Illness and Insurance Hell

Multiple Sclerosis Activism Foundation

2010-07-02T17:42:00.000-07:00

What happened to us should not happen to anyone in this country of ours, especially to a man with an incurable and debilitating disease. It's why we've started the MS Activism Foundation, a 501(c)(3)--because we can't wait for a cure.

MS Activism.org or reach me at margaret@msactivism.org.

There Will Be No Further Postings. Thank You All Who Made Reform Possible.

2010-03-25T09:41:00.001-07:00

ERISA Schmerisa or The Lessons I Have Learned Thanks to the Profit-Mongers at CIGNA

2010-03-23T11:58:00.000-07:00

I have been educating myself over the past year about ERISA (Employee Retirement Income Security Act) and quite frankly, the more I read the more I become disillusioned with our current system and those in our Congress and Senate fighting to keep it this way. Their behavior is criminal.

Don't worry if you can't understand ERISA completely, they don't want you to. For instance, from the Department of Labor's website, you can find answers to your questions about claims in clear, concise language and some in convoluted form.

Clear form:

Before you file, however, be aware of the Employee Income Retirement Security Act of 1974 (ERISA), a law that protects your health and disability benefits and sets standards for those who administer your plan. Among other things, the law and rules issued by the Department of Labor include requirements for the processing of benefit claims, the timeline for a decision when you file a claim, and your rights when a claim is denied.

Convoluted form:
Q-A9: What benefits are “disability benefits” subject to the special rules applicableunder the regulation for disability claims?

A: A benefit is a “disability benefit” under the regulation, subject to the special rules for disability claims, if the plan conditions its availability to the claimant upon a showing of disability. It does not matter how the benefit is characterized by the plan or whether the plan as a whole is a pension plan or a welfare plan. If the claims adjudicator must make a determination of disability in order to decide a claim, the claim must be treated as a“disability claim” for purposes of the regulation. As the Department stated in the preambleto the regulation, 65 FR at 70247, n.4, “where a single plan provides more than one type of benefit, it is the Department’s intention that the nature of the benefit should determine which procedural standards apply to a specific claim, rather than the manner in which the plan itself is characterized.” Accordingly, plans, including pension plans, that provide benefits conditioned upon a determination of disability must maintain procedures for claims involving such benefits that comply with the requirements of the regulation applicable to disability claims, including the requirements for de novo review, the consultation requirement for medical judgments, the limit on appeal levels, the time limits for deciding disability claims, and the disclosure requirements in connection with extensions of time. However, if a plan provides a benefit the availability of which is conditioned on a finding of disability, and that finding is made by a party other than the plan for purposes other than making a benefit determination under the plan, then the special rules for disability claims need not be applied to a claim for such benefits. For example, if a pension plan provides that pension benefits shall be paid to a person who has been determined to be disabled by the Social Security Administration or under the employer’s long-term disability plan, a claim for pension benefits based on the prior determination that the claimant is disabled would be subject to the regulation’s procedural rules for pension claims, not disability claims.

This is an illustration of why you hire an attorney if your claim is denied.

However, I found an excellent article on ERISA and long term disability that clarifies every question about procedure here at Physician's News Digest. It's well-written and lays it all on the line so you do know what you will be up against if you decide to fight the fight.

The article by Mark F. Seltzer, Esq (told you it takes an attorney), is written with physicians as his audience, keep that in mind as you read it, but the information pertains to anyone with a LTD claim. Everything in blue is taken directly from the article:

Do you have group long-term disability coverage that pays you if you become disabled? If you get sick or hurt, are you relying on that group LTD policy to pay you benefits? If you do, don’t count on it. There are three primary reasons for this: (1) inferior contract language, (2) ERISA, and (3) relevant court decisions. If you become disabled, you may be in for the fight of your life.

Yes, the fight of your life. And when you are sick, what is the very last thing you want to do? The answer is fight. In our case, we just wanted to be left alone and let Paul try and get better. Insurance companies, like CIGNA, know this all too well. It's one of their tactics in claim denial; wear you down. You are already sick, how much wearing down will it take?

But unfortunately, while disabled, when you are most vulnerable, is the worst time to mount a fight against the big insurance company.

Exactly, and that is one of the first things they are counting on, is preying upon your illness or disability to their advantage. What a racket!

There is a reason that LTD policies cost on average about one-sixth of the premium for a quality individual insurance policy: group policies are designed to limit coverage and the amount of benefits payable. This is done in many ways, including limited definitions of disability, offsets against benefits, as well as significant limitations and exclusions in the policy. Group coverage is inherently inferior to individual disability coverage.

Limited definitions of disability. Interesting the overall, gotcha' quality permeating these plans, isn't it? And that's because it's a pure money-making scheme for the insurance companies, a scam. They collect and collect the monthly premium from their risk pool and never pay out. In my husband's case CIGNA was looking at paying out over $2 million in his lifetime until retirement.

You will, no doubt, be denied your claim more than once. Your recourse then becomes this:

Again, this appeals process is established by ERISA and must be adhered to by both sides. If, after you have gone through the internal appeals process, the claims administrator still maintains its "adverse decision," and in effect, you have "exhausted your administrative remedies," you will then have the right to file a lawsuit in court.

A lawsuit. Of course. And here's where it begins to get ugly.

What is absolutely critical in considering LTD cases is that the burden of proof that must be met by the insured physician establishes that the claims determination made by the claims administrator after considering the information of record was "arbitrary and capricious." This is a difficult standard to meet. Sometimes, under certain circumstances, this standard is "heightened." However, usually, the Court simply reviews the administrative record and determines whether or not there has been an "abuse of discretion" relative to the claims determination.

In Black & Decker Disability Plan v. Nord, the Supreme Court of the United States held that "ERISA does not require plan administrators to accord special deference to the opinions of treating physicians," therefore, effectively ending the use of the treating physician rule in ERISA-governed claims.

Bad Faith. Black’s Law Dictionary defines bad faith as, "the opposite of good faith, generally implying or involving actual or constructive fraud, or a design to mislead or deceive another, or neglect or refusal to fulfill some duty or some contractual obligation, not prompted by an honest mistake as to one’s rights or duties, but by some interested or sinister motive." In 1990, Pennsylvania enacted a bad faith statute relating to insurance carriers. Prior to 1990, there was no such codified statute in Pennsylvania.

You need to read the article to fully digest what the writer is saying here, but in essence there is no real codified body of law regarding Bad Faith, it varies from state-to-state because the "business of insurance" is exempt from federal anti-trust laws due to McCarran Ferguson Act of 1945. The laws are left to the states and each states' laws vary.

The pre-emption issue as to state bad faith has created a major problem for both those attempting to bring bad faith causes of action as well as those defending same. Decisions have been rendered by different District Courts throughout the country concluding totally different positions on virtually the same given set of facts.

ERISA, you see, falls under federal jurisdiction so recourse for you, the insured, falls only on this path of restitution and not the path of using your state's laws. As of this writing, I am still unclear whether any decision had been made by the Supreme Court regarding ERISA pre-emption. If you do know, please contact me. Email link on the left.

There is no question that the current trend in the sales of disability insurance, as well as the high growth area in disability insurance, is group policies. On the surface, this seems to make sense. After all, most group policies are offered by employers (usually hospitals) as an employee benefit. The "policy" is usually part of a greater employee benefit plan, which is part of a benefit package that most physicians are quite happy to have. The "policy," per capita, is cheaper, easier to sell, easier to administrate, and in every way more profitable for the insurance company, as opposed to individual disability insurance policies.

Cheaper, easier to sell, easier to administrate, and in every way more profitable for the insurance company. See, when peoples' lives are at stake, and I mean being given the ability to heal and the continuation of income when the breadwinner is unable to work which is the whole point of a disability policy, then it is clear to see how profitability and health care don't mix.

However, what you may not realize is that the benefits, especially in view of the policy provisions, are far inferior to the benefits in an individual policy, especially those sold in the 1980s and early 1990s.

But wait, it gets worse. Not only are the group benefits inferior, but the very same ERISA procedures enacted as a built-in safeguard for plan participants have been used to sabotage claims. The ERISA procedures in concept were sound and made sense. The insured had the ability to perfect a submitted otherwise defective claim because, under ERISA, the carrier upon arriving at an adverse decision is required to provide the insured with an explanation for its decision as well as any documentation upon which it relied in making its determination. This gave the insured physician multiple opportunities to perfect his/her disability claim by curing the defect.

Your doctor is simply filling out a claim form with simple, understandable answers and sending test results to prove your disability. He is, after all, a physician not an attorney. He went to school to practice medicine and heal the sick and NOT learn how to fill out insurance forms in such a manner as to appease the insurance bureaucrat looking for any way to deny your claim. Here are your bureaucrats, Ms. Palin of Alaska.

However, this very same procedure has been used by the carrier for the exact opposite purpose in order to defeat that same claim. Because of the fact that the Court, upon appeal, will most often only review the administrative file, and further, because the standard of review is usually that of arbitrary and capricious, the insured is forced to produce all evidentiary documentation at the administrative level and during the administrative appeals procedure. This allows the insurance company to simply take a defensive posture in "sitting back" and picking apart the insured physician’s completed claim.

And, even worse, in view of the fact that there is no longer the use of the treating physician rule in order to "level the playing field," as long as the insurance carrier follows the "yellow brick road" map by having its team of internal medical consultants and "experts" properly address the claimant’s medical documentation, it could be virtually impossible to overturn the group carrier’s decision to deny or terminate a claim.

And now, the final coffin nail. The bottom line here is profit and an unpoliced profit motive. If the Supreme Court rules in favor of pre-emption and therefore holds that there is no right to a state bad faith claim under ERISA, it will continue to allow the "icing on the cake." Therefore, not only does (and will) the insured-physician have an untenable burden in prosecuting and prevailing on these claims, with virtually every tool at the insurance company’s disposal but, in addition, the Courts will in effect be condoning the use of any claims practice to defeat the claim. And, what is the worst case scenario for the insurance carrier? Most likely, holding on to the insured’s money for an additional year or two.

If you have a group LTD policy, if you become disabled, and if you expect to collect benefits under that policy, you need to know your policy and the application of ERISA like the "back of your hand." You will have to anticipate every company strategy that will be employed to defeat your claim. You will have to proceed in the face of a "mine field" of unfavorable court-decisions. And, you will have to "paper the file" with the "sun, moon and stars".

The essence of an arms-length good faith business transaction is to get what you bargain for. The problem with ERISA-governed disability policies is that the insured physician most often does not know or understand the bargain. There is an old maxim that says "you get what you pay for." But, between the group LTD policy language, the internal ERISA claims process, the insured’s burden of proof in a lawsuit, the flurry of insurance company-favorable court decisions, and the trend towards (and possibly permanent) pre-emption of state bad faith, it will be extremely difficult to get anything that is paid for. That little "lamb" can’t wait to sink its "teeth" into your claim. I think this will give you food for thought.

Mark F. Seltzer, Esq., is an attorney practicing in Philadelphia, Pennsylvania, representing physicians and professionals in disability insurance claims.

The system is corrupt and broken and does not have your welfare in mind. We need to change this. I urge you all to help fix what's wrong so others don't have to go through what we went through and what many of your friends, neighbors and co-workers are going through now. Please visit Jo Joshua Godfrey's non-profit organization, United Patients of America, dedicated to uniting patients against insurance abuse. Help take back our health care.

The Health Reform Bill has Passed, RIP Bad Health Insurance Practices--Maybe...

2010-03-22T16:16:00.000-07:00

Rest in peace, this whole for-profit, rotting system of a health insurance industry that stands in the way of our national health and well-being. Middlemen who do nothing, that's the health insurance industry. (Although, they are so good at protecting their ability to make billions by doing nothing that they will keep at it; finding new ways to undermine the new bill--those lobbyists have to earn their keep!)

RIP members of the GOP who cemented their fate by this shameful display of hatred and loathing to those very Americans they were elected to serve. Give up your federally-financed health insurance if our government is such a horrible disease to the health and care of our nation. Give up you federally financed pension as well.

Go ahead, try repealing the health reform bill, try rolling us back to abuses we have suffered as premium-paying customers; parents and children whose policies are rescinded because they got sick, women with breast cancer left to die because their insurer did not want to pay, sick children like Kyler Van Nocker whose insurer, Coventry, won't pay for his cancer treatment, Americans with chronic conditions unable to find any policy, let alone an affordable one, that will pay for their medications.

Try. And see how utterly inconsequential you are to the very fabric of our society. You are the patsies of your corporate overlords as you wait lustfully for your campaign coffers to be filled with money, the only intent of which is to purchase your influence. Shame on all of you who fought against reform. Shame.

The Only Certainty in the Fight for Health Reform

2010-03-15T16:27:00.000-07:00

No matter who you are or where you live.

If you are an insurance executive making your living (and stock options) by denying claims.

If you are the claimant who has just been denied.

Maybe you are one of the people who protested against reform, maybe you protested for it.

Maybe you receive Medicare and don't realize it's a government-run insurance program but you feel very strongly against a government reform of health insurance.

Whoever you are, from the former CEO of CIGNA, H. Edward Hanway to the countless people with and without the ability to get affordable health care--Death will find all of us, one way or another.

And we can either treat it and ourselves with dignity or we can keep allowing ourselves to be lorded over and hounded into our graves by an uncaring, profit-driven system.

And because of that, I ask myself and I ask you all: What side of this moment in history do you want to be on?

The side that helps Death along, helps it find us all sooner and with more suffering because we are without affordable care and treatments? Want to be on the side that denies a 5-year old boy his cancer treatment, like HealthAmerica (part of Coventry) did to Kyler Van Nocker? The side that believes the lies paid for by billionaires like the Koch Brothers?

Coventry Health Care, parent company of HealthAmerica, which is denying Kyler Van Nocker's $110,000 claim for life-saving neuroblastoma treatment, is in extra super-duper financial shape these days.
The Dow Jones Newswires reports today that Coventry's fourth-quarter earnings rose 24%, beating profit expectations, as overall membership rose while medical costs fell.

"Coventry's medical-loss ratio, or the percentage of premium revenue used to pay patient bills, declined [to] 83.2% from 83.8% a year earlier and 84.4% in the prior quarter," notes Dow.
This has helped boost Coventry's profits to $109.1 million, or 74 cents a share, up from $88.2 million, or 60 cents, a year earlier. Revenue increased 15% to $3.43 billion as premium revenue rose 17%.

Or do you want to be on the compassionate side that wants this nation to have a Universal Health Plan like every other industrialized nation in this world? The side that wants to limit pain and the indignation of dying from something that could have been easily prevented and treated?

Death finds every single one of us no matter who we are and that is the one certainty of life. From billionaire to the homeless, it finds us all.

I want to be on the compassionate side. I want it to be said that I fought for the health of my fellow citizens because it was the right, moral, just and compassionate thing to do.

It's with this posting (and admittedly some disgust on my part with what I see going on out there, Beck et al) that I, really and truly, say goodbye. I'm done. Let the over-paid talking head idiots like Rush and Herr Beck chatter away. They have chosen their side and it's the wrong one.

Peace and good health and may reform come to this nation because if we are to retain any of our ability to compete globally, we need it.

And Liz Cheney, shut-up and go home.

Image above found here.

How the Health Insurance Industry Became Greedy

2010-03-10T14:04:00.000-08:00

A really excellent article here about how Blue Cross, which started out as a not-for-profit insurer, became part of the mess that is our health insurance industry today. Written by Jonathan Cohn, a senior editor at The New Republic, there is also some history about the health insurance industry in general:

As Robert Cunningham and Robert Cunningham Jr. recount in their 1997 book, The Blues, those early Blue Cross plans had several defining characteristics. Among them were the twin principles of “guaranteed issue” and “community rating.” The plans would sell insurance to anybody who wanted to buy it. And they would charge the same premium to every person, regardless of the person’s medical condition. The plans did this because they were non-profits, designed not to earn money for shareholders but to insure a steady supply of paying patients for the hospitals. (It was the hospitals, who were struggling to pay their own bills during the Great Depression, that established the plans.)

What enabled the Blue Cross plans to succeed was their effective monopoly on the health insurance business. They had a huge, diverse base of customers--one based heavily on large groups of employees, like the Dallas schoolteachers--which meant they had sound finances. The majority of people were relatively healthy, with few medical bills. Their accumulated premiums were sufficient to cover the bills for that small group of people who, because of accident or disease, had much higher bills.

But as enrollment in the Blue Cross plans swelled, the commercial insurance industry took notice--and saw an opportunity. If Blue Cross was selling to everybody and charging everybody the same rate, that meant some people--healthy people--were effectively paying a bit extra in order to subsidize the sick. The commercial insurers figured that if they could target just the healthier customers, by charging higher premiums or refusing coverage to people with medical problems, they could offer lower premiums to these people and still make a profit.

They were correct. And the effect on Blue Cross was devastating. Over time, Blue Cross plans lost more and more healthy customers, leaving a pool of beneficiaries in relatively worse health. In order to finance their medical bills, Blue Cross had to raise everybody’s premiums. With each increase, more and more healthy people fled for cheaper plans, creating a vicious cycle. Eventually, the Blues faced a choice: Start acting like the commercial insurers, in order to compete, or go out of business. They chose the former.

Soon Blue Cross plans were screening potential customers, charging them higher premiums or no coverage if they came with pre-existing conditions. Eventually, some of the plans converted outright to for-profit entities.

Eleven Ugly Truths About Health and the Health Insurance Industry in Our Country

2010-03-10T09:19:00.000-08:00

There are several incontrovertible truths about health and care in our country:

1. Human beings can and do get sick. Some more sick than others. These are simple facts of life.

2. We are at the mercy of our health insurance company to get our health care paid for; from doctors' visits to medicines to hospital stays, without their prior consent we cannot get our care.

3. If you are employed, both you and your employer pay for your policies. Sometimes you have both a health and a disability policy through your employer.

4. Paying your premiums absolutely does not guarantee that the insurance company will uphold their end of the contract (purposely written in vague language) and pay out a claim.

5. Your health insurance company can dump you at any time. This practice is called rescission.

6. Your health insurance company can raise your premiums at any time, and hikes in premiums have outpaced wages and inflation. If you are self-employed and cannot afford a rate hike on your policy, you lose your coverage. This practice is called purging. You may still make too much money to qualify for government help, in which case you are simply out-of-luck and health care.

7. Profits are the only motivating factor for an insurance company. Money is made by the company when they deny a claim, such as I have documented on this blog, or when they delay in paying a claim.

8. We are the only industrialized nation in the world without a National Plan to ensure the health and well-being of our people, to give us the ability to build enterprises and our own wealth because we are chained to any "job" just so we can get some form of health insurance.

9. The insurance industry is immune to federal anti-trust regulations making things like collusion and price fixing, practices they can and do employ. Sometimes they get caught, most times they do not, thanks to their immunity from these laws. See the McCarran Ferguson Act of 1945 for more information.

10. Over 45,000 Americans die each year due to lack of health insurance. Why does this matter? Because the health insurance industry is the gate-keeper to our medical care. We should be able to go see a doctor or receive treatment without fear of losing our retirement funds or our homes or having to declare bankruptcy, but we cannot because we are all (from consumer to provider) slaves to an industry whose only motivation is to secure profits for their shareholders.

11. Health care costs are out of control, thanks in huge part to the health insurance industry. The blame rests squarely with the insurers as they are not only the gate-keepers to our care, they are also the gate-keepers to reimbursing doctors, hospitals and pharmacies. Deals are struck with all the providers, but only after the insurance profit margins are in place.

Finally, if being in the insurance business is so risky and expensive, as Ms. Angela Braly of WellPoint stated before Congress on February 24 of this year, then why do WellPoint, CIGNA, UnitedHealth Group, Aetna and Humana stay in the business? Why not close up shop and forget it?

Why bother with such a risky and expensive undertaking as collecting billions in premiums? If the profit margins are so low, as they claim, why bother spending the countless millions of dollars in lobbying fees to keep everything the same as it is now? Why do they purchase corporate jets, have vast real estate holdings and give their executives such generous compensation packages if the business is just so hard to keep profitable? Why keep at it?

Because the business model of collecting ever-rising premiums for doing absolutely nothing is an extremely lucrative one and they all make an immorally obscene amount of money from infirmity, from the sick and the dying in this country of ours. That is a very ugly truth.

The image above was found here.

America Goes Uninsured While Congress Fiddles--and Gets Lifetime Health Insurance On Us!

