Jane Cline, offering a lot of incriminating evidence against Cline. No response. Yet another closed door.

What next? The troubling news about our economy brings with it some good news. Lack of government oversight is being blamed for much of our economic collapse. The future will demand much more regulation over the present display of self interest at the cost of the common good.

In God's time, and with your help the light of justice will shine on Cline. As the public learns, new voices will rise.

The new social media is enabling many to be loud, clear, and demanding to a wider, now available, audience. Just google "Christine Stenger" and "Christine O'Brien Stenger" and discover how just one person's voice is making a difference.

The tide is changing. There are many of us who know this as truth.

Mental Health Abuses

2010-12-07T13:17:00.000-05:00

Tuesday’s Tirade

Shhh… An Arrangement Behind Closed Doors

“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. (my emphasis) 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.”
~ http://www.answerbag.com/q_view/363941#ixzz14Fysrbbg.

Has Spillman,Thomas and Battle, P.L.L.C., the law firm who represents Carelink Health Plans Inc of West Virginia in my civil lawsuit against Carelink, crossed the line into unethical representation of a guility client.? I have uncovered a lot of evidence that describes Coventry “egregious” treatment of a consumer.

What happened to justice for the common man? My case is not just about me but really about the ability of the justice system to afford the mentally ill equal justice before the law. Oh, my, my, my. There are few people who could withstand the barrage of personal attacks, unconscionable delays, and many other abuses. Then, these thoughts are only the blubbering meanderings of someone who is mentally ill and cannot be trusted.

What follows in one of my favorite blogs, written in 2008; it has also drawn the attention of many other of my readers.

Are you interested in tracking down the truth? The truth teller always points to the correct road. He moves people beyond appearances to facts that are confirmed by others and official documents.

Just who is telling the truth about how health plans perform their functions? Coventry Health Care, Inc. of Bethesda MD or Christine O’Brien Stenger? Do Coventry records of financial success and happy customers speak the truth? Or do the accounts of my experience to which I link evidence, suggest something truly sinister?

Ultimately, you must choose and be correct. Soon. When it comes to quality health insurance, you better do your homework. Our world suffers while we choose to wait.
Why should you believe me? I am not an expert, but I have thoroughly investigated my former HMO, inside and out, for a long, long period of time. Future posts will take you inside corporate headquarters and inside Carelink and Customer Service where I was trusted by key personnel. We both trusted each other. But that was then. That was before I threatened to write a blog about shocking discoveries.

There are also many family documents that describe “what’s in my heart.” Here's a newspaper cliping of an interesting story. The text describes my family as being prominent in West Virginia history since the Civil War. It "has contributed doctors, lawyers, judges, and a newspaper editor." http://www.freewebs.com/courageoffaith/O%27Brien%20Family.pdf (Cut and paste in browser) I include my history, not out of pride as some connected with Carelink may think, but to present who I am and why I do what I do.

catholic Diocese of Wheeling Charleston http://www.freewebs.com/courageoffaith/Bishop%20Schmitt%27s%20Recommendation.pdf followed by an appointment I recently received from the Diocese. http://www.freewebs.com/courageoffaith/Disabilities%20Council.pdf

Then begin to look at the evidence. Question where it points. Which evidence is indisputable? And remember, while Coventry publishes a lot of information, do not be swayed by the sheer volume. Advertising and repetition do not always create truth.

Web of Deceit

Each state and the District of Columbia has established an agency dedicated to regulating the business of insurance. The West Virginia Insurance Commission, Jane Cline, Commissioner, is responsible for monitoring the health insurance industry and enforcing applicable laws in West Virginia. As part of its monitoring and enforcement functions, the commissioner maintains a process by which physicians and patients can file complaints against health plans.

On September 28, 2005, I filed a formal Grievance with the West Virginia Insurance Commission against Carelink Health Care, Inc. of West Virginia, my HMO. This September marks my third full year of continual fighting against the the West Virginia Insurance Commission. My rights were violated as, shockingly, Jane Cline of the West Virginia Insurance Commission never enforced the Final Order 06-AP-024 that she signed on December 14, 2006. The same order the WV Consumer Advocate argued is essential to begin to clean up health care in our state. http://www.freewebs.com/courageoffaith/2007%208%2028%20Letter%20to%20Jane%20Cline%20re%20Carelink%20Defiance.doc (Please note that today, December 7, 2010, Ms. Cline is the President of the association of all insurance commissioners in the US...hmm)

Future Tirades and Tales will detail the many twists and turns of my path to justice with the Insurance Commission. They will expose the sad plight of West Virginians and health problems relative to other states. For today ponder these questions: Does this sound like corruption? Is there collusion between the Commisison and Carelink? Are their political contributions involved?

To clarify, Carelink and Coventry challenged the ruling of Judge Jack DeBolt, to authorize my benefit of medically necessary surgery to treat severe sleep apnea, all the way to the Appeals Court in Kanawha County, West Virginia. Final Order 06-AP-024 also mandates that Carelink review all initial inquiries fropm consumers or doctors, thoroughly review these medical requests, to avoid the “egregious behavior” towards me being repeated again and again. Once the final order was signed, Carelink was obligated to follow the order.

It was then that Carelink began a series of legal maneuvering to get the order reversed.

In a response to a civil lawsuit, Christine O Stenger vs. Carelink Health Inc, et al on January 2, 2008, Carelink revealed a secret. Something happened behind closed doors at the Commissioner's office and Carelink dropped their appeal. That was my only notification that Carelink and the Commission had worked out a deal. A document. A copy of a document intended to present Carelink's position in my cival lawsuit. I have sinced learned that Ms. Cline amended the final order to include solely requests from me. Hmm.)

Nafarious actions? Heinous Crime? Who knows? No one notified me of this key meeting. Don’t know but I believe that Jane Cline never had the intention of enforcing Final Order 06-AP-024 from the beginning. The web of deceit broadened. See last page 4, first paragraph: http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

In the summer of 2007 three different physicians requested three different procedures for me. Each was denied on the spot. http://www.freewebs.com/courageoffaith/2007%2011%201%20Dr.%20Rogers%20Complaint%20%40%20Claim%20Dismissal.pdf (I have linked to one of my doctors complaints. There are two more doctors who details their complaints as I describe.) It only takes this one instance for Carelink to be in defiance of Final Order 06-AP-024.)

No thorough investigation as required. Had Carelink done an investigation as ordered by Final Order 06-AP-024, they would have authorized a procedure for me, a $3100 procedure to treat my severe sleep apena, much less than the costly surgery they have authorized. Most importantly, they would have learned that Dr. Bernard Costello, my surgeon, advised me a year ago that because of the continued stress in my life due to dealing with Carelink, he will not perform the surgery. Too risky. And so I wait.

Now I live from day to day knowing that I must have medically-necessary surgery. I know that the West Virginia Insurance Commission by WV State Code must intervene. I know that three different attorneys, inside and outside state government, have warned me of the corruption within the commission. And I know much more about the web of deceit in my state.

Tuesday’s Tale

Stigma

…So for tonight we pray for

What we know can be.

And on this day we hope for

What we still can't see.

It's up to us to be the change

And even though we all can still do more

There's so much to be thankful for.

Look beyond ourselves

There's so much sorrow

It's way too late to say

I'll cry tomorrow

Each of us must find our truth

It's so long overdue

So for tonight we pray for

What we know can be

And every day we hope for

What we still can't see

It's up to us to be the change

And even though we all can still do more

There's so much to be thankful for…

~"Thankful" sung by Josh Groben

I have never tried to hide who I am, warts and all, and in the spring of 2004, I approached the Editor of the Wheeling News Register, Mike Myers, to help me begin to educate the public about mental illness and the vast stigma that inhibits too many from seeking help. Myers agreed, but he had a request, “First I would like to write a story about you.”

On March 25, 2004, Tammy Woods, Staff Writer, wrote the first of three articles about my successes living with bipolar illness and my commitment to advocating for the mentally ill. I share the second story today, not out of pride but out of belief in the potential of the human spirit to overcome adversity, even the adversity of character assassination by the defendants in my lawsuit.

BIPOLAR DISORDER IS A LIFE ALTERING DIAGNOSIS
By
Bethany Holstein
Health Writer, Wheeling Intelligencer

July 5, 2006

Wheeling – A life-changing illness has become a Wheeling woman’s path to empowerment through helping others.

Wheeling resident Penny Stenger, 58, has been coping with bipolar disorder for most of her life. Now that she has things in her life on track and a treatment plan that is working¸ she said her next goal is to spread awareness and education to help others who may be suffering the same disorder.

“I have had this for forty years, and it has not been easy. One of the many things that I have learned is that I have to take ownership of my illness,” Stenger said. “I am now working to promote the facts that will fight stigma.”

One of the ways she is looking to reach this goal has been through the formation of a Wheeling Depression and Bipolar Support Group. Stenger said the group meetings could be a lifeline for people who are out there suffering from an illness and lacking skills to deal with it.”

“You end up sharing ideas of how you life and that helps other people,” Stenger said “Primarily, what happens is you know you are not alone…Most people wouldn’t want to tell people that they are mentally ill, but it sets you free.”

And Stenger said the support group is a good way to able to tell the truth about a disorder without an accompanying fear because the people in the support group are in the same situation.

“This group is not only for people with mental illness, but also their caregivers,” Stenger said. “We want to grow this organization.”

According to Stenger, her bipolar illness went undiagnosed for about 18 years. She said being a part of a support group has really been a tremendous help to her, especially because it gives her a chance to talk to people who really understand what she is going through because they have already gone through it or are going through it, too.

“To be healthy and to be stable, you must attend a support group. “It is one of the things I did that helped me get my sanity back.”

Stenger described countless nights of insomnia, followed by days and days of laying in bed unable to fight the all-consuming depression that kept her there. She talked about the exhausting search for the correct medication and suffering through the numerous side effects each medication would bring.

“Until I had the right psychiatrist, it had not come together,” Stenger said. She added, too, that some of her hobbies, including painting, have served as a way to cope.

She said that now she feels she can really do anything she wants to do. She said she just has to remember to not put so much stress on herself.

Her goals not only include spreading education and awareness on the topic of bipolar disorder, but also to be an advocate to fight for justice on behalf of those with mental illnesses who cannot do it. She said that she was brought to this path by her own fight with her insurance company over a denied claim ¬– something she said that has made her sensitive to the issue of access to care for the mentally ill.

She said she hopes this group, the Wheeling Depression and Bipolar Support Group, can help her make some headway into advocacy and into spreading awareness. Stenger said the group meets on Tuesdays and Thursdays from 7:30-9 p.m. at Wheeling Jesuit University. For more information, call (xxx) xxx-xxxx.

Coventry Health Care Inc Sick In America

2010-11-30T15:51:00.013-05:00

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.

Mental Health Parity and Coventry Health Care Inc

2010-11-23T12:39:00.002-05:00

“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

TUESDAY’S TIRADE

TOO MANY UNANSWERED QUESTIONS

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

Prologue

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

Coventry Health Care's Deadly Spin

2010-11-15T16:55:00.004-05:00

TUESDAY’S TIRADE

A REAL LIFE DAVID AND GOLIATH STORY

“I know what insurers are thinking because, not long ago, I was on their side. I am sorry to admit it, but over nearly two decades I had a hand in planning the industry’s PR and public policy strategies to either kill or shape any health care reform proposal that might hinder profits (my emphasis). I was part of the strategic-communications team that planned and carried out the successful attack on the Clinton plan in the 1990s as well as the one that killed the patients’ bill of rights a few years later. I left my job handling communications for Cigna because I didn’t have the stomach to be part of yet another campaign to cheat Americans out of the reform they needed (my emphasis).”

~Wendell Potter of the Center for Public Integrity, published by Newsweek, November 15, 2010

One of the most dramatic stories of the Old Testament is the story of a shepherd boy David who singlehandedly defeats a large enemy. God entered the battle with David, who with a slingshot and a few stones, slayed a giant.

Now it’s my turn. I, too, have been misjudged as too weak to fight against the wicked and immoral policies of Fortune 500 Coventry Health Care Inc of Bethesda MD. My trial against them nears. I will not be alone in the courtroom.

My fifth stone: Meet Fr. Jeremiah McSweeney, the pastor of St. Michael Catholic Church in Wheeling West Virginia. St. Michael, one of the largest catholic parishes in the Diocese of Wheeling Charleston West Virginia, has been my home for over fifty-five years.

I first approached Fr. Jerry for spiritual direction in 2009. The direction continues to this day. Last March we met again.
Listening to my bizarre story, Father did not move. He expressed no doubts. No questioning of my integrity and honesty, only 100% acceptance and an offer to help “in whatever way” I would need him.

March 23, 2010:

“The bright spot of my day was the spiritual direction with Father Jerry. We spoke for over an hour about my work for justice and discussed ways to bring balance to my life. Father loaned me two tapes by Dyer. "Dreaming" is gthe first topic. That was providential.

Fr. McSweeney blessed me unlike any other spiritual director to date. He spoke of the Holy Spirit's role in providing me the spiritual energy to win against Coventry Heatlh Care. He searched for words to describe my personality and character and added something I needed to hear, "You are fully alive and one heck of a woman."

As I continue to be besieged with ruthless accusations, I need only go to my memory bank of my many visits with Fr. Jerry.

“Lies. Lies. Lies, Fr. Jerry once exclaimed.”

I smiled. Apparently, many Coventry personnel do stomach disseminating false information.

Tuesday’s Tale

A Community of Reform Advocates

“So, what do you think? With God on our side like this, how can we lose?”
~ Romans 8:37

It has been five long years since Fr. Jim O’Brien, S.J., a professor at Wheeeling Jesuit University and social activist, advised me that to win a battle for social justice, one must join a community of like believers. Over the years, as I fought against constant assaults from Coventry - 2006, 2007, 2008, 2009 and 2010 - I shared my story and doors opened.
A community of support grew.

