cford114
07-28-2001, 07:19 PM
Emailed daily since 5/24/00 to ALL OFFICIALS AT FEDERAL AND STATE LEVELS!
Below is my original letter, now gaining national attention and also my
response to BCMH, as
well as two responses to the Ohio Department of Insurance which does not
want to accept my
complaint against United Health Care!
IF YOU HAVE A NEWSLETTER/NEWSPAPER, PLEASE PRINT ME!
This letter may sound like I am attacking and I am! Most mothers do when
their child is being
denied basic rights and medically necessary treatment! A condensed version
is not available as I
cannot condense the atrocities of what is happening to my baby!
This letter is drawing attention. We just finished a spot on WBNS TV that
was aired yesterday
with Maureen Kocot here in Columbus, Ohio. Abbee's story was published at www.fairfielddailypost.com. (http://www.fairfielddailypost.com.) A copy can be obtained by writing to
editor@fairfielddailypost.com. Also, there is a newsletter at www.insurancejustice.com (http://www.insurancejustice.com) that has
an excellent review of my letter. You can also go to
medicalreporter.health.org and see my letter
to the editor! There are several other newsletters that have picked this up
as well as several
medical journals, as well as many websites relating to Health Care
mismanagement, etc. I also
received a call from Margaret Mahoney, MD author of the book Saving the Soul
of
Medicine who is involved with the National Organization of Physicians Who
Care. 10,000
EMAILS SINCE 5/24/01 AND STILL GOING! Emailed daily to all members of House
and
Senate!
Also, TO DATE, I HAVE ONLY RECEIVED 2 RESPONSES FROM AN ELECTED
OFFICIAL. That is Mr. Hottinger. However, I've only gotten an email and
very little action. He
did place a call evidently and BCMH in turn wrote me a letter (my response
below) but changes
have not been made! And Mr. McCain, who wrote via US Mail and said he was
forwarding a
copy to Mr. DeWine and that was it! (This is even though I voted for him
AND he is sponsoring
one of the Patient Bill of Rights
Also, WTOV in Steubenville, Ohio is going to do a story about Abbee as
well.
To Whom It May Concern:
My name is Christy Ford. My daughter's name is Abigail (Abbee) Ford and
she was born
3/29/00 at OSU Medical Center in Columbus, Ohio at 23 weeks gestation
weighing only 1 lb and
6 oz and being 12 inches long. She is the light of my life! She spent
100 days in the NICU
there. She developed alot of the "normal preemie problems" such as
Respiratory Distress
Syndrome, BronchioPulmonary Dysplasia, Retinopathy of Prematurity, Reflux,
etc...
She was diagnosed about one month ago with Cerebral Palsy as well. I am
sure most of you
have children, but cannot imagine the heartache that going through an
ordeal such as we have
had with Abbee, only to have her diagnosed with cerebral palsy, has brought
into our lives.
Worse than that heartache, however, is the complete ignorance we are having
to deal with in
regards to getting this child the therapy she so desperately needs. We have
United Health Care
as a first insurance, Medicaid (Healthy Start) as a second and BCMH as a
third. The problem
lies in the fact that first of all, I think United Health Care, as her
primary insurance company
should pay for the "prescribed" therapy, as her doctor see's fit, just as if
it were an antibiotic.
They say they will only pay for 20 visits, or at least some representatives
say that. Some say you
can extend her services. Some are rude and hang up on you, etc... We have
an occupational
therapist, Brenda Brodbeck, who has been one of the few people Abbee will
let handle her.
Brenda has many years of experience and is trained/qualified to deal with 23
week preemie
babies. Others in our county only deal with older children/adults. Half of
the battle with Abbee
is getting someone that SHE will allow to touch them. This child has been
through enough and
I WILL NOT subject her to any more than she absolutely needs to be
subjected to. The
problem lies in the fact that Brenda is a BCMH provider but CANNOT become
Medicaid
certified. My daughter has three routes of payment and now that her 20
visits are up with
United Health Care, my husband is looking at getting a second job to pay
for therapy that she
needs. THIS DOES NOT INCLUDE PHYSICAL OR FEEDING THERAPY.
I wonder, if your child was in the same position, would this outrage you!
Although I am sure
you make quite alot more than my husband does for sitting in those offices
and "laying down the
law"; maybe it wouldn't be so traumatic in your case. I want most of you to
remember one
thing--you are elected officials or appointed to your posts. You are put
there for a reason and
that is to work for consumers. I am a consumer and I DEMAND better
treatment and
options than what I presently have. The following is a quote on the home
page for United Health
Care which I find a HUGE JOKE.