2010-03-08T11:00:00.000-08:00

You've gotta' love a good hypocrite--they're so bold in the face of things that contradict what they say or believe--usually what THEY have said or professed to believe.

And the best example of this is the way our dear public servants, especially the ones against any sort of health insurance reform, get treated when they retire. All on us! And look, they don't have to pay premium increases on their insurance--why? Because we pick up the tab for them.

Uncle Sam will continue federal employee's health benefits, as long as you were enrolled in the program for the last five years, however you must pay the same monthly amount that you paid while working.

And health insurance benefits aren't all. They get a nice pension as well--after a mere 5 years of service! Yes, thanks to us.

My fellow citizens, our public servants get a great deal of a ride into their retirement, which is why they campaign so furiously--it isn't about serving the public, it's about serving themselves so they can chalk up the pension dollars.

What I find really galling about the whole mess, besides the obvious selfishness inherent in their voting behavior, is how the National Taxpayers Union grades these same nay-sayers as being friendly or "good" to us taxpayers. But they don't see the ridiculousness in having us pay for their, sometimes, multi-million dollar pensions and for a lifetime of health insurance benefits--all while denying us access to a single payer system? Also, Steve Forbes is on their Board. When's the last time he saw a payroll deduction on his paystub? Like he gets a paystub?

Call your public servants, tell them "Hey, get off the payroll and give up your pension, the one we pay for, or give us all your great, government subsidized health insurance plan." Here's the link, you can email it to them to remind them of their sweet, and hypocritical, deal. http://www.opm.gov/INSURE/HEALTH/

Entire Congressional retirement package PDF here. From this PDF, I leave you with this. Please note how public outrage made it all go away before.

The Civil Service Retirement Act of 1920 (P.L. 66-215) established a pension system for federal employees in the executive branch of government. Coverage under the Civil Service Retirement System (CSRS) was extended to Congress in January 1942 by P.L. 77-411. That law was repealed just two months later in response to adverse public opinion. In 1946, P.L. 79-601 again extended CSRS coverage to Congress, at the option of Members, with higher contributions and greater benefits than those applicable to regular federal employees. In reference to that legislation, S.Rept. 79-1400 (May 31, 1946) stated that a retirement plan for Congress:
would contribute to independence of thought and action, [be] an inducement for retirement for those of retiring age or with other infirmities, [and] bring into the legislative service a larger number of younger Members with fresh energy and new viewpoints concerning the economic, social, and political problems of the Nation.

A Libertarian and Law Professor's Point of View of Health Care Reform

2010-02-28T19:17:00.000-08:00

In my never-ending search/quest for answers, reasons, explanations and peace of mind as to why we don't have a more reasonable, just, moral, rational and, dare I say it? competitive system of health care in this country, I ran across this article, Private and Public Competition In Health Care. I found it at Forbes.com and it was written by Richard A. Epstein.

Equipped with my trustworthy computer, fiber-optic internet account and dogged determination for knowledge, I Googled Richard A. Epstein and I found out he's a very distinguished professor of law and now he's at the NYU School of Law. (I went to NYU, but not the Law School part)

He's staged his Libertarian argument in this article on the idea that enough competition to the big guys already exists within the health insurance arena. The big guys are WellPoint, Aetna, CIGNA, United and the Blues.

Right now a multitude of small firms coexist with such huge operations as Aetna, Blue Cross/Blue-Shield, Cigna, United HealthCare, and WellPoint. But does this medley of firms suffice? In a recent Wall Street Journal column, Robert Reich, a former Secretary of Labor, suggests that the answer is no.

Professor Epstein insists competition from a public entity, as Mr. Reich suggests, won't work.

He quotes Mrs. Reich's article from the WSJ, where Reich says, "Without government as competition, the private sector has little incentive to improve."

What is Professor Epstein's rebuttal?

The claim is a simple economic blunder. The private sector is not some monolithic entity. If it tried to behave as such, its members would be on the antitrust chopping block for engaging in horizontal price fixing. Instead, these large players compete flat out in all market segments. What, then, will one new player do to the overall level of competition?

Let's start with "its members would be on the antitrust chopping block for engaging in horizontal price fixing." If you know anything about how insurance works, as I am sure Professor Epstein does, you know this: It is immune to federal anti-trust laws due to the McCarran Ferguson Act of 1945:

It is fair to say that the McCarran-Ferguson Act antitrust exemption is very expansive with regard to anything that can be said to fall within "the business of insurance," including premium pricing and market allocations. As a result, "the most egregiously anticompetitive claims, such as naked agreements fixing price or reducing coverage, are virtually always found immune."⁽⁶⁾

What then, is Professor Epstein going on about in his article. Is the professor not aware of the law already in place that keeps the anti-trust regulators away? (highly doubtful) Or, is he writing to an audience of people who only want to hear one thing? Who want some affirmation that profiting from the sick and dying is okay. Those who think they can't get sick and who believe the market knows best. What's that saying about the Forbes.com readership?

If you are educated about health insurance practices you also know that as a consumer you have little substantive recourse if your health insurance company doesn't want to pay your claim or denies your disability or causes suffering or kills you. And that's because of ERISA or the Employee Retirement Income and Security Act of 1974.

In the case of employee health benefits, you are covered by the federal courts because employee health benefits plans fall under ERISA. However, ERISA is written in favor of the plan and not you, the disabled person with say, Progressive Multiple Sclerosis. A good attorney-written blog on all things ERISA here.

Professor Epstein goes on to say this:

Worst of all, no government entity ever operates on a level playing field. A government's dual capacity as regulating and regulated party creates a nonstop risk of bias, either by inadvertence or design. What private firm will sue a government corporation for unfair trade practices if they know that the Justice Department, Congress, the Federal Trade Commission or the Securities and Exchange Commission can investigate them? Who wants to litigate an unfair competition case, no matter how solid, and go head to head with a government firm that always has home court advantage? And who wants to compete economically against a firm whose thousand disguised government subsidies allow it to undercut competition?

As it is now, there is no level playing field the way private insurance works. As a premium paying consumer, you cannot go to the Federal Trade Commission for help. Period. So that point is well, pointless. McCarrran Ferguson again is why you cannot seek reprieve from the FTC.

As far as litigation, I urge Professor Epstein to click on the link above in the upper left hand corner of this blog and tell me what's fair when it comes to ERISA litigation when 21 Federal Judges go booze it up at the Helmsley Park Lane Hotel with insurance companies, big pharma and benefits plans general counsels to discuss defending against ERISA claims. I urge the professor to explain the fairness of ERISA, in general, to claimants.

And Professor Epstein asks "who does want to compete against a firm whose thousand disguised government subsidies allow it to undercut competition?"

I'll tell you who, the people of this country, people like my family who are sick to death of the parasitic practices of the private health insurance monopoly we are chained to for life and blood. Literally.

Health care cannot be about the market and competition because of the importance of life, of trying to meet death with dignity and compassion and all the subtleties in between; of the mother of two small children who is dying of breast cancer yet denied her pain medications, of a 5-year old boy trying to see yet another day of his new world yet denied the one treatment that may allow him to see his 6th year, of the woman with lung cancer who had it hidden from her--and why? Profits, the market, the bottom line.

I'll leave you with Professor Epstein's parting words in the article. Don't know what to make of it. I say we are already at disastrous.

The critics who treat the public health care plan as a Trojan horse for a single-payer health care plan have a real point. All libertarians know that private monopolies are problematic--and that state-run monopolies always prove disastrous.

Oh! The Money CIGNA (and other insurance companies) Spend on Lobbying.

2010-02-25T14:41:00.000-08:00

The link to this chart is here. This is taken directly from The Center for Public Integrity. If you are curious as to who is lobbying against you, as a premium-paying, insurance-carrying American, go here and type in your insurance carrier. They spend lots o' cash on desperately trying to keep the status quo alive--which means profits over health and care, America.

Information about the Nickles Group here. Information on Heather Podesta & Partners here. CIGNA's lobbyists' information here. This last link is a good one, from Littlesis.org, since you get to see the filing papers and the amount spent on lobbying. What a system. What a waste. What a mess.

Company or Organization	Lobbying Representative	Expense	Quarter	Sector	Details
CIGNA	The Nickles Group, LLC	$60,750	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$450,000	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$450,000	2009 1st Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$260,000	2009 2nd Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 2nd Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 2nd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 2nd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 3rd Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 3rd Quarter	Insurance	View
CIGNA	BLANK ROME GOVERNMENT RELATIONS LLC	$50,000	2009 3rd Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 3rd Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$260,000	2009 3rd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 4th Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$850,000	2009 4th Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$640,000	2009 4th Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 4th Quarter	Insurance	View
CIGNA	Blank Rome Government Relations, LLC	$50,000	2009 4th Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 4th Quarter	Insurance	View

Health Dialog, Foundation for Informed Medical Decision Making, CIGNA's Revolving Door and Why Your Health Care is Now One Word, Part I

2010-02-25T11:11:00.000-08:00

(Originally posted October 26, 2009)

Once, sometime in the not-too-distant past, health care was spelled with two words. Then along came some shiny suited corporate marketer, fresh from B-School, full of some ideals, who blended those two words into one, and thereby cemented the hold on health and care in our nation into the hands of The Corporation.

Trademarked and proprietary, thank you very much.

Health care used to be about you and your doctor trying to keep you healthy with your regular check-ups or trying to figure out how to heal what was wrong with you. Remember that quaint notion? Remember when pharmaceuticals weren't allowed to advertise on TV? Oh, the day. Now, I'm all for dissemination of information, but seriously, we've become one hell of a pandered-to nation. The Ambien ad makes me laugh every single time I see it. "Sleepwalking, and eating or driving while not fully awake, with memory loss for the event, as well as abnormal behaviors such as being more outgoing or aggressive than normal, confusion, agitation, and hallucinations may occur."

Our health care has been so grossly intruded upon by so many people trying to get their fair-share, piece of the American health care pie, that we are left with a mockery of what health care is supposed to be about. Your doctor is just one small step up from you on this ladder--and you and I, the sick person, the consumer, we're on the bottom rung.

It's such a wasteful system that it spawns all sort of ways for companies to figure out how to make money from all that waste--a way to grab a piece of that pie. How big a piece? Let's look at one company making a play for the pie, Health Dialog.

Here's an excerpt of an interview at HealthCareEuropa.com with Chris Coloian (formerly of CIGNA) now of Health Dialog. And CIGNA is now a Health Dialog customer! Works out nicely, doesn't it? Full interview here.

We talk to Chris Coloian, Senior Vice President Health Services at Health Dialog, a US population health and health improvement company owned by UK healthcare insurer BUPA. Chris is the former vice president of health advocacy at CIGNA Healthcare, where he provided strategic, product, and marketing direction for the company’s portfolio of care management and health coaching programs.

HCE: How do you see the European market for chronic disease management programmes growing over the next few years?

CC: Very fast, maybe doubling in the next few years. I see no reason why in 2-3 years it shouldn’t be 20-25% of the US market, which today is around $2.5bn and growing at 10-15% a year.

HCE: Why this very fast growth?

CC: I think European policymakers, like our own president, really 'get it'.

HCE: Hmm, I hear mixed reports. In the USA, where people stay with insurers for 4-5 years, I’ve heard that chronic disease management programmes make sense, as they effectively reduce the acute care that an individual will need over that limited time period.
But people in Europe tell me that it is different for healthcare payors like UK primary care trusts, who will be paying out until the person dies. In those circumstances, do these programmes really deliver savings?

CC: To understand the full impact on society, one has to look past medical costs and consider productivity and contributions, such as increased tax revenue. You may extend someone’s life by, say, 2-5 years, but you will also have a much more healthy individual, who will be able to contribute more.
The studies I have seen show that this productivity bonus far outweighs any extra costs. And the cost of the extra few years is not very great anyhow, as most of the costs for any individual are incurred in the last six months of life. I think European policymakers and politicians understand this.

Where to begin. Let's start with the fact that Chris is talking about growth in the European market--growth off which his company can feed in the chronic disease management arena because European policymakers "get it." What do they get? That integrated care is the future. I did not know our President "got that" because we can't even get a Public Option let alone a National Plan. So, who's going to pay for this integrated care of the future? You and I will via our premiums--so that we can help our insurance companies cut costs. Make sense? Think bottom rung.

From the International Journal of Integrated Care.

One big difference exists between the USA and Europe. There, disease related integrated care is provided by independent, mostly commercial disease management programs. They do their work instead of regular primary health care and regular hospitals. In Philedelphia, this approach was at the centre of the congress. Not all speakers agreed with this outcarved, independent approach. Medicare's health care innovator, Linda Mango, preferred to embed DMPs within the regular structures, because persons with one chronic condition (still?) do need all types of services. In contrast, Wallstreet broker Brooks O'Neil has lost all trust in carers as usual, in regular primary care and hospitals, and wants to invest as much as he can in commercial DMPs. He sees DMPs as a tool for a revolution to replace ordinary fragmented working doctors and hospitals.

Yes, yet another way to grab a piece of the Health Care Pie--commercial Disease Management Programs like what Health Dialog peddles, you know, Health Coaching and the like. Go to their website, it's a prime example of some really awful corporate writing.

Our predictive models deliver individual-level information that predicts (don't predictive models already predict?) financial risk and provides insights into the impactibility or readiness of each individual to become engaged in the healthcare process. By incorporating this concept of impactibility we identify those who can most benefit from Health Coaching or other care management programs within a specific time frame, and then match intervention to need.

Psst, Health Dialog, impactibility isn't a word.

And the interviewer asks why the European market should grow like the U.S because here, we use the predominant employer-based insurance system and on average, we change jobs every 4-5 years, thus change insurance. So the programs here reduce acute care costs over that limited time period--but for who? Insurance companies and our employers who have to pay into our insurance.

While I am all for reducing the need for acute care, what is the price for reducing this need? Because as you know, we don't have a great track record here in the U.S for taking care of our sick people--even the ones with insurance. 30% of all claims were denied in the state of California just within the first 6 months of 2009. 30%! That reduces acute care all right.

And don't you just love being thought of as a contributor to "tax revenue?" Thanks, Chris. Really puts the human in your humane thought.

And the only reason I stumbled upon Health Dialog and companies of their ilk was due to my research and personal interest into Ms. Abigail Johnson of Fidelity Investments. I was trying to figure out where she stood on health and care in our country. What I found besides Ms. Johnson's campaign contributions, was her husband, Mr. Chris McKown. He's one of the founders of Health Dialog. From the Health Dialog website:

Health Dialog is a leading provider of care management and analytic services and is a wholly-owned subsidiary of Bupa, a global provider of healthcare services.
Health Dialog Services Corporation (Health Dialog) was founded by George Bennett and Chris McKown in 1997. The company was built in collaboration with the not-for-profit Foundation for Informed Medical Decision Making (FIMDM) to directly address unwarranted variation in healthcare. The firm provides sophisticated analytics that drive actionable and measurable solutions for your population, including care management programs and provider measurement services.

"To directly address unwarranted variation in healthcare" (one word). What's all that mean? Part 2 tomorrow.

How we Bear the Burden of Paying Their Taxes and the Health Insurance Industry Still Denies Our Claims

2010-02-22T10:43:00.000-08:00

When all this uproar over reforming our health care insurance began, I (among others) blogged about how the health insurance industry and its lobbying arm, AHIP, were doing and saying anything to obfuscate in the minds of the American people the real intention of health care reform: giving private insurance some competition.

Most people who come to this blog don't know that the insurance industry is immune to federal anti-trust laws because of something called the McCarran Ferguson Act of 1945. Most people can't conceive that the company they pay premiums to, for health care or for disability, would do anything to not have to pay a claim. Like Coventry denying a 5-year old boy, Kyler Van Nocker, his cancer treatment. Or CIGNA denying a 6-year old girl hearing implants or denying that Jo Joshua Godfrey had cancer let alone treating her for it.

And why deny life-saving treatments or deny a child the ability to hear? Well, because of profits, that's why. Profits have to be made and paying for treatments takes away from profits. And how are we bearing the burden of their taxes?

With the industry's practices involving their executives' pay. Let's look at an excerpt from a story from Reuters below taken from 2008, link embedded. United's CEO is now Stephen Hemsley. Interesting story here about a class action lawsuit (now settled) for back dating of stock options--former CEO McGuire was charged with fraud.

The biggest loss comes from a "stock option accounting double standard" that allows corporations paying executives stock options to deduct more than their actual expenses, they said. For example, when UnitedHealth Group Inc paid CEO William McGuire 9 million stock options, it put on its financial statement that the compensation cost the company nothing, according to the Institute for Policy Studies and the group United for a Fair Economy. But it claimed a tax deduction of $317.7 million, the groups said.

United claimed a $317.7 million tax deduction. Wow.

Here is another study done by Global Subsidies Initiative. Link to full report here. Who Global Subsidies Initiative is, here.

US taxpayers provide 20 billion dollars in subsidies for executive salaries according to report

Taxpayers in the United States are subsidizing the salaries of country's top business executives to the tune of US$ 20 billion a year, according to a report by the Washington-based Institute for Policy Studies (IPS).

The report "Executive Excess 2008: How Average Taxpayers Subsidize Runaway Pay," presents the result of IPS' 15th Annual CEO Compensation Survey, which highlights five major tax and accounting loopholes it argued were directing taxpayer dollars to fund excessive executive pay.

The largest of these tax loopholes, the so-called stock option accounting double standard, cost taxpayers US$ 10 billion last year, according to IPS. The tax rule allows companies to account for stock option expenses on their financial sheets when they grant the options, but then claim the tax deduction when the CEO actually cashes out the options, often years later when their worth has usually increased. The result is tax deductions that are much higher than the original expenses.

Another major loophole is the unlimited tax deductibility of executive pay, which allows companies to deduct executive pay from their income taxes as a business expense so long as the pay is ‘reasonable'. The IRS has failed to define reasonable, and a 1993 attempt by then President Clinton to cap these deductions at US$ 1 million failed.

Senators Levin and McCain introduced a bill to amend the Internal Revenue code to stop all this,
S.1491 - Ending Excessive Corporate Deductions for Stock Options Act.

And what has happened to that bill? Business as usual. It sits. And you and I, who do pay our taxes and our insurance premiums, what do we have to show for it?

We are chained to an industry that preys upon the sick and dying for profitability, an industry that denies a man with Progressive Multiple Sclerosis his disability benefits, an industry who regularly kicks sick people off their policies, who looks at acne and rape as a pre-existing conditions for which to deny life-saving treatments and an industry that doesn't pay its fair share of taxes. They burden us, America.

We need a single payer system. There is still time to be heard, I urge you all to please call your members of Congress and explain to them that the health insurance industry has served up too many abuses, rate hikes and denials to really be in the "Health Care" business.

Here's the Reality We Live In, Now Let's Change It--You Do That by Voting

2010-02-19T09:15:00.000-08:00

This blog started for a reason. I became so incensed over the injustices served up by our long term disability insurance carrier, CIGNA, that I decided I had to call out this behavior and make others aware. And it's not just us, we are no isolated incident--far from it. I've highlighted a few of them on this blog. Read below, link embedded, to see how far the insurance industry will go to not have to pay a claim, any claim, from health services to disability, emphasis is mine:

After MetLife rejected Glenn’s claim, asserting that she was still physically capable of performing full-time sedentary work, Glenn brought suit against the insurance company under ERISA, which authorizes federal courts to review the decisions of benefit plan administrators. Glenn lost her case in district court but prevailed before the Sixth Circuit. In concluding that MetLife had abused its discretion in denying Glenn’s claim, the court of appeals relied on what it regarded as several key factors. For example, although Glenn had qualified for permanent Social Security disability benefits, MetLife ignored the findings of the Social Security Administration in deciding to deny her claim. The company also disregarded certain medical reports that supported Glenn’s claim, withheld some of those reports from the expert hired to review Glenn’s medical files, and failed to address evidence that job-related stress of any kind exacerbated Glenn’s illness. These factors, plus the existence of MetLife’s conflict of interest, convinced the Sixth Circuit that the claim denial was unreasonable and should be reversed.

We the People, can do something about this. It's called civic action. You are responsible for who represents you, well, you were until the Supreme Court Decision that just got handed down, but we still have a voice. It may not be a well-funded corporate voice, but we can still bug the hell out of our Congresswomen/men by calling, writing and letting them know health care reform must take place in this nation.

We can fund unnecessary wars but we cannot reinvest in our national health and well-being? I think we can and you must tell your representatives that.