Today five holy men are the core of my community. Each a respected cleric of great faith and action. They are wise men who know that Coventry can attempt to run from justice, but, with God on our side, ultimate victory is ours.

Coventry Health Care Inc Accreditation Questionable

2010-11-08T20:06:00.004-05:00

Tuesday’s Tirade

DAVID AND GOLIATH: the FOURTH STONE

BISHOP BERNARD W. SCHMITT, DIOCESE OF WHEELING CHARLESTON (WV)

" Be sure you put your feet in the right place, then stand firm." ~Abraham Lincoln

There is an epic story in Scripture that depicts a very weak, frightened shepherd, named David, slaying the giant Goliath with one of five stones he brought to the battle. An inexplicable event if one does not see through the eyes of faith.

Today’s blog continues a series of blogs where I introduce the people who closely walk with me as I continue to fight against the Fortune 500 Heath Insurance giant Coventry Health Care Inc of Bethesda MD.

Bernard W. Schmitt is the Bishop Emeritus of the Diocese of Wheeling Charleston WV. He has been a loyal shepherd and friend for decades. I have learned much by sitting at his side and listening to his wisdom. It was natural to seek the bishop's guidance as I dealt with ruthless treatment by my former HMO, Coventry Health Care Inc of Bethesda MD, ruthless treatment that continues to this day.

Bishop Schmitt became my spiritual director in June 2007 and that relationship continued until the spring of 2009. Bishop’s advice ranged from how to write effectively to stir others to action to how to approach others to unite in community.

Most importantly, our visits were peppered with spiritual advice and encouragement. God has great love, for me, as He uses me to fight evil, Bishop Schmitt reminded me often. God’s goodness will, Bishop stated emphatically, ultimately win against Coventry.

I always left the Bishop’s home singing, considering the many amazing thoughts that elevated my soul and spirit:

• Writing my blog must be a top priority, as it can provide talking points for discussion groups studying the quality of healthcare in West Virginia.

• Seek out priests like Rev Msgr. P Edward Sadie, VF, of the Co-cathedral in Charleston WV.

• Use my journals as a way to guide me and see God’s direction for my life.

• Develop the seven gifts of the Holy Spirit as I must now learn a new way to communicate well my story.

• Make sure all details about Coventry are factual.

• God uses problems as a way to direct us. As we surrender to these problems and give up our timetable, miracles will happen.

• Recognize your limitations. Balance work with rest.

• Ride on the coattails of people like Michael Moore.

• Many people today do not feel it is necessary to tell the whole truth, especially when it affects them personally.

• I told Bishop Schmitt that an accreditation agency awarded Carelink an “Excellent” seal of approval despite the existence of the “egregious” treatment of me. He reminded me that deceit is how the devil uses others to ensnare man. The saints persevered through persecution and suffering; I, too, must suffer and persevere.

The devil has a firm grasp on society universally. God has given free will to man but today man has chosen self-interests which destroys the quality life for others. People are too caught up in “What’s best for me?” and search for more possessions as a way to create joy for awhile. It will not work.

Today, as always, I believe Bishop Schmitt speaks truth. He encouraged me to write daily. I do. It’s my way of contributing that 10% of my talent for which Bishop Schmitt called me to do over three decades ago.

Tuesday’s Tale

Another Victim. Another very sad story.

Why is it that victims are oftentimes demonized for seeking justice in a court of law?

It’s all there in my daily notes and correspondence. Coventry is targeting me, suggesting it is I who have done wrong, not they. My wild imagination, my lies, and the danger and violence that they describe as part of my life have intimidated them. So they say. They never intimidated me or caused me emotional harm. So they say.

Among the many notes I have collected, there are accounts of others, I personally know, who have been denied their rightful benefits by Coventry. Meet Nancy Tsien.

Nancy Tsien, age 87, has been my friend for over twenty-five years. We worked together in a bible study program in our local parish twenty-two years ago. I learned Nancy’s story and my admiration for her grew. Today Nancy has very little support from her family or friends. She is eccentric and she lives with dementia. I am her contact with the real world.

In 2009, Nancy authorized me to act in all matters related to her life. Not surprising, in a cruel twist of fate, I learned that Carelink Health Plans, Inc of West Virginia denied Nancy of medically-necessary therapy. I received Carelink’s letter directed to Nancy re her denial. I receive all her mail.

Nancy Tsien, age 86, confused and suffering from dementia, back hurting from three recent falls was denied essential physical therapy. The Carelink CSO did not ask for an explanation, just advised Nancy of her rights to appeal Carelink’s decision by letter. For those who are not familiar with my story, it took me four appeals followed by 19 months to receive authorization for my medically necessary surgery. Nancy remained in pain.

Nancy Tsien, an elderly, sick woman, has paid her dues to society and contributed much to our small corner of the world. Does Carelink expect Nancy to fight by herself with no skills and a foggy mind? Nancy did not. Nancy could not.

That last fall, according to a former neighbor, was a nasty one, down concrete steps, with Nancy’s striking her back and head. Did Carelink ask any questions? No. The real outrage is that this brutally cruel way of Coventry’s doing business occurs again and again.

This is not the rest of the story. So sad to report.

Coventry Health Care Inc of Bethesda MD Suspicions

2010-11-02T20:03:00.003-04:00

“Justice and power must be brought together, so that whatever is just may be powerful, and whatever is powerful may be just.” ~ Blaise Pascal

Tuesday's Tirade

David v. Goliath, My Third Stone

The Women’s Retreat Conference of the catholic Diocese of Wheeling Charleston sponsors two weekend retreats for women every year. Here I met strong people of faith who encouraged and greatly strengthened me to pursue justice. One holy man is Fr. Mike.

In April 2004, I met Fr. Michael Greb, O.F.M., a hermit with the Capuchin order of friars in the Catholic Church. As a Capuchin hermit, Father Mike offers half of each day to prayer and the other half to service. He was my spiritual director beginning in 2004 through December 2006.

Fr. Mike is a lovable bear whose warmth and hospitality is present in every gesture. He is also a modern day prophet. In the guidance, unconditional love, and compassion he gave me, he has sustained me as I advocate for the mentally ill.

In my September 2004 journal, I recorded:

“Father Mike desires that I write my story, focusing on the very human struggle to survive over great obstacles as one walks in Faith. He blessed me by saying that my gifts – intellect and ability to communicate well - must not be lost because of others’ misunderstanding of my mental illness and its symptoms. He expressed his sincere belief that I would do great things.”

I last spoke with Fr. Mike Greb in December 2006. My husband Tom and I were asked to address local diocesan priests about the need for support for the mentally ill in our parishes. At the end of the meeting Fr. Mike and I said our goodbyes.

Suddenly Fr, Mike reappeared briefly. He looked directly at me and said, “Do not be afraid!”

I smiled and replied, “Those are Pope John Paul II’s words. (Pope John Paul II began every one of his audiences with this admonition).

“No, it was Jesus Christ who called us forth.!”

Tuesday’s Tale

And So I Blog…

I am an unlikely hero: a senior citizen, a woman, living on disability with little exposable income, two social security checks for my husband and myself. But I do believe in the richness of possibilities. I believe that David did conquer Goliath so, for this and many other good reasons, I have devoted over five years of my life to issues of justice in health care for the mentally ill.

My father’s heroic spirit inspired me to set my sights high. To persevere and be bold.

Who I am is important to this story. I was born into a family of litigators, prominent in Wheeling, West Virginia – the O’Briens of Country Cork Ireland. My great grandfather Col Thomas O’Brien immigrated to the United States in 1830. With his wife Katherine Gilespie, and the O’Briens rose in stature in the community and in the state with the Colonel becoming the first Secretary of State in West Virginia.

The following extract is from an editorial appearing in the Wheeling Register on the day following the death of Colonel O'Brien:

Colonel O'Brien was a man of exceptionally strong personality and sterling integrity. Mistakes he made, as we all do, but they were always of the head and not the heart. Probably at no time in his long and busy career did he espouse a cause until he had first satisfied himself that it was just and worthy, and the movement which enlisted him in its support always had a vigorous and influential advocate and defender. He never lacked the courage of his convictions. His interest in public affairs was broad, and he was a militant factor in many campaigns for civic betterment and for the moral improvement of the community.

Colonel O'Brien was called to many positions of responsibility and trust, and he invariably laid them down honorably. He was conscientious and painstaking in his public service; conservative and safe in his financial and business activities. He was devoted to his church and its interests without being narrow and intolerant in his religious views, and during a half century of unusual activity in this community his character was never assailed. His usefulness may not be measured so much by constructive enterprises and business movements in which he was a factor, as by his influence upon the moral and material welfare of the community, and the splendid example to young men which his career affords.

The O’Brien character traits have been passed down from generation to generation. There are over 600 O’Brien’s in the Colonel’s extensive family. Uppermost to many has been the practice of the Catholic faith and virtues including integrity, honesty, community service, and humility.

Not as highly prized to many in my family, Colonel O’Brien passed on the bipolar gene to family members. While the gene does not manifest itself in the majority of the O’Brien family, many have lived and suffered with this debilitating mental illness. I am one of these O'Brien as was my late father, Richard J O'Brien, Jr..

It is likely that my first bipolar symptom occurred following my father’s tragic death in 1965. At that time, there was little knowledge of bipolar illness, known then as manic depression. Oftentimes it remained undiagnosed for years. It was not shocking that it took doctors until 1991 to diagnose my illness.

By 1996, with proper treatment and a healthy understanding of the life changes I needed to make, I began to smile, to celebrate life again, and share my successes with others. Hope replaced fear and I became an advocate for the mentally ill. I speak for those who are still very frightened and confused. I offer them unconditional acceptance and love.

I could not ask for a more fulfilling way to spend my days. The mentally ill have become my treasure.

Coventry Health Care Fights David

2010-10-26T11:00:00.002-04:00

There is something even more valuable to civilization than wisdom and that is character.
~ Henri Louis Mencken

What do I do when confronted with deceit and lies? I cry, then I laugh and then I consult with one of several “men of God” who have encouraged me to boldly tell my story.

Today I introduce you to another remarkable man, a friend, who in the eyes of many is a saint on earth. My relationship with Fr. James O’Brien, S.J. goes back forty-five years. There is no “loose association” here.

Fr. Jim, a Jesuit catholic priest, is a model for peace and justice to all he meets. He has enjoyed a variety of positions at Wheeling Jesuit University in Wheeling WV since the mid-1950s. He is a social activist, a gentle giant of sorts, quietly inviting others to join him and make a difference.

It was early 1998, when a small group of Catholics met twice a month to study the Spiritual Exercises of St. Ignatius at Wheeling Jesuit University facilitated by Fr. Jim. Tom and I would remain a key part of this group for over 7 years, learning how to apply key Jesuit principles to our lives.

The Spiritual Exercises of St. Ignatius of Loyola are a … program of meditations, prayers, considerations, and contemplative practices that help Catholic faith become more fully alive in the everyday life of contemporary people. ~Society of Jesus, Oregon Province, 2009

It was out of this relationship with Fr. Jim and our years practicing the Spiritual Exercises of St. Ignatius of Loyola that I first “discerned” my role as an advocate for the mentally ill.

The year was 2000. Cambridge Massachusetts was the site of the 2000 Annual Depression Bipolar Support Alliance which Tom and I attended as a prerequisite to establishing the first DBSA support group in West Virginia. It was the city that would soon welcome our son as a Harvard Law School student.

In 2005 Carelink (Coventry Health Care Inc of Bethesda MD) denied my expert surgeon Dr. Bernard Costello’s request for medically necessary surgery. Having devoted five years in my community to supporting the mentally ill, I was known and supported by the community in Wheeling, WV, my home town. But it was approaching Father Jim O’Brien, S.J., always in prayer, that strengthened my Faith to persevere with my ministry to hold Coventry accountable for discrimination against a mentally ill person.

It was November 2005 when a memorable moment took place. Father Jim O’Brien had just read “the” letter from Carelink's former CEO Patrick Dowd that falsely accused me, a mentally ill person, of fraud. Father sadly remarked, “Penny, I have read much about the injustice in the health care system, but I have never seen anything as ruthless as this letter.”

Discrimination? Yes. Intentional? Yes. Did I understand the full implications of “the” letter on November 1, 2005? No. In time, others would condemn Coventry as Fr. Jim had. In early fall 2005. I was only beginning to understand the full scope of Carelink’s cruel ways.

Tuesday’s Tale

Cancer Patient Fought Coventry For Treatment

May 24, 2007

CITY, Mo. -- A cancer patient is fighting to receive treatment.

Leo Miller, 64, has multiple myeloma, which is a complex cancer of the blood. He said figuring out how to get the stem cell transplant his doctor said he needs has become difficult.

"It's pretty tough, I'll tell you," Miller told KMBC's Jim Flink. "I'm waiting for word from a judge about my transplant -- I'm in a danger zone, really."

Miller said he already has stem cells frozen from his first transplant for multiple myeloma. But his second transplant has been denied.

A similar situation happened to Julia Slaven, who also has multiple myeloma. I was told by a support that Slaven threatened to picket her insurance provider, Coventry Health Care. That same day, Slaven's appeal of her claim was accepted.

It appears that Slaven had the right idea: spotlight Coventry with a public demonstration and force the issue. It worked.

Unfortunately, Coventry did not, if appears, support Leo Miller.And jsut as unfortunately, it took twenty-two months of for Carelink to authorize my medically necessary surgery.

At what cost to our communities?

Coventry Health Care: Home

2010-10-19T15:40:00.004-04:00

Tuesday’s Tirade

Coventry Health Care Inc Trial Developments

Back in business...