"The serenity of open fields, The energy of big city lights, some people
like predictability, Others
thrive on change. Each person is unique, Each has different needs and
desires. For too many
years, the health care industry has told you what works for them. We think
it's time a
health care organization turned that around and asked, "What works for
you?" Granted, this is a
dramatically different approach. But we are committed to improving the
health care experience
for everyone involved-for the employers who purchase health benefits, the
doctors who deliver
the care and most of all the INDIVIDUALS WHO USE THE HEALTH SERVICES". AND
"At
United Health Care, we believe that the people best qualified to make
decisions about health
care are patients and their doctors. We believe that Care Coordination will
promote positive
health experiences for members and restore the joy of practicing medicine
for physicians." If
you look under Invester Relations, the quotes get worse! As you can
imagine, after reading this
on their site, I pretty much wanted to throw up. This is such a lie for
those of us who actually
have to have United Health Care as a provider. The joy hasn't left Abbee's
providers, at least not
until they have to deal with the insurance company. I know that her
therapist AND her
pediatrician love her almost as much as I do. However, people like Davina
(Care Coordinating
Supervisor for UnitedHealthCare 1-800-248-8573), do not think as much of my
daughter. I think
a requirement of being a supervisor for United Health Care is to take a
class called "No
Feelings", because almost every person I have dealt with or anyone else
involved here has dealt
with seem to be made of steel. They are rude and very unprofessional. I've
made up my mind
that the few decent people I have spoken to were the "flunkies" of that
class.
The following is quoted from the Early Intervention web page as one of their
so-called
objectives: "enhance the capacity of state and local agencies and service
providers to meet the
needs of historically under served populations, such as minorities,
low-income, etc.. and
facilitate the coordination of payment for early intervention services from
federal, state,
local and private sources (including public and private insurance coverage)"
Again, I am
physically ill reading this.
And last, but not least, I found the following quote on the BCMH page: "The
Bureau promotes
early identification of children with handicapping conditions and treatment
of those children by
appropriate health care providers. ....funding services for the
diagnosis/treatment of medically
eligible conditions...collaborating with public health nurses/departments to
assist in increasing
access to care...... and assisting families to access and utilize
appropriate sources of payment for
services for their child."
Well as you might have guessed, none of the items quoted in any of these
paragraphs are
actually happening. I think the comments are there strictly for the
auditor's benefit or just for
show, because they certainly do NOT do what they say they are doing. I am
living proof of that
and there are about 300 other families in my county alone that are in the
very same situation.
I however, WILL NOT cave in to the biases/discrimination being inflicted on
me because my
daughter happens to qualify for Medicaid. I am not jeopardizing her
well-being because some
idiot sitting in an office decided that only people who are Medicaid AND
BCMH certified can
see her. Brenda knows what she is doing and more importantly has the
repoire with Abbee
to get her to cooperate and get her to do it. With Abbee--that is 1/2 the
battle!
I think that one of you needs to do something about this. Does anyone of
you besides me, feel
that it is ludicrous that I have three routes of payment and need to get out
a checkbook?????? I
would suggest you that are lawmakers look at this letter carefully. I can
assure you that I am
a very, very vocal advocate when it comes to my children. I can also assure
you that if I don't get
satisfactory results, I WILL do everything in my power to see that you are
not re-elected or
appointed. I know everyone in this town and many in many others as well as
being very
experienced updating my web page. I'll put so many signs on my house, in my
yard and on my
web page that I'll have the news team here within a day. I do know how to
get my point across.
How dare you people be allowed to tell me how much therapy is enough for my
daughter? Only
her doctor has the right to say that and you or anyone should never have the
right to override that
decision. What if one of your family members had cancer and I was able to
come in and say
"OK, we're only going to pay for 4 chemo treatments--you pay for the rest!"
What would you
do? You'd be doing the same thing I am doing right now. I guarantee it!
I would also like to say at this time that the Governor's office and Rep.
Hottinger's office has
already been made aware of this problem by Abbee's therapist, Brenda George
Brodbeck. So as
far as I am concerned, you have already had your chance and blew it and now
ought to really
look at the situation this time and fix it!!!! Brenda is very professional
about everything she
does, whether it is therapy, talking on the phone, etc. I however am
Abbee's mom and I WILL
NOT REST UNTIL I SEE RESULTS. Please do not think for a minute that I will
let this lay. I
will keep emailing and pushing and shoving and calling and getting home
phone numbers until
I get what so many of us in this county and I am sure in other counties,
need. That is to be
treated equally as consumers--not penalized because we happen to qualify for
some kind of
assistance.
Where are Abbee's rights being met here? Where are her choices?
I am supposed to "roll over" and go to the therapist/agency that the state
determines so they can
get their kickback! First of all, I will not take my Abbee to a "facility"
for her therapy as it
endangers her immune systems which is already compromised, not to mention
that I don't
have to, since Brenda makes home visits. Second of all, no matter the cost,
I do not jeopardize
my daughter's well being for anyone and lastly, NOBODY tells me who/where to
take my
daughter for her medical treatment. I DECIDE THAT AND ALWAYS WILL. MAKE NO
MISTAKE ABOUT IT. If that means more money out of our pockets, so be it!