Welcome to the Blog, Coventry Health Care, Denier of Kyler Van Nocker's Cancer Treatment

2010-02-17T09:21:00.000-08:00

Instead of wasting time (and money) on perusing my blog, wait, on second thought it's probably good you are here because maybe you will now begin to understand that human life and profiteering don't mix. Welcome, take a look around, and learn!

Coventry is the parent company for HealthAmerica who denied 5-year old Kyler Van Nocker his cancer treatment because it was considered "experimental," rather it was too expensive and they did not want to pay.

Coventry Health Care (208.66.124.31)

Cranberry Twp, Pennsylvania, United States

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WellPoint Cancels Investors' Day and Californians are Still Facing 39% Rate Hikes

2010-02-16T10:18:00.000-08:00

With 2.7 million Americans now uninsured in the last year alone, and WellPoint poised to hike rates by almost 40%, you think our public servants may come to our rescue and you know, introduce a single payer system for those of us who want it? You want to keep paying these profit mongers, have at it, but I'd like my premiums to actually help pay for my, and my risk pool's, care rather than paying for corporate jets, millions in executive pay and denial of care so Wall Street is happy.

Shares of WellPoint fell to $57.67 and I say, good. Trading in the shares of a company that deals in the health, life and death of human beings sickens me. How many individuals and institutions make money from denying claims to sick Americans--like HealthAmerica (part of Coventry) denying 5-year old Kyler Van Nocker his cancer treatment? The health insurance industry is a dinosaur, set for extinction because their time on this earth has come to an end.

This is taken directly from the Wall Street Journal.

By Russ Britt

A congressional hearing into WellPoint Inc.'s (WLP) proposed rate increases in California has prompted the health insurer to cancel its investor day, taking a bite not only out of its shares but those of other carriers as well.

Shares of WellPoint traded off nearly 3% to $57.67 in recent action, on the heels of the insurer's disclosure that its investor day, scheduled for Feb. 23, would be cancelled.

The news seemed to put a chill on all insurers, with virtually all of them in the red by a percentage point or more despite the broader equity market's gains.

The company said in a press release that the House Energy and Commerce subcommittee on oversight and investigations has requested information on premiums it planned to charge in California. WellPoint's Anthem Blue Cross of California plans to raise premiums on individual health plans by up to 39%.

The panel also is asking that a senior WellPoint officer appear before the subcommittee at the Feb. 24 hearing.

"The investor-day program was canceled in order to allow the company to prepare appropriately for the hearing," WellPoint's press release said. "The company is confident that its rates were established consistent with actuarial principles and state law, and welcomes the opportunity to discuss the underlying rise in health costs and actuarial dynamics."

Anthem was supposed to impose the rate increase by March 1 but, amid continuing controversy over the raise, it has decided to postpone it until May 1.

WellPoint said management would review its 2010 financial outlook during a conference call on March 17. The company said it still expects net income for the year to hit at least $6 a share.

Analysts polled by FactSet Research are forecasting the company will post earnings of $6.10 a share, while a ThomsonOne estimate calls for WellPoint to earn $6.12.

Among major insurers, UnitedHealth Group Inc. (UNH) was off 1.7%, Aetna Inc. (AET) lost 1.4%, Cigna Inc. (CI) dropped 1.3% and Humana Inc. (HUM) was down 1%.

-By Russ Britt; 415-439-6400; AskNewswires@dowjones.com

Hypocrisy and How Dana Rohrabacher Said the Taliban Were Not Terrorists

2010-02-15T10:44:00.000-08:00

I always knew my congressional representative, Dana Rohrabacher (R), was firmly on the side of anti-health insurance reform. Looking at his voting record is depressing. He has voted against, that is a big, fat NO to:

-Restructuring Medicare payments and the Pay-As-You-Go Budget Rule
-Health Care Reform including getting rid of pre-existing conditions
-Food Safety Regulations
-FDA Oversight of Tobacco Products
-Economic Package aka Stimulus
-Farm Bill
-Mental Health Coverage Bill
-Children's Health Insurance Program Reauthorization Act
-Four weeks of paid parental leave for federal employees
-Medicare Prescription Drug Price Negotiation Act

But he Voted YES on decreasing gun waiting period from 3 days to 1! Why?

Let's see, he votes for abstinence only programs, but doesn't vote to help pregnant mothers in need. If you are anti-abortion (Dana is) then help out the women who do wind up getting pregnant, Dana. Or better yet, teach them to use birth control and the whole abortion issue wouldn't be an issue.

But it was this that truly made me realize that Dana is so waay out of touch with his constituents and the problems we face. Dana liked to fancy himself CIA-guy or a character out of a Ross Thomas novel as he was flitting around the mid-east as late as April of 2001. Read here what Dana had to say about the Taliban, link is embedded within text:

The potential rise to power of the Taliban does not alarm Rohrabacher, because the Taliban could provide stability in an area where chaos was creating a real threat to the U.S. Rohrabacher says that under the previous situation Afghanistan was becoming a major source of drugs and a haven for terrorists “an anarchistic state of narco-terrorism.” In contrast, the Taliban leaders have already shown that they intend to establish a disciplined, moral society.

Rohrabacher calls the sensational media reporting of the “harsh” imposition of strict Islamic behavior, with the underlying implication that this somehow threatens the West, “nonsense.” He says the Taliban are devout traditionalists, not terrorists or revolutionaries, and, in contrast to the Iranians, they do not seem intent on exporting their beliefs. Rohrabacher would have preferred to see a negotiated compromise among the various factions (but with no role for Gulbuddin Hekmatyar) rather than a bloody confrontation. But in the absence of such a compromise, he believes a Taliban takeover would be a positive development.

Calls the sensational media reporting of strict Islamic behavior as a threat to the West "Nonsense?" The Taliban are "devout traditionalists, not terrorists?" You changed your tune quickly after 9/11, didn't you? Even went as far as blaming Clinton for 9/11. But here's a reminder from August 6, 2001 when Bush was in office.

See that's called hypocrisy, Dana. And you and whole slew of your fellow public servants seem to operate solely on hypocrisy. You profess one thing but really hold another view. And when the landscape quickly changes, proving your views to be unworthy, you quickly change your words to go along with the current trend. What do you really believe?

And where was Dana in April of 2001? In Qatar. Doing what you may ask? He met with "Taliban Foreign Minister Mullah Wakil Ahmed Muttawakil, an advisor to Mullah Omar. Diplomatic sources claim Muttawakil sought the congressman’s assistance in increasing U.S. aid—already more than $100 million annually—to Afghanistan and indicated that the Taliban would not hand over bin Laden, wanted by the Clinton administration for the fatal bombings of two American embassies in Africa and the USS Cole."

Time to go, Dana. Retire. The 80's are so over, Dana. Hell, the 90's are gone too. Get out of public service because you are doing absolutely nothing to serve the public, your constituents. We have real issues to deal with involving affordable health care and jobs and we don't need you wasting tax payer money on things that don't matter. You voted yes to fund a baseless war yet you won't vote to re-invest in our nation by funding health care and jobs creation?

Stay home, help your wife take care of the triplets and leave law making up to people who don't fancy themselves, CIA-guy.

HealthAmerica, the Company Denying 5-Year Old, Kyler Van Nocker His Cancer Treatment

2010-02-12T12:31:00.000-08:00

HealthAmerica is part of Coventry Health Care. From HealthAmerica's website:

Whether you are an employer, broker, provider, or health plan member, we’re constantly improving the quality of care and service you receive.

If by improving you mean working only to satisfy your investors, then denying a life-saving cancer treatment to a 5-year old boy Kyler Van Nocker, seems the profitable thing to do. Coventry and HealthAmerica are businesses, after all, right? They have to be profitable, yes?

But if they were actually involved in the process of health and care, then concern over achieving greater and greater profits would not be an issue. After all, health care is about saving lives and not about making a quick buck because that would be immoral. Profiting at the hands of very sick and dying people, well, that's really reprehensible, isn't it?

A government sponsored system, like Medicare, opened up to all United States Citizens, would free-up small businesses from having to insure their workers, would put money back into the system by increasing the risk pool with a larger, premium paying base, would allow us the choice of getting out of companies like HealthAmerica who refuse treatments based on the fact that it's expensive (never mind about saving 5-year old Kyler's life) and would save lives.

And no, saving lives is not socialism.

Keep at it members of the GOP, you are all revealing yourselves as heartless profit-mongers, interested in keeping the American people under the thumb of the Health Insurance Industry, securing your campaign coffers with huge health insurance and big pharma donations and not much else--certainly nothing to do with your constituents, the American people. John Boehner, have you ever had an original thought that did not involve yourself? Why are you in politics? Eric Cantor, same for you, what motivates a person to fight against equal health care for all in this, the supposedly richest nation in the world? You can throw money and lives at needless wars, but not put it back by investing in the health and well-being of our nation?

Here's Coventry's stock quote for today for all you investors out there:

Feb. 12, 2010 12:38 p.m. ET

Minimum 20 Minutes Delayed

CVH	$22.22
Change:	0.38 (1.68%)
Volume:	549,633

Previous Close	$22.60
Today's Open	$22.30
Intraday High	$22.38
Intraday Low	$21.87
52 Week High	$27.27
52 Week High Date	01/20/10
52 Week Low	$7.97
52 Week Low Date	03/06/09
Rolling EPS	2.14
PE Ratio	10.3832
Shares Outstanding	147,983,000
Market Capitalization	$3,288,182,260

I Say We All Stop Paying Our Premiums and Let the Industry Die a Slow Death

2010-02-11T13:28:00.000-08:00

Anthem Blue Cross to hike California health premiums as much as 39 percent

Associated Press

Posted: 02/05/2010 08:37:08 AM PST

Updated: 02/05/2010 08:37:09 AM PST

LOS ANGELES — Anthem Blue Cross has told some customers it will raise their health insurance premiums as much as 39 percent beginning March 1.

The increases, reported today by the Los Angeles Times, involve as many as 800,000 customers who buy individual coverage. People with group coverage aren't affected.
In a statement, the Woodland Hills-based insurer declined to specify the size of the rate changes or how many people will be affected. The company — which is the largest for-profit health insurer in California — blames the increases on rising health care costs. It says its prices may be adjusted more frequently than its typical annual increases.
Anthem's rates are under review by the state insurance department.

Go to Anthem's web site here. They have a lot of web copy about "affordability." I don't think they know the meaning of the word. I'd like to go back to when my health care was between me and my doctor. If we all stop paying...

What Part of This Financial Crisis Does the GOP Not Understand?

2010-02-10T08:18:00.000-08:00

I'm going to say "all of it," in light of this genius idea by Republican Senator Kit Bond. You know, as an aside here, I'm giving up trying to be totally civil in this blog so here goes: When are all these old, stupid, white guys, who are so out of touch with reality, going to stop dicking around in the Senate and actually do something for the American people? They're not, they're too out-of-touch.

What genius idea am I talking about? Why Senator Bond's idea to privatize Medicare. Kiss your health insurance safety net goodbye, senior citizens! As for the seniors who were on my block a few months ago with signs that read "Government Run Health Care Makes Me Sick?" Great, my protesting friends already on Medicare, you may get your wish.

You see, the problem with Genius Bond's idea here is that privatizing Medicare means handing it over to the people who don't really want to pay for your care: The Insurance Industry. He wants to hand you over to a voucher system. From St. Louis Today:

Even before he asked, Missouri's senior U.S. senator was outlining his: Privatize Medicare and limit benefits for upper-income retirees.

Meeting with Post-Dispatch editors and reporters on Friday, U.S. Sen. Christopher "Kit'' Bond suggested radical changes to the federal health insurance program that covers 45 million elderly and disabled Americans...On Friday, Mr. Bond called for giving Medicare enrollees a voucher to buy health insurance on their own.

"You're going to have to means-test the benefits," he said, adding that upper income retirees wouldn't "get much of a voucher."

U.S. Rep. Paul Ryan, R-Wis., the ranking Republican on the House Budget Committee, recently released an "alternative budget" that calls for privatizing both Medicare and Social Security.

Ah yes, privatizing Social Security. Let's see, does anyone remember what just happened on Wall Street? Banks too big to fail? You saw your 401-k evaporate overnight, what do you think would have happened to your Social Security benefits if George W. Bush had gotten his way and privatized Social Security. That's your money, Mr. and Mrs. Citizen--if you've been paying into Social Security all your working life, those are your dollars, and poof! they'd be gone now if George and his band of middle class wreckers had gotten their way.

The idea that corporations can somehow do things better than the government is an idea that has just been totally disproven during this financial meltdown.

To mistrust our own government, the same government that runs our military to protect our borders, the same government that we freely elect our officials to, is simply an absurd notion, it makes no sense and quite frankly, it's unpatriotic. But to hand over our health care and retirement to the very industries that don't want to pay claims (see Kyler Van Nocker) and that took the world to the brink of a financial meltdown, that is pure, unadulterated idiocy.

Insurer, HealthAmerica, Denying 5-Year Old Boy Cancer Treatment

2010-02-09T16:26:00.000-08:00

The entire article below this photo is taken directly from Think Progress.org. All of you out there protesting against health care reform--you really want to go there, really? Saving lives is a "slippery slide into socialism" is that still true, Ms. Ding?

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims for medical treatments, which are often necessary for saving patients’ lives.

Kyle Van Nocker’s story shows that even 5-year-old kids are not exempt from this insurance company abuse. Van Nocker has neuroblastoma, which is a very rare form of childhood cancer that targets the nervous system and creates tumors throughout the body.

Due to successful treatment in 2007, Van Nocker’s cancer went into remission, giving him 12 months of pain-free life. Unfortunately, in Sept. 2008, the cancer returned, and Van Nocker was once again in need of treatment. Unfortunately, his health insurer, HealthAmerica, refused to pay for one form of treatment doctors believe could save his life (MIBG treatment) because they consider it “investigational/experimental” since it has yet to be approved by the FDA.

Yet in April 2008, the insurer approved cheaper treatment for Van Nocker that was also “experimental,” prompting Philadelphia Daily News columnist Ronnie Polaneczky to ask, “So why, pray tell, is HealthAmerica playing the ‘experimental therapy’ card in the case of the MIBG treatment Kyler now needs? Gee, money couldn’t have anything to do with the decision, could it?”
Van Nocker’s parents are suing HealthAmerica, citing the fact that the company has apparently been dishonest about its criteria for the types of treatment it will cover and is denying payment for treatment in this case because of the high cost of the procedure — $110,000 pays for only two rounds of MIBG treatment. “These companies have to be brought to the courthouse to get them to do the right thing,” says the VanNockers’s family attorney. “This child needs this treatment, or else.”

The sad truth is that Van Nocker is certainly not alone in having his claim denied by a major health insurer. The California Nurses Association (CNA), a nurses’ union and health care advocacy group, recently released a comprehensive study of claims denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted.

The United States is the only industrialized nation without cradle-to-the-grave, universal health care. In no other developed country would a child with cancer have to go without care because an insurance company decided it was not profitable enough to cover him.

A Guide to Awareness for Friends and Family of Those With Multiple Sclerosis

2010-02-02T09:27:00.000-08:00

Full size of this great image found here.

Even though I originally posted this with the holidays in mind, the guide below is useful year round.

With the holidays fast approaching, I thought now might be a good time to post some facts and thoughts about Multiple Sclerosis awareness--before the parties and get-togethers begin and social tensions hit their impending highs. You know they will, it's the holidays.

Friends and family can help their loved ones just by being equipped with some knowledge about MS. Uncomfortable situations can be avoided if you have an understanding of what MS can do and how someone who has been diagnosed may feel.

1. Let's start with this fact: Multiple Sclerosis is different for every individual afflicted with the disease. My husband's case of MS is particularly aggressive as he has Progressive MS. Not everyone is affected the same as Paul. Be aware that if you know someone with MS who shows no signs of affliction, there may be another person with the disease who is using a cane, has been blinded or is in a wheelchair. The course of the disease varies greatly with each person.

2. Educate yourself. Take 30 minutes or so and read about Multiple Sclerosis. What is it? It's an autoimmune disease that attacks a person's brain and spinal cord by destroying the myelin. What's that? Myelin is the protective coating we all have around our nerve cells. And autoimmune diseases are diseases that occur when a person's immune system attacks and destroys their healthy body tissue--like myelin. Why does a person's immune system attack their own body? No one is quite sure why this happens. What does it do? Any number of things and I have many links for you on this site where you can read more. The MS Society is a good place to start. Read about the symptoms (extreme fatigue, numbness, tingling, loss of balance, tremors, spasms, spasticity, headaches, double vision, vertigo) of the disease. This will go a long way in helping you understand what a person with MS may be feeling, which can be lousy, so be aware.

3. Sensitivity to someone with MS, or any chronic disease, is a very important step in helping shape the way you communicate with that person. Think of it this way, you wouldn't ask someone with a full cast on their leg to go for a jog, would you? It's the same thing with MS, there may be no cast but body parts are still broken but in a different way. So before you ask a potentially uncomfortable question like, "Well you look fine, Fred, why don't you get out and bike again?" find out from your friend or family member what they are capable of doing. It never hurts to ask and it shows you are concerned.

4. Health care tips are best kept to yourself. As well-meaning as advice on health may be, it is not a brilliant idea, at all, to give this advice to someone who has Multiple Sclerosis. "Taking vitamins and eating well has helped my friend with MS," may be true for your friend and it is certainly true for everyone, but when you are faced with uncertainty about what your body is going to allow you to do today, tomorrow or next year, these bits of information are best kept to yourself. And again, it's because this disease is different for everyone. Had you told me after Paul's first exacerbation that he'd be getting much worse and have to go through chemotherapy 4 years later, I would have broken down on the spot.

5. Put yourself in their shoes. Think of your favorite activity--and I don't mean having a pint at the pub--your favorite physical activity. For those of you with filthy minds, fine, MS can affect sex as well so go ahead and think it. Paul's favorite thing in the world was skiing. He was an excellent skier; a natural. He can never ski again. Why? Because the myelin has been eaten away, the nerve damage is done and he can no longer feel anything from just above both his knees downward. If he does feel something it varies from horrible pain, numbness, tingling and what he describes as "Like I have two dead weights strapped to me that I move around with my thighs."

6. Disease modifying drugs are no walk in the park. People with Multiple Sclerosis are usually on one of 5 disease modifying drugs, plus whatever other medications are needed to help them with pain, fatigue or depression. I won't highlight Tysabri here because it hasn't been proven to be safe yet and may never be--both of Paul's doctors did not recommend it. The drugs (chart below) are injected on a daily, weekly or somewhere in between basis. These drugs have their own special side effects as well. I can speak from our experience with Rebif that Paul was made to feel horribly sick for one to two days after he injected himself and since he had to inject himself every three days, this was pretty much ALL the time. He has since been prescribed Copaxone and is doing much better in handling that drug.

Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Novantrone (mitoxantrone)
Rebif (interferon beta-1a)

* Flu-like symptoms ( fatigue, chills, fever, muscle aches and sweating during initial weeks of treatment. Therefore it's recommended that the injection be taken at bedtime. Taking Tylenol or Advil or Motrin before each injection and during the 24 hours after the injection may help relieve the symptoms
* Reactions at the site of injection (swelling, redness, discoloration and pain). Contact your health care provider if the injection site becomes hardened. Do not inject into that site.
* Interferon drugs can cause ongoing sadness, anxiety, irritability, guilt, poor concentration, confusion and difficulties sleeping or eating. These symptoms should be reported to a health care professional immediately.

7. Give to your favorite MS foundation. Okay, you got me, that's not advice on how to talk to your friend, brother or sister who has MS. It's a request to help us fight this disease. Our favorite foundation is the Myelin Repair Foundation. Send a donation in the name of your friend or loved one--they (and we) will appreciate your kindness, generosity and help.

Why Multiple Sclerosis Patients Can't be Denied Coverage--Ever

2010-02-01T17:00:00.000-08:00

Image above found here.

I write about our particular situation with MS and work and insurance because that's my experience--it's what I know. CIGNA's denial and reprehensible tactics were my call to action to bring attention to what is not just an isolated incidence of insurance abuse. Let's face it, they are hurting some very ill people.

In all my postings about the politics behind health insurance, lack of corporate responsibility, how some of our public servants have thrown their own constituents under a bus, I sometimes lose sight of the fact there's a disease Paul has to live with every day; the daily injections of Copaxone, a medication to try and control the neuropathic pain and another to fight the constant fatigue and the constant underlying fear he may slip back to where he was a year ago.

I found a story today about a young couple struggling with a new diagnosis of Multiple Sclerosis and want to share it with you because access to good and affordable care should be everyone's right in this country, not just the lucky ones or those with enough money--everyone. And it's important to keep in mind that Multiple Sclerosis treats everyone differently. A lesson the insurance companies need to learn.