Christine Stenger v Carelink Health Plans Inc of West Virginia and Patrick W Dowd will not be going to trial beginning November 8th as we expected. This is the second continuance, a shocking move by Coventry Health Care, Inc.

Where is justice today for me? Where is it for the thousands of mentally ill who seek health remedies that are frequently wrongly denied? How long can Coventry Health Care run from the truth?

On Friday, October 15, 2010, there was a Pretrial Conference before Judge Michael Gaughan of the First District Court of Ohio County. Defense sent a letter to Judge Gaughan indicating defendants intend to remove this case to Federal Court. In my view, this action is outrageous, totally without merit, and undertaken purely for the purpose of delay. It is simply more of Carelink's inexcusable and indefensible behavior. We will be forced to again move to remand the case to State Court.

While continuance has a grave effect on my emotional state, there is nothing my attorneys or the Judge can do to stop Carelink from removing the case again. Judge Gaughan was prepared to move this case forward to trial, and all of the necessary pretrial motions and disclosures had been made.

Unfortunately, the Rules permit Carelink to engage in this conduct even if it is totally wrong. Based on defense counsel's representations as to Carelink's intentions, Judge Gaughan continued the trial date pending a second removal and remand.

In the terminology used by my attorneys in recent legal matters, I now "pray" that ultimately sanctions will be imposed against Carelink.”

Tuesday’s Tale

What is Carelink Health Plan, Inc. Doing for West Virginia Citizens

Recent Statistics on the State of West Virginia

W.Va. Has Highest Disabled Population: About 25 percent of all West Virginians - or about 500,000 state residents - live with some kind of disability, according to Sherri VanTassel, executive director of Russell Nesbitt Services Inc. ~ By JOSELYN KING, August 27, 2009

Obesity in the United States has been increasingly cited as a major health issue in recent decades. West Virginia ranks #2 in the prevalence of obesity. ~Wikipedia

#2 adult current smokers (2006-2008) ~Trust for America’s Health

WV first in prescription drug use…top ten medicated states. – Forbes, 2010

#2 Lack of Adult Physical Inactivity (2007-09 average)

1st Diabetes Rates, % Adults (2007-09 average)

#2 Hypertension Rates, % Adults (2005-09 average)

The Big Race

2010-10-05T07:25:00.000-04:00

Since we have such a huge crowd of men of faith watching us from the grandstands, let us strip off anything that slows us down or holds us back, and especially those sins that wrap themselves so tightly around our feet and trip us up; and let us run with patience the particular race that God has set before us. Hebrews 12: 1

It was July 14, 1983. I was in pain, suffering from deep mental and emotional anguish. That day I began the first of many entries to personal journals written over decades with faith and hope. My opening paragraph would prove prophetic:

I’m in training as of this moment and I truly sense God’s presence as my personal trainer. Because I’m training for the Big Race and I’m planning on winning I’m recording my journey – to stimulate me when I’m down or when I’m up – to be a record of my successes and failures along the way. It’s God and me in this race and that truly excites me, Lord. I dedicate this race to your honor and glory and just want you close to me to share the triumphs and defeats. I am ready to train.

Let’s go, “Big God”!

COVENTRY HEALTH CARE INC OF BETHESDA MD'S DARK SIDE

2010-09-27T10:50:00.001-04:00

Tuesday's Tirade

The administration of justice

"The right to freedom of speech is recognized as a human right under Article 19 of the Universal Declaration of Human Rights and recognized in international human rights law in the International Covenant on Civil and Political Rights (ICCPR). The ICCPR recognizes the right to freedom of speech as "the right to hold opinions without interference. Everyone shall have the right to freedom of expression".[1][2] Furthermore freedom of speech is recognized in European, inter-American and African regional human rights law. ~Wikipedia

There are two tirades today. I did not intend to write today. My God is a God of Surprises.

We all fight giants in our lives. As the case with David of biblical times, it oftentimes takes men of great faith to slay them. David brought stones to his battle against the giant Goliath. I bring five stones to my fight for justice in the health care system.

The Very Rev. Jerome McKenna, CP, V.G.

The second most powerful Catholic cleric in West Virginia stated that there is “a systemic evil in the healthcare system in West Virginia.” Too many people know this is true but turn their backs on injustice. Many, however, are denied the truth.

It was an auspicious meeting on March 24, 2004, of two people who shared the same faith and a passion for justice. A sinner and her confessor met for the first time in a confessional. The Confessor was a gentle, loving soul who changed dramatically when I stated, “They did not know what they were doing.”

Suddenly, there was intensity in the room as the priest puffed himself up and practically ordered me to fight against injustice as “they assuredly did know what they were doing…. I will help you discern God’s will.”

It was September 17, 2005, when I met my priest friend, who now had a name, Fr. Jerome McKenna. I had frequently pondered our first meeting, especially Father’s passion for justice. But I personally had done nothing but pray for direction.

“Do you remember me, Father?” I asked with a gentle smile on my face. “Yes,” Fr. Jerome replied.

“Do you always encourage little old women to fight for justice during one’s confession?”

“No.”

This time I shared about an injustice that was committed against me, about the ruthless acts of Carelink Health Plans Inc of West Virginia and the denial of my medically necessary surgery, describing the deceit, false promises, the fact that this is a Fortune 500 company.

Silence. A piercing quiet before I asked, “Would you be my Spiritual Director, Father?”

I was surprised to sense Father’s hesitation as he himself as a much younger priest was successful in advocating against powerful corporations when he lived as a young priest in Washington, D.C. Something held Father’s attention.

Father Jerome quietly reflected for several long moments before he nodded and said, “Yes, I will guide you… You must be ingenious with this adversary.”

And then there was that friendly, warm smile that I experienced in 2004. A wonderful hug before we parted, knowing that we would create a strong bond and meet again soon.

I later learned that Bishop Michael Bransfield of the catholic Diocese of Wheeling-Charleston (WV) named my friend Fr. Jerome McKenna as the Vicar General of the diocese in 2006.

Note: A vicar general is the principal deputy of the bishop of a diocese for the exercise of administrative authority. As vicar of the bishop, the vicar general exercises the bishop's ordinary executive power over the entire diocese and, thus, is the highest official in a diocese or other particular church after the diocesan bishop or his equivalent in canon law. ~Wikipedia

Fr. Jerome McKenna, CP, V.G. would become my spiritual director for several years while he remained in Wheeling as Vicar General offering an “exemplary record of pastoral care.”

Frequently over the years I have referred to my God as “my God of surprises.” There has never in my life been such a significant relationship as what would become a close friendship with Vicar General Jerome McKenna, CP, a man who acts with compassion and justice. Together we have moved moutains.

God sent me four more God-fearing men in the last five years to lead me to wisdom, to call me to boldness and faithfulness. It is in the name of these five compassionate priests I move forward, always in weakness strengthened by Faith.

Tuesday’s Tale

A Heartless Act

Another Coventry Victim, Dale Fausset of Omaha Nebraska
Dale Allen Fausset
BORN: September 8, 1954
DIED: May 17, 2008
LOCATION: Omaha, NE

In the spring of 2008 Omaha firefighter and paramedic Dale Fausset, who fought the city (and Coventry Health Care Inc of Bethesda MD) to get coverage for a bone marrow transplant, died. Coventry authorized the rightful benefit but it was too late for Dale. Sadly, there is family who also suffered unbearable pain that will last for years: Dale Fausset was preceded in death by one daughter. He is survived by his wife Judy and two children.

As many are aware, I, too, have struggled with a ruthless health insurance company over an extended period of time. By the grace of God I live to tell about it and about the many others who suffered tragic endings too soon in their lives.

Omaha firefighter and paramedic Dale Fausset, who fought the city to get coverage for a bone marrow transplant, died Saturday night. (May 17, 2008)

Fausset was forced to wait because the city, which is self-insured, initially wouldn't approve the $150,000 cost. After weeks of fighting, the insurance company settled last month.

April 10, 2008

Fausset worked for years at Omaha Fire Station 5 (formerly Station 20) as a paramedic shift supervisor, living his life on a watch, always knowing time is everything when saving lives.

Fausset had a lung transplant, but it got worse and doctors determined he needed a bone marrow transplant because of complications, but insurance to cover it was denied.

Coventry, the city's health benefits manager, finally agreed to pay for the procedure after an appeal by Fausset, his family, and his union. "It was a very big extended period of time,” says Bates. “We have been fighting this for a very extended period of time. We were fighting for weeks to get him coverage for the bone marrow transplant."

Others provided chartered flights and fundraisers to offset medical expenses not paid by Coventry. His brother agreed to donate the bone marrow, but infection took over his body before the bone marrow could take effect.

"He was never able to fight off the infection," says Bates. "The whole idea of the bone marrow transplant was so that his body could begin fighting that kind of infection, producing white cells that would be able to start fighting infections."

~WOWT.com, Omaha Nebraska

Tuesday's Tirade Part II

"The Peculiar Evil of Silencing"

The peculiar evil of silencing the expression of an opinion is, that it is robbing the human race; posterity as well as the existing generation; those who dissent from the opinion, still more than those who hold it. If the opinion is right, they are deprived of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error.
~John Stuart Mill, On Liberty, 1859

Someone has violated my rights to speak the truth freely. In this case to speak the truth about the insidious evil that lies within our health care system. We all have been violated.

I, as do many, write featured articles for Newsvine.com's section on Health. Until today, I have enjoyed much success in reaching others to discuss the America's broken health care system.

Yesterday, September 26, 2010, I wrote an article entitled Coventry Health Care Inc the Dark Side. Today several of my articles that speak so eloquently and truthfully about this issue have disappeared to readers. Or have they?

Remember Fr. Jerome McKenna's advice to me? The first direction Fr. Jerome gave me years ago was a call to be ingenious. I think of those wise words often.

Father Jerome will be proud of me today. I located the missing article. You can now read it at:

http://healthinsurancebetrayal.newsvine.com/_news/2010/09/26/5182416-coventry-health-care-inc-of-bethesda-mds-dark-side-?last=1285518893&threadId=1086270&sp=0&pc=25#last_1

Coventry Health Care Inc of Bethesda MD in Legal Battle of their Life

2010-09-21T11:03:00.000-04:00

Deceit Meets Perseverance

Since we have such a huge crowd of men of faith watching us from the grandstands, let us strip off anything that slows us down or holds us back, and especially those sins that wrap themselves so tightly around our feet and trip us up; and let us run with patience the particular race that God has set before us. Hebrews 12: 1

Coventry Health Care Inc of Bethesda MD wants to believe they know who I am, that an interview with their forensic psychologist Dr. David Clayman of Charleston WV in the spring of this year will enlighten them and enable them to “spin” a case against me. Ultimately, my peers will be the judge.

There has been talk of "loose relationships" and a questioning of the role catholic clergy have played in my life these past five years. Just words. Ever so casually spoken, I believe, to place doubt about my character.

I have enjoyed a close, warm relationship with Bernard W. Schmitt, retired Bishop of the Catholic Diocese of Wheeling-Charleston (WV) for over thirty years. Bishop Schmitt recommended me to become a member of the Persons with Disabilities Advisory Council of my diocese in 2008:

Persons with Disabilities Advisory Council Candidate Recommendation

I am happy to recommend Penny Stenger to be considered as a member of the Persons with Disability Advisory Council for the Diocese of Wheeling-Charleston. I have read and understand the rationale, criteria for membership and eligibility guidelines and believe this person will be a good council representative.

Additional comments:

“A truly dedicated, committed, and persevering individual.”

Bernard W. Schmitt
Bishop Emeritus
Retired Bishop of the catholic Diocese of Wheeling-Charleston

April 28, 2008

Tuesday’s Tale

Coventry's Miscue

by Joe Padula

Managed Care Matters

July 2, 2010

Yesterday's Louisiana appellate court ruling against Coventry's First Health work comp network is a major blow to comp insurers, employers, and networks in Louisiana, with potential impact in other states as well.…

The court's finding supported a lower court's ruling affirming a state statute requiring PPOs to provide injured workers with PPO identity cards or give notice to providers 30 days before taking discounts. While Coventry will appeal to the state Supreme Court, the appellate court ruled against almost all of Coventry's arguments, making this an uphill battle for the nation's biggest work comp managed care firm. I'd also note that the decision itself takes Coventry's legal team to task for failings to accurately cite evidence in its written appeal, stating the "failure to provide record citations suggests that many of these assignments were interposed only for purposes of delay and confusion." (My emphasis)

Ouch. (no pun intended)

While the finding may be bad enough, the size of the penalty is stunning - Coventry will have to pay $262 million - $2000 for each of the "131,024 instances in the past 10 years when it discounted providers' charges below the state workers' compensation fee schedule." (WorkCompCentral)

Some workers comp networks decided early on to avoid doing business at all in LA; MedRisk (HSA client) left the state after the initial ruling against Coventry along with several other PPO and specialty networks.

Implications

For Coventry, it doesn't look good (My emphasis). While I have taken the company to task in the past for what I perceive to be missteps, and some would argue that they should have pulled out long ago, it's hard to fault Coventry for believing they could conduct business in LA as they do in most other states, by contracting with providers to deliver discounted care to workers comp claimants. The additional notice requirements in Louisiana are unique to that state; in retrospect all networks should have picked up on this nuance, but in retrospect we all would have sold our stocks two months ago...

It doesn't look good for employers in Louisiana either. As MedRisk's General Counsel, Darrell Demoss noted in the WorkCompCentral piece, WCRI data suggests comp medical costs are significantly higher in Louisiana than in other states. Now that the ruling has been upheld, expect insurers and managed care organizations to avoid the state completely in fear that they too could be nailed by class-action suit.

On a national basis, this ruling will likely cause many network vendors and insurers to stop and very carefully review each state's laws and regulations pertaining to networks, with compliance staffs tasked with doubly ensuring their contracts comply with the letter and spirit of each jurisdiction's rules and regs. That's not a bad thing, as it's a heck of a lot cheaper to pay attorneys and compliance staff than a $262 million penalty.