I will be anxious to see also, just how many "real" responses I do receive
to this plea for help.
I hope that all of you take a good look at your "healthy" children and thank
God that you are not
having to deal with the "mess" that I am that was created by those of you
who sit behind a desk
and dictate other people's lives without talking to them first and getting
their input and/or ideas
or ever having a real "clue" as to what life with a "disadvantaged" child is
like.
I guess there is not any more I can say at this point except that I will
keep pushing this issue from
all aspects until there is a change made.
Respectfully,
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
CERTIFYING INDEPENDENT THERAPISTS THROUGH MEDICAID(STATE AGENCY),
SINCE BCMH (STATE AGENCY) ALREADY DOES WOULD SOLVE THIS PROBLEM.
ONE STATE AGENCY SHOULD CERTIFY WHAT THE OTHER DOES!!!!!!!!!!!!!
The following is my response to a letter received from BCMH signed by Mr.
Bryant, Director.
I wanted to let you know about a couple of things. First of all, I don't
believe Abbee's BPD is
severe enough to see a pulmonologist, or I would have been there by now.
She should be on the
program for cerebral palsy.
As far as the required paperwork from Dr. Strominger's office, he advised me
he would be
sending the paperwork the same week we saw him and I am sure he did so,
which was the week
of April 18, 2001. No one told me that anything other than what he had sent
you was necessary.
I spoke with someone in your office back in early March and they said I
needed to take Abbee to
a BCMH provider and have cerebral palsy either excluded or verified, which
is what I did. I
have done what I was asked to do and for that I get "At this time, Abigail
is not enrolled on the
BCMH treatment program". If there was something else I needed to turn in,
don't you think once
Dr. Strominger sent in whatever it was he did, you would've contacted
someone by now? Better
yet, wouldn't he have the paperwork you are requesting. Dr. Strominger, in
my opinion, did a
very thorough exam and only confirmed what we already knew.
As far as Early Intervention is concerned--yes, they did provide us with I
believe Abbee's initial
four visits and that is where we began obtaining Brenda's services. I
notice that you, like others
that have been in contact with Ms. Shaffer, feel that this all falls on the
individual provider--that
Brenda should shoulder the burden here. THIS IS NOT ABOUT BRENDA, THIS IS
ABOUT
ABBEE. Abbee's needs have been identified, by Brenda, not Ms. Shaffer, as
well as by her
pediatrician and Dr. Strominger. She NEEDS therapy and she NEEDS one of her
three methods
of payment to step up to the plate and make payment to her therapist.
Having talked with Ms.
Shafer about this once already, I can tell you what that call will entail.
It will entail her saying,
again, that Brenda could bill through someone. I am not a stupid person and
I already know that.
It will also entail her saying that I can take Abbee through the MRDD
program, which is an
option that I am presently not interested in. It's obvious she didn't make
you aware that
Abbee was terminated from Early Intervention services, once I said I would
like to keep Brenda
as Abbee's therapist. I am not saying that Early Intervention never helped
Abbee as they did
provide us with Brenda and for that I'll be forever grateful. However, I
don't feel that this ball
should entirely land in Brenda's lap, or for that matter, any other
provider's lap. What is supposed
to be everyone's concern here is Abbee's quality of care and presently she
is getting the best
quality of care around, there is just nobody willing to take responsibility
for making sure that
provider is properly reimbursed. I am not going to have my child "corralled"
into the system. I
want her provider to come here to work with her because A: she does her
best in her own
environment, B: she is medically fragile in that a cold/virus for her is a
major event and by
taking her to the center, she is subjected to just that many more germs, C:
I want Brenda to
continue to be her therapist.
Let me say also, I am not into the government paying for her therapy by a
long shot. I personally
feel that first of all, United Health Care should pay for what, within
reason, her doctor orders.
However, I was told to apply for medicaid and BCMH the day I left that
hospital without her and
that I wouldn't have to worry about anything that she would ever need,
medically if she were to
become disabled. I think that the walls being thrown up by all three
methods of payment DO
NOT take into account those children who may fall through those cracks or
those children whose
parents believe that they have the most qualified person doing the job and
do not wish to change
and have their child handled by anyone different. I prefer to have someone
who has many years
of experience working with babies, especially preemies, as opposed to
someone who routinely
works with the elderly or older children. I see nothing wrong in me wanting
the most qualified
person for the job of administering therapy to my child. That is exactly
the reason Brenda is her
therapist, Dr. Pope is her pediatrian and Dr. Strominger did her BCMH
evaluation. I only want
those providers who I feel are qualified working with this child. Not the
providers YOU deem
eligible. In your letter you talk about not having any medical information
describing the severity
of Abbee's medical conditions before you can identify the most appropriate
BCMH managing
physician? I DO THE CHOOSING HERE-- AND I CHOSE DR. STROMINGER, someone
that
I was told from YOUR office was a BCMH managing physician! That is who I
choose to be her
managing physician since it cannot be her pediatrian. You should have a
mound of paperwork
from her stay at OSU and you should also have Dr. Strominger's report. What
else exactly do
you need?