The man in this story, Chad Green, is in a wheelchair. But he is strong. He is resolved to get up and walk again; get back to work and live his life to its fullest. No mention of Mr. Green's insurance is made other than to say the family does have medical insurance. I'm not sure why his infusion treatments, as you will see below, are not being covered either partially or in-full. Donation information is given at the bottom.

Link to the full article is here. It is taken from Greene County Daily World written by Anna Rochelle.

I read it with a very heavy heart and all I could think of was my husband's same reaction a few days before we knew what he had, "Why am I limping all of a sudden, this is embarrassing." And Chad Green is only 25 years old.

WORTHINGTON -- Officer Chad Green was on patrol on a Monday evening last February when he was dispatched to the scene of an accident on the highway south of Worthington near the "Flasher Light" junction.

A pickup truck had rolled over twice and landed upside down in the southbound lane of the highway.

The driver was injured and an ambulance crew took him to the hospital.

The truck was carrying a load of rabbit feed, and rabbits.

Green remembered, "There were rabbits scattered all over!"

Green helped with picking up the rabbit feed and as things wrapped up, headed back to his patrol car. "I was walking across the highway going back to the car, when my feet started dragging," said Green.

Remembering that night, he said he would pick his feet up like normal, but his legs wouldn't lift high enough and his toes were dragging the pavement with each step. He didn't know why.

"It was embarrassing," said Green. "I didn't know what was going on."

That was the last night of patrol duty for Officer Green.

"When I woke up the next morning, I tried to get up. But I couldn't walk," said Green.

He has since been diagnosed with Relapsing Multiple Sclerosis (MS), a chronic, often disabling disease that attacks the central nervous system. Symptoms of MS may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.

In Green's case, it hit him fast and it hit him hard. He's confined to a wheelchair.

About a week or so before working that accident scene, he'd been to the WalMart Vision Center for a checkup and everything was fine. Four days later, he noticed his vision was getting blurry in one eye. He thought a high pressure weather system might be to blame but he went back to see the optometrist. He was told to see a specialist right away because one of his optic nerves was extremely swollen.

Visits to a neurologist followed along with MRIs on his spine and brain, tests, tests and more tests, infusions and injections.

For six months, Green was giving himself an injection of steroids every other day.

Over the last few months, there have been times when he felt like he was getting a little better then he would backslide. Whenever he has been able to take a few steps, it's extremely difficult.

"It's like walking uphill through two feet of snow," said Green.

He's been in pain and extreme discomfort every day for months.

"It's like my hands are asleep and my joints are glued together," said Green.

His legs won't work, he can't move his toes, his ankles and his feet are asleep all the time and he has constant pain in his hands and wrists.

The Greens have medical insurance but it doesn't cover all their expenses plus there's the loss of Chad's full-time income.

Besides financial distress, Green struggles every day to keep his chin up and maintain hope for the couple's future.

Jaimie has had to learn how to drive a fence post and toss out hay while her husband watches and feels helpless. On Tuesday, Green posted a picture on his Facebook page of Jaimie learning to drive a tractor. He says she hasn't complained but it bothers him.

"I tell her all the time I'm sorry," said Green.

Early in October, Green started a new therapy that requires him to go to the Bloomington Infusion Center for an infusion of medication every 28 days.

"It's supposed to stop it -- put it in remission," said Green.

The cost of each infusion is over $7,000 and it's not known how long it might take before he sees results.

After the first infusion, Green reported his vision had improved but he still wasn't able to walk. Faith, and a positive attitude, is said to help the healing process and Green has that. He believes the new treatments are going to work and that he is going to get back up on his feet again.

Suggestions that he might never be back up to par again, should just go on disability and collect a check every month don't sit well with Green.

"No. I want to go back to work. I want to go back to work at the hospital. I love what I'm doing, I love all the people I work with and I want to be a police officer. And I want to be able to take my wife out to dinner again," said Green.

The community is invited to a "Benefit Dinner for Chad Green" featuring an auction and a beans and cornbread dinner on Nov. 6 at the Greene County Fairgrounds. For more information, see the "Benefit Dinner for Chad Green" event page on Facebook or contact Officer Eric Floyd at 384-5909 or Officer Don Richardson at 798-1068.

How Broken is Our Health Care System? An Article from a Republican--Who is Headed in the Right Direction.

2010-01-31T12:54:00.000-08:00

And he's headed in the right direction because he came face-to-face with just how messed up our current system is. Until you experience navigating the system, including getting sick or losing your job, then you can't fully realize how corrupt and insane the current private health insurance system has become. No one would believe you. It's why I write this blog; to educate the naysayers to reform and to illustrate that our experience can happen to you. Look, it happened to a Republican!

I found Mr. Hewko's article at the Washington Post. Mr. John Hewko is a Republican, a lawyer and public policy scholar at the Woodrow Wilson International Center. Here he describes what he found when he tried to buy private insurance--not through his employer.

Wonder what the company he applied to, CareFirst BlueCross BlueShield, would say about someone with Multiple Sclerosis? Mr. Hewko was denied for "borderline hypertension" and having to take an occasional Advil for muscle stiffness. Holy _____!

(Try having your COBRA subsidy reversed like Fidelity did to us, that smarts too, Mr. Hewko. Update: The Department of Labor reversed Fidelity's reversal upon appeal so we now have the subsidy.)

Link to the full article here. Emphasis below is mine.

I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath -- and it isn't pretty.

Recently, I left my job with the federal government -- I was a political appointee, so my tenure was limited -- and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51-year-old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication and mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "pre-existing conditions" -- conditions that millions of Americans my age experience -- was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

So I am forced to roll the dice with my health. What happens when my COBRA runs out (coverage might be available under the Health Insurance Portability and Accountability Act, but CareFirst's premiums for my family would be $3,000 a month and annual prescription coverage is limited to $1,500)? Will I again be denied when I apply for coverage after 18 months, particularly since my "pre-existing conditions" aren't going anywhere and many companies ask whether a previous application has ever been declined? Should I cancel my annual physical for fear that some new condition might pop up? Or, do I take a job, any job, so that I can get covered through an affordable employer group health plan?

And, even if I am able to get nongroup coverage, will my policy be rescinded later because I forgot to list a medical condition on the application, however minor or unrelated the omission was to the illness being treated?

William Kristol, in a recent commentary in The Post, stated that "there is no health-care crisis." He either has a cynical hidden agenda or he's ignorant of what millions of Americans who don't have access to employer-based plans face. The system is broken. I'm one of the lucky ones, because I have the means to pay for COBRA and to cover any catastrophic prescription costs and high deductibles under CareFirst's guaranteed coverage policy. But what about the laid-off factory worker or office clerk who cannot?

No silver bullet will solve all our health-care problems, but four measures would address one of most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can't afford the premiums; a prohibition against denying or rescinding coverage for "pre-existing conditions"; and meaningful tort reform. Yet Congress continues to make the ideological perfect the enemy of the desperately needed good. Democratic ideologues reject tort reform and insist on a public option that many suspect is a Trojan horse to a single-payer system, while their Republican counterparts deny that a crisis exists, decry any reasonable attempt at reform as a government takeover and fail to articulate an acceptable alternative.

Meanwhile, millions of honest, hardworking, self-employed or laid-off Americans continue to play Russian roulette with their health. Maintaining the status quo is unacceptable. A failure to adopt at least these four measures would be a national disgrace.

And to those Americans who are insured through their employers and are puzzled by all the buzz about a health-care system in crisis. Just remember: You are but a pink slip and a minor pre-existing condition away from insurance hell.

Indeed, hell is just one life-altering disease or condition away.

Image above found here.

SCOTUS Schmotus and Calling all Members of the Tea Party

2010-01-21T10:51:00.000-08:00

Well I had to come out of my non-blogging shell to write about the latest fiasco put upon us by the conservatives. Yes, all my Republican and Tea Party friends, the conservative-appointed members of the Supreme Court seem to think it's okay to allow corporations to behave like individuals when it comes to federal campaign finances. The Supreme Court, a bitterly divided one (can you guess the line of division?) "ruled that the government may not ban political spending by corporations in candidate elections."

Guess who is going to win? We the People? Hardly. We the Corporation, now they stand a good chance.

Here's a comment I found today on the New York Times website, by Dave from Tucson. He sums it up rather well I think.

Maybe the candidates should wear jumpsuits, like the NASCAR drivers, with the logos of all their corporate sponsons emblazoned on them. That way we can vote for the candidate that is sponsored by our favorite corporations!

"Under today's decision, insurance companies, banks, drug companies, energy companies and the like will be free to each spend $5 million, $10 million or more of corporate funds to elect or defeat a federal candidate -- and thereby to buy influence over the candidate's positions on issues of economic importance to the companies."

"With its ruling today, the Supreme Court has given a green light to a new stampede of special interest money in our politics," said President Obama in a statement. "It is a major victory for big oil, Wall Street banks, health insurance companies and the other powerful interests that marshal their power every day in Washington to drown out the voices of everyday Americans... That's why I am instructing my Administration to get to work immediately with Congress on this issue. We are going to talk with bipartisan Congressional leaders to develop a forceful response to this decision."

I don't see the Republicans jumping on this one, unless they actually decide to listen to their constituents--for once. Tea Partiers, the ball is in your court. I can't think your movement would in any way support the purchasing of federal elections by large corporations. Corporations are not individuals and do not deserve the same rights as individual citizens. Time to step up.

CIGNA, Fidelity Investments and the Reality of the Precarious Nature of Health: Why We Need Reform

2009-12-02T16:48:00.000-08:00

For now, this will be my last posting as Paul and I are moving forward with our new non-profit (more on that at the end of this posting). Over the last few months, I have learned quite a lot and, I hope, I have shed the light of reason and sanity on a few things for you as well, kind readers.

For instance, how anti-reform protest really has its roots in sponsorship from billionaires who don't worry about how to pay for their health care, how GOP politicians who are supposedly serving their public receive much campaign finance money from health care special interests and how the GOP has offered no reasonable plan for reform. Like this, this, this and this.

This blog started as a result of CIGNA's denial of our coverage. My husband became too ill to work and we thought, rightfully, our disability insurance policy would cover us. After all, he has Multiple Sclerosis, a chronic disease. Disability insurance, as I have demonstrated, is an enormous corporate scam. A gigantic money-making scheme for the health insurance industry and one where they have no intention of actually following through on their contractual obligations.

It's cheaper for the health insurance industry (makes Wall Street happy) to let you file an ERISA claim in Federal Court and maybe one of the judges they have in their back pockets will be there to help them find a way not to pay you.

They hope for one of two things, 1. To wear you (the sick person with no income) down to where you give up or; 2. You will settle for less than the amount of the policy. Either way, they come out ahead and you, the disabled, sick or injured person, come out stepped upon by a large, faceless, inhumane corporation, jobless and without any recourse since insurance is exempt from federal anti-trust laws. You cannot seek assistance from the Federal Trade Commission Consumer Protection agency for example.

Health and disability insurance are not about your health or seeing you get better. Insurance is about profits. And you, premium-paying consumer, get in the way of that.

Illness happens. It's the luck of the draw; the throw of the dice in the great genetic crap shoot that is humanity. We thought we were protected. After all, we did the right things: had disability insurance, we even purchased extra, special, in-case disability coverage. My husband worked hard at his new job. He even worked in a new position at Fidelity Investments all through his chemotherapy treatments.

And while I'm at it with Fidelity, I learned something else. The management of Fidelity is so insulated from the people who work for them, from their own clients even, and are so paranoid they hire companies like Cyveillance (who use free Google searches as part of their "internet monitoring" and "sophisticated intelligence gathering") a regular visitor to my site, to keep up with what is being said about them on the internet. My site? This blog, written by a woman whose husband has Multiple Sclerosis and was forced into signing a separation agreement with Fidelity or allow his health to suffer? I shudder at my own dangerous self.

Fidelity can sponsor a million MS Bike-a-Thons, but their actions with my husband speak volumes about how they really feel about Multiple Sclerosis. Not in my backyard, comes to mind.

Here's an investment tip: Many socially responsible funds do way better than Fidelity funds. Check them out for yourself. Start here. Put your money where people count first.

What Paul and I didn't quite grasp, even in the face of CIGNA's denials, was how insurance companies will do absolutely anything to not have to pay their claims. You really have no idea of this unless you have experienced it yourself. I would have never believed it myself, it is that surreal. We are living proof of their unethical and inhumane behavior. In my blog, I have brought to attention all kinds of claims that CIGNA has refused to pay. They have a particular habit of not paying disability claims to people with Multiple Sclerosis.

Facing a $1400 per month COBRA payment while unemployed is insane. And that's why Health Care Reform needs to pass now, because we should not be faced with this payment while unemployed nor should we be so scared, as we are, to never have coverage again because with Paul's illness, no private health insurer will ever cover him. Why? Having Multiple Sclerosis can be expensive. Is that a good reason to keep someone from receiving health care, America?

But now it's time for me to do more than just write this blog.

Paul and I have started our own foundation, a non-profit 501(c)(3) that will, for now, focus on helping all people with Multiple Sclerosis.

It's the Multiple Sclerosis Activism Foundation, and our aim is twofold. First, we hope to be a resource for questions or issues regarding MS, care, treatments, doctors who specialize in MS or any issue you have that can't be easily answered. We are here to help you. And if we don't have the answers, we will get you to where you need to find the answers. We'll do the work for you. It's a dizzying maze of information out there and we will act as filters and conduits to the correct answers and sources of information.

Second, we are aiming to affect policy when it comes to people with MS and other chronic, debilitating conditions. We do not just want to take a "stand" on a position, we want to affect change as well. And this takes your voices. Let us know your issues, questions and stories. We are here to get your voice heard, to help and to make things better for all people with disabilities.

Finally, our Constitution, which has been thrown around by so many of the anti-reform protesters, the GOP and the Hair-Bumped One's fans as their reason for everything that emanates from their mouths, especially anti-health care reform rhetoric, has made me wonder if these people have even read it. The Preamble clearly states (click on the links for historical context):

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

Promote the general Welfare. That means addressing our national happiness, health and well-being. It means it's time to get out of the dark ages of serfs (us) and feudal lords (insurance industry) and take over a program that should not have profit as its most basic of motives.

The Foundation's website will be coming shortly. In the meantime, if you have questions, want your story heard, have a way to help or just want to tell us you are glad we are here, you can reach the MS Activism Foundation at (310) 363-0197.

Fight for Health Care Reform, it's a right you deserve as a citizen of these United States.

I Hope Fidelity is Getting Their Money's Worth--Geesh

2009-12-02T10:34:00.000-08:00

This is from Statcounter
Cyveillance (38.100.21.210) [Label IP Address]

Ashburn, Virginia, United States, 5 returning visits

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Social Security and Medicare and the Socialist/Communist/Fascist/Marxist Presidencies of Roosevelt, Truman and Johnson

2009-11-30T09:33:00.000-08:00

President Johnson signing the Medicare program into law.

As Social Security and Medicare, two very important programs for our national well-being (see the preamble to the Constitution), were being introduced as bills, they were treated with the same revile and unsound arguments against them as Health Care Reform is being treated today.

Below is beginning text from the Social Security Act signed into law August 14, 1935 by President Roosevelt.

An Act

To provide for the general welfare by establishing a system of Federal old-age benefits, and by enabling the several States to make more adequate provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health and the administration of their unemployment compensation laws; to establish a Social Security Board; to raise revenue; and for other purposes.

Here are the same arguments AGAINST the Social Security Act that are going on today about Health Care Reform.

The resulting Senate and House bills encountered opposition from those who considered it a governmental invasion of the private sphere and from those who sought exemption from payroll taxes for employers who adopted government-approved pension plans.

Yes, that argument "governmental invasion of the private sphere," was all over the place in 1934-35. Can you imagine the uproar seniors and others who receive these benefits of this "government invasion" if Social Security and Medicare were suddenly taken away? Can you then imagine the lines for food assistance programs then doubling after benefits were revoked? Of the indignity of having to seek out assistance and charity at an elderly age when you have been a good citizen and paid your taxes, maybe even served in our Armed Forces? At any age for that matter, in this, the richest nation in the world.

Health care reform has been tossed about our national psyche for a while now. In 1945, President Truman wanted to enact a National Health Care Plan. For the full text of President Truman's message to Congress see here.

In his message, Truman argued that the federal government should play a role in health care, saying "The health of American children, like their education, should be recognized as a definite public responsibility." One of the chief aims of President Truman's plan was to insure that all communities, regardless of their size or income level, had access to doctors and hospitals.

And,

The most controversial aspect of the plan was the proposed national health insurance plan. In his November 19, 1945 address, President Truman called for the creation of a national health insurance fund to be run by the federal government. This fund would be open to all Americans, but would remain optional.

An optional plan? How did that go over with the special interests?

The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socialized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line."

Socialism and Communism, sound familiar? See Tea Baggers of today for all kinds of mixed ideological name-calling. President Obama is everything from a Fascist, Marxist, Socialist to Communist--did I leave any "ists" out?

The Medicare Act was signed into law by President Johnson, July 30, 1965. The full text of President Johnson's speech here. President Truman, who was there to witness the signing was the first man to sign into the Medicare Program had this to say;

This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available. Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don't want these people to have anything to do with charity and we don't want them to have any idea of hopeless despair.

And,

Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right.

With the same arguments being flung all over the place as the ones that were being used today, one has to question where these arguments really come from? From the Tea Baggers themselves who are calling President Obama a Fascist/Socialist/Marxist just like their counter-parts did to Presidents Roosevelt, Truman and Johnson? Well, we've certainly had a lot of Communists/Socialists elected to the White House then, and imagine, ones who did things like sign Social Security and Medicare into law? The horror!

Or do these arguments against a National Health Plan or at the very least, a Public Option, come from private insurers who have fought so hard to keep their money train rolling ahead at full speed at the expense of all ill Americans? More information about the Social Security Amendment for the Medicare Act here.

Private insurers had long considered this illness-prone population a "bad risk.” A broad debate about the need for a social insurance program to provide older Americans with reliable health care coverage started within the Social Security Administration and in Congress. Public hearings were held, and the House of Representatives considered several proposals, but the debate did notintensify until 1960, when it became clear that private insurers were becoming increasingly incapable of providing comprehensive, affordable health care coverage to the rapidly growing population of older adults.

This time, let's not allow a handful of corporate rapists such as CIGNA, Aetna, WellPoint, UnitedHealth and all the others, the upper hand on how we, as a nation, look after our general well-being. Stand up for reform. It's in your best interests to look at our past, learn from it and see that all the vile rhetoric around Health Care Reform is as hollow and shallow as the people who speak it.

Happy Thanksgiving!

2009-11-25T07:21:00.000-08:00

If you have a job which gives you employer-subsidized insurance, be thankful. If you are a member of the House or Senate and you are for helping millions of Americans without insurance coverage, I'm thankful. Again, members of Congress be thankful for the wonderful insurance program you have called the Federal Employees Health Benefits Program and think about extending that program to all your fellow citizens, Ben, Blanche, Mary and Joe. See how government sponsored health insurance can be good?

If you are on Medicare, be thankful, it's a good program. If you are on Medicare and protesting against reform, take stock of yourself and rethink what it is you are protesting against--your own health care coverage?

Happy Thanksgiving and a special Thanksgiving greeting to all our armed service men and women everywhere and especially to those fighting in Iraq and Afghanistan.

Fidelity Investments Stockpiling Tamiflu and CIGNA Denying a Six-Year Old Girl the Chance to Hear

2009-11-22T09:24:00.000-08:00

Corrected posting. I made an error and said that Fidelity was stockpiling H1N1 vaccine and this is incorrect. They are stockpiling Tamiflu. But CIGNA is still denying a deaf 6-year old child the ability to hear.

CIGNA story here and here. Fidelity Investments story here and here.

As we approach the holidays and the season of giving, I'd like you all to think about how large corporations like Fidelity Investments and CIGNA only care about their bottom lines. Not their employees, the people they are contractually bound to assist or how their actions (or lack of) can profoundly affect the populations within their realms for that matter. A butterfly flapping its wings in Tahiti...

They are stockpiling Tamiflu to give to their employees, all with the blessing of the drug company, Roche, that makes it. That would show that they are concerned with their health, right?

“Fidelity’s greatest concern is for the well-being of its employees,’’ one memo said.

