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.
Sunday, December 26, 2010
Friday, December 24, 2010
Former OVMC CEO Sues a Wheeling Hospital
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
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
Thursday, December 23, 2010
A Child is Born Again
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.
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.
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.
Friday, December 17, 2010
COVENTRY HEALTH CARE EXECUTIVE ON TRIAL IN WEST VIRGINIA
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
Tuesday, December 14, 2010
Coventry Health Care Inc Loss of Moral Compass
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 RosaryThe Lessons of Bernie Madoff
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.
Tuesday, December 7, 2010
Mental Health Abuses
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.
Tuesday, November 30, 2010
Coventry Health Care Inc Sick In America
Tuesday's Tirade
Carelink takes control of A Patient Bill of Rights!
A Reprint of Monday, August 11, 2008, blog.
“Hell hath no fury like a woman scorned.”
~William Congreve
How has the brazen disregard for insurance law and humane treatment of HMO subscribers been tolerated for so many years? Where is our outrage? What are we doing to promote reform? Alas, too little and too late for many.
For years Carelink Health Plans Inc, of West Virginia was my Health Maintenance Organization (HMO). At its best a HMO works with its subscribers to insure that they receive quality health services. Carelink, as an HMO, is expected to follow published rules of Governance as well as adhere to A Patient Bill of Rights. While Coventry Corporate excels at making profits, its behavior can be repugnant. Simply stated, for me it stinks.
In the latter part of the twentieth century, health care organizations began to adopt what is today known as a Patient Bill of Rights. It’s a statement that defines the rights a HMO ought to provide a subscriber.
“The dramatic growth of health maintenance organizations (HMOs) has prompted calls to give patients a stronger voice in decisions about which medical procedures will be covered by insurance.” (Washington Post, Politics: Heath: Patient Bill of Rights)
Here's a link to the Patient Bill of Rights published by my HMO, Carelink Health Plans, Inc. of West Virginia: http://www.freewebs.com/courageoffaith/HMO%20Patient%20Bill%20of%20Rights.pdf (Note: Cut and paste this link.)
Coventry Health Care, Inc of Bethesda MD, the parent company of Carelink, is a business, a big business. Theodore R. Marmor, professor of public policy and management and political science professor at the Yale School of Management noticed a significant "change in the amount of lives" for which health insurers are responsible. "I think the big story in health insurance is its big business, as you see in the options given to key executives," Marmor says in 2007. That is three years after there appeared published accounts of Coventry’s CEO Dale Wolf's earning an obscene salary package of $32 million. "Thirty years ago nobody expected to get rich that way in the insurance business,” Marmor continued.
Carefully reread Carelink's HMO Patient Bill of Rights (linked above), which is an industry standard for treatment of subscribers by health plans. Coventry Health Care, Inc, a Fortune 500 company, ought to have adopted this standard in each of their dealings with the subscriber.
Instead, Coventry blatantly disregarded this standard time and again in its treatment of me. My treatment was rife with conflicts and intrigue. I was not treated fairly. Period. I fought hard to receive authorization for my rightful benefits according to my plan. Period. I am angry. Period.
Carelink's Patient Bill of Rights includes the following guidelines:
" Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care."
On July 29, 2005, Nanci Philips of the Appeals Department of Carelink ruled against my appeal. Earlier that day Philips had received what was the 4th appeal for my medically necessary surgery. In a rush to send in the paperwork while I had Philips' attention, I overlooked including Dr. Costello's documented appeal. This essential document was required to make an informed decision. No other appeals were logged into the system by Carelink.
Here's the link to Dr. Costello's appeal: http://www.freewebs.com/courageoffaith/2005%205%2016%20Dr.%20Costello%27s%20Appeal.pdf (Note: Cut and paste this link.)
This is the first of four appeals either Dr. Costello or I mailed to Carelink in the spring of 2005 to the Appeals Department that described the medical necessity of this treatment. This document was not reviewed by Dr. Rod McKinney, Carelink's Medical Director, as part of the appeal review process.
See this link to Dr. McKinney's sworn testimony at the August 10, 2005, hearing before the West Virginia Insurance Commission, page 139 lines 15 - 24 and page 140 lines 1 -7.
http://www.freewebs.com/courageoffaith/Dr.%20Rod%20McKinney%20Testimony%2C%20139-140.pdf (Note: Cut and paste this link.)