In you last paragraph you state that you encourage me to work with the
resources available to me
in order that she receives the therapy that she needs to grow and develop.
What in the world do
you think I am trying to do. I didn't get angry until it became apparent to
me that if a child just
happened to fall through one of the many cracks of the system, nobody in the
system was
available to help or willing to correct the situation. If she were your
daughter, would you expect
nothing less than the best. I think not. So why should you expect me to
react any differently. I
will continue emailing/faxing/mailing my letter to anyone who will listen
until some things in
this system are really looked at. A call from your agency to Early
Intervention in Lancaster and a
"pat" answer might be good enough for you, but not for me. I don't think it
is too much to expect
that if I believe that Abbee has the best therapist for her, I should be
able to have Abbee continue
with her present therapist.
AGAIN, THIS IS ABOUT MY DAUGHTER AND HER RIGHT TO HAVE QUALITY
HEALTHCARE. This is not about who should be billing who or what. Medicaid
and BCMH
say they are to assure that children are insured who are eligible, but at
what cost? You tell me
how it makes sense for me to driver one hour to Children's Hospital, another
major source of
germs, let them administer her therapy, and you and Medicaid are willing to
pay them the
$200-$300 they bill you, but you say you won't pay for her therapist to come
into my home
and pay her $60? Where is that cost effective? Where is that saving the
taxpayers money. I
think any person with half a brain can see that it IS NOT cost effective and
it all comes down to
the kickback portion of my previous letter. I would really like an
explanation to that question by
the way. How is it more cost effective? How is it utilizing the taxpayer's
money more
effectively.
In closing I would like to say that I can see that unless some real pressure
is put on government
officials and especially private insurance companies, there will be problems
with children like
Abbee for many years to come. Let me assure you that I am able to apply
that kind of pressure.
I am not going to be satisfied until something here gets changed. I thank
you for I guess at least
bothering to check into things at all. I also thank Senator Hottinger's
office for at least taking the
time to check into the situation. BUT "CHECKING INTO SOMETHING" AND MAKING
A
POSITIVE CHANGE ARE TWO VERY DIFFERENT THINGS. Making a few simple phone
calls and not getting anything but rhetoric about rules/regulations is not
answer enough.
Rules/regulations sometimes need to be changed when it is discovered that a
child or children's
needs are not being met. I can say for sure that ABBEE'S NEEDS are not
being met by your
agency, Medicaid or Early Intervention.
I am disappointed that children like Abbee, who have already been through so
much, will be
forced to endure even more due to agencies that are politically motivated or
motivated by the
bottom dollar and not by the welfare of the child.
Sincerely,
STATISTICS
The Families USA report says that William McGuire, chief executive officer
of one of the
biggest managed-care companies in the nation, UnitedHealth Group, received
$54 million in
salary and other compensation in 2000, not counting unexercised stock
options. Those options
were valued at $357.9 million.
Roger Crozen, a UnitedHealth spokesman, said the $54 million included a
one-time exercise of
stock options. He said the company, which is based in Minneapolis and
provides coverage to 16
million Americans, has voluntarily granted its members many of the medical
guarantees in the
bill.
In response to an email from the Department of Insurance of Ohio!
The following is part of the text I have received from United Health Care,
Holly Robertson, on June 5, 2001:
"In accordance with your Certificate of Coverage, outpatient rehabilitation
services, which includes physical, occupational and speech therapy, is
limited to 20 visits for each therapy per policy year. Therefore, visits
beyond the benefit maximums are not eligible for coverage."
"I understand your frustration, however UHC must be consistent in the
interpretation of their contracts and unfortunately cannot make an exception
in your case."
The appeal procedure was initiated by myself on 5/24/01. It was begun by me
so that Abbee would not have to not have therapy while UHC/Department of
Insurance "jumped their hoops" or "coordinated" their denials of her
rightful, medically necessary coverage. UHC are treating it as such as in
their plan booklet it states on page 14 under Complaint Procedures, "Issues
related to quality of care and treatment will not be addressed through a
complaint hearing, as described in Section 5.2, but will be reviewed by the
appropriate Physician Specialty Panel. The Panel's recommendation will be
forwarded to the Physician's Quality Review Committee. The Covered Person
will be notified in writing, within five days of the final review of the
complaint."
First of all the title of Physician's Specialty Panel or Review Committee is
a joke. Ms. Robertson told me on the phone when we spoke on June 1, 2001
that there were no physicians present at these committees!