Wow, that certainly seems like concern. In my husband's case, they were not so concerned, which is why we are paying $1400 per month for COBRA coverage. But the Boston.com article went on to state:

“The idea of employers stocking antivirals for the indiscriminate use of their employees runs counter to sound public health principles,’’ said Dr. Lauren Smith, medical director of the Massachusetts Department of Public Health.

Runs sound to public health principles. Just got to keep the employees working, I guess, even if they are sick.

People may confuse the common cold for the flu and inappropriately down a few Tamiflu capsules, they said, which over time can diminish the drug’s effectiveness against influenza by allowing the virus to become resistant to the medication.

Affiliated Physicians, the group Fidelity hired, they like to push Tamiflu, that's for sure.

Under the new plan, businesses pay a nominal annual fee to “reserve” their own stockpile of Tamiflu, which Roche will store and rotate to keep “in date.” The contract comes up for renewal annually, at which time companies will have the opportunity to re-evaluate their investment decision. A nominal fee, huh? From Boston.com:

One of the Fidelity memos contains an admonition to employees: If you lose your supply of Tamiflu, you’re out of luck. Prescriptions will not be replaced.

Guess Fidelity is only willing to spend so much on employee health.

And then we come to CIGNA. They are denying a child the ability to hear. Is there anyone out there who would argue this isn't about money?

Here we are, in the richest nation in the world and one where we pride ourselves on our technology and ingenuity that can give a deaf person the ability to hear again. And the window of opportunity where this implant can work is closing--the child may be permanently deaf.

I am waiting to see how they spin this one as they were very quiet last Wednesday when the story broke and then hit the internet news outlets on Thursday. Chris Curran, how do you sleep at night knowing you have to face the sane world and explain away another cruel "health" insurance act? It must be impossible.

And H. Edward Hanway, you have become a very wealthy man thanks to CIGNA's claims denial process, do you really have a conscience, as a man, a human being? Can you enjoy your wealth knowing your money has been made by acting so callously?

Or if you want to be pragmatic, I'll state it this way: You have made your money by finding illegal ways to deny care CIGNA is contractually bound to cover (like with us) and then waiting for the lawyers to be called in to force you to keep your end of the bargain, which usually doesn't happen since most people can't afford attorneys, so CIGNA keeps the money, the accountants do their work and everything looks incredibly profitable and investors keep buying shares of CIGNA.

And a deaf little girl doesn't ever get to hear the sound of her mom's voice.

Too bad Jacob Marley's ghost can't visit both CIGNA and Fidelity's Board of Directors. Who am I kidding, even old Jacob wouldn't make a dent in their collective souls.

Image of Jacob Marley found here.

Sarah "Death Panels" Palin and Going Rogue in Michigan

2009-11-18T21:08:00.000-08:00

One of the reasons I restarted this blog about our insurance hell was thanks to Sarah "Death Panels" Palin. She heard that term from Betsy McCaughey and thought it sounded "right" enough to repeat. Why bother with fact-checking, if it sounds catchy, go with it.

Anyway, I'm watching Countdown tonight (and by the way, Keith and you other pundits, you guys spend way too much time on a woman with deplorable grammar and who thinks a noun, progress, is a verb, progressing) and I see the line of people at a Michigan mall waiting to get a copy of Sarah's book, Going Rogue (I think Going Rouge would have been a more apt title considering the amount of blush piled on her cheeks) signed by the Hair Bumped One herself.

And I got to thinking. This line of people, they aren't there just to get some face time and a quick wink and a "Hiya" from Mrs. Palin. Nope. Don't think so. They're smarter than that.

They are thinking about the distribution and consumption of goods and services and how to get a piece of her action. Look at Michigan's unemployment rate, thanks in large part to the auto industry. They've been hard-hit by this economic downturn and if you are an enterprising resident of Michigan (Michiganer? Michigander? If you know the correct word, please email me) you would be there in line, too, waiting for a chance to get a signed copy from the Great Rouged One herself.

You could sell it on Ebay. Maybe bring in a few more $$ than it's worth. It's worth a try and why not? You never know the capacity for which some people have to part with their money. Like the Virgin Mary Grilled Cheese sandwich that sold for $28,000. See? Worth a try with the holidays coming up.

Note: Above links for Ebay will expire.

Wendell Potter Should Have Helped Craft the Health Care Bill

2009-11-17T09:26:00.000-08:00

Really. And it's because he knows how important health INSURANCE reform and regulation are needed to make sure premium-paying Americans get what we pay for and not booted off the policy or denied long term disability coverage while on chemotherapy.

Surrounded by Two Sides of Crazy; Right-Wing Nutjobs and the Insurance Industry, That's You, UnitedHealth Group

2009-11-15T22:15:00.000-08:00

I don't know how we, as a nation, have come to this, but we have. And it makes me wonder if we can continue to prosper when all intellect seems to be missing.

Between wading through the new 353,000 word health care bill with its annoying legalese, reading badly researched articles in the LA Times; stumbling upon blogs comparing health care reform to Nazi Germany (as if we don't already have insurance bureaucrats denying care, Dr. Hieb, and I would suggest you re-read your Hippocratic oath before blogging against treating those who are ill); trying to figure out why anyone would so mistrust our government to the point of this discourse (move if you hate it here so much) and complaining about paying into a risk pool (you already do that) by comparing it to "holding a gun to your head,"

No citizen would consider it moral to put a gun to his neighbor’s head and demand that he pay for his mother’s medical care -- no matter how much she may need it. It is no more moral when people use the government as intermediary. (Uh, Dr. Hieb, it's called Medicare and I suspect you see those patients in your practice)

reading where UnitedHealth Group and CIGNA had enlisted their employees to write and speak-out against reform; finding more blogs railing against health care reform whilst selling advertising space to Aetna, I have to ask: Did we lose our collective intelligence here in the U.S? Are people really this stupid? And selfish? Dr. Hieb? Does the G.I. Bill ring a bell?

The GOP Becoming More Ineffectual Every Day: Part Two, a Case of Turning on Each Other and CIGNA

2009-11-14T14:52:00.000-08:00

Over at CQPolitics, an uber right-wing website/blog, Bill Pascoe asks this question.

Does anybody at the Republican National Committee understand how insurance works?

Ooh, my Spidey senses went all a-tingle at that one because well, look who this Bill Pascoe is. From the blog over at CQPolitics.com and the typo is theirs, not mine:

Bill Pascoe is CEO of The Foundation for American Freedom, a think tank headquartered in Alexandria, Virginia.
A longtime conservative and Republican consultant and communications strategist, he has managed a number of high-profile statewide campaigns, served as chief spokesman of the Republican National Committee, written a regular newspaper column, hosted a nationally syndicated radio talk show, served as a congressional chief of staff, and smuggled cash and computers behind the Iron Curtain when there still was an Iron Curtain. His career also included stints at The Heritage Foundation and the American Conservative Union, and he even once put his own name on athe ballot for a seat in his home state’s legislature — in a seat, he proudly notes, that had voted Republican precisely once since Reconstruction. He notes, not quite so proudly, that he kept the GOP streak intact.

Doesn't sound like Bill is helping out his buddies at the RNC very much by asking that kind of question.

But to be fair to the RNC, not many people (especially the GOP) have a good idea of how insurance works. You have to get sick, like my husband, to really understand how it works. It doesn't. Or, you have to shop around in the open market for it, like this gentleman did (a Republican as well) and find out how messed up a system it really is. Hint, insurers don't like sick people--at all--even ones with mild symptoms that require an Advil or two.

Mr. Pascoe goes on to state in his article found here that:

Republican National Committee had offered as a part of its standard employee benefits package a health insurance policy that included coverage for elective abortion services. Given the the most recent GOP Platform calls abortion "a fundamental assault on innocent human life," and given Republican House members' votes on Democratic Congressman Bart Stupak's amendment to the health insurance reform bill to ensure that no federal funds be used to fund abortion services as part of health insurance reform, it looked like the RNC was being more than a bit hypocritical -- so much so that Steele moved quickly to take action to head off what surely could have become a pro-life firestorm.

"Money from our loyal donors should not be used for this purpose," Steele told Politico. "I don't know why this policy existed in the past, but it will not exist under my administration. Consider this issue settled."

But it hasn't been settled as more right-wingers are getting in on the action. Mr. Pascoe goes on to further investigate the situation and found that RedState blogger, Leon Wolf, didn't like Mr. Steele's actions as he wants someone, anyone at the RNC fired for this policy provision with CIGNA.

and, further, demanded that no pro-lifer donate money to the RNC until heads roll.

Mr. Pascoe, however, does understand how insurance works and he understands risk pools. He HAS to explain it to his fellow Repubs.

But unless the Republican National Committee is the only client to whom Cigna sells its health insurance policies, the issue isn't settled at all -- because donations from RNC contributors will continue to fund abortion services.
Funds sent by the RNC to Cigna in exchange for the insurance coverage its employees receive are pooled with other funds received from Cigna's other clients -- most of whom, I'm guessing, will continue offering their employees a standard benefits package that includes abortion services.
That's the way insurance works.

And here's where it gets good. See, the GOP can't seem to stick together these days on anything except calling the President a socialist (we're a republic that's how he got elected--you know, a political system in which the supreme power lies in a body of citizens who can elect people to represent them) and appearing on FOX.

Mr. Pascoe adds his own turning-of-the-knife into the already wounded body of the GOP:

If Steele and the RNC are truly committed to ensuring that no RNC donors' contributions are used to pay for abortions, then it must find and move its coverage to another health insurance provider -- one that explicitly does not even offer abortion coverage in any of the policies it offers.
Only then, Chairman Steele, will the issue be "settled."

Drop the policy with CIGNA! Wonder how many Republicans have received campaign donations from CIGNA executives? Hint, a lot. You can look it up, start with H. Edward Hanway.

Wonder how many of these Republican men can get pregnant or have to deal with a tragic pregnancy where your baby's heart stops and you have to go get a D&C (also called abortion) because your child is dead in your womb. Hint, none.

The GOP Becoming More Ineffectual Every Day--Even Within Their Own Corporate-Friendly Agenda

2009-11-14T10:40:00.000-08:00

Found this over at OpenCongress.org. Our friends in the Corporate Shills Party can't even agree with who lines their campaign coffers.

Tension between Republicans and the nation’s top CEOs over healthcare reform escalated this week when the executives released a report praising aspects of President Barack Obama’s top initiative.

Republicans in Congress and some of their business allies in Washington are fuming over a new report commissioned by the Business Roundtable (BRT), an organization that represents more than 50 of the nation’s biggest corporations. […]

Can you say "ineffectual?"

Kentucky's 5th Congressional District Rep. Harold Dallas Rogers and Trying to Purchase Insurance in Cumberland, KY

2009-11-14T09:42:00.000-08:00

When you think of Kentucky a few thoughts may come to mind; bluegrass, (since it is the bluegrass state) horse racing, the Derby, mint juleps on the veranda and well, Mitch McConnell. I'm no fan of Senator McConnell especially after I saw how much money is in his campaign funds thanks to Health Care special interests. It's sort of an oxymoron, isn't it? Health and care when put in the hands of those lobbyists. I digress. Photo of Rep. Rogers found here.

What struck me today was Kentucky's 5th district and this fact.

Kentucky’s Fifth Congressional District, which includes Harlan and Perry counties, has the lowest life expectancy of any district in America: 72.6 years for men and 76.4 for women.

Granted, many factors contribute to low life expectancy but when your representatives, Sen. McConnell to the 5th district's congressman, Rogers, are so against health care reform, you have got to wonder what Mitch and Hal are doing up there in Washington.

The counties making up Rep. Roger's district were mostly all dependent on coal mining for many years and when the coal stopped, a trail of poverty was left in its wake. The 5th district is a microcosm for what ails most of rural America: heart disease, diabetes and obesity.

I decided to do a test at eHealthInsurance dot com (over 1 million customers insured!) to find out what coverage would cost me in Cumberland, Kentucky in Rep. Roger's district. For a quick profile of Cumberland, go here. Estimated household income in 2007 was $21,917 while for the state it was $40,267 and 36.9% live below poverty level. It's a solid Republican community.

So how much would insurance cost my family? I plugged in my family's data, same birth years and we're not smokers. Of course, they haven't gotten to the Multiple Sclerosis part, but for the sake of this exercise, we're going to pretend there is no pre-existing condition, otherwise we could not afford coverage on $22,000--which brings me to another issue, but I'll deal with that later. Suffice to say this from the MS Society:

Chronic illnesses such as MS, which are long-term and incurable, are typically not covered by private medical insurance, although the costs of diagnosis (seeing a neurologist or other specialist and paying for tests) may be covered.

Here's what popped up from my Pretend-We-Don't-Have-A-Pre-Existing-Condition-And-We-Live-In-Kentucky Insurance Search:

We found 63 plans starting as low as $181.00 a month

Results based on 4 applicants located in HARLAN County, effective 12/1/2009 ( Edit )


As low as $239 monthly UnitedHealthcare Optional Dental, Maternity, and Vision now available! Plans underwritten by Golden Rule Insurance Company, a UnitedHealthcare Company.
As low as $202 monthly Anthem Blue Cross and Blue Shield New plans available, large provider network, optional maternity, dental, and life benefits.
As low as $181 monthly Aetna With Aetna's National Networks, plans travel with you. No waiting period for Preventive or Dental care too. 24-hr response on apps!

UnitedHealth was our last carrier so I clicked on them to see what they have to offer a family making around $22,000 per year. I'm going to have to go with the high deductible since I don't make that much money. I'll have to roll the dice on that one. Health care in the United States of America is a gamble--bet you didn't know that. It's shameful, isn't it, especially when compared to other countries who enjoy National Plans for all their citizens. See Switzerland, Germany, France, Italy and the UK.

Here's what came up for policy and deductible choices. If I go with a $10,000 deductible for my family (that's half my income right there) then my yearly payments would be around $3600 and for that I get to pay for all my doctor's visits until I meet the $10,000 deductible--which is half my yearly income anway.

So let's play a game here and see what happens if I go for broke (which I will) and spend $750.02 per month to cover my family. I get the lower deductible of $2300, but I will spend $9,000 per year which is, roughly, half my income and I still have to meet the $2300 deductible so that brings my spending to $11,300 and that is more than half of my yearly income.

When do I get to pay for: Housing, food, clothes, utilities, car payments, education savings for my children?

I don't.

This is a very broken system, isn't it? The CEO of UnitedHealth Group, Stephen Helmsley, he manages to bring in a little over $3 million in total compensation to make sure his investors, both institutional and individual, are happy with their stock prices.

Health, healing and unfettered profiteering should not be part of the equation in how we take care of ourselves in this country.

Gimpy Guys T-Shirts Are Here!

2009-11-11T11:07:00.000-08:00

Gimpy Guys Rule t-shirts available now and with every purchase of a shirt, 10% goes to the Myelin Repair Foundation. Not only will you be a trendsetter sporting your new "T," you will prove yourself a charitable, forward-thinking human being. Yes, t-shirts do say a lot about a person.

And please send us your photo wearing your Gimpy Guys Rule t-shirt and we'll post them up here and on Paul's site.

220 Votes in the Right (Correct) Direction

2009-11-08T08:08:00.000-08:00

I want to share the paragraph below with you as it perfectly sums up why we need health insurance/health care reform in this country. It was written by Michael Ricciardelli at Health Reform Watch dot com.

On a regular basis writers on this (Health Reform Watch dot com) blog have discussed health reform as a moral imperative: citing religious doctrine, philosophers, economists and statistics to show that health care, unlike the purchase of automobiles and designer shoes, is not correctly a conventional aspect of a market economy– that the distribution of healing and life itself should not be premised upon who is the best capitalist, or, for that matter, the child of the best capitalist. That uninsured hospitalized children face a 6o percent increased risk of dying says that in a way that I simply cannot add to. Lack of insurance kills.

Very well put, Mr. Ricciardelli, health care is not correctly a conventional aspect of a market economy and lack of insurance kills. We are headed in a better direction by 220 votes.

Sarah Palin's Hair Bump Fridays--Political Hair Raisers for the Week

2009-11-06T08:28:00.000-08:00

From NBC’s Madeline Rullo

After receiving national fame for his "You lie!" outburst during President Obama's healthcare speech before a joint session of Congress in September, Rep. Joe Wilson is speaking out again. It's still about healthcare, but this time he's speaking in turn.

Wilson is introducing an amendment for the Democratic healthcare bill, requiring all members of Congress to enroll in the public option.Wilson says he has been bombarded with questions from American citizens, "If this public option is so good, then why don't the congressmen take the plan? After about eight times of bringing this up, I said, ‘Enough already.’ I said, ‘I would introduce that when I come back to Washington.’”

Joe, Joe, Joe, you already have a Public Option, the one enjoyed by all members of the Federal Government. Remember? Here's a refresher: Federal Employee Health Benefits Program. It's the one funded by U.S. Taxpayers--that Public Option you so enjoy. Maybe Joe is getting forgetful, he is near Medicare age. Another government insurance program he can enjoy when he's done with this one.

Got a good political hair raiser for the week? Send them in.

Condolences

2009-11-06T08:06:00.000-08:00

Prayers and thoughts to all families involved in the tragedy at Ft. Hood yesterday.

Why Do These Rich, Old White Guys Still Want to Deny You Affordable Health Care?

2009-11-04T21:14:00.000-08:00

The Koch Brothers are at it again and this time they have former-nanny Rep. Michele Bachmann working with them. Now ask yourself this as you read the posting below, "What does Michele Bachmann think about evolution?" An update from September and an answer at the end.

There are some very wealthy people in this country whose foundations are supporting the crusade against health care reform. The biggest question I have is why would these people who have all this money like Charles Koch and his brother David, want to prevent most middle-class Americans from receiving health care? Doesn't seem right.

My other question is why are these same middle-class Americans so clueless that they go out and protest the very reform that would help them receive affordable health care? Ask the equally clueless and repugnantly ignorant Rep. Michele Bachmann as she is heading up the protest that is to happen tomorrow in D.C.

In a conference call Wednesday night with bloggers and activists for the advocacy group Americans for Prosperity, Rep. Michele Bachmann (R-MN) called on protesters to “scare” members of Congress into killing the proposed health care reform bill.

If the protesters succeed in scaring lawmakers, Bachmann said that it could cripple efforts to restructure health care for a decade.

“Nothing scares members of Congress more than freedom-loving Americans,” Bachmann said.

Wow, Michele, cripple the efforts to restructure health care for a decade? So 45,000 United States Citizens who die each year from a lack of health insurance times 10 years equals 450,000 dead citizens. This is what Rep. Bachmann wants--dead Americans. Rep. Alan Grayson was so very right. The GOP does want us to die.

My guess is the fools who do show up tomorrow have no idea of the billionaires behind the message. Charles and David Koch certainly will never have a worry in the world if they or one of their family members became ill. So, why prevent legislation that can help the average American? The brothers sponsor a whole lot of anger via their Front Group charitable giving. See Americans for Prosperity.

I started digging around to see, exactly, who the Koch Family Foundations give money to and, thanks to the efforts of many websites including SourceWatch.org, I found out. Watch out, it's more shocking than I anticpated.

1. FreedomWorks. Co-chaired by Dick Armey, they have sponsored Tea-Bag parties and town-hall meetings.
2. Citizens for a Sound Economy. Again, Dick Armey is co-chair. Supposed to be a Think-Tank, it was founded by the Koch Brothers. Citizens belongs to Health Benefits Coalition "which lobbies on behalf of the healthcare industry and has spent millions of dollars opposing a Patients' Bill of Rights and other patient protection proposals"
3. Competitive Enterprise Institute. I can't even begin to describe how crazy these people are.
4. Hudson Institute. Again, anti-health care reform. Ms. Kravis' article here was in Forbes. Serisouly? Ms. Kravis writes, "Now to the homicide rate, ten times as high in the U.S. as in the U.K. Will insurance cards replace guns? Can anyone credibly argue that health care reform will lower the homicide rate?" Right-wing Institutes like Hudson and your ilk who promote the insanity of allowing the gun culture to run rampant in our country do promote the homicide rate, Ms. Kravis: "Marshall Wittmann, former legislative director at the Christian Coalition and now a political analyst with the Hudson Institute, a conservative think tank, sees the NRA as filling a vacuum left by the decline of the religious right." And my counter-argument, Ms. Kravis, would be homicide rates would drop if more people had access to health care. A person whose basic needs are met does not have to resort to crime.

The Koch Family Foundation contributions list continues here at SourceWatch.org.