What does this mean for you?

Sorry, but bad news on a Friday - and a holiday Friday at that.

Except if you're a comp provider in LA.

Thanks to WorkCompCentral for the heads up.

Coventry Health Care Worst Practices

2010-09-14T09:26:00.001-04:00

Tuesday’s Tirade

STIGMA AND MENTAL ILLNESS

“Women are like teabags. We don't know our true strength until we are in hot water!”
~Eleanor Roosevelt

There are tears in my eyes as I write today’s blog. Lack of public education regarding the nature of mental illness can result in abusive behavior to the mentally ill. Endured over many years it may cause irreparable harm. It is costly to all parties involved.

People who have identities that society values negatively are said to be stigmatized. Stigma is a reality for people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life. Society feels uncomfortable about mental illness. It is not seen like other illnesses such as heart disease and cancer. Due to inaccuracies and misunderstandings, people have been led to believe that an individual with a mental illness has a weak character or is inevitably dangerous. Mental illness can be called the invisible illness. Often, the only way to know whether someone has been diagnosed with a mental illness is if they tell you. The majority of the public is unaware of how many mentally ill people they know and encounter every day.

Why does stigma surround mental illness?

We all have an idea of what someone with a mental illness is like, but most of our views and interpretations have been distorted through strongly held social beliefs. The media, as a reflection of society, has done much to sustain a distorted view of mental illness. Television or movie characters who are aggressive, dangerous and unpredictable can have their behavior attributed to a mental illness. Mental illness also has not received the sensitive media coverage that other illnesses have been given. We are surrounded by stereotypes, popular movies talk about killers who are "psychos," and news coverage of mental illness only when it related to violence. We also often hear the causal use of terms like "lunatic" or "crazy," along with jokes about the mentally ill. These representations and the use of discriminatory language distort the public’s view and reinforce inaccuracies about mental illness.

What are the effects of stigma?

If you became physically ill, you would go to a doctor. Once you got better you would expect to get on with life as usual. Life, however, does not always fit back into place for people diagnosed with a mental illness. Everyone has the right to fully participate in his or her community, but individuals struggling to overcome a mental illness can find themselves facing a constant series of rejections and exclusions.

Due to stigma, the typical reaction encountered by someone with a mental illness (and his or her family members) is fear and rejection. Some have been denied adequate housing, loans, health insurance and jobs due to their history of mental illness. Due to the stigma associated with the illness, many people have found that they lose their self-esteem and have difficulty making friends. The stigma attached to mental illness is so pervasive that people who suspect that they might be mentally ill are unwilling to seek help for fear of what others may think. Spouses may be reluctant to define their partners as mentally ill, while families may delay seeking help for their child because of their fears and shame.

How do we erase stigma?

We can battle stigma when we have facts. We all have times when we feel depressed, get unreasonably angry or over-excited. We even have periods when we think that everything and everybody is out to get us and that we can’t cope. For someone with a mental illness these feelings become enveloping and overwhelming. There is no particular way to develop a mental illness. For some people, it occurs due to genetic factors in their family. Other causes may relate to environment stressors such as experiences or severe child abuse, war, torture, poverty, loss, isolation, neglect or abandonment. Mental illnesses can also occur in combination with substance abuse.

No matter people develop mental illness, there is usually some form of help available which will help them to improved health and a productive life. The support of family, friends and employments is also critical.

~Mental Health Works.ca, Mental Health Facts

Tuesday’s Tale

Worst Practices: Coventry Health Care

2008 revenues: $9.9 Billion

Customers: Over 5 million

Spending on Federal Lobbyists $40,000 thus far in 2009

2007 Total Revenue of $9.87953 billion Net Income of $626.09 million.

2008 Total Revenue of $11.91365 billion Net Income of $381.89 million.

CEO (former): Dale B. Wolf $9,047,469 (Total compensation for 2008). (You might want to know about the $34 million payment package Wolf once "earned" I believe in 2004.) Wolf carried a base salary of $965,000 in 2008, and earned just over $1.9 million in stock awards. His "other compensation," which amounted to $486,447, included transportation on the company's airplane, a company match retirement savings plan and a company match 401(k) plan.

Cancer Patient Denied Coverage for life-prolonging drug

In 2007, Coventry refused to cover the costs of a doctor recommended drug for cancer patient Mary Casey, saying it is experimental. Casey suffers from adenoid cystic carcinoma, a rare form of cancer. She had surgery and radiation two years ago, but the cancer had spread to her lungs. Her doctor prescribed a drug called Tarceva, which is approved by the Food and Drug Administration to treat some forms of lung and pancreatic cancer; it is still being tested for other types of cancer. The drug costs $3,600 a month ‐‐ more than the Casey family can manage. "Because Ben and I both work, we don't qualify to get the drug for free," Casey said. "They say it's experimental. It will always be experimental for my cancer because it is so rare." Her doctor said she needs a drug to - survive, but her insurance company refused to pay for it. KMBC's Bev Chapman has the story of a cancer patient who made a difficult decision this week. Mary Casey said she's never wanted to make her health problems a topic for public discussion, but that's exactly what has happened. "It's kind of like David versus Goliath, but you have to keep fighting," Casey said. (Hey, that’s how I feel.)
[KMBC‐TV, Kansas City, 5/10/07]

Investors sue Coventry, claiming securities violations. Pension fund says insurance executives made $46 million in improper stock sales

An institutional investor has filed a class‐action lawsuit against Bethesda insurance company Coventry Health Care, claiming company executives violated federal securities laws and that a "scheme" enabled the executives and others to realize $46 million in stock sales, causing plaintiffs and others to suffer "economic loss." The complaint was filed in U.S District Court in Baltimore by Plumbers Local N. 98 Defined Benefit Pension Fund, represented by Coughlin Stoia Geller Rudman & Robbins, a San Diego law firm with an office in Washington, D.C. Named as defendants are former Coventry CEO Dale B. Wolf, CFO Shawn M. Guertin and Corporate Controller John J. Ruhlman. The suit seeks redress for the plaintiffs, including damages to be determined at trial. Attorneys at Coughlin Stoia could not be reached for comment. Coventry executives did not return a phone message. The complaint against Coventry alleges that from Feb. 9, 2007, to Oct. 22, 2008, the defendants made "numerous positive statements" regarding the company's financial condition, business and prospects and that these statements were "materially false and misleading because defendants failed to disclose" adverse facts. [Gazette.net, 9/1/09] and [PR Log, 9/9/09]

North Kansas City Hospital filed a lawsuit against Coventry Health Care. The hospital is suing
Coventry Health Care for $5 million. The lawsuit claims Coventry has underpaid the hospital for medical services. [KMBC, 10/16/06]

"When I arrived at Coventry eight years ago, my goal was simply for Coventry to be known as a well‐run business," said Allen F. Wise. Source: The Free Library

Carelink Health Plans, Inc. of West Virginia, a subsidiary of Coventry is being sued for
discrimination against a person with disabilities. [Health Insurance Betrayal Newsvine]

In 2007, Coventry was fined $264,000 by Medicare because they unlawfully marketed plans to seniors and the disabled. “Elderly people who aren't competent, can't read or don't speak fluent English have been pressured into joining the plans, known as Medicare Advantage.” [Business Publications Resource]

In 2007, Coventry was selected by West Virginia’s Public Employees Insurance Agency as the Medicare Advantage Plan to provide health insurance to retirees. [Red Orbit]

Coventry’s Rising Insurance Costs Leads to Bad News for Retirees and Creates controversy in WV

Maryland‐based Coventry Health Care is increasing its monthly per‐enrollee rate for handling Medicare Advantage by 37 percent, from $163 to $223, as of July 1. It also plans to stop managing such privately run portions of the government health program for seniors at the end of this year. West Virginia's health care program for public employees decided Thursday to end subsidies for retirees, starting next year with all new hires, and was promptly told to expect a lawsuit. American Federation of Teachers‐West Virginia President Judy Hale vowed to sue following the vote by the finance board for the Public

Employees Insurance Agency. "It's one of the things that helps us recruit teachers, retain teachers," said Hale, whose group continuously battles for pay raises, with mixed results. "It's outrageous in light of teacher shortages ... We will settle this in court."

[ West Virginia Gazette]
Prepared by USAction.org

Coventry Health Care Insurance Scams

2010-08-31T16:47:00.224-04:00

Tuesday, September 7, 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 would contact 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.
500 Virginia Street, East, Suite 400
Charleston, 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.

Cordially,

Christine O Stenger

ENCLOSURE

Cc:

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.

TUESDAY'S TALE

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.

Postscript

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.

Coventry Health Care Reports of a Consumer

2010-08-31T07:25:00.006-04:00

There is a higher court than courts of justice and that is the court of conscience. It supercedes all other courts.
~Mohandas Gandhi

Last week I opened mail from my attorney Paul Tucker. I have been receiving a a lot more mail from Mr. Tucker these past few months as my civil lawsuit against Coventry Health Care, Inc. of Bethesda MD grows close.

For many Americans wealth is an accumulation of riches. For me it is a single piece of paper, a notification that a Patrick W. Dowd will be deposed today at 1:30 p.m. as part of an oral examination in the civil action of Christine Stenger v. Carelink Health Plans Inc. of West Virginia and Patrick Dowd.

It was early November 2005, when I opened a puzzling letter addressed to me, certified mail from Mr. Dowd, former CEO of Carelink. "The" letter, as it has come to be known, shattered my world.

BY OVERNIGHT MAIL

Mrs. Christine Stenger
163 Bello Vedere Avenue
Wheeling, WV 26003

Dear Mrs. Stenger,

The records of the Carelink Customer Service Operation (CSO) indicate that a phone call was received the morning of Thursday, October 27, 2005, from your home phone. The CSO representative who handled the call was under the impression that she was speaking with Dena Wildman of the West Virginia Insurance Commissioner's office based on the information you gave her, and the way you expressed the purpose of your phone call. It could be said that you attempted to misrepresent yourself as Ms. Wildman. Indeed, the CSO representative had no indication from you that you were not Ms. Wildman.

Please be advised that if you phoned the CSO representing yourself as Ms. Wildman, such behavior would be deemed fraud, and possibly a violation of state law which makes it a misdemeanor to "knowingly impersonate or purport to exercise any function of a public official, induce a person to submit to or rely on the fraudlent authority of the person." Further, such actions would be fraud under your HMO benefit plan, and grounds for termination. Section 4.1 of the HMO Evidence of Coverage (EOC) states that Carelink can terminate you, with at least 15 days written notice, if you participate in fraudulent or criminal behavior. We have handed this matter over to the State for investigation, and have confirmed with Ms. Wildman that the information you conveyed to the CSO representative was inaccurate and untrue.

This letter shall serve as a warning that any similar behavior by you in the future will be grounds for your termination. We have apprised you of your rights to contact the Department of Insurance to review your appeal, and we have informed you countless times that your appeal rights with Carelink regarding your request for a lefort graft have been exhausted.

Sincerely,

Patrick W. Dowd

President and CEO, Carelink Health Plans, Inc.

cc Mary Jane Pickens, General Counsel, West VIrginia Insurance Commission.

A tragic mistake for Mr. Patrick W. Dowd. He had targeted me, so he likely thought, so effectively, covering all possibilities that might trigger my termination. Dowd began to dig his own grave that day.

The O'Briens of West Virginia of whom I am a member, with a long history of the law, are not easily fooled by words. Dowd, I believe, unwittingly crossed the line as he accused me directly of fraud with his parting words: "any similar behavior by you in the future. " As I look back over five difficult years, tide turned that day in my favor.

Last night I raised my glass of Merlot, the first in many months, to Mr. Dowd. I held my glass high as I prayed for him, that he would today do the right thing.

I raised another toast to my brilliant, compassionate attorney, Paul Tucker. Two men soon to be adversaries in the courtroom. But I am rushing things. Today, at 1:30 p.m. at a conference room at the Albany International Airport Paul Tucker will depose Mr. Patrick W. Dowd, former CEO of Carelink Health Plans Inc of West Virginia.

Which way will the scales tip? Truth or fabrication?

If you enjoy drama and suspense with twists and turns, return each Tuesday. I have learned that the pen is mightier than the sword and mightier, at times, than a court of law.

TUESDAY'S TALE

Health Insurers Are Backing Republicans With Campaign Donations By 8:1 Margin

Insurers became the target of the White House’s attacks in the closing days of the health reform debate and so perhaps it’s no surprise that they’re “backing Republicans with campaign donations by an 8-to- 1 margin, favoring the party that’s promised to repeal President Barack Obama’s health-care overhaul if it wins back Congress.” Bloomberg’s Drew Armstrong has the scoop:

WellPoint, along with Coventry Health Care Inc. and Humana Inc., gave Republican candidates $315,000 from May through July, according to U.S. Federal Election Commission records. That compares with $41,000 given to Democrats by the three companies as the parties near November elections that will determine who controls the U.S. House and Senate next year.

While Republicans aren’t likely to win the large majorities necessary to override a presidential veto and repeal the health law Obama signed in March, they may be able to slow or stall its implementation, said James Morone, a political science professor at Brown University in Providence, Rhode Island. At the same time, the turn to strongly favor Republicans may anger Democrats who had been receptive to insurers’ concerns, he said.

The Wonk Room explains why insurers are donating to Republicans, the party devoted to repealing the individual health insurance mandate.

~Think Progress blog at http://thinkprogress.org/2010/08/27/insurers-gop/

There are over ninety comments to date to this article. My five year investigation into the workings of Coventry Health Care attest to the veracity of what you will now read. It may be extreme; then, again, there just might be kernels of truth.