She told me that the panel would review it and then I would have a written
DENIAL, not answer, within five days! Obviously, if my letter is dated June
5, 2001 that is what happened. So, I have followed the procedures and
expect the Department of Insurance to act on the complaints I filed against
United Health Care. Anything less than action taken on their part would be
criminal. I am following the correct procedures and UHC is following the
procedures at least as far as my complaint is concerned by answering within
five days. Now it is the Department of Insurance's responsibility to act
upon this situation.
Your website says you are committed, amongst other things, to providing the
highest level of service to Ohioans. How exactly do you propose to do that
if you won't act upon claims made by consumers? It also states that Mr.
Covington worked to pass the Governor's Patient Bill of Rights and initiated
PromptPay! Yet your department is just going to keep putting me off until
they cannot any longer. IF UNITED HEALTH CARE IS TREATING THIS AS A
COMPLAINT (AS INCOMPETENT AS THEY ARE), SO SHOULD YOU!
I will wait for your response. If you would like to provide a fax number, I
can provide you with a copy of that letter. There are several lawyers
gathering information on this case against United Health Care and I'm sure
they'd love to know that the Department of Insurance isn't going to
acknowledge the complaint!
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
Dear Mrs. Ford:
Please let me clarify the correspondence below. We understand that you have
initiated the appeal process, however it is not completed at this time. As
stated below, we are forwarding this information directly to United
Healthcare in order to assist you in continuing this process. If you have
any questions, please do not hesitate to call.
Sincerely,
Julie Phillips, FLMI, ACS, AIE
Analyst Supervisor, Health Unit
Ohio Department of Insurance
2100 Stella Court
Columbus, OH 43215-1067
(614) 644-3411 voice
(614) 995-7123 fax
julie.phillips@ins.state.oh.us www.ohioinsurance.gov (http://www.ohioinsurance.gov)
> -----Original Message-----
> From: Julie Phillips
> Sent: Monday, June 18, 2001 4:09 PM
> To: 'cford@fairfieldi.com'
> Cc: Lee Covington; John Pouliot
> Subject: Re: CSD-1076871 Abbee Ford v United Healthcare of Ohio
>
> June 18, 2001 (614) 644-2673
> (800) 686-1526
>
>
> CHRISTINE FORD
> 114 HOLDER RD
> BALTIMORE, OH 43105
>
> RE: Our File Number CSD-1076871
>
>
> Dear Mrs. Ford:
>
> We have received your most recent email correspondence of June 14, 2001,
> regarding your healthcare complaint with United Healthcare of Ohio.
>
> We have been advised that you have not completed the internal appeal
> process outlined in your member handbook/certificate. While we
> understand your frustration, you must first complete this process.
>
> In order to assist you, we are forwarding a copy of your complaint to
> United Healthcare and ask that they initiate the internal appeal process
> on your behalf.
>
> If upon completion of the internal appeal process, you are not satisfied,
> please contact this Department again for further investigation.
> According to recent legislation, you may be entitled to an additional
> review. Please be sure to include:
>
> * A copy of the final response from the Appeals Committee
> * A copy of your certificate of coverage
>
> Again, we hope this matter will be resolved to your satisfaction.
>
> Sincerely,
>
>
> Julie Phillips, FLMI, ACS, AIE
> Analyst Supervisor, Health Unit
> Office of Consumer Services
> Julie.phillips@ins.state.oh.us
> (614) 644-3411 voice
> (614) 995-7123 fax
>
>
> Cc: Holly Robertson, United Healthcare of Ohio
> J. Lee Covington, Director, Department of Insurance
> John Pouliot, General Counsel, Ohio Department of Insurance
>
>
June 19, 2001
Dear Ms. Phillips:
I am faxing a copy of the complaint procedures that are in our plan booklet.
The internal process IS COMPLETE. There is nothing else for them to do that
I see in this plan. We have went through Section 5.1. Requesting a hearing
according to Section 5.1, is not possible if the issue is related to quality
of care and treatment. Therefore, we are at the paragraph where it says you
have the right to take your grievance to the Ohio Department of Insurance!
I am now clarifying for you the following: I don't know what they are
telling you, but I am telling you that I CAN READ and that you are being
advised incorrectly! And according to my certificate of coverage I have
done everything I should do and am now waiting on the Ohio Department of
Insurance to do their job!
I am beginning to see that your organization doesn't really regulate the
insurance companies. It appears to me that they aid the insurance companies
in trying to get people to back off from claiming. That may work with other
people, but not with me. I have had to spend hours just on this aspect of
the appeals process because I can't make you see that my filing a claim with
you was justified at this time.
Please take two minutes and read the pages I faxed and hold United Health
Care accountable.
Respectfully,
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
Dear Ms. Robertson:
I am writing this letter in response to your letter dated June 20, 2001
where you again deny my daughter's medical treatments.
First let me tell you, I made this appeal, therefore you will direct any
further correspondence directly to me and not dance around me to my husband.