You don't get to be a billionaire by being overly concerned with those around you or by being charitable. But to actively participate and sponsor the efforts of trying to deny families who make $40,000 a year the ability to insure themselves and their children? Why?

Now that I've had the time to think about it more since I first raised this question back in September, my answer is as follows.

I believe the Koch Brothers and their ilk are simply scared of allowing the average citizen access to the advantages they received, such as a good education and decent health care, because they live in a constant state-of-fear that one day someone so contemptuously beneath them, someone who grew up with a public education and government sponsored health care, will come along, upend them and take away all their billions. Better to keep you uneducated, unskilled and at their mercy.

To answer my second question, I see the people rallying against reform, the very people who need help with health care, as helpless in their ignorance. Pure and simple. They think by allowing the government to open up the system to include more people (a larger risk pool lowers the costs not raises them) access to insurance, they will lose what they already have. Like my idiotic neighbors protesting against health care reform the other day. They're all on Medicare. You know, that government run insurance?

They are the followers of this country, easily led, easily manipulated, loud of mouth and small of brain. They listened raptly while Dick Cheney led them into a war of lies and they are listening and, unfortunately for them, believing the lies again. Or they are incredibly selfish.

Oh, and I am certain they have no idea that David Koch gave $15 million to the Smithsonian for the Hall of Human Origins. Yep, a hall dedicated to the story of human evolution--the one those Teabaggers don't believe in since the earth is only 2,000 years old. Shows you what David really thinks of his ignorant minions and their misspelled protest signs. Contempt.

But this time, I am not going to allow this to happen. I'll be at a phone bank tomorrow calling on my fellow citizens to urge our members of Congress to pass a bill. One that will make sure people like my husband, who has Multiple Sclerosis, and others like him with chronic conditions have the ability to get affordable health care.

And finally, what does Michele think about evolution?

Bachmann supports the teaching of intelligent design in public school science classes.^[78] During a 2003 interview on KKMS Christian radio program "Talk The Walk", Bachmann said that evolution is a theory that has never been proven, one way or the other.^[79] She co-authored a bill that would require public schools to include alternative explanations for the origin of life as part of the state's public school science curricula.^[80] In October 2006, Bachmann told a debate audience in St. Cloud, Minnesota, that "there is a controversy among scientists about whether evolution is a fact or not.... There are hundreds and hundreds of scientists, many of them holding Nobel Prizes, who believe in intelligent design."^[81

Citations can be found here.

From Good Morning America, What Happens to Your Health Insurance Premiums

2009-11-04T08:46:00.000-08:00

Health Care Premiums Also Used for Lavish Salaries, Luxury Items, Underwriters
West Virginia Democrat Wants Transparency in Insurer Health Care Spending
By KATE SNOW, ELIZABETH TRIBOLET and SUZAN CLARKE
Nov. 3, 2009

Sen. John D. Rockefeller, D-W.Va., chairman of the Senate Committee on Commerce, Science and Transportation, wrote to 15 of the biggest health insurance companies in August, asking them to provide information on how much of policyholders' monthly premiums was spent on medical care versus the amount that went to administrative costs and company earnings.

Such figures are known in insurance industry-speak as "medical loss ratios." But when insurance companies balked, saying the information was confidential and proprietary, Rockefeller's investigators went digging through public documents and found that much of policyholder premiums was going to nonmedical costs.

The insurance industry has long pointed to federal data that says about 87 percent of every dollar that people spend on premiums goes toward actual medical care, but Rockefeller's investigators found the average for the top six insurance companies is closer to 82 cents on the dollar for medical care.

That five-point difference represents billions of dollars.

Oh, and look who may have submitted inaccurate filings--CIGNA.

In a stern letter sent Tuesday to H. Edward Hanway, chairman and CEO of Cigna, a major health insurance company, Rockefeller wrote that his initial request had been meant to provide helpful information to consumers who were shopping for individual or business policies.

Rockefeller contends that consumers get more information from window stickers on new cars for sale than they do from insurance companies.

"Instead of disclosing medical loss ratios to help consumers and small business owners make informed health care choices, health insurance companies have hidden them behind a wall of corporate secrecy," he wrote, adding that the committee found Cigna appeared to have submitted inaccurate state insurance regulatory filings for its activities in certain areas.

Insider Shares Industry Practices

None of this surprises Wendell Potter.

He is a former Cigna insurance company executive turned whistle-blower and has testified before the committee about industry practices.

Potter has long said that insurers spend less than they claim on medical care and spend a big chunk of money to actively seek ways to avoid paying claims.

Discriminating Against People With Multiple Sclerosis and Two Stories, Two Members of the GOP and One Big, Bad Nightmare

2009-11-03T15:55:00.000-08:00

I found this story yesterday and saw that Keith Olbermann talked about it on his show last night. It's about the McCain campaign's "top health-care guru" Doug Holtz-Eakin. He's out of a job now and his COBRA is about to run-out. But he's not worried. Why?

"Let's not whine too much about me," he said. "I'm a wealthy, affluent American in the big picture."

Oh, that's why. He can afford an individual policy despite a pre-existing condition. One like Multiple Sclerosis.

Despite his personal trials, however, Holtz-Eakin said his conviction on the hot-button issue of health care is unchanged. He believes that reform is needed, but that President Obama and congressional Democrats are going about it the wrong way. The system is "broken," he said, but the bills now before Congress do not cut costs enough.

He thinks the Democrats are going about it the wrong way. And I suppose Republican John Boehner (check out his campaign finances here and see who tops the list) has the right idea? Take a look at what the GOP has in mind.

Boehner said Monday that the measure would not include language banning insurance companies from denying coverage to consumers with preexisting conditions, a prominent feature of Democrats' bills in both the House and Senate.

How typical of the GOP. Let's ignore something like pre-existing conditions when we write our Bill. The Insurance Industry and their campaign contributions are waay more important than the health and well-being of our constituents. In fact, let's keep them uninsured so they get even more sick and die. They can't vote a Democratic ticket then.

Allowing pre-existing conditions to go on is a form of Discrimination. The lawmakers, like Boehner and his GOP cohorts, are practicing Discrimination against people with Multiple Sclerosis and every other chronic disease. Yes, Discrimination: the willful and purposeful unfair treatment on the basis of the prejudice that a group of United States Citizens had the grave misfortune of becoming chronically ill. They should be excluded from ever getting affordable health care coverage. Discriminated against for getting sick and being sick. You can't help getting a disease like Multiple Sclerosis any more than you can help the color of your skin, Johnny.

And to address ending "junk lawsuits" as an issue to out-of-controls costs, let me site an excerpt from a blog written by a California lawyer, Richard Johnston. His blog, Problem is Erisa, is a valuable resource of information.

As of now we have a situation where the law tells insurers they face no meaningful consequences if they deny care improperly or even commit outright fraud. As one federal judge has commented, "if an HMO wrongly denies a participant's claim even in bad faith, the greatest cost it could face is being compelled to cover the procedure, the very cost it would have faced had it acted in good faith. Any rational HMO will recognize that if it acts in good faith, it will pay for far more procedures than if it acts otherwise, and punitive damages, which might otherwise guard against such profiteering, are no obstacle at all." Insurance companies, of course, are not charities, but corporations; their boards are subject to a fiduciary duty to maximize shareholder value. If it is possible to accomplish this by mistreating insureds, then it follows insurers will do precisely that (and believe me, they do).

You have it all backwards, Boehner. Backwards Boehner, has a ring to it. You and your fellow GOP Discriminators need to change the laws guarding the Insurance Industry from ever being held legally liable for the damages they inflict.

Going on about tort reform is old, hollow and it's been disproved as a mechanism to cost control. It accounts for maybe, 5-9% of overall health care costs. From FactCheck.org:

But both the GAO and the CBO now question their sweeping conclusion. When the CBO attempted to duplicate the Stanford economists’ methods for other types of ailments they found found “no evidence that restrictions on tort liability reduce medical spending.”

How to fix health care? Start a National Plan. Open up that Federal Employees Health Benefits Program, that all members of the House and Senate enjoy, to the entire nation. Repeal McCarran-Ferguson so that the Industry is now like every other corporation and subject to anti-trust laws and then get rid of ERISA laws for health insurance plans. There's your reform. End Discrimination, John.

CIGNA and How they Consider Denying Disability Insurance Claims a Game

2009-11-02T08:50:00.000-08:00

Disability Insurance was not available to Disability claims managers because there was a fear we knew how to "play the system." That quote was found at Jobvent.com. It was made by a former CIGNA claims manager in Dallas, Texas.

Read that again. CIGNA would not give its own employees, namely claims managers, disability insurance because there was a FEAR they knew how to "play the system." A fear of what? Of having to pay out a disability claim CIGNA was contracted to pay--after having collected premiums to do so? A fear that their own filthy tactics and proscribed system of denying claims would be used AGAINST them to force them to honor their contract? There is a book out there that CIGNA wrote. In that book, that operating manual, are all the steps involved in the Claims Denial Process.

They play a game, a very dangerous game. And they do this by toying with some very ill people, like my husband, all for the sake of desperately trying to NOT pay a claim. Be damned with the sick person and his family, money is more important. Please read their letters to us. All the links are on the right.

As if being diagnosed with Progressive Multiple Sclerosis is a game and the person with the disease is playing at something.

Is it a game to be facing chemotherapy, CIGNA?

Is it a game to be faced with zero income, CIGNA?

Is it a game to face a life with a crippling disease, CIGNA?

At what point does CIGNA, a publicly traded company, face up to its own unethical, immoral and abusive conduct? The answer to that is probably never as there will always be people like H. Edward Hanway, willing to rake in millions by stepping on the bodies of sick people--his fellow citizens. And there will always be people like Chris Curran, willing to take a job spewing out disinformation and distortions.

At what point do the shareholders; institutional (Fidelity Investments) and individual investors alike take a look at this company and sell off their shares in abject disgust--because what they did to my husband, they will do to you.

Wake up, America. Private insurance companies are making our nation ill. Cut out the cancer that is the likes of CIGNA and lets move on to a National Plan where our health and well-being, and not profiteeting at all costs, will be the main focus. Let's build a healthy society and not a fat, immoral and corrupt corporation. We are better than this.

No Illness or Insurance Hell Today, Just Lawrence O'Donnell, an Honest Man

2009-10-31T08:08:00.000-07:00

Lawrence O'Donnell called out the very less-than-honorable Cheney family last night. I applaud you, sir.

Happy Halloween! Unfortunately, the Photo is Reflective of Our Current Health Care Situation

2009-10-30T12:03:00.000-07:00

Call your senators and congressmen. Remind them 45,000 U.S. citizens die each year because they do not have health insurance. Remind them that outside the hallowed halls of the congress and senate, we are still not a third-world country, despite the GOP's attempts to get us that way.

Tell them to vote for the Public Option because even as shallow as it may be it's a step in the right direction.

And speaking of Halloween and ghoulish behavior there's Sarah Palin at it once again. Go check out her Facebook page. She actually sites NewsMax stories on health care--now that's frightening.

Cyveillance and Google Search, From StatCounter.com--Excellent Source to See Your Web Traffic

2009-10-29T15:35:00.000-07:00

Warning: The search terms below have some--not-so-nice words, but they aren't MY search terms, they are Cyveillance's search terms. Yep, Cyveillance is a regular visitor to this blog and has been for some time but for some reason they started showing themselves as "Cyveillance" and not "Performance Systems International." Unfortunately for me, my blog shows up on this nasty little search of theirs. I have this to say about that: WTF? Yeah, WTF?

Is Fidelity this paranoid? Was this search even for Fidelity?

And if Fidelity is paying for this, do they know they're paying for Google searches? Wonder how much they're shelling out for free information. Must have been a very impressive PowerPoint.

Copied the chart below from my handy-dandy StatCounter. It's free and it's an excellent tool.

______________________________________________

Cyveillance (38.100.21.149)[Label IP Address]

Springfield, Virginia, United States, 0 returning visits

Date	Time	Type	WebPage
29th October 2009	08:31:30 AM	Page View	blogsearch.google.com/blogsearch?hl=en&safe=off&scoring=d&ie=UTF-8&q=%22fidelity%22 phish OR phishing OR breach OR hack OR fraud OR scam OR login OR protest OR boycott OR kill OR bomb OR threat OR security OR rally OR revolt OR suck OR fuck OR riot illnessandinsurancehell.blogspot.com/2009/10/whats-it-like-working-at-fidelity.html
29th October 2009	08:39:43 AM	Page View	blogsearch.google.com/blogsearch?hl=en&safe=off&scoring=d&ie=UTF-8&q=%22fidelity%22 phish OR phishing OR breach OR hack OR fraud OR scam OR login OR protest OR boycott OR kill OR bomb OR threat OR security OR rally OR revolt OR suck OR fuck OR riot illnessandinsurancehell.blogspot.com/2009/10/whats-it-like-working-at-fidelity.html
29th October 2009	08:42:20 AM	Page View	www.blogger.com/profile/04664006648656318840 illnessandinsurancehell.blogspot.com/
29th October 2009	08:42:36 AM	Page View	illnessandinsurancehell.blogspot.com/2009/10/whats-it-like-working-at-fidelity.html illnessandinsurancehell.blogspot.com/2009/10/whats-it-like-working-at-fidelity.html

What's it Like Working at Fidelity Investments--I'll Let the Employees Speak for Themselves

2009-10-29T00:01:00.000-07:00

Seems CIGNA and Fidelity Investments have a lot in common besides a revolving door of executives, and a vested interest in seeing CIGNA's stock price stay way up despite evidence that they offer no real service; they also seem to have a lousy corporate culture and no ethics.

I told Paul, see, they treat pretty much everyone badly. You just happen to have Progressive Multiple Sclerosis--and had to work through chemotherapy.

I wonder if Ms. Johnson's billions insulate her from really knowing what's going on at HER own company.

All the excerpts below are from JobVent.com.

respect: this is a joke. the first day i met my manager when i was in new hire he made a joke about screwing me from behind. ummm gross? yeah, welcome to fidelity! let's just say if you are a female expect to be harassed and to just smile it off because HR is a joke. anythign you tell HR will go into a thing called "eworkplace" where your boss will document everything that you do. anything you tell HR or your boss you can be sure your boss will joke about to another boss within earshot. HR tells you that "fidelity is like a big locker room so suck it up" and " this is corporate america". my new hire training was a bunch of crap about how fidelity was such a great culture to work in. then you get on the floor and you realize that the managers will use intimidation and swear at their reps all the time! so inappropriate.

team outings are at a local STRIP CLUB called marks showplace. inappropriate. this about sums up the culture at fidelity! the managers use the fidelity credit card at a STRIP CLUB and call it "team building". i call this unprofessional.

work environment: TOXIC. it's so hard to go to work every day knowing you will be told you do everything wrong by your manager and told when to take your 2 15 minute restroom breaks and constantly berated and harassed.
________

Fidelity was such a great company to work at, but that is all in the past! Any of the senior leaders that were good people leaders were run out of there. I was there well over a dozen years and have watched the values crumble. No respect for service. It is a SELF-PRESERVATION culture. The worst survive. They proclaim to be product neutral but are not.
The executive team of NY cronies are starting to fail now. The Johnsons will wrestle it back into their control but then what. The leaders supposed to protect the culture were the worst offenders. Fidelity is now just like any other average big company out there. Sad!
_______

3) Diversity: Exists at Fidelity only in pockets such as HR and customer service. The financial groups, IT and other professional areas of the organization are starkly white male. This is especially true in Marlbourgh, Smithfield, Boston and Merrimack. The company is private and does not make any effort to recruit young bright and talented minorities that are out there. So if you are a young bright, professional and talented minority that happens to find yourself at Fidelity, just be aware what you are in for: stares, lonely lunches by yourself, and a huge lack of respect from coworkers.
_______

There are three things that one with career experience will notice immediately. 1) Personality trumps professionalism 2) Financial company with no apparent real interest in finance. 3) Total disregard for ethics.
_______

Worked there over 10 years. Experienced sexual harrasement twice.
_______

To begin with, you come in a hour early because you always have to work mandatory overtime. Then, you get situated at your cubicle and turn on your aspect phone. (an aspect phone is a device that holds calls and counts every single second of your day. As well as what you are doing at all times.) Once it is on you will notice a red light. This means you have 50 plus people waiting on the line to speak with you. There are other colored lights that represent less people waiting, but I have never seen them. For a few hours you will be berated with unpredicatble questions and comments. It will all be recorded, so that your manager can listen to them and tell you how much you need to improve. Make no mistake about it, you will take calls. Financial anaylist= calls, 401k rep = calls, trader= calls. It is all the same and calls are terrible. Then you need to use the restroom, so you put yourself on a break with your phone. This time counts against you and your bonus because your phone knows you are not taking calls and being screamed at. God forbid you need to do some off phone work on an account. It counts against you, even though you are making an extra effort to help a client. Then you get a 30 minute lunch where you have the opportunity to pay for really expensive caffeteria food that you dont have time to eat. Then it is calls for the rest of the day. But dont forget about that mandatory overtime! You get to stay and extra 1.5 hrs and leave your kids at daycare until 8pm. Isnt this great? If you have time, you can use the company gym (that you have to pay for) and stay at work a little longer.
_______

I see Fidelity made an announcement they are now shifting 950 employees from Marlborough back to Boston and further south to RI. Many of these people will no doubt be the same people who were forced to leave Boston back in June 2008 or, as many did, opt out with a severnace package.

This constant movement conjured up by Fidelity Senior Management highlights a few very sad tell-tale possibilities:

Behind door #1, Senior Management are a totally confused, unfocused lot, incapable of making medium to long term decisions that stick. Said another way, they do not know WTF they are doing. That is enough to make me pull my money.

Behind door #2. They continually move people to bring about attrition thru forced job loss. That is even worse than #1. Said another way, they could care less about people and families; they totally suck. That is enough for me to pull my money and not look back.

Behind door #3, there lurks a dark pool containing a huge power struggle amoung the sharks swimmming around the fading abilities of Ned Johnson. He obviously no longer has the strength to untangle the mess Fidelity has become. He can no longer prevent the train wreck from gathering steam. Abagail - either can you.

The Hartford and Why McCarran Ferguson Needs to be Repealed--Price-Fixing!

2009-10-28T12:08:00.000-07:00

The Hartford were the underwriters of our Long Term Disability policy with CIGNA. Guess what? They reached a $1.3 million settlement for price-fixing. And guess what else? They took $3.4 billion in government bailout money.

My dear foolish and misguided protesters I saw today, this is the problem. This is what you should be protesting.

Link to full article here.

The Hartford Reaches $1.3 Million Settlement in Price-Fixing Suit

By Carrie Burns, Insurance Networking News

October 28, 2009

Connecticut Attorney General Richard Blumenthal reached a $1.3 million settlement with The Hartford Financial Services Group Inc., resolving claims that its now defunct subdivision, Hart Re Co., participated in several anticompetitive schemes that illegally inflated insurance and reinsurance costs nationwide.

The Hartford settlement stems from Blumenthal's ongoing litigation against Guy Carpenter & Co. LLC. In 2007, Blumenthal sued Guy Carpenter for orchestrating a series of alleged conspiracies with dozens of reinsurers that illegally inflated costs for insurance companies and consumers nationwide. In some cases, according to Blumenthal, prices rose by 10% to 40% over the course of several decades. The Hartford participated, as a reinsurer, through its subdivision, Hart Re Co., in several of the conspiracies beginning in 1986 until 2001.

The Hartford, which is no longer involved in the reinsurance market, cooperated with Blumenthal's investigation and, as part of the settlement, provided critical information that has supported the action against Guy Carpenter. The information, including evidence, has allowed Blumenthal's office to expand the allegations against Guy Carpenter in an amended complaint filed this week.

Medicare Recipients Protesting Their Own Health Care in Rolling Hills Estates, CA. Palos Verdes Residents Didn't Seem to Notice.

2009-10-28T09:04:00.000-07:00

This unenlightened group of seniors and some who are on the verge on being senior citizens are on the corner of Hawthorne Boulevard and Silver Spur today protesting against health care reform.

These folks are perfect representations of the selfish cretins that are out there, nationwide, protesting against health care reform. It's fine with them to partake of a government program that helps them out, but they want to make sure you and I don't get the chance.

And here I thought with age came wisdom or at least the understanding that Medicare is a government run insurance program.

What's It Like to Work at CIGNA?

2009-10-28T07:06:00.000-07:00

I don't know as I have never done so, but these poor slobs have and it isn't pretty. In fact, it's quite horrible.