P.D. says:

These people are so immoral, so evil. They will let people die in the streets. The Almighty Dollar is their God. They will people we love, we care about die because of the bottom line. I am getting some wine….
August 27th, 2010 at 6:05 pm

Hoodathunk (Man the Pumps!) says:

The HI companies aren’t satisfied with the mandate because they know it won’t survive. They know single payer is coming and they are terrified. Ten years from now HI companies will join the buggy whip boys.

August 27th, 2010 at 6:18 pm

bob h says:

Prior to HCR, the private health insurance industry was in a long-term death spiral, offering an increasingly unaffordable, inadequate product to declining numbers of customers. These political contributions are intended to get back to that happy state of affairs?

August 29th, 2010 at 7:00 am

David and Goliath

2010-08-27T13:53:00.029-04:00

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy." —Martin Luther King, Jr.

It has been a few months since I last blogged. I continue to prepare for my day in court against Coventry Health Care Inc of Bethesda MD. My tale is bizarre but will be supported by evidence that will reveal the gross, ruthless machinations of one "darling of Wall Street." I will record much here, as frequently as possible, a narration of sorts, of how one prepares to win a court battle against a very large, powerful, influential corporation.

So today I begin again...

A small, smooth stone lies on my desk in plain view for everyone to see. It has been in that same place for many years.
As a young child attending St. Michael Catholic School in Wheeling, West Virginia, I was taught by the Sisters of Divine Providence. I well know the story of David and Goliath. Today I live that story.

Let me share the core of who I am today. I am a bright, mature woman who has made bipolar illness her friend. On my office walls are many certificates that attest to the integrity of four generations of my family. First and foremost they were defenders of the Catholic faith who practiced law in an imperfect judicial system. Four generations of honorable men.

For me the stone represents the power of an ordinary citizen to hold a giant of the health care industry accountable for egregious, ruthless deeds. How can an ordinary, disabled, elderly woman accomplish such an impossible feat? With faith. With patience. With perseverance.

On November 8, 2010, I will face Injustice with a capital "I," in the guise of corporate suits who daily make life and death decisions for their consumers.

It was November 1, 2005, when former Carelink CEO Patrick Dowd falsely accused me of fraud.

Likely Dowd, as well as other Coventry suits, failed to understand that having a mental illness is not a prison sentence.

Likely they were ignorant of the truth that people who live with mental illness, like Winston Churchill, Beethoven and Abraham Lincoln, celebrated life and created because of their illnesses.

That recovery is possible today.

My lawsuit Christine Stenger v. Carelink Health Plans, Inc. of West Virginia and Patrick Dowd will soon occur in the First District Court of Ohio County, West Virginia. Ironically, as Plaintiff, I will appear in the same courtroom in which three generations of my family represented justice.

I'll close with a telling tale. It involves Dr. David Clayman, a forensic psychologist, hired by Carelink. In the spring I underwent and intense and lengthy "forensics" evaluation.

According to Dr. Clayman's understanding of complex personalities and mental illness, I exhibit patterns of Personality Disorder, Narcissism, Borderline, Histrionic Personality and Paranoia. Let me state here that not one of several clinicians whom I have visited over a twenty year period has ever discussed any of these illnesses with me.

Dr. David Clayman believes that a forensic examiner is as good or as bad as his last forensic exam. For once I agree with Dr. Clayman.

Coventry Health Care Profits Rise 24% 4th Quarter 2009

2010-03-09T07:36:00.016-05:00

Please join us at United for Justice by sending correspondence to Post Office Box 2181, Wheeling WV 26003-2181. If you do not act now, when will you do it? I am being called a hero by several of my clergy - a real hero wakes up in the morning and loves life no matter the circumstances.

What each of us chooses to do or not to do affects our communities. That's a heavy responsibility, but it is the truth. Join with me now. Do it.

There will be much more to describe next week. Just ponder the truth that a company who recently made 24% profits for the 4th quarter 2009 and who, in 2004, paid their former CEO Dale Wolf $32, 000.000, denied me medically necessary surgery for 22 months. How many other vulnerable citizens of one of the best countries in the world have paid for that 24% profit with denials of rightful benefits?

Please keep me in your prayers on March 15th and 16th. For you who have some appreciation of the depths of despair of the mentally ill at times, you will understand. You will join me as so many have done to date.

God bless and be well.

Official Carelink West Virginia

2010-03-01T14:33:00.012-05:00

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy." —Martin Luther King, Jr.

No individual, let alone one who is mentally ill, must ever face the insurance industry as I have for almost five years. Never again. But today I am standing tall. I will face my accusers in the First Circuit Court of West Virgina in Wheeling, my hometown. The trial will begin April 26, 2010 and it is not soon enough for me.

Take some time to reread my blogs that detail the many obstacles Coventry Health Care placed to deny me my rightful benefits. And somehow they manage to remain accredited as an "Excellent" insurance company today.

Our court system, though established to insure justice, sometimes has its hands tied. If Coventry is to retain its first-class image, it must win. It matters not what tactics it uses to control the truth.

"Defendants object," Coventry attorneys state, "to any request for production or interrogatory that seeks information to Plaintiff's claim for benefits or the appeal of the same. Any such information is irrelevant and it not likely to lead to the discovery of admissible evidence in as much as Plaintiff has already admitted that her claims are unrelated to her claim for benefits or her appeal."

Hmmm. That means that the juror will never hear of the events that led to the discrimination by former CEO Patrick Dowd. Those dirty tricks that were played and their motives for covering up wrong-doings. They will never hear that about three days before I received the intimidating letter from Mr. Dowd, I asked Ruthie Simpson to request action from Patrick Quinn, who worked closely with Dowd, to advise Quinn I was writing a blog.

What are the consequences of greed? Who will be accountable for wrongdoing that may be repeated time and again? Would you believe that Carelink denied an elderly friend's request for physical therapy, suggesting a 60 day appeal as the next step? Did Carelink know that the woman had fallen four times and the therapy was necessary? Did they care?

But I must tell you more. Carelink "has asserted an affirmative defense denying that the plaintiff has any disability." As a consequence the judge has ordered a two day evaluation by Carelink's "Expert" Dr. David Clayman in Charleston WV. Friends, this is the most cruel tactic that has ever happened to me.

I have lived with bipolar illenss for forty-five years having been diagnosed by three different psychiatrists and a family doctor, having received Social Security benefits for ten years and, fortunately, having records of the existence of my symptoms time and again and again. Coventry attorneys have access to many of those records.

Who is Dr. Clayman? I would have expected an expert psychiatrist, but Clayman is a forensics psychologist, who is on record as saying that of the many titles he has received, he likes "entrepreneur" the best. Additionally, it has been reported that he "maintains an aggressive public relations campaign to keep the name of his practice in the forefront of attorneys, judges and the business community." The National Psychologist

Dr. Clayman's resume includes a long list of accomplishments. One would hope that he would have experience in psychiatric evaluations, but that is not in the lengthy resume. What more can I say? Oh, there's this interesting self-evaluation written my Dr. Clayman in the WV State Journal in May 2009:

"While some people effect change in a calm and diplomatic manner, that has not been my style. My more direct, outspoken approach has not always made me well liked. Taking the lead from one of my life heroes, I have remained committed for battling for what I believe is right, not giving giving up and adhering to the spirit of my late professor's major lesson in effectiveness."

Whew! While Dr. Clayman is describing how he advocates for important issues, I can only question: Which Dr. David Clayman will "interview" me?

What a circus. Only this is painful. Truly painful.

Check back with me sometime after March the 16th. I will have a lot to say about my interview with a forensic psychologist and I will discuss the harm that can result from undergoing such an intense examination.

Be well.

Covenyty Health Care Warning - Patients First Not Profits

2009-08-04T20:13:00.001-04:00

A red and white placard hangs in my home office: it reads "Patients First - Not Profits." A personal victory as my husband and I have officially entered the health care battle. Our voices are unified and passionate.

Tom and I represent 20% of the population who have been harmed by a health care company. We had been naive like many people who do not realize that they are one step away from a health care crisis. Today we are statistics. We earned the right to travel to Washington D.C. to advocate Single Payer Health Care on July 30, 2009.

Tom and I are at that golden age when we thought we would have some respite, Having raised a son and a daughter who entered the fields of law and medicine, we thought life would be a little easier on us. Now we are committed to educate ourselves about the realities of the various health care options. While injured, we search for truth amidst a lot of noise.

Today the president of the largest health insurance trade association condemned people for "demonizing" health insurance companies. Our response: you reap what you sow.

On November 1, 2005, Patrick Dowd, former CEO of Carelink, a Coventry Health Care company in West Virginia, falsely accused me of fraud. I suspect that I had learned too much about Carelink's questionable business practices and, therefore, had become a real threat.

In 2006, Mr. Dowd moved on, but we will meet next year in the courtroom. While a federal law prohibits a consumer from suing an HMO for damages (any surprise here?), West Virginia enacted a state law that protects people with a disability from discrimination. And therein lays my pain and my glory.

Carelink records evidence knowledge that Carfelink was aware that I lived with what some say is a major mental illness, bipolar illness. Dowd's letter was not only discriminating, it was intimidating and ruthless. While I shut down for some months, this egregious deed fueled my passion for justice. Under great duress I proceeded. Bipolar illness did not limit me as Carelink may have thought.

I have investigated Coventry Health Care, Inc of Bethesda MD, former darling of Wall Street, for over four years. Coventry unwittingly offered me access to places few consumers go. You will want to read the many true stories I will now continue to write.

Shocking realities that give credence to the existence of demons within the health insurance industry.

Poverty and Health Insurance Corruption

2009-06-09T08:58:00.002-04:00

Poverty and Insurance Corruption: Is There a Causal Relationship?

KATHY MEYER: They said my monthly premium would be $1,020 -- I'm going to start crying. So I appealed, and they sent me another letter twisting everything the doctors said. And at the bottom, they said, "If you continue to appeal this, we may delve further into your records and find more information and you may pay more." ~PBS Online Newshour, June 8, 2009

The horror stories are increasing, stories, similar to mine, of the grave abuses of insurance plans and the very regulatory agencies that have violated the public trust. Time and again. Time and again.

It is a new day in the history of American politics as ordinary citizens are enabled to demand change. To urgently press for accountability. All those individual attempts to speak out for justice, similar to my efforts in writing Tuesday’s Tirades and Tales, are joining together to speak power and authority to the heretofore mighty insurance lobbyists.

It is time.

On June 10, 2008, my blog Tuesday’s Tirades and Tales began to chronicle the injustice and corruption within the state of West Virginia. Of particular focus is Coventry Health Care, Inc. of Bethesda MD and the West Virginia Insurance Commissioner, Jane Cline.

The evidence is clear and shocking. Criminal behavior continues in West Virginia as secrecy and silence hide the truth. While my blog has successfully reached a wide and educated audience, it’s not enough. It is time.

Today’s blog concludes Tuesday’s Tirades and Tales. My message over the last 356 days has reached so many people, planting seeds of concern, distress, and, yes, hope. But today is a different time. As the health insurance debate swells, my story must reach a new audience, the ordinary and naïve people of West Virginia, many of whom have little appreciation of the evil that exists within our state.

Poverty and ignorance fuels corruption. Rated the #1 state for the most uneducated populace, West Virginia has been targeted by dishonest people. But the real threat, I believe, to West Virginians is that we remain uninformed; we are easily deceived. That must change. It is time.

Last week I received notification of the proposed schedule for my civil lawsuit against Coventry Health Care Inc of Bethesda MD: Christine Stenger v. Carelink Health Plans, Inc. and Patrick Dowd. The time approaches for Coventry Health Care, Inc of Bethesda MD to face the citizens of West Virginia. By May 2010, they will be an informed citizenry. It is time.

My father, Richard J. O’Brien died an untimely, unjust death at age 44. Although Dad’s life was short, he left an invaluable legacy. We must live an honest, just life, fighting for those who have no voice.

My prayers of thanks to the many who have supported me this last year. Blogging is intrinsic to shaping our histories. We speak with one voice. We link our hearts. Our efforts are strengthened.

It’s a brand new day. An exciting one, for I have only just begun.

Health Care Dilemma – Who’s Telling the Truth?

2009-06-02T18:54:00.004-04:00

Tuesday's Tirade

The Many faces of Coventry Health Care, Inc. of Bethesda MD

No matter what one reads in mainstream media or online, there is always a contrasting opinion from another source. Who to believe?

Here are a few recent accounts of the “health” of Coventry Health Care, who has struggled financially since suffering major losses in 2008.

Coventry Health Care profits slump 65%
Tuesday, April 28, 2009

Coventry Health Care Inc. generated a hefty jump in revenue last quarter but it was not enough to overcome higher medical costs and profits declined by almost two-thirds.

The Bethesda-based provider of health plans announced Tuesday that net income in the first quarter was $44.2 million, or 30 cents per diluted share, compared to $125 million, or 82 cents per diluted share, in the year ago period.

Coventry credited growth in all of its Medicare products for a revenue increase of 21.5 percent to $3.6 billion, but higher sales and administrative costs, and medical costs that swelled 31percent to $2.83 billion, ballooned operating expenses to $3.5 billion and sank the bottom line.

Coventry (NYSE: CVH) forecast full year revenue of $13.59 billion to $13.99 billion and full year earnings of $1.70 to $1.90 per diluted share.

~ Washington Business Journal - by Tucker Echols Staff Reporter

Coventry's work comp financial results - stellar

Coventry released its financial results for Q1 2009, and the work comp financials are, to say the least, strong.

Revenues were up almost 10% quarter over quarter to $188 million, while gross margin actually declined by a couple points to $130 million. The 10-K states that the growth in revenue was driven primarily by an increase in the company's work comp PBM revenues.