How dare you address your correspondence to him when it was my name on ALL
correspondence you have received. I WILL NOT BE IGNORED! I can assure you
he feels as passionate as I do that UHC should be paying for her medical
treatments. He has a job to do for a living and needs to devote his time to
that. THIS IS MY JOB NOW! I am acting on Abigail's behalf. You will note
on the bottom of this letter, Steve has signed this letter and has made me
his "designated representative".
In your first paragraph, you say I am requesting additional physical therapy
visits beyond the benefit maximum. First of all, Brenda, for your
information, is an occupational therapist, not a physical therapist and in
my original complaint, it states this plainly. Secondly, we are requesting
that you pay for Abbee's medically necessary treatments that her physician
has
prescribed and ordered. There is nothing in my certificate of coverage that
denies her medically necessary treatment.
In your second paragraph, you state due to this benefit limit, the question
of medical necessity is not considered in our decision. Let me tell you
something that obviously UHC is not seeing here: her medical treatments are
medically necessary and do address her quality of care, as they are being
ordered and prescribed by her
physician. Medical necessity and quality of care is at the bottom of this
issue--IT IS THIS
ISSUE! You are denying this child the medical treatments she needs to get
Better and that are not excluded in your contract. That is the bottom line
here!
At one place in the "process", and I use that term very loosely, you treat
my original complaint as in section 5.1 (page 14) with issues related to
quality of care and treatment. You yourself told me on the phone that I
would have an answer within five days and I did. You also informed me, when
asked directly, that even though the panel is called the Physician Specialty
Panel, it had no physicians or nurses serving on it! Of course medical
necessity is not considered in your decision. That is because there is no
one qualified on the panel to make that kind of determination.
I, at 9:30 a.m. on Saturday morning, on your voice mail, requested a formal
hearing with two witnesses standing here. You state in your third paragraph
that you will coordinate the hearing on my behalf. Nobody from UHC is
qualified to represent myself or my daughter. It is obvious that no one
there has this baby's best interests or medical needs and necessities in
mind.
You also state in paragraph four that according to Ohio law, the appeal to
UHC must be completed in 60 days and give me seven days to forward a
request. The day I started this campaign, and I can assure you I will NEVER
forget it, was May 24, 2001. I received a call from your Corporate Public
Relations Manager on the Tuesday following that. So where you are getting
that I only have seven days is beyond me.
I can now see that this entire process is a joke, as I was already advised.
There really ISN'T an appeal process in the State of Ohio. It is just a
series of letters being thrown around. There is no one in charge of what
UHC does. It is supposed to be the Department of Insurance, but they are
holding UHC's hand. As the saying goes "don't bite the hand that feeds
you!"
Lastly I want to quote your website at www.uhc.com (http://www.uhc.com) under Investors. (It is
obvious you save the best comments for those who want to give you money as
opposed to children like Abbee who want to use their benefits!) "In the
face of a child, you see a vision of the future. You see a sense of
potential, a sense of growth and a sense of limitless achievement. We see a
future filled with opportunity as today's potential becomes tomorrow's
success. " How can you possibly deny this child the "opportunity" to live
up to her fullest potential and limitless achievement? This is exactly what
you are doing by denying her medical treatment.
I will assume I will hear from you on Monday morning to set up a hearing. I
WILL BE PRESENT AT THAT HEARING!
Sincerely,
Christine Ford
I am giving my wife the right and responsibility to act in Abigail's behalf
with regard to her appeals to United Health Care, effective June 22, 2001.
She is my "designated representative". However, if you question my feelings
about this issue, you may reach me during daytime hours at 614-833-6655 or
614-679-8266.
Sincerely,
Steve E. Ford
Cc: D. Clay, Lumbercraft
J. Metz, California
R. Hottinger
S. DeWine
S. Voinovich
M. Kocot WBNS
D. Cummins Fairfield Daily News
J. Mooney Insurance Injustice
S. Petty, Ohio Legal Rights
L. Covington Ohio Dept. of Insurance
B. Taft, Governor
W. McGuire CEO UHC
July 21, 2001
Ohio Department of Insurance
Consumer Services Division
2100 Stella Court
Columbus, Ohio 43215-1067
ATTENTION: Mr. Lee Covington
Dear Mr. Covington:
I am filing, again, a complaint with the Ohio Department of Insurance
regarding United Health Care. My daughter's coverage was again denied for
no "legal" reason and for incredibly false advertisement.
In the hearing at United Health Care on July 18, 2001, UHC plainly stated on
tape (copy of which can be provided) that they were denying Abbee's claim
due to benefit maximums of Outpatient Rehabilitation Services of 20 visits
each year for physical, occupational, speech and cardiac/pulmonary.