Some excerpts from JobVent, here and here. (The site previously known as JobVent has changed since this story was first published. The site is now Jobitorial and it seems, the reviews are not written by actual employees or ex-employees, as was the case with JobVent. I cannot find information on who purchased and now owns Jobitorial, but rest assured whoever it is has a stake in making sure those real reviews, by those real employees as you will see below, will never see the light of day again.)

It's hard to explain just how frustrating a company like this is to work for. The mantra is "A Business of Caring" yet they offer employees the worst benefits package possible, do not award workers for exceptional performance, and often give credit to the completely wrong department (usually because of office politics).
It's become a very large pump-and-dump scheme. Senior management is doing everything it can to milk out the last drops of value in the company, pump the share price up as high as it can go with misleading numbers that will only sustain themselves in the short term. Keep the bubble high, then cash out before it implodes.

They have a business montra of "A Business of Caring" we can't figure out who they care for except the top tier management. They treat their employees as if they are on the way out the door at all times and we don't do justice for the customer, since they have production quotas on all work and when you hurry you can't do a good job. The continuously get rid of people with many years of service. Our insurance for the employees is horrible. We have had to start getting our prescriptions from Canada to get better prices. Almost all employees are on blood pressure meds and mood altering drugs from the doctor. My doctor said all of his CIGNA patients were on Blood Pressure meds and either Prozac or Zoloft or some other depression treatment.

RESPECT: What the heck is that. I was a teacher for 6 yrs before coming here, thought I knew what that word meant, however, i had to constantly look it up to make sure that I had it right! I have LUPUS, was on intermittent FMLA and the stress of this job kept me sick, but i continued to go in sick. My doctor even filed an Americans with Disability Act form request for job modifications for me to work from home. They denied it, found out recently that I can have a Million dollar lawsuit against them. I was promiesed that I could work from home, that is the only reason i stayed, but when it came time for the review, they acted clueless.

I have been with CIGNA for almost 20 years and couldn't be happier. Granted, over the years there have been numerous incompetent managers. People that had no business in those types of positions, and that had no idea how to "manage" people. But you just try to outlast them, since you know they're not going to be in that position for too long.

I worked in the claims department for a few years. And while the pay was only average, that's expected when all you do is data entry with minimal analysis and required skills. The overtime that was available made up for the pay. During my years in claims, I never made less than $36,000, and made as much as $53,000 during years I worked a lot of overtime. I averaged about $46,000.

If you would enjoy micro-management and being treated like a dog, go work here.

The pay was decent, but the health care benefits arehorrible. Being a manged care company, Cigna makes all of their employees select a consumer driven health plan. Basically it gives you the illusion of health care coverage, but you have a very large deductible to meet, which with a family you are often going to have a lot of out of pocket expenses.

Co-worker competence is nill, no one can take the time to help you out in a pinch with a claim, because they are tooooo busy pushing claims thru the system for their NUMBERS. And what I mean by pushing their claims thru the system I mean it! Claims should be analyzed for errors that is the whole reason it came to you in the first place. Instead, they just hit the magic key and Good-bye claim.

And my personal favorite, despite bad spelling, since it's from Dallas and from the Claims Department--the same department that denied Paul's claim. This is all you need to know:

From Dallas, TX — 09/21/2006

Category	Rating
Pay	-2
Respect	-4
Benefits	-2
Job Security	2
Work/Life Balance	2
Career Potential/Growth	-5
Location	3
Co-worker Competence	-4
Work Environment	-2

I worked here as a Claims Manager for 3 years. The pay was average for a college grad coming out of school, but the raises were autrocious. A 1% raise was considered the norm. Respect was non existent. Management had unrealistic expectations of the job, without knowing how to do the job at all. You are talked too in a horrible manner by claimants and expected to grin and bare it. Incompetence was rewarded, and as long as you went to happy hour with the right people you were positioned to move up into roles created for you. The Vice President's wife worked there and to this day if you ask anyone what she does it is simply listed as "projects" no one even knows her job title. Ethics were not present in management. People would get fired for not being liked. People were denied raises and promotions because management preferred to hire friends and family. Management was like a clique in which people would talk about employees behind their backs and laugh at them. People were denied raises because their manager did not like them. There were constant law suits filed against the company due to sexual harassment and racial discrimination. Even those these law suits came every year, managment never changed its stance, and no one was ever let go for their behavior. In terms of benefits, even though it was an insurance company, it had the worst benefits. The Flexible Spending Accounts were black holes, which if you didn't spend it at the end of the year you lost it. Disability Insurance was not available to Disability claims managers because there was a fear we knew how to "play the system".

Health Dialog, Foundation for Informed Medical Decision Making, CIGNA's Revolving Door and Why Your Health Care is Now One Word, Part II

2009-10-27T09:31:00.000-07:00

Continued from this post, yesterday.

"To directly address unwarranted variation in healthcare" (one word). What's this all mean?

It means someone is paid to doodle-up some fancy PowerPoints peppered with their trademarked, registered and service-marked terms and busy-sounding business words like "actionable and measurable solutions for your population" to try and make yet another company believe that everyone not involved with The Corporation has the potential to wreak havoc on the bottom line.

Then after they've convinced the Person-in-Charge to pay for this, thanks to their imaginative PowerPoints and impressive cast of PowerPoint presentation givers, they get to implement their proprietary solutions, which usually run over-time and budget, but hey, we're helping you save money!

Health Dialog provides Collaborative Care^SM services to health plans and employers. Collaborative Care supports individuals and families across the entire continuum of healthcare needs through Shared Decision-Making^®-certified Health Coaches who are supported by advanced predictive modeling and information technology.

Oof, can you believe someone got paid to write that? Shared Decision-Making®-certified coaches, huh? Is there a Kaplan book I can buy to study for the certification process?

The whole reason for the existence of Health Dialog is to make money by trying to build a case for excessive costs in health care that may affect me, Mr. CEO, of XYZ Corporation and my shareholders.

Health Dialog has this to say about health care and its associated costs.

If you live in northern Idaho, and you develop back pain, chances are good that you’ll undergo surgery to treat your pain. Move to the southern tip of Texas, however, and the chances that you’ll undergo that same surgery will drop by a factor of 6. The surgery is no more effective in Idaho than it is in Texas. It’s just that doctors in the northwest are more likely than those in southern Texas to recommend surgery. This phenomenon, in which doctors practice medicine differently depending on where they’re from, is called practice pattern variation. And it isn’t limited to treating back pain, or even surgical decisions. There is also variation in treatment for chronic conditions, such as use of beta blockers for individuals with Congestive Heart Failure (CHF) or lipid testing for those with diabetes1.

Sighting Wennberg's paper on Medicare spending does nothing to address the influence of private insurance on the cost of medical spending--Health Dialog's customers aren't involved with Medicare. This is all workplace insurance we're talking about. Private insurance with large salaries to CEO's, stock options and high Wall Street expectations.

Taking a good look at private health insurance, their monopolies and the variances in state laws would be in order when it came to Health Dialog's business, wouldn't it? They could better address the problems inherent with the rising costs of health care and not just site practice pattern variation as a major issue with costs.

But large insurance corporations, like CIGNA, don't have much interest in cutting their costs except by figuring out how remove as much spending to the consumers and practioners as possible, like lowering reimbursements to physicians or denying claims and treatments to premium payers. See my post here. And visit the Center for American Progress.

So why would they SPEND all this money on Health Coaching? Altruism isn't in their vocabulary, I assure you of that.

Let's go to a specialist; another consultant and see what he has to say about practice pattern variation.

The folks at SignalHealth have published an interesting paper on practice pattern variation in Medicaid within New York State. I've been interested in variation, small area analysis and the results thereof ever since reading John Wennberg's seminal study of hospital discharge variations in New England, and Signalhealth's contribution is quite useful.
For those not quite as geeky about these matters, practice pattern variation is simply the geographical differences in medical practice for similar demographic groups. Or, why do people in New Haven have significantly fewer hospital admissions than those in Boston (to quote Wennberg).
One of the problems with this somewhat-arcane topic is what do you do with the information? Yes, there are significant public policy implications involved here, but what could an employer, insurer, or managed care firm do about practice pattern variation?

Arcane topic? That's because Wennberg's first artcle on this topic was published in 1973. And who is John Wennberg? He's the senior policy adviser over at Foundation for Informed Medical Decision Making. The Foundation is a non-profit. Says so on their website.

The Foundation does not accept funding from any source with a financial interest in any particular approach to medical testing or treatment. In addition, foundation employees and clinical content experts do not accept support from companies that commercially market any kind of treatment or device that might be relevant to a program. Much of the Foundation’s funding is derived from a unique partnership with Health Dialog.

So the Foundation for Informed Medical Decision Making gets most of their funding from Health Dialog. But they do not accept funding from any source with "...particular approach to medical testing or treatment. " Okay. But they accept funding from Health Dialog. And Health Dialog does things like this:

Our program is also shown to reduce surgeries appropriately for coached individuals. Research shows that the Shared Decision-Making® approach can reduce surgeries appropriately by as much as 20-40%. Additionally, the program delivers significant improvements in diagnostic tests and medications that are key indicators of clinical quality¹. For example, the program increased:

Lipid testing and prescriptions for members with CAD

Use of Beta Blockers for members with CHF

Eye exams, lipid testing and prescriptions, and microalbuminuria testing for diabetics

Sounds like an "approach to treatment" to me. And Health Dialog is a wholly owned subsidiary of BUPA.

Of course, to complete the cycle, guess who does business together?

"Educating consumers about their health care options and choices is an important part of addressing unwarranted variation in health care, a problem Health Dialog has been working to identify and address along with the Foundation for Informed Medical Decision Making since our inception," said George Bennett, Chairman and CEO, Health Dialog. "We are extremely pleased to be collaborating with CIGNA to help address this issue.

Back in 2003, Health Dialog also sold their goods to Fidelity Investments.

While many care management programs serve the critically ill who account for less than 1% of the population, the Health Dialog program offered as part of Fidelity's services broadens support to participants with chronic conditions and significant medical conditions, which can account for as much as 50% of total health care costs in some commercial populations². Health Dialog engages and supports these employees through its Health Coaches as well as unbiased, evidence-based electronic and print communications to help them work with their physicians to select the most appropriate care.

Health Dialog's Health Coaches - available by telephone or online at virtually any time - are certified in Shared Decision-Making^®, a methodology that helps patients understand the risks and benefits, and outcomes of available treatment options, recognize and express their own values and preferences, and ask their physicians for answers to the questions that will help them evaluate their health care options. Participants can work with their physicians to navigate the health care system, make informed treatment decisions, and improve the management of their conditions - resulting in more appropriate care and better-managed health care costs.

For example, a patient with lower back pain who is considering surgery can speak to a Health Coach to learn about all treatment options, including any non-surgical, less-invasive treatments that may be appropriate.

Whatever happened to just talking to your doctor and not some disembodied voice over the phone or internets with not one iota of interest in your personal health and well-being?

Oh, that's right, that involves reimbursement to your doctor and we all know what practice pattern variation can do to costs. Let's just have you talk to a Health Coach. Let's remove your doctor from the equation as much as possible.

I don't want to pay for a Health Coach, I want my premiums to pay for my doctor.

This country needs a National Plan because we should have a choice. I would like to choose not to be a part of a private plan because I am positive my health is not relative at all--just how much money can be made from me--or not.

Welcome to the Blog, Cyveillance

2009-10-26T11:10:00.000-07:00

Thanks for stopping by! Who are they? Here, here. here and here.

Billionaires for Wealthcare at AHIP Conference--Brilliant!

2009-10-23T12:34:00.000-07:00

Further Evidence of CIGNA's Denial of Claims Based on Profits and not Medical Evidence

2009-10-23T09:24:00.000-07:00

From the Center for American Progress is this posting by Scot J. Paltrow, "Insurers’ Black Box, Now-Secret Claims Denial Rates Could Tell Consumers a Lot About Their Insurance Company."

Because of the nature of the pending legislation, especially the Baucus Bill, which is an outright gift to the insurance companies, we consumers would have the ability to go "shopping" for health insurance. But it's hard to buy a good product when there is a fundamental lack of information about the product you are buying and the behavior of the company you are buying into.

(It's also hard to buy a decent product when your choices are limited thanks to a legal monopoly, which will, hopefully, being going away. And I would ask Mr. Mackey of Whole Foods to read Mr. Paltrow's well-researched posting regarding insurance and consumer choices after his Murdoch-owned WSJ opinion piece full of hot air.)

Explained is how insurance companies hold on tightly to information that would be beneficial to the consumer, such as the rate at which they deny claims, which is pretty much a key piece of information needed when assessing an insurance product. Emphasis is mine.

But health insurance companies don’t disclose the percentage of claims they reject and decline to pay. And inquiries by the Center for American Progress show that the nation’s insurance regulators have not asked them to do so.

Remember, insurance is regulated by each individual state. And this, along with McCarran Ferguson (which may be going away sooner than later) is why insurance companies can operate under a veil of secrecy. The states need help in regulating the "business of insurance." Even the NAIC has said so. "The NAIC recognizes that the nation’s health care crisis is beyond the capacity of the states to solve independent of federal reforms."

As for the insurance companies releasing claims data themselves?

CAP also asked each of the nation’s seven largest for-profit health insurers—Aetna, Anthem Blue Cross Blue Shield, Cigna, Coventry, Health Net, Humana, and UnitedHealth care—if for the purposes of this report they would disclose their overall rates of claims denials and breakdowns by reason for the denials. All of the companies declined or did not give any direct response to the request. Spokesmen for the companies in general said that the insurers pay the vast majority of claims, and that denials are fair, with most occurring for routine reasons such as a patient erroneously submitting the same claim twice or a physician sending a claim to the wrong company.

Declinced or no response and said "that denials are fair." I have an aresenal of proof against that statement.

Only one state, California, has required the insurance companies doing business here, to release their claims data. The data released in California shows that 30% of all claims filed within the first 6 months of 2009 were denied and that Gasp! insurers may be going beyond "reasonable standards" and "may be improperly using claims to boost profits."

Anyway, what is most bothersome is who is making the decisions to deny claims. Doctors? You know, the men and women who actually went to Medical School?

The most sensitive and potentially controversial claims are those based on medical criteria—such as whether a treatment is medically necessary or should not be covered because it is deemed experimental. CAP learned in interviews with former senior medical personnel at several of the largest insurers that big insurers—including Aetna, Cigna, and UnitedHealth care—made internal changes in recent years that gave business executives more direct authority over the companies’ doctors who evaluate claims based on these medical criteria.

Insurance companies had previously maintained a separation between the medical evaluation staff and the executives responsible for financial performance. The doctors and nurses reported to the companies’ chief doctor—known as the chief medical officer—who had final say on whether coverage for a particular individual’s treatment should be granted or denied based on medical criteria. But beginning about a decade ago, in a shakeup that evidently received no public attention, companies changed their policies so that the medical staff reported to regional business executives. These executives were given the authority to determine the doctors’ pay, bonuses, and promotion, and consequently they gained the power to influence the doctors’ decisions. The new systems generally kept “dotted line” reporting to the chief medical office, who would still weigh in on the most difficult claims decisions.

Former Cigna Executive Wendell Potter said that having medical directors report to business managers “means they are part of a team that is very much involved in making sure that the company is profitable at all levels.”

I would say to all the doctors who bought into the Faustain deal (stock options, big offices, 2 martini lunches and no patients to see, what?) of working for an insurance company, "Get out now, while you still have an inkling of what your Hippocratic Oath was for."

When we reach this point in our health care, we no longer have any control over our health. None. Your own doctors don't have control either. The only ones calling the shots are the corporate grunts trying to keep their jobs by denying you medical care.

For example, from the posting:

Insurers say that they base decisions to turn down claims only on objective, clear-cut standards, but individual stories highlight that companies at times can take wide latitude in applying them. For example, records from a federal lawsuit in North Carolina show that Cigna of North Carolina refused to pay for specialized treatment for a baby born with a severely deformed skull. The baby’s doctors wanted to use an orthotic device to help mold her head into a more normal shape as she grew. The doctors said that without the treatment more medical problems could ensue, such as a worsening malformation of her jaw. Cigna declined to pay on the ground that such treatment was a “cosmetic procedure.” A 2002 federal appeals court decision noted that Cigna never provided any definition of “cosmetic procedure” in its policy and ordered the company to pay.

What further proof do we need that we are at a tipping point in our society? We need a National Plan like every other civil and industrialized nation in the world.

Dude, Senator Dianne Feinstein, Democrat from California, is Like, Totally Awesome

2009-10-22T11:24:00.000-07:00

I write to my Senators and Congressman and sometimes, I get answers. Senator Feinstein sent me an email response (okay, she probably sent it to all her constituents who wrote to her) but check this out, the McCarran Ferguson Act of 1945 is set to go bye-bye and with it the monopoly the insurance companies have benefited from for the past 64 years. Now, it's a first step and a good one, but when it comes to health insurance specfically, they need to address the ERISA laws as well. And from Rachel Maddow's show last night this:

At the beginning of the day today, the health insurance industry and Major League Baseball had one thing in common. They both enjoyed a privileged status, courtesy of the federal government. Unlike other industries, health insurance and baseball are allowed to be monopolies in this country.

Major League Baseball gets to operate without competition from other baseball leagues, and health insurance companies are exempt from the federal laws that block every other industry, just about from doing things like price fixing, or tactics that aren't fair to the competition.

Health insurance and baseball-two industries in this country that, as of today, have special permission to not have to compete. It's a nice work if you can get it, right? Well, as of today, one of them might not be getting it anymore. It looks like baseball might be the only industry of those two that gets to keep that special position.

Today, Democrats in Congress move to end the 64-year-old exemption that allows the health insurance industry to basically act as a monopoly, by a vote of 20-to-nine, the House Judiciary Committee voted to strip the health insurance industry of its privileged status.

In the Senate, Democrats announced today that they intend to do the same thing in coming weeks.

Letter from Senator Feinstein:

Dear Mrs. Welman Paez:

Thank you for writing to express your support for S. 1681, the "Health Insurance Industry Antitrust Enforcement Act." I appreciate hearing from you and welcome the opportunity to respond.

The escalating cost of health premiums continues to make obtaining health insurance difficult, if not impossible, for many Americans. I believe that all Californians should have access to high-quality, affordable health care services and reducing healthcare premium costs is absolutely essential in this regard. As you may know, the insurance industry is one of the few industries that has an exemption from Federal antitrust laws. Between 2000 and 2007, combined profits for 10 of the country's largest publically traded insurance companies rose 428 percent. I believe it is important to ensure that the health insurance marketplace remains a vibrant and equitable forum where businesses compete fairly and comply with applicable guidelines.

On September 17, 2009, Senator Patrick Leahy (D-VT) introduced S. 1681, the "Health Insurance Industry Antitrust Enforcement Act," and I am pleased to report to you that I am an original cosponsor. This legislation would eliminate the antitrust exemption for health insurance and medical malpractice insurance companies when they engage in anti-competitive behaviors, including price fixing, bid rigging, and market allocations.

S. 1681 has been referred to the Senate Committee on the Judiciary, of which I am a member.

Again, thank you for writing. I hope that you will continue to keep in touch on issues of importance to you. If you should have any further questions or comments, please feel free to call my Washington, D.C. staff at (202) 224-3841. Best regards.

Sincerely yours,

Dianne Feinstein

United States Senator

Image above from Wikipedia.

Andy Bichlbaum of The Yes Men at Brave New Studios

2009-10-22T11:23:00.000-07:00

Paul and I got to go to Brave New Studios yesterday and be part of a Q & A with Andy Bichlbaum of The Yes Men and see some scenes from their movie, The Yes Men Fix the World. I am sorry I didn't ask Mr. Bichlbaum how he got started, really, you know, what was the defining moment that made him realize he was on to something, but maybe next time.

Brave New Studios, is home to Robert Greenwald's Brave New Films and his great exposes on the health insurance industry--to name a few.

The Yes Men are a group of comedic activists who, instead of employing the usual methods of protesting, sign-waving and sit-ins, use a more audience-engaging way of exposing the hypocrisy, ills, inequities and nastiness at work in our world (like corporate greed over the well-being of humanity). They use well-staged and well-acted pranks.

And when the media gets involved, the power of their work is amazing and that much more effective--all messages need an audience. See Mr. Bichlbaum's interview on the BBC when he was impersonating a Dow Chemicals executive apologizing for the Bhopal, India disaster that killed 3,800 people.

Another example of their civil disobedience is The Survivaball, manufactured, of course, by Halliburton.