I'm more than a little surprised by the gross margin number. Coventry's PBM, FirstScript, has been aggressively expanding, slashing prices to do so. Margins in the WC PBM business have been declining of late, under pressure by the dynamics and market forces of a rapidly maturing market. Yet Coventry's gross margins are holding up quite well.

It is likely that the company's well-documented efforts to raise prices on network rental services have helped keep the gross margin number where it is. Kudos to Coventry for this success; it's taken a lot of work and come despite strong resistance from many clients.

The slight drop in gross margin dollars (understanding it is a larger decline in percentage terms) will likely turn around in Q2, as Coventry has recently laid off a number of managers and directors in the work comp business.

Work comp is - by far - the most profitable business for Coventry. Although comp only accounted for 5.3% of Coventry's revenues for the quarter, it delivered about 19% of gross margin.

Those are pretty strong numbers, and shows exactly why the new management team is enamored with the business. Any business that produces $520 million in gross margin on $850 in annual revenue is going to have lots of Board support.
~May 12 2009 Managed Care Matters, Joe Padula

Coventry Health Care, Inc., Q1 2009 Earnings Call Transcript

In general we view the future of many of our businesses having some challenges, but more than the challenges there are even more opportunities… In summary, it’s been a good quarter. I believe we’re doing most of the activities to improve our business in the future; however, it’s clear that we still have a lot of work to do. I like our platform, I am proud of our management group, and I’m optimistic about this year. I think that many of my comments today reflect our efforts to make this a better company in 2010. Our management team understands the direction, understands the company isn’t for sale, and that we must execute both today and tomorrow to accomplish our long-term strategy.
~ Coventry CEO Allen F. Wise, April 2009

My Experience as a Coventy Consumer

While Coventry suggests that their focus on different markets is stronger, I am very concerned about a customer base that is more and more dissatisfied with lack of quality service. Coventry has done an excellent job insulating itself from public scrutiny as well as marketing its services. I fear that someone, willing to do a lot of digging, will discover their Achilles’ heel.

Will many analysts agree with CEO Wise that “it’s been a good quarter?” In the end, it will not be the company’s performance that is critical; it will be how transparent Coventry is willing to be? If my case is representative of how Corporate does business, there are hidden agendas through the system, agendas that limit quality life of the consumer.

~June 2, 2009, Christine O’Brien Stenger Plaintiff : Civil Lawsuit Christine Stenger v. Carelink Health Plans, Inc. of West Virginia and Patrick Dowd (former) Carelink CEO.

Tuesday’s Tale
All Eyes are on West Virginia

There are a growing number of ears out there for me. A slow trickle of support and new revelations.

On Thursday, I spoke with the director of an advocacy group interested in justice within West Virginia. I was not surprised to hear of his sharing yet another experience exposing Jane Cline, WV Insurance Commissioner.

A few years back my friend attended a national business meeting and was seated next to a distinguished gentleman who was familiar with state politics throughout the country. Upon learning that my friend lived in West Virginia, his face saddened, “My young man, do you not know that Jane Cline of West Virginia is the most corrupt insurance commissioner in this country?”

I guess the secret is not as secret as I had thought. The Good Guys scored another point.

The Dark Days of Health Care

2009-05-26T17:28:00.003-04:00

Tuesday's Tirade

Jennifer Gigliello. Hannah Devane. Ivyl Garnes. Kyler, 3. Julia Slaven. Selah Schaeffer. Mary Casey. Steven Hailey. Tracy Pierce. Lisa Howard. Dale Fausset. Denied life.

There have been some very dark days in our history when people believed falsehoods and evil flourished because good people remained indifferent.

Adolf Hitler murdered millions of Jews.

Wall Street financial institutions committed crimes that wiped out millions.

The indescribable genocides in Rwanda, Bosnia and Darfur. To identify a few.

America was caught sleeping. Or was it? More importantly, will we allow inhumane treatment of others for the sake of profit again? As critical decisions are being made in Congress today about health care that may mean life or death to many, do you understand that deceit and intrigue are a part of this decision? Where is the anger?

It is serious. Very serious. Google the names of the people listed in the headlines. What do they have in common? They are only numbers to some health plans. Numbers who were denied quality health care though it appeared the benefits had always been a part of the consumers’ benefits packages.

Today one cannot be too careful what he hears or reads about the health care issue. Spin and half-truths diminish understanding. Is that not what one insurance regulatory body hopes to do with US News and World Report Best Health Insurance Plans? While the well-known regulatory body NCQA talks about rigorous standards, those few who dig have discovered that NCQA was formed on 1979 by organizations supporting HMOs.

Rigorous standards? Just voluntary information. US News and World Report? Just an advertisement that is laid out so well that one easily misses that it is promotional material, spinning half truths. Entrapment? False adverting? It works.

NCQA does not want you to know of their sinister beginnings. Max Baucus does not want you to know that he is the highest Democratic recipient of donations from insurance companies. And the health plans do not want you to learn of the outrageous profits that pay executives like former Coventry Health Care CEO Dale Wolf an OBSCENE $32,000,000 salary package.

There was a lot of outrage over Ponzi scams, perks at AIG but it was too late. Do not make the same mistake. It’s time to raise your voices and demand the truth from your representatives in Congress. Do not wait. And do stay healthy. I would not want you to find out how insufficient your coverage may be.

Tuesday’s Tale
WV PEIA’s Plight

Suspicious behavior? Poor judgement? Corruption? This story, I believe, describes a bizarre journey.

It begins with West Virginia’s Governor Joe Manchin’s appointment of Ted Cheatham to be the Director of West Virginia PEIA. It continues with a lucrative contract for medical coverage awarded within a few short months to the highest of three bids, Coventry Health Care, Inc. of Bethesda MD. Cheatham is the former CEO of a Coventry company.

Now with legislators already hearing from very unhappy retirees, the end is near. It did not, however, play out as I thought with the many unhappy consumers demanding a change in insurance carriers. No, quite the opposite.

Here’s just one of many reports:

CHARLESTON, W.Va. (AP) - West Virginia's health care program for public employees decided Thursday to end subsidies for retirees, starting next year with all new hires, and was promptly told to expect a lawsuit.

American Federation of Teachers-West Virginia President Judy Hale vowed to sue following the vote by the finance board for the Public Employees Insurance Agency.

"It's one of the things that helps us recruit teachers, retain teachers," said Hale, whose group continuously battles for pay raises, with mixed results. "It's outrageous in light of teacher shortages ... We will settle this in court."

Board members countered that the change puts West Virginia's coverage more in line with that of other states. But Hale also questioned the board's ability to cast such a vote during an emergency meeting. She further blamed Gov. Joe Manchin, seeing his fingerprints on the outcome.

"This appears to be a well-planned sneak attack on public employees by PEIA," Hale later said in a statement.

A Manchin spokesman said the governor believes the board "did what they thought would be best for the state and its employees."

"Certainly the governor is sympathetic with Judy's concerns, and wishes there were an easier decision," spokesman Matt Turner said. "Any time finances are involved, tough decisions have to be made."

But other groups representing public employees said they are consulting lawyers over the move.

"I wouldn't rule anything out," said President Dale Lee of the West Virginia Education Association. "We will do everything we can to ensure that this benefit continues to be provided so that we can retain and attract the best and brightest to this profession."

Visit the following link to read the rest of the account:
http://wvgazette.com/ap/ApTopStories/200905140607?page=2&build=cache

Senator Max Baucus “tries” to Restore Order

2009-05-19T11:16:00.003-04:00

Tuesday’s Tale

More Questionable Actions of Senator Max Baucus

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy." —Martin Luther King, Jr.

Quality health care is a basic human right. Do Senator Max Baucus of the Senate Finance Committee and the insurance lobbyists he appears to represent believe otherwise?

A basic human right? Tell that to the families of the victims of an unjust, at times, ruthless health care system: men and women like Dale Fausset, Jennifer Gigliello, Hannah Devane, Ivyl Garnes, Mary Casey, Julia Slaven, Selah Schaeffer, Tracy Pierce, Steven Hailey and Lisa Howard. To name only a few. Many denied life. Hopes dashed. Lives destroyed. Business as usual.

Every day I receive an e-mail or read about someone who is boldly challenging the health care system. Today it may be a trickle. Tomorrow it just may grow into a sea of advocates putting it all out there, no matter how embarrassing to regulators, insurance companies, and government officials.

We are winning the small battles. There is an undercurrent of dissatisfaction and distrust. While it’s business as usual for HMOs like Carelink Health Care, Inc of West Virginia, the foundation continues to crack.

Here’s an example of the essence of e-mails I have begun to receive…regularly:

Senator Dick Durbin said last week that the banks own Congress. That's true. But they don't come close to the hammerlock their brothers in the health insurance and drug companies have over the place.

The drug companies and health insurance companies control every nook and cranny on the Hill. If you doubt it, look no further than the events of the past two weeks at the Senate Finance Committee.

Committee chair Senator Max Baucus called a full 28 witnesses for two hearings on health care reform. Senator Baucus called on the Business Roundtable. He called on the Heritage Foundation. He called on the lobby known as America's Health Insurance Plans. But not one of the 28 witnesses called by Baucus supported what the majority of the American people want.

And what the majority of doctors, nurses and health economists want.

Single payer, full Medicare for all, everybody in, nobody out, free choice of doctor and hospital health care.

And so, Single Payer Action, citizen action organization, decided to act. Last week, eight citizens - including three doctors - led by Single Payer Action - simply demanded that Baucus add a seat at the table for a single payer advocate. Instead of adding a seat at the table, Baucus called for the police. The eight were arrested, handcuffed, and charged with so-called "disruption of Congress."
The police left behind undisturbed the horde of corporate lobbyists accustomed to "the purchase of Congress.

This week, two doctors, two nurses, and a citizen from Maine - inspired by the actions of the Baucus 8 - rose and simply demanded that Baucus add a single payer advocate to the witness list. Again, Baucus refused. And again, Baucus called for the police.

Now it's the Baucus 13.

Single Payer Action will not rest until America gets what every other Western industrialized country has - universal, not-for-profit, health care - everybody in, nobody out. More efficient. And more humane.

Single Payer Action has gained widespread publicity - on National Public Radio, Democracy
Now, in Politico, the Associated Press, and the National Journal. Opportunity is knocking…To defeat the insurance and drug industries. And secure single payer national health insurance for all Americans.

It appears that Senator Baucus may not be interested in representation from we consumers. Is anyone discussing the reality that 50% of Americans did not receive the health care benefits they expected from their health insurance plans? Alarming news.

For me another personal lesson: Senator Baucus spins the truth in his desire to control outcome. On his website Baucus invites public comments and states he will contact the writer within three weeks. Admirable intentions. But just words. He does not care to hear my incriminating tale.

Finally, there are two books that may be of interest. Galvanizing reading:

Health Care Meltdown by Robert LeBow, MD, revised and updated by Dr. C. Rocky White - a Republican doctor so fed up with the needless suffering caused by the insurance industry that he became a leading advocate for single payer and Ten Excellent Reasons for National Health Care, edited by Mary O'Brien and Martha Livingston.

Yes, today there is more distressing but not surprising news: We consumers, a force for good, are not represented Senator Max Baucus’ table.

Tuesday’s Tale
A little bit of Kindness Goes a Long Way

“You are such a fine couple,” Sara told me. My husband Tom and I were leaving a birthday celebration for one of our members of the Steubenville Ohio chapter of Depression and Bipolar Support Alliance. We are fine people. And so are those who joined us to show we care about one troubled individual.

You know, when you suffer with a mental illness, it makes you more sensitive to the human condition than when one operates in the confines of business as usual. I cannot judge the people in HMOs like Carelink when they deny benefits to the mentally ill and the elderly. They just don’t get it.

But stigma is a life sentence to the mentally ill. Oh, it’s so easy to know when a person has no clue about another’s disability, when a person closes the door to any opportunity that would otherwise be offered someone.

In 2001 Tom and I founded the first chapter of DBSA in West Virginia. Today we have eleven chapters meeting throughout West Virginia, succeeding in helping heal people who suffer with mental illness.

"Richard" is just one such individual. He is so dear to my heart. When Dick first came to DBSA of Ohio Valley, he spoke little or nothing at the meetings for some time, tension always a part of his posture. When he began to share his story, it was in little cryptic pieces. One learned that Dick suffered with depression before we learned that he lives with daily paranoia and hallucinations.

Ponder this definition and count your blessings:

Schizoaffective disorder is a major psychiatric disorder that is similar to schizophrenia. The disorder can affect all aspects of daily living, including work, social relationships, and self-care skills (such as grooming and hygiene). People with schizoaffective disorder can have a wide variety of symptoms, including problems with their contact with reality (hallucinations and delusions), mood (such as marked depression), low motivation, inability to experience pleasure, and poor attention. The serious nature of the symptoms of this disorder sometimes require clients to be hospitalized at times for treatment. The experience of schizoaffective disorder can be described as similar to "dreaming when you are wide awake"; that is, it can be hard for the person with the disorder to distinguish between reality and fantasy."

A beautiful mind? A remarkable transformation. Over a year later, Dick still lives with the grave symptoms of schizoaffective disorder, but he controls them much more effectively. He leaves his bedroom now and his charming, brilliant, affable personality comes alive at DBSA. The group has so affected him that he now longer withdrawals from the public. He has been loved and he now loves us in return.

Our world is a better place because Tom and Penny along with many others in DBSA are such fine people. That reality is what fuels my hope, determination and perseverance.

Dying for Lack of Insurance

2009-05-12T13:14:00.003-04:00

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.

And…

“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.

Coventry Health Care, Inc. Exposed Again

2009-05-05T10:32:00.006-04:00

Tuesday’s Tirade

Deceptive Marketing or Fraud?

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy."

—Martin Luther King, Jr.

There is a systemic evil in our health care system. It costs lives.