Nanci Phillips, former Appeals Coordinator, denied my appeal in a very short period of time, without the required medical justification. As governed by law, I received a notice from Carelink advising me of my rights to have my physicians be a part of the appeal process. Unbelievably, the notice is dated July 29, 2005, the same day as Phillips ruled on my appeal.Link to Nanci Philips' sworn testimony:
http://www.freewebs.com/courageoffaith/Testimony%20Nancy%20Phillips%20pp%20110-117.pdf (Note: Cut and paste this link.)
This testimony is but a small excerpt from Philips’ sworn testimony in a court of law. When compared against the partial sworn testimony by former Appeals "Manager" Patrick Quinn, it raises serious questions and doubts. Link to Patrick Quinn's sworn tesitimony:
http://www.freewebs.com/courageoffaith/Testmony%20Patrick%20Quinn%20pp%2086-89.pdf (Note: Cut and paste this link.)
"Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you."
There were many instances in 2005 when I was treated with disdain and discrimination. Reread Carelink’s former CEO Patrick W. Dowd’s letter to me dated November 1, 2005. Link to Patrick Dowd's letter:
http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf (Note: Cut and paste this link.)
Within the hour my son, an attorney, dictated a formal response to Mr. Dowd in response to his ruthless behavior. Link to my letter to Patrick Dowd:
http://www.freewebs.com/courageoffaith/2005%2011%204%20My%20Response%20to%20Patrick%20Dowd%27s%20November%20Letter.pdf (Note: Cut and paste this link.)
"Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities."
Chapted 33 of West Virginia code established a code of behavior for all health maintenance organizations doing business in the state. A part of this declaration is a statement about including physicians in the process:
"WV State Code 33(8) The HMO shall have physician involvement in reviewing medically related grievances. Physician involvement in the grievance process should not be limited to the subscriber's primary care physician, but may include at least one other physician;"
Additionally the grievance process is to be completed in a reasonable period of time:
"(6) The HMO shall process the formal written subscriber grievance through all phases of the grievance procedure in a reasonable length of time not to exceed sixty days, unless the subscriber and HMO mutually agree to extend the ... "
In the fall of 2005, Patrick Quinn, former "Manager" of the Appeals Department at Carelink, received a letter from Dena Wildman, the Grievance Examiner with the West Virginia Insurance Commission. I had filed a formal Grievance complaint with the Commission on September 28, 2005, and Examiner Dena Wildman reminded Quinn of my complaint in a letter.
This letter was revealed at the time of my hearing on August 10, 2006. The testimony of Wildman is serious and damaging to both Carelink and the West Virginia Insurance Commission.
There was too much discussion between the Commission and Carelink. Discussion which suggests in this letter that in Dena's mind, I had indeed impersonated her. Discussion about the conversations Carelink must have had as to what to do about me. It took 3 1/2 months to resolve the grievance. Where are my privacy rights? Where are my rights to have a quick response because of the urgency of Dr. Costello's request? Should not this letter be considered a grave indictment of a systemic evil that West Virginians confront?
Read Wildman's letter:
http://www.freewebs.com/courageoffaith/2005%2012%2021%20Wildman%20ultimatum%20to%20Quinn.pdf (Note: Cut and paste this link.)
Wildman's incriminating letter is a significant piece of evidence.Wildman oversaw a grievance process that began on September 28, 2005, and lasted 3 and 1/2 months. A time when my integrity was once again called into question before the West Virginia State Examiner. I am incensed by the games Carelink continued to play together with the West Virginia Insurance Commission. Games that have cost me dearly.
Sad statement about the dark abuses in West Virginia.
Did I sit quietly and allow this injustice? No. I contacted and re-contacted Carelink headquarters, Supervisor Debi Kalorik. I contacted corporate headquarters, attorney Robyn Aronberg. I contacted the Office of West Virginia Insurance Commission Examiner Dena Wildman. Not one person would take my call. From late October 2005 until January 2006, I was fully blocked from receiving my rightful benefits as a subscriber of Carelink Health Plans, Inc of West Virginia and a citizen of our "wonderful and wild" West Virginia.
There will be a lot of evidence to come that will indict Coventry Health Care, Inc. of Bethesda MD and the West Virginia Insurance Commission and Commissioner Jane Cline. Additionally, there are others who conspired in fraud. Others who created obstables to justice. Others who turned away with indifference.
I am not remaining quiet. My conscience moves me out of my complacency.
Tuesday’s Tale
God's Providence
"As long as the king followed the paths of God, he prospered, for God blessed him"
~ 2Chronicles 26:5
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.
Tuesday, November 23, 2010
Mental Health Parity and Coventry Health Care Inc
“Courage! We must really act like men today if we are going to save our people and the cities of our God. May the Lord’s will be done.” 2 Samuel 11:12
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
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.
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.
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
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.
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
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