Now, I wonder if Halliburton was also responsible for the Blancmange?

The Bellicose Nature of Health Insurance Companies, an Example of Interference by WellPoint

2009-10-21T09:10:00.000-07:00

Health Insurers like to fight for profits. It's as simple as that. And their tactics keep getting dirtier.

Some of the arguments thrown around by those opposed to health care are "government will be calling the shots about my health care," and "I don't want a government bureaucrat coming between me and my doctor." Having witnessed, first-hand, how Medicare works as I was taking care of my mom at the end-stage of her life, I know that no government anyone or anything came between her and her doctors or care.

This came to me today from Health Care for America Now and it's a story we have been hearing over and over again: An Insurance Company Interfering With Treatment. Thankfully, our government helped Ms. Shouse as she wound up being eligible for both Medicare and Medicaid. They paid for the new chemotherapy treatment that WellPoint refused to pay for.

Our government's programs extended her life. Even though she was diagnosed with end-stage cancer and given a few months to live, her chemotherapy treatments have managed to keep her alive for 4 years. What would that mean to you, if you were this ill and given the necessary treatments to help you live? Life is more important than corporate profits. As a taxpayer, I am more than happy to help pay for a national plan.

A video interview from a Fox affiliate is here.

This article is by Shawn Chubb from Suburban Journals covering the St. Louis Metropolitan Area and surrounding Missouri and Illinois counties, Emphasis is mine.

Melanie Shouse is grateful for her dark sense of humor.

It helped her see the humor when she was told she "hit the jackpot" by having terminal cancer. It meant that she would automatically get Medicare as soon as she was eligible.

Shouse, 40, of Overland, was diagnosed nearly four years ago. She had put off going to the doctor because she knew she couldn't afford health care costs. She had a catastrophic health insurance policy with a $5,000 deductible. She calls it "hit by a bus kind of insurance."When she did seek care, she went straight to Siteman Cancer Center.

"By then, I could have been diagnosed from across the street. It wasn't a surprise," she said.
Shouse would like to see all Americans get the health care coverage provided to federal employees. Through the Federal Employees Health Benefits Program federal employees and retirees and members of Congress can choose from a pool of insurance plans.

Shouse, who had co-owned Sweet Meat Stix, a beef kabob business in St. Ann, had only carried the catastrophic policy. Her business partner, Steve Hart, also carried a catastrophic policy. He has since battled liver disease.

Shouse said they could only afford such policies because they saved, borrowed and maxed out their credit cards to start their own business. They previously had sold their product at festivals, but opened a store in 2004.

It was only after spending $30,000 to transform a former Domino's store into a business that Shouse noticed her first tumor. She finally was diagnosed in October 2005. She soon became too ill to work.

Once on Medicaid, a lawyer provided pro bono work to apply for her to get Medicare. That's when she learned Stage 4 cancer is a "jackpot" diagnosis for being certified disabled and receiving Medicare - after a two-year waiting period.

Her bills are now mostly paid by Medicare and Medicaid. What bills remain go into a pile that she never looks at. That still does not keep her from having to worry about health care.

Shouse is now on her third round of chemotherapy to fight off the bone cancer and liver tumors. That treatment did not keep her from becoming bedridden for a month this spring. She was then given Avastin, a biologic therapy that costs $6,500 for a two-week supply. Since then she has been able to keep food down and "get off the couch." Her insurance provider has since sent her a letter saying it won't pay for Avastin.

"The insurance bureaucracy shouldn't stand between me and my doctor and treatment," Shouse said. "Like they know more than a world-renowned oncologist."

Why does Avastin cost so much? If you go to this website Free Bee Foreign Pharmacy, about purchasing the SAME drugs from another country, you will see we get charged WAY more in the United States than in Canada. Why? Because Big Pharma knows that the insurance companies will pay--except when they won't, like in Ms. Shouse's case. And this is where WellPoint is playing God. This is where insurance companies are insinuating themselves into our health care. They simply should not--they are insurers and not health care providers. Or they should get out of the business. Oh yeah, collecting premiums from large risk pools without any competition is hugely profitable and when we create our own barriers to prevent us from having to pay out claims, it's even more hugely profitable. Never mind there are people we cover who are really sick and need help. No one can stop us, we're immune to anti-trust laws.

A National Plan, like Medicare, would allow us all access to any of our health care professionals, without worry of in-network or out-of-network coverage:

In some cases, patients may feel they have no choice but to go outside a network. Last October, Stacey Herzlinger, a 29-year-old police officer in Northern Virginia, was at a conference in Orlando, Fla., when she had severe stomach pain. Ms. Herzlinger called her in-network doctor back home, and was told to go to an Orlando emergency room, where she was examined and received medication — and a bill several weeks later for $3,168. The hospital said her health plan, UnitedHealth, would not pay because she had gone out of network.

“It was excuse after excuse after excuse why they weren’t paying,” said Ms. Herzlinger, who has hired Mr. Flynn to work with her on getting reimbursed.

While not commenting on the specifics of Ms. Herzlinger’s case, UnitedHealth says that emergency-room visits are typically covered under its plans and that it works with customers to resolve any concerns they have with their bills.

...or any of the other ridiculous insurance-created barriers that have been put in place to limit our access to decent care and inflate their profit margins. These are the bureaucrats between you and your care.

Found this at Reuters and McCarran Ferguson Post is Coming Along--Slowly...

2009-10-20T00:03:00.000-07:00

I saw this at Reuter's, "Placebo effect is in the mind as well as the spine" by Ben Hirschler, and was immediately interested because of the spinal cord activity. And the fact that the mind was able to induce this response with a placebo.

With Paul's MS, he has several lesions on his spine and those lesions have a profound effect on his motor skills--and his pain.

This research was done on men without any demyelination of their spinal cords, but the response to dampen pain was real as measured by functional MRI. Possibly this response could shed light on demyelination patterns in the spinal cord and why some MS patients have no pain, while others range from mild pain to sometimes very severe pain like Paul has.

It's not all in the mind -- the so-called placebo effect is real and reaches right down to the spine, German scientists said on Thursday. The finding may help in the hunt for better ways to tackle pain and other disorders.

Using modern imaging technology the researchers found that simply believing a pain treatment is effective actually dampens pain signaling in a region of the spinal cord called the dorsal horn, suggesting a powerful biological mechanism is at work.

"It is deeply rooted in very, very early areas of the central nervous system. That definitely speaks for a strong effect," lead researcher Falk Eippert of the University Medical Center Hamburg-Eppendorf told Reuters.

Eippert and colleagues used functional magnetic resonance imaging, or fMRI, to study changes in spinal cord activity. They applied painful heat to the arms of 15 healthy men and compared the spinal cord responses when they thought they had been treated with either an anesthetic cream or a placebo.

Both creams, in fact, were inactive but the fMRI scans showed nerve activity was reduced significantly when subjects believed they were getting the anesthetic.

Hey, Health Insurers Your Free-Ride at the Expense of Sick Americans is Coming to a Close!

2009-10-17T11:32:00.000-07:00

I found this post via the Huffington Post. It's from Norman Goldman's website. Mr. Goldman is an attorney and hosts his own talk show. You can listen here. Why I have highlighted this posting and Mr. Goldman is because his experience as an attorney gives him insight into the legal free-ride the Insurance Industry has had over the past 64 years since Congress passed the McCarran Ferguson Act in 1945.

The list below (in blue) is taken directly from the link above and remember, this is all due to the McCarran Ferguson Act and the Insurance Industry's legal exemption from Federal Anti-Trust laws. And the three things they demand at the end of Mr. Goldman's first list--why those three items are in the bill from the Senate Finance Committee--the one Max Baucus and his counsel who used to work at WellPoint drafted for us.

Insurance companies have 10 things already:

1) No rate regulation;
2) No rate caps;
3) No competition;
4) No federal regulation;
5)Anti-trust exemption;
6) ERISA protection (podcast my Oct. 8, 2009 show for lots on ERISA);
7) Domination of state regulators;
8) Pre-existing conditions to cherry-pick only the customers they want;
9) Rescission to dump patients who cost them money;
10) Life time caps to limit their liability and exposure to paying claims.

BUT WAIT, THERE'S MORE!! They now demand three more things:

11) A federal mandate to buy coverage;
12) Whopping penalties to enforce the mandate and make our government their enforcement and collection agent;
13) Whopping subsidies of tax dollars (some call it money laundering) to pay for their overpriced, crappy product.

This is why the Health Insurers will do anything to prevent Health Care Reform. From spending millions in lobbying fees; paying off our esteemed members of Congress, most notably members of the GOP to whom campaign money is more important than their constituents, sponsoring fake grassroots events, disseminating outrageous lies to a gullible American public already crazed by 8 years of the antics and expenses of Bush/Cheney (some of whom will believe any crazy claim since they can't fathom they have an African-American president) to threatening us with raising premiums if reform passes.

You are solely in control of the premiums you charge, CIGNA, WellPoint, Aetna, Humana, etc, and reform scares you, it's why you use it as the excuse to claim "premiums will rise." The threat is hollow. We know you will raise premiums regardless, as it's what you do. We're calling you out. Your free-ride at the expense of sick Americans is over.

Want to Know How Much CIGNA and 26 Other Insurers Made Just From Long and Short-Term Disability Premiums?

2009-10-16T11:01:00.000-07:00

They made a $1.3 billion killing! And this is only the mid-year report. You may wonder, like we do, why they all DENY claim after claim when they're raking it in like this? It is, after all, a risk pool. Take in a lot, pay out a little, right? Picture of the Billionaires below says it all.

Link to report about disability earnings here--in all its glory.

It's a very interesting read. For instance, The Hartford, you know them, they took $3.4 billion in bailout money, well, they reported the biggest profits in 3 out of the 4 categories for both long and short-term disability sales and earned premium results. How's that make you feel, Joe and Jane Taxpayer? I can tell you how we feel since The Hartford was the underwriter of my husband's LTD policy with CIGNA. It makes me realize I will not stop pointing out their egregious behavior when they profit from a man like my husband with Progressive Multiple Sclerosis. I. Won't. Stop.

The report was done by JHA. From their website:
JHA is the disability and group life reinsurance, risk management and research division of General Re Life Corporation, which conducts business as Gen Re LifeHealth. Gen Re is one of the first and largest reinsurers in the world, and has superior financial strength ratings from the major rating agencies.

From the report:

JHA is pleased to present the 2009 U.S. Group Disability Mid-Year Market Survey. This annual survey provides the industry with an opportunity to benchmark sales and market growth for group disability products (LTD & STD) for the first half of the year. With 27 insurance carriers participating, the 2009 Mid-Year Market Survey covers approximately 95% of the group disability insurance marketplace. Unless otherwise stated, survey results are for Traditional and Voluntary business combined.

Sales Premium
On a combined basis (Total LTD & STD), group disability sales premium totaled nearly $1.3 billion at mid-year 2009. (Exhibit A) For companies providing comparable data for both years, results were unchanged from mid-year 2008.

CIGNA and all the Other Insurance Vipers (apologies to the Viperidae family), The Baucus Bill of Shame and an Interview with Wendell Potter at Truthout.org

2009-10-16T08:10:00.000-07:00

You and I are paying for it, America!

Max Baucus--What a Guy!

Snowe Job? Insider Says Senator Is "Disingenuous or Naive"
Thursday 15 October 2009
by: Greg Palast, t r u t h o u t | Report

"Potter, once vice president of CIGNA, told Truthout.org that, "The insurance industry, if it were honest" would admit that it "loves" the Senate Finance Committee's version of the health care legislation as the bill provides nearly half a trillion dollars ($461 billion) in subsidy payments directly from the Treasury to the industry."

The quote above came from Truthout.org, link here, in an interview with Wendell Potter, former CIGNA executive. It once again highlights the disconnect between our elected Public Servants and the needs of their constituents when they think they can snow job us with the Baucus Bill of Shame that gives money right back to the Insurance Industry. Would that be taxpayer money? To deny even more claims with? Swell.

Blogger Me This

2009-10-16T00:01:00.000-07:00

Here we see Senator (I so love our love of things Greek and Roman) Homer Ferguson (right for Republican) and Senator Pat McCarran (left for Democrat) of the McCarran Ferguson Act of 1945 that rendered the "business of insurance" exempt from federal anti-trust laws. It's why the business of insurance is left up to the states. There is no federal authority over the insurance industry. It is also why you cannot sue your insurance company for anything beyond the terms of your policy if they have done something wrong, like deny coverage or drop your policy for getting sick.

Now Blogger Me This, what could have so possessed them both to align themselves with the Act bearing their names that rendered the "business of insurance" exempt from federal anti-trust laws? Answer on Monday. Well, the somewhat uncomplicated version anyway. Both photos taken from Wikipedia.

John Boehner, High Priest of The Freedom Project, Rejecter of His Constituents' Needs and All-Around _________(fill in your own adjective.)

2009-10-15T00:01:00.000-07:00

I wonder at what point during the process of becoming a Public Servant does the total disconnect begin--you know, does it happen before they enter office or does it happen somewhere along the way of navigating the duties of public office or does it happen the first time the scent of money being deposited into their campaign coffers rushes to their eager nostrils intoxicating them beyond all rational hope--but at what point do these senators and congresspeople become so amazingly detached from the reality of their constituents that they can go on camera and say this:

Johnny has the state of Ohio and his constituents trying desperately to talk him off that Lobbyist ledge of decadence he's been standing on for a while now. Visit them at ProgressOhio. Boehner exposed at the Buckeye State Blog as well.

Didn't the Senate Get Our Mandate From the Masses?

2009-10-14T00:01:00.000-07:00

Help! I'm a premium-paying insured American and I'm being repressed. And we got rid of our king-issues a couple of hundred years ago, yet here we are still fighting the tyrants who would have us kneeling before their great throne of private health insurance profits.

We traded one despot for a whole group of them: CIGNA, WellPoint, Aetna, Humana... Wonder if the CEO's don powdered wigs for those executive team building retreats they go on.

What Do You Get When You Cross 21 Federal Judges with Fidelity Investment's Associate General Counsel (among others), Insurance Companies, Big Pharma and an ERISA Litigation Conference?

2009-10-12T10:09:00.000-07:00

A royal screwing over of the Insurance-Premium-Paying American Public.

What am I talking about? Why the ERISA Litigation Conference. What's this all about? Taken directly from the site (it won't be up much longer as the Conference is scheduled for October 19-20), but here's the link just the same. Never fear, I have a link to the official conference information below.

The premier ERISA litigation conference devoted entirely to the defense of claims, led by an unparalleled faculty of 28 in-house counsel, 21 federal judges, and the top outside counsel defense litigators and firms.

The volume of ERISA litigation has greatly increased. The cases are complex and the stakes involved for defendants are exceptionally high. There are huge variations in the types of cases that arise under ERISA, as well as substantive differences involved in defending against the various claims. The best plaintiff attorneys are getting into these cases because, among other things, they can recover attorney fees. As a result, the defense bar is seeing more and more class actions, with the top ten settlements for ERISA-related class action cases topping $17 billion in 2008.

Wow, entirely dedicated to the DEFENSE of CLAIMS. Well sure the volume of ERISA litigation has increased when all the insurance companies DENY claims. So they have to get together and figure out how to better defend against these claims when they come up as lawsuits.

Funny, if they didn't deny valid claims in the first place, like say denying a man with Progressive Multiple Sclerosis his benefits, maybe they wouldn't have this problem. Oh wait, they'd lose all those obscene profits if they had to pay out what they are contractually obligated to do. (They'd still make money because it's a risk pool.) But how would H. Edward Hanway rake in millions upon millions each year if CIGNA actually serviced their customers?

But the most insidious fact in all this is that 21 Federal Judges will be in attendance at this lovely get-together where the main topic is the DEFENSE of claims. And good thing I downloaded the PDF and uploaded it for you for this shindig, as now they want you to register before you receive the information.

What are they trying to hide? Oh yes, the fact that 21 Federal Judges are rubbing elbow with the Insurance Industry at a very lovely hotel in New York--with wining and dining and all the other things that make conferences so enjoyable, like Broadway Plays. Hey, Mama Mia! is still playing at the Winter Garden. Think of the sing-a-long to Money Money Money they could all bond over.

But aren't judges supposed to be impartial? In case you are wondering, here is the Code of Conduct for United States Judges. I see a problem. What kind?

Let's look at what this Evil Gathering will be talking about for 2 days, shall we? From the PDF:
In-House Think Tank on Containing Costs, Preventing and Managing Litigation & Using the Claims Review Process to Set Up, Control and Strengthen the Defense

Well I sure as hell wouldn't want the judge hearing my case to be spending time listening to defense attorneys and insurance plan counsels explaining how to use the claims review process to boot my claim out of court. I don't think that is serving justice.

Preventive Measures to Eliminate or Mitigate ERISA Exposure
• Internal compliance assessment and making sure your ERISA house is in order – Knowing the plans, fiduciary roles, insurance coverage issues, and contracts well before a lawsuit is filed

Once a Suit is Filed for Benefits Under an ERISA Plan, How to Address Evidence Outside the Administrative Record, Standards of Review, Conflicts of Interest & Discovery

Address evidence outside the administrative record. You know, like important medical records. Unbelievable.

And my personal favorite:

Evidence Before the Court
• Dealing with the case as it is handed to you following a poorly handled administrative process
• Defending the adequacy of administrative claims review
• Limiting the evidence that plaintiff attorneys can present regarding the claim

Federal judges are going to be educated about limiting evidence attorneys can present regarding the claim? Sickening, isn't it? And check this out below, the panel of the Federal judges and what will be discussed.

View From the Bench: Federal District & Magistrate Judges Speak out on How to Convey Complexities to a Court (including a Plan and the ERISA Statute), Effective Theories/Defenses, Evidentiary Approaches, Statute of Limitations, Deciding Cases Early, Discovery, Forum Shopping and More
• Early defense considerations (motions to dismiss, preemption, summary judgment practice)
• Novel approaches to case management
• Making the decision to allow or not allow extensive conflict of interest discovery
• Discovery limits
• Jury demands, motions to strike, motions to sever non-ERISA claims from ERISA claims
• Conveying the complex to the court, including the technical aspects of the ERISA statute or of the procedural differences in ERISA cases
- how to enhance the court’s knowledge of ERISA application, including the standards on recovery and discovery, scope of review issues, and procedural nuances such as exhaustion, preemption, privilege issues and the like
- explaining a plan and ERISA to the court in a simple and clear fashion – how to get the judge in your case up to speed on the terms of the ERISA plan and record and the basis for the denial of a claim for benefits

When I hear the outrage of certain Public Servants wanting to deny us Universal Health Care--hey, members of the GOP that would be you, and then I see this outrageous behavior on the part of Federal Judges, then I know what it's all about and that is Corporate America comes before The People. Hope you are all proud of yourselves, all 21 of you. Give up your robes. You are all a disgrace to the Bench.

More ERISA information can be found from the following resources.

Problem is ERISA
Families USA
The Kaiser Family Foundation

New Jersey's Largest Health Insurer, Horizon Blue Cross Blue Shield, Attempts to Boot Woman From Hospital Bed

2009-10-09T13:19:00.000-07:00

From the Washington Post today, October 9, 2009. Article by Amy Goldstein. Link here.

Health-Care Tug of War Puts Patients In the Middle
Battle in New Jersey Illustrates Problems

BAYONNE, N.J. -- One February morning, a courier arrived at the front desk of Bayonne Medical Center, trying to get to a patient's bedside. His mission: to deliver a letter from New Jersey's dominant health insurer warning that the patient would face a huge hospital bill if he did not leave right away.

Hospital security guards stopped the courier -- and 13 others who came soon after -- before they reached patients' rooms. But then came the faxes and, after that, the letters mailed to patients' doctors and homes. Told that her health plan would not pay for her to stay in the hospital, a 35-year-old social worker named Lisa with a severe lung infection was so unnerved that, tethered to an IV pole dripping antibiotics into her arm, she began to pack her gym bag before a staff member coaxed her back into bed.

The hardball tactics being used to pry patients from their sickbeds illustrate the colliding financial interests that pervade U.S. health care. It is a tug of war over where patients are treated, who decides how much care they receive and -- fundamentally -- which parts of the health-care industry gain or lose when people become ill.

The battle playing out in Bayonne has particular relevance as Congress tries to rewrite the rules that govern health care nationwide -- with hospitals, insurers, doctors and other stakeholders descending on Capitol Hill to angle for advantage. The bills before the House and the Senate would shift the system's balance of power that has evolved over decades -- a balance at the core of the dispute here.

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