Take a real close look at Coventry Health Care, Inc. of Bethesda, MD, formerly a Fortune 500 Company. They are not what they “appear” to be. In late 2008 a promotional brochure began to circulate:

THE COVENTRY HEALTH CARE DIFFERENCE IN WEST VIRGINIA

With over 120,000 members throughout West Virginia there are many good reasons to choose Coventry.

Committed to Unparalleled Service

In September 2007, Carelink was awarded a three year accreditation status of “Excellent” on our commercial HMO/POS products by the National Committee for Quality Assurance, Carelink’s accreditation status is the highest possible level.

The reality, however, is shocking and disturbing.

We know that regulatory agencies must protect the public from the self-interests of health plans. One such agency is the West Virginia Insurance Commission, headed since 2001 by Jane Cline who describes her role on the Commission’s website:

“It is essential that a healthy, competitive insurance industry be accessible to all West Virginians. As Insurance Commissioner, my primary goal is to make certain that the insurance industry in West Virginia provides excellent service to consumers. I am also committed to increasing the number of quality insurance companies offering products throughout the state."

West Virginia Insurance Commissioner Jane Cline signed Final Order 06-AP-024 in January 2007. This order mandates a radical change in how Carelink is to do business in West Virginia due to its “egregious” treatment of a consumer. Carelink, a Coventry company, defied this order. Cline has refused to enforce an order she signed.

Even more disturbing, NCQA, the regulatory agency that accredited Carelink with “Excellent” in 2007, as stated in the 2007 Coventry brochure, was formed in 1979 by and for HMOs. That accreditation is paper thin as it is based solely on voluntary information. A health plan is not investigated and, therefore, does not have to provide involvement in questionable activities.

The dictionary defines fraud as deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage.

As NCQA wields its influence across our country, US News and World Report annually publishes its top 100 health plans. It relies on NCQA data. Deceit? Trickery perpetrated for profit or to gain some unfair or dishonest advantage?

Google “HMO horror stories." Form your own judgment about Coventry, other health plans and the insurance regulatory system that should protect the consumer.

If you accept what is reported here, stand up against the ruthless treatment of consumers by their health plans. Today Congress is preparing to pass health care reform championed by special interests. We must hear your voice.

Join me today in making a difference.

Tuesday's Tale

A Milestone

It was May 5, 2005, when Dr. Bernard Costello, my neurosurgeon, requested that Coventry Health Care Inc authorize my medically necessary surgery to treat severe sleep apnea. Coventry quickly denied Dr. Costello’s request. That was four years ago today.

During four years of investigating Coventry, a new face was revealed. Coventry has operated with indifference to the pain and suffering of the consumer. And they are getting away with it!

Attorney Jim Bordas of the Wheeling law firm Bordas and Bordas employs a successful strategy when mediating with the Defendant. Bordas employs a taped reenactment of the events that led to a trial. The language indicts:

(The defendant) disregarded the laws of the state of West Virginia and federal government with deadly consequences. They demonstrated disrespect and contempt for the law with a direct knowledge of employers.

(The defendant) even disregarded its own policies and procedures to which they played lip service and which were established to protect the public. Worst of all, some of its actions were clearly deliberate.

They were willing to sacrifice lives for a profit. (The defendant) made conscious decisions puts people in peril for their lives; their indifference insures death.

The case in unusually strong, including powerful evidence of corporate wrongdoing and egregious violations driven by the bottom line. There is an avalanche of evidence that their own employees confirmed.

The jury will be shocked. Specific details will horrify the jury and send a message that this behavior will not be tolerated in West Virginia.

Coventry Health Care Inc of Bethesda MD will soon face a court of law, having been accused of discrimination and intimidation of a consumer. I believe that the attorney for the Plaintiff will employ much of the same language cited in the above case to convict Coventry.

And, yes, the jury will be shocked.

Who Does Max Baucus Really Represent?

2009-04-28T14:29:00.007-04:00

Tuesday’s Tirade
Part of the Problem: Senator Max Baucus

"When the engineer of the health care reform train is getting more fuel from the HMOs and drug companies that any other Democrat on Capitol Hill, you have to wonder who is really driving the train and whether average Americans will be tied to the tracks," commented Carmen Balber, Director of Consumer Watchdog's Washington D.C. office.

~ Maggie Mahar , Health Beat

Bashing lobbyists is nothing new. Senator John McCain, the 2008 Republican presidential candidate, described lobbyists as "birds of prey" who "descend to get their share of the spoils" and vowed to ban them from his administration, if elected. Why? Because lobbyists work in the background to excessively influence policy.

It’s called influence peddling. Legalized bribery.

Senator Max Baucus is the Chairman of the Senate Finance Committee, a key position in determining the future of our health care in America. Does the public know that Baucus is one of the few democrats in Congress to attract sizeable campaign donations of pharmaceutical and health insurance industries?

“At the recent White House health care summit, Senator Baucus said that the insurance companies and drug companies had told him they would help drive a solution,” stated Maggie Mahar of Health Beat. Trudy Liebermann, a journalist for 35 years and Director of the Consumer Health Choices at Consumer’s Union added: "… Baucus says lobbyists just want the best for America. On camera, Baucus offered this opinion of them: 'They really care about our country,' he said."

Lobbyists do not represent the interests of the average American. They are a business whose interest is the bottom line. Max Baucus and others have no idea of the destructive forces at work, a systemic evil, within the health care system.

Take West Virginia, for example. Citizens are regularly denied rightful health care benefits in a state that has a troubling record of health care:West Virginia is 44th for overall health, #1 for obesity, #1 for smoking, #1 dirtiest state, #1 for depression and poverty, one of the worst states to medically deal with the mentally ill.

In West Virginia state government is working against the consumer to avoid policing health insurance companies. “W. Va. Code Section 33-2-9 requires the West Virginia Insurance Commissioner to 'thoroughly examine the financial conditions, and business affairs, of all insurers licensed to transact business in the State of West Virginia every five years.'" In February 2009 the West Virginia Insurance Commission defied state code by not performing a market conduct survey on Carelink Health Plans, Inc. of West Virginia, described in this blog as a ruthless and abusive health plan.

Max Baucus may not care about increased transparency and regulation but we certainly do. Laws are enacted to protect the citizenry, not the special interests groups. The citizens of West Virginia have lost dearly. If Max Baucus is listening to the wrong people as we suspect, we all may lose.

It never ends does it? Greed controls choices. Corruption begets corruption. People turn their backs on evil. Others are harmed. But, then, why should I care?

Tuesday’s Tale
Citizen Journalism

Citizen journalism is the concept of members of the public "playing an active role in the process of collecting, reporting, analyzing and disseminating news and information," according to the seminal 2003 report We Media: How Audiences are Shaping the Future of News and Information. Authors Bowman and Willis say: "The intent of this participation is to provide independent, reliable, accurate, wide-ranging and relevant information that a democracy requires." ~Wikipedia

Four years ago I had no idea about the world of activism. I solely wanted my medically-necessary surgery that was denied me. I began to knock on doors to locate support.

Concerned citizens drove me to act, not just on my behalf, but on the behalf of vulnerable people in our society, the mentally ill and the elderly. Many lack the tools and time to pursue their health benefits as guaranteed by their plan. Many are unaware of a state government that does not care about justice as it refuses to regulate the health insurance industry.

Today I am a citizen journalist. I have discovered yet another avenue to speak justice to power. In a strategic move to educate the public I have become a “featured writer" on MSNBC’s online magazine Newsvine. People are beginning to listen.

My blog, Tuesday’s Tirades and Tales, has reached 700 unique visitors since I wrote my first blog on June 10, 2008. Many people repeat their visits, but none so much as Coventry Health Care, Inc., parent company of Carelink Health Plans, Inc of West Virginia and their attorneys. Coventry has visited my blog over 300 times! Incredible? Without a doubt.

Depositions have begun in my civil lawsuit Christine Stenger v. Carelink Health Plans, Inc. and Patrick Dowd for discrimination against someone with a disability. Does Coventry hope to discover something important to their defense? Am I stretching it to view this very unusual pattern as a sign that my lawsuit has merit? I believe so.

More key puzzle pieces are beginning to fit. By the time both the Plaintiff and Defense meet in courtroom, we will both have a great appreciation of each others’ strengths and weaknesses. We each have collected intimate knowledge of one another. But there’s a difference. My research does not come with a large price tag.

Max Baucus A Pathetic Statesman?

2009-04-21T06:17:00.006-04:00

Tuesday’s Tirade
Who Is the real Senator Max Baucus?

America continues to be outraged by the economic crisis facing us. Daily there's a new chapter to discover that describes the moral and ethical decline of America.

Our leaders work hard to convince us that their motives are pure. Does their action support their words? Sadly, many times truth is missing.

Take for example Senator Max Baucus of Montana. Senator Baucus, as Head of the Chairman of the Senate Finance Committee, plays a lead role in defining health care reform in America today. He is passionate and eloquent; most importantly Baucus knows how to attract campaign finances. Large sums.

Here's an alarming e-mail I recently received from ConsumerWatchdog.org:

Stop HMO $ From Gutting Obama-Care

Christine :

Outrageous! A new Consumer Watchdog study shows that the leading architect of health reform on Capitol Hill, Senator Max Baucus, has received more campaign contributions from HMOs and drug companies than any other Democrat, and is the third biggest recipient on the Hill overall.

Please send a free message to President Obama asking him to not waver in his demand for real affordable, accessible health care for every American. You can also find how much this excel chart of the $24 million in HMO and drug company contributions your legislators took by downloading.

Responding to our study, which was featured in this Washington Post article, Senator Baucus' spokesperson said the HMO money didn't matter. Yet Baucus' health plan requires every American to buy private insurance policies and doesn't allow all patients access to Medicare.

HMO executives are gathering at the Ritz-Carlton in Georgetown today, plotting how to hijack the president's health care plan. They cannot be allowed to. Our DC director Carmen Balber took this video at a protest of the HMO conference. Please weigh in now with your protest note to President Obama.

Thanks for all your support. We are constantly amazed by how little the consumer's voice seems to matter on Capitol Hill. Your tax-deductible contributions allow us to make the politicians hear the public's will.

Thanks for all that you do.
Jamie Court

For four years I have investigated my former HMO Carelink Health Plans Inc of West Virginia, a subsidiary of Coventry Health Care Inc of Bethesda MD. Not only has Carelink been found guilty of "egregious" acts at a formal hearing of the West Virginia Insurance Commission in 2006, I believe Carelink acted out of fear that I might be becoming too intimate with their internal workings, uncovering many dirty tricks.

On November 1, 2005, the former Carelink CEO falsely accused me of fraud and threatened me with termination. I turned deep anger into passion and have devoted well over 3000 unpaid hours to learning about the evils within the health care system. I am an expert, having opened doors that very few consumers have dared open.

And I speak with authority: the sins of the financial markets pale in comparison to the power of HMOS to destroy lives. How does this happen? Well, just like today's suspect financial institutions, HMOs employ a variety of tactics to keep their dirty tricks secret.

Investigate insurance regulators and you will likely discover much deception. Investigate the media and the lack of focus on the hidden agendas of insurance companies. Study the public records of state and national officials to learn just how much insurance lobbyists protect insurance companies from real scrutiny. And never forget the insurance accreditation agencies like URAC. Study URAC's Board of Directors and discover one key official with strong ties to Coventry Health Care, ties that go back many years.

And now arrives Senator Max Baucus of Montana. Do you really believe that Senator Baucus fully represents the people? Is his work on this national issue of health care reform compromised by the HMO lobbyists who have contributed so generously to his campaign chests? There is urgency to our learning the truth. Real urgency.

Over the recent decade many politicians and corporations have been destroyed by investigative reporting. Many of us persevere in searching for evidence of wrongdoing. We await the next ax to fall. Will it bring others corporations down with it? Likely.

It will not come too soon for the most vulnerable in society.

Tuesday’s Tale
Flashback December 11, 2005

In early December 2005, I was still reeling from the emotional pain of having been accused of fraud by Carelink CEO Patrick Dowd. At times like these, many would feel powerless. Writing a blog, My Father’s Legacy: Voices for Justice, helped heal a wounded spirit. It also propelled my case into the limelight. Many people have joined me; many will come. The stakes are high. One’s very life lies in balance.

In 2008 I spoke by phone with a dear friend I describe below. My eyes were opened during this conversation to the significance of my former HMO’s abuses tied to what we both believe to be the unquestionably illegal activities of state officials and regulatory agencies. “In addition to corruption being at the core of this “systemic evil,” politics plays a role” cautioned my friend. “Something significant must be done now as there is urgency unlike what most consider.”

Ponder the grave injustices committed within America’s financial institutions and ask, “Are the core values of greed and pride found only within our financial institutions?” Look around at other big business and government and lament the base treatment of man to man.

Miracles

"Ingenuity, plus courage, plus work, equals miracles."
~ Bob Richards

A miracle happened yesterday. I met a man who cares about justice. His encouragement continues to uplift me. In early September, someone highly respected in our community urged me to fight for justice. His words were, “You must fight for justice.” To many he represents Truth and Justice.

Tall order, huh? Many might think so. I, however, believe in miracles. I believe it is God’s plan to bring about justice through his faithful. Others will join me. It may take awhile but they will. One at a time.

It takes just one person with courage to step out in Faith, speaking out to another person about injustice, for God to become a miracle worker. Many never do see miracles. A pity. I am blessed to have experienced many miracles in my lifetime and I now expect them. God does not let me down.

My friend gave me one piece of advice that September day. He advised me that to win against evil I must be ingenious. My response was, “Would developing a blog be ingenious?” He smiled and blessed me.

Hmm. Are there other people of Faith in our community who want to learn about the tactics of my HMO and its parent company? As time passes, I will continue to boldly speak out. At the right time, the truth will set me free.