However, they also stated that nowhere in the certificate of coverage was
there a definition of these services. They then stated that they used CPT
codes to determine the meaning. These CPT codes are not in any certificate
of coverage, nor are they provided to any employer or individual that
purchases their insurance. Therefore, they have denied my daughter's
services based on a definition that myself or anyone else who purchases
their insurance could possibly be aware of. This in my book is DECEPTIVE
advertising. I also requested copies of all their advertising and as I
expected, they have denied that request. I have attached some advertising
that I found on the internet. Most of this comes from their own website or
websites of their subsidiaries. They state in many of their advertising
campaigns that they want the doctor to decide. Abbee's doctor has decided
what is best for her and they are denying her anyway.
The services I am seeking for my daughter and that have been ordered by her
physician are not clearly and unambiguously defined anywhere in the policy
language. It is my understanding that any services that are not clearly and
unambiguously defined by the certificate of coverage are not subject to any
number of visit limitations according to the certificate of coverage and
according to standards applied in a courtroom proceeding. This being the
case, UHC has provided no reason, based on policy language, for denying
Abbee's coverage.
On page iii of my certificate of coverage, UHC states in paragraph five,
that Only Medically Necessary services are covered under the policy. Abbee'
s physician has already deemed her services medically necessary. (Letter
attached) They also state in paragraph seven of the same page that they can
provide coverage for services, which would otherwise not be covered.
In Section 1751.01 of the ORC, Basic services are listed that must be
provided as well as supplemental services. Occupational therapy is not
listed in supplemental services. However, since her physician has deemed
these services as medically necessary, they are covered under Section
1751.01 of the ORC and UHC is now in violation of that code. In addition,
on page 17 of my certificate of coverage, section 6.12 (Conformity with
Statutes) it states that any provision of the policy which, on its effective
date, is in conflict with the requirements of state or federal statutes or
regulations, is hereby amended to conform to the minimum requirements of
such states/regulations. So as I see it, again, UHC is in violation of
state law as stated in ORC 1751.02 I as well as ORC 1751.18 Discrimination,
and is not adhering to its own statements in my certificate of coverage. It
is your job sir, to force UHC to abide by state law. It is now your job to
fine UHC up to $100,000 dollars and order them to repair the deficiencies of
their certificates of coverage or order them to cease and desist operations
in the State of Ohio as stated in ORC 1751.45.
In Section 1751.08 D, it states that you are not to be considered as
practicing medicine. However, that is exactly what you are allowing UHC to
do in denying my daughter's coverage.
Also in ORC Section 1751.83, UHC is supposed to provide an internal review,
which was on 7/18/01 by a "clinical peer". There was no "clinical peer"
present at that hearing. There were three voting members, none of whom
would be considered clinical peers. After reviewing the audiotape, you will
see that I am correct.
If Abbee does not receive these needed medical services; UHC would be bound
by Section 1751.14 of the ORC, which would only further their costs, as they
would have to continue to cover Abbee beyond the age of 18.
I want to take a moment too and comment on the UHC building in Westerville
where I was required to drive for this hearing. I was speechless, looking
at the marble floors and restroom facilities the size of rooms in my home.
They can afford all of this due to their denials of claims such as Abbee's.
I am now demanding that the Ohio Department of Insurance do their job and
make UHC adhere to the laws of this state and to their own promises. If
they indeed want to advertise nationally, trying to lure in new employers to
"invest" in their company, then they should be made to adhere to those
advertisements. Enough is enough.
I want to let you know too, as of Friday, July 20, 2001, I am the official
Director of the Ohio Chapter of the World Association of Disabilities, at
the request of the International Director. I have their complete support on
this issue and the State of Ohio Department of Insurance needs to be aware
that all the members of this organization, as well as tens of thousands of
others who have backed me in this quest to make UHC to adhere to law, are
watching and expect that you only do your job.
I will look forward to hearing from you in the near future.
Respectfully,
Christine R. Ford
(Mother to Abigail Rose Ford)
CRF/cf
Cc: J. Metz NCHCC
M. Kocot WBNS
D. Cummins Fairfield Daily Post
B. Montgomery Attorney General Ohio
D. Clay VP Lumbercraft
G. Kerford WAPD CEO
J. Mooney Insurance Crime Outline
A. Archibald WAPD Flordia Chapter
D. Belling WAPD Texas Chapter
B. Taft Governor State of Ohio
M. DeWine Senator State of Ohio
G. Voinovich Senator State of Ohio
J. Hottinger Representative State of Ohio
D. Hobson Representative Ohio
IF YOU DON'T CARE ABOUT WHAT YOUR CONSTITUENTS/CLIENTS NEEDS ARE AND WOULD
LIKE TO BE REMOVED FROM THIS LIST, REPLY AND TYPE REMOVE ME IMMEDIATELY IN
ALL CAPS AND YOU WILL BE REMOVED AND ADDED TO MY WEB PAGE UNDER THE HEADING
"OFFICIALS WHO DON'T GIVE A DAMN ABOUT WHAT THEIR CONSTIUENTS/CLIENTS
NEEDS ARE".