Please pray for Liberty and Justice for all.

Health Care Reform and Regulation

2009-04-14T12:18:00.003-04:00

Tuesday’s Tirade
Masked Justice by Insurance Regulators

According to a new national survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health, health care reform is a top concern of 43% Americans. This priority is third, following the priorities of the economy and fighting terrorism. While reformers look at different facets of reform, I ask, “Who is regulating the health insurance regulators?”

West Virginians live in a very dangerous place today. Statistics show high obesity rates, major abuse of smoking, poor overall health, depression and high suicide rates. But the real evil behind some of these statistics is the widespread fraud, collusion and corruption within West Virginia that my four year investigation of West Virginia health insurance revealed.

Rather than perpetuating “good government,” state officials like Jane Cline, West Virginia Insurance Commissioner, ignore the plight of those in need of quality health care, ignore the very codes that are the law in West Virginia.

Article III Bill of rights.
Government is instituted for the common benefit, protection and security of the people, nation or community. Of all its various forms that is the best, which is capable of producing the greatest degree of happiness and safety, and is most effectually secured against the danger of maladministration; and when any government shall be found inadequate or contrary to these purposes, a majority of the community has an indubitable, inalienable, and indefeasible right to reform, alter or abolish it in such manner as shall be judged most conducive to the public weal.

On December 14, 2006, Insurance Commissioner Jane Cline, signed Final Order 06-AP-O24, a thirteen page order that was drawn from evidence provided at a six hour administrative hearing, Christine Stenger v. Carelink Health Plans Inc of West Virginia, before WV Examiner Judge Jack W. DeBolt on August 10, 2006. Judge DeBolt, in examining the voluminous evidence, cited Carelink’s “egregious deeds” as reason to order Carelink to “thoroughly review” all future incoming requests for benefits before making a determination.

On February 26, 2007, Insurance Commissioner Jane Cline denied Carelink’s request for a rehearing. Cline cited that there “are no new issues or procedural errors to justify a rehearing.”

On April 4, 2007. Consumer Advocate Frank Hartman, who represented me at my hearing, described the importance of my win:

First and foremost it is important because consumer victories against insurance companies are few and far between. Think of all you have gone through, from the physical suffering of your illness to the treatment you received by Carelink representatives. The long drawn-out process is emotionally draining and extremely difficult. The vast majority of people quit long before this. You have survived. Simply by being here and fighting you have won.

Next, the case is significant for the far-reaching implications about how HMO’s must do business in the state of West Virginia henceforth. As a result of the Commissioner’s Order, HMO’s must evaluate all reasons for the coverage determination of a requested procedure and make a more thoughtful and accurate initial decision because they will be bound to that decision throughout the appeals process. They can no longer deny first and determine a rationale later only to subsequently change the stated rationale yet again.

Link to Hartman’s letter:
http://www.freewebs.com/courageoffaith/2007%204%204%20Frank%20Hartman's%20Discussion%20of%20Facts.doc

West Virginia Code: §33-25A -17a. Quality assurance. (1) The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this article if he or she finds that any of the following conditions exist: … The health maintenance organization has violated a lawful order of the commissioner.

Why is this order so important to the health of West Virginia citizens? My three different providers have documentation that verifies that Carelink denied benefits without thorough investigation as is mandated by Final Order 06-AP-024. How many thousands of West Virginia citizens have found the same fate since December 14, 2006?

The Insurance Commission never thoroughly investigated my claim in September 2007. The Commission spoke directly with and only with Carelink representatives and reported that Carelink had no record of one denial, that Carelink never received another request for service, that Carelink reported that no request for another service was received, and there is nothing in Carelink’s system that relates to the gynecological matter that related to a requested benefit.

Why did the investigation not include contacting my physicians? Maybe it is because of the rule that for the Insurance Commission to begin an investigation there must be a request for services. Carelink had no records of ANY of the three requests. Is it likely that Cline did not want an official hearing? Is it likely that Cline does not want to hold Carelink accountable?

The West Virginia Insurance Commission never publicized Final Order 06-AP-024. It has never been enforced though Commissioner Jane Cline signed and reaffirmed the order at a later date.

Cline continues to display an arrogance and disdain for the law. We hurt in West Virginia, hurt real badly sometimes, as Cline closes her eyes to insurance fraud and acts as if she will never be held accountable. Unfortunately, as Jane Cline reigns over her fiefdom, ignoring blatant fraud of health care providers, the consumers’ anger grows. We are discovering our voice and that voice is no longer still and small.

Tuesday’s Tale
Polishing the Bottom Line

Health insurance plans are businesses. Bottom lines rule. Denying benefits is just one way health plans increase the bottom line. There are many more. Link to 8 Stupid Things:
http://www.freewebs.com/courageoffaith/8%20%20Stupid%20Things.doc

Friends call me “Queen of the Internet.” Give me some time and a computer and I can locate information about anyone, even where former Coventry CEO Dale Wolf lives and where his children go to school.

In early 2006, following an emotionally difficult period, I returned with renewed determination to learn the real truth about Coventry Health Care, Inc. of Bethesda, MD, parent company of my former HMO Carelink Health Plans Inc of West Virginia. Something gnawed at me. I am no financial wizard but I had just read the book ENRON, and I wondered. As Coventry bought more and more health plans, I wondered. As more and more people within Carelink ignored Coventry’s governance practices, I wondered.

It was in 2006 that I first discovered a phenomenon I lightly speak of as going “AWOL.” Have you ever googled a topic and tried to link to the original document and it was not there? Typically what appears is a message that there has been an error and the page is missing. Or maybe it states that this page is no longer available. What’s to hide?

Today I uncovered the partially completed rating by US News and World Report’s ranking of Coventry Health Care of Delaware as 79th on the Report’s Best Health Plans. 79th? Who is fooling whom? Not only is there no accreditation given Coventry, their reported ratings identify a lot of problems, problems that might send a lot of other institutions to the bottom of the barrel. Given that parent company Coventry Health Care Inc of Bethesda MD is fighting to survive according to analysts, how does a questionable document like this get published?

Is this not fraud? It appears US News and World Report does not care about the integrity of the work it publishes. So why should we care? Because real people are suffering needlessly while others grow wealthy. Simple as that in my eyes. Simple enough to stir the emotions!

Coventry Health Care Wars against Regulation

2009-04-07T10:25:00.009-04:00

Tuesday’s Tirade
Fraud at High Corporate Levels

"There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” ~Elie Wiesel

On April 3, 2009, BILL MOYERS interviewed WILLIAM BLACK on the Bill Moyers Journal on PBS. WILLIAM BLACK is a bank regulator and author of the book, “The Best Way to Rob a Bank is to Own One. It was a disturbing conversation about the financial bailout of large financial corporations using America’s money.

WILLIAM BLACK describes the present economic crisis as driven by fraud. He made it “clear that calculated dishonesty by people in charge is at the heart of most large corporate failures and scandals, including, of course, the S&L.”

BILL MOYERS: But is that true? Is that what you're saying here, that it was in the boardrooms and the CEO offices where this fraud began? Black responds, “ Absolutely.”

WILLIAM BLACK: Fraud is deceit. And the essence of fraud is, "I create trust in you, and then I betray that trust, and get you to give me something of value." And as a result, there's no more effective acid against trust than fraud, especially fraud by top elites, and that's what we have. They involve deceit, which is the essence of fraud.

BILL MOYERS: So you're suggesting, saying that CEOs of some of these banks and mortgage firms in order to increase their own personal income, deliberately set out to make bad loans?

WILLIAM BLACK: Yes.

BILL MOYERS: How do they get away with it? I mean, what about their own checks and balances in the company? What about their accounting divisions?

WILLIAM BLACK: All of those checks and balances report to the CEO, so if the CEO goes bad, all of the checks and balances are easily overcome. And the art form is not simply to defeat those internal controls, but to suborn them, to turn them into your greatest allies. And the bonus programs are exactly how you do that.

The Bush Administration essentially got rid of regulation, so if nobody was looking, you were able to do this with impunity and that's exactly what happened.

BILL MOYERS: You're talking about significant American companies… Is it possible that these complex instruments were deliberately created so swindlers could exploit them?

WILLIAM BLACK: Oh, absolutely.

BILL MOYERS: So if your assumption is correct, your evidence is sound, the bank, the lending company, created a fraud. And the ratings agency that is supposed to test the value of these assets knowingly entered into the fraud. Both parties are committing fraud by intention.

WILLIAM BLACK: Right, and the investment banker that — we call it pooling — puts together these bad mortgages, these liars' loans, and creates the toxic waste of these derivatives. All of them do that. And then they sell it to the world and the world just thinks because it has a triple-A rating it must actually be safe. Well, instead, there are 60 and 80 percent losses on these things, because of course they, in reality, are toxic waste.

BILL MOYERS: You're describing what Bernie Madoff did to a limited number of people. But you're saying it's systemic, a systemic Ponzi scheme.

WILLIAM BLACK: Oh, Bernie was a piker. He doesn't even get into the front ranks of a Ponzi scheme...

You must read the transcript of this enlightening interview. The truth is very painful to read and it’s frightening to consider the possible consequences once this truth becomes public knowledge. The link is http://www.freewebs.com/courageoffaith/Corruption%20and%20Fraud%202009%203%203%20Moyers.pdf

Fraud, I believe, is at the heart of the operation of Coventry Health Care, Inc. of Bethesda MD and likely other large health plans. It suggests wholesale greed. Brazen transgressions. Fraud. Misrepresenting oneself falsely. Does it not? Read on.

The alarming news about our financial institutions creates wider, serious implications for the health care industry. Consider a few of the injustices I uncovered during my four year investigation of Coventry and you might just connect the dots. Did Coventry executives knowingly set into place policies that harm the consumer? Awfully suspicious.

Let’s take a quick tour of some of the fraudulent activities I have uncovered within Coventry Health Care Inc, the former "Darling of Wall Street."

“Coventry Health Care Inc. and Humana Inc., two of the largest providers of U.S.-subsidized health plans, were fined by Medicare for improperly marketing the policies to the elderly and disabled. Coventry, based in Bethesda, received a civil penalty of $264,000, while Louisville, Ky.- based Humana will pay $75,000, according to Medicare officials. State health regulators and patients have told congressional committees that elderly people who aren’t competent, can’t read or don’t speak fluent English have been pressured into joining the plans, known as Medicare Advantage.” ~The Reluctant Regulator

An investigation into the questionable activities of Appeals Dept Head Patrick Quinn was filed away with no consequence to Quinn.

Patrick W. Dowd, former, CEO of Carelink, falsely accused me of fraud, someone who lives with a mental illness, someone who might be especially vulnerable to tactics such as this bizarre accusation.

Carelink CEO Cosby M. Davis, III provided partial information to insurance Regulator NCQA and based on the volunteer information was awarded a rating of excellent in December 2007. Not only did West Virginia Insurance Commissioner Jane Cline accuse Carlink of egregious deeds committed in the appeals process during 2005, but Carelink was ordered to radically change the way they executed their business. This was December 14, 2006 and Carelink has defied this Final Order.

How long will America permit this outlandish activity by health care plans? How much longer will we individuals stand quietly by as others lose their benefits and sometimes their lives?

Calculated dishonesty? What a messy situation!

Tuesday’s Tale
Violence in America

PITTSBURGH – A 911 call that brought two police officers to a home where they were ambushed, and where a third was also later killed during a four-hour siege, was precipitated by a fight between the gunman and his mother over a dog urinating in the house.

The Saturday argument between Margaret and Richard Poplawski escalated to the point that she threatened to kick him out and she called police to do it, according to a 12-page criminal complaint and affidavit filed late Saturday.

When officers Paul Sciullo III and Stephen Mayhle arrived, Margaret Poplawski opened the door and told them to come in and take her 23-year-old son, apparently unaware he was standing behind her with a rifle, the affidavit said. Hearing gunshots, she spun around to see her son with the gun and ran to the basement.

"What the hell have you done?" she shouted.

The mother told police her son had been stockpiling guns and ammunition "because he believed that as a result of economic collapse, the police were no longer able to protect society," the affidavit said.

Friends have said Poplawski was concerned about his weapons being seized during Barack Obama's presidency, and friends said he owned several handguns and an AK-47 assault rifle. Police have not said, specifically, what weapons were used to kill the officers.

By JOE MANDAK, Associated Press Writer Joe Mandak, Associated Press Writer – Sun Apr 5, 4:25 pm ET

In the last month alone there have been seven incidents of multiple murders, leaving forty-eight people dead. These incidents are not isolated. In the latest incident, a sick mind took the lives of three police officers in Pittsburgh PA. The accuser remains in the mental ward of the jail at this time.

Wake up, America! Take note of these senseless killings and begin to question a health care system in crisis. Why is the mass murderer so enraged? Does this type of rage fester within other Americans, awaiting something to snap?

It is too early to tell if many of the killers in the recent massacres were mentally ill. But history tells a tragic story of the ravaged mind of the mentally ill. One incident after another. The killers at Columbine and Virginia Tech? They were mentally ill individuals who needed a great deal of help and it was denied them. Denied by health plans? Nothing would surprise me.

This is a dangerous time. Anger grows as we learn of the fraudulent activities of large financial institutions which have left many destitute. Today we learn about secret, illegal activities to grow wealth of a few. Tomorrow the spotlight will be on health reform.

Soon Americans will be furious to learn of the degree of fraud within the health care industry. There will be very disturbing information revealed about the greedy operations of health plans. We all will cry for swift justice for those who are frustrated by health plans to care for the mentally ill and the elderly, society's most vunlerable.

Do not be shocked by the mass murders that have increased in 2009. It’s beginning to be a weekly news item, is it not? The sad news? If greed were not part of the corporate picture in health care, some of these killings may never have happened.

We’ve got to figure a way to deal with this senseless violence.