Ohio Chapter WAPD (World Association People w/DisAbilities) 114 Holder Road
Baltimore, OH 43105 (740) 862-5352 email cford@mail.WAPD.org www.fairfieldi.com\~cford (http://www.fairfieldi.com\~cford)
------------------
Ohio Chapter WAPD World Association of People with Disabilities http://www.fairfieldi.com/~cford
Below is my original letter, now gaining national attention and also my
response to BCMH, as
well as two responses to the Ohio Department of Insurance which does not
want to accept my
complaint against United Health Care!
IF YOU HAVE A NEWSLETTER/NEWSPAPER, PLEASE PRINT ME!
This letter may sound like I am attacking and I am! Most mothers do when
their child is being
denied basic rights and medically necessary treatment! A condensed version
is not available as I
cannot condense the atrocities of what is happening to my baby!
This letter is drawing attention. We just finished a spot on WBNS TV that
was aired yesterday
with Maureen Kocot here in Columbus, Ohio. Abbee's story was published at www.fairfielddailypost.com. (http://www.fairfielddailypost.com.) A copy can be obtained by writing to
editor@fairfielddailypost.com. Also, there is a newsletter at www.insurancejustice.com (http://www.insurancejustice.com) that has
an excellent review of my letter. You can also go to
medicalreporter.health.org and see my letter
to the editor! There are several other newsletters that have picked this up
as well as several
medical journals, as well as many websites relating to Health Care
mismanagement, etc. I also
received a call from Margaret Mahoney, MD author of the book Saving the Soul
of
Medicine who is involved with the National Organization of Physicians Who
Care. 10,000
EMAILS SINCE 5/24/01 AND STILL GOING! Emailed daily to all members of House
and
Senate!
Also, TO DATE, I HAVE ONLY RECEIVED 2 RESPONSES FROM AN ELECTED
OFFICIAL. That is Mr. Hottinger. However, I've only gotten an email and
very little action. He
did place a call evidently and BCMH in turn wrote me a letter (my response
below) but changes
have not been made! And Mr. McCain, who wrote via US Mail and said he was
forwarding a
copy to Mr. DeWine and that was it! (This is even though I voted for him
AND he is sponsoring
one of the Patient Bill of Rights
Also, WTOV in Steubenville, Ohio is going to do a story about Abbee as
well.
To Whom It May Concern:
My name is Christy Ford. My daughter's name is Abigail (Abbee) Ford and
she was born
3/29/00 at OSU Medical Center in Columbus, Ohio at 23 weeks gestation
weighing only 1 lb and
6 oz and being 12 inches long. She is the light of my life! She spent
100 days in the NICU
there. She developed alot of the "normal preemie problems" such as
Respiratory Distress
Syndrome, BronchioPulmonary Dysplasia, Retinopathy of Prematurity, Reflux,
etc...
She was diagnosed about one month ago with Cerebral Palsy as well. I am
sure most of you
have children, but cannot imagine the heartache that going through an
ordeal such as we have
had with Abbee, only to have her diagnosed with cerebral palsy, has brought
into our lives.
Worse than that heartache, however, is the complete ignorance we are having
to deal with in
regards to getting this child the therapy she so desperately needs. We have
United Health Care
as a first insurance, Medicaid (Healthy Start) as a second and BCMH as a
third. The problem
lies in the fact that first of all, I think United Health Care, as her
primary insurance company
should pay for the "prescribed" therapy, as her doctor see's fit, just as if
it were an antibiotic.
They say they will only pay for 20 visits, or at least some representatives
say that. Some say you
can extend her services. Some are rude and hang up on you, etc... We have
an occupational
therapist, Brenda Brodbeck, who has been one of the few people Abbee will
let handle her.
Brenda has many years of experience and is trained/qualified to deal with 23
week preemie
babies. Others in our county only deal with older children/adults. Half of
the battle with Abbee
is getting someone that SHE will allow to touch them. This child has been
through enough and
I WILL NOT subject her to any more than she absolutely needs to be
subjected to. The
problem lies in the fact that Brenda is a BCMH provider but CANNOT become
Medicaid
certified. My daughter has three routes of payment and now that her 20
visits are up with
United Health Care, my husband is looking at getting a second job to pay
for therapy that she
needs. THIS DOES NOT INCLUDE PHYSICAL OR FEEDING THERAPY.
I wonder, if your child was in the same position, would this outrage you!
Although I am sure
you make quite alot more than my husband does for sitting in those offices
and "laying down the
law"; maybe it wouldn't be so traumatic in your case. I want most of you to
remember one
thing--you are elected officials or appointed to your posts. You are put
there for a reason and
that is to work for consumers. I am a consumer and I DEMAND better
treatment and
options than what I presently have. The following is a quote on the home
page for United Health
Care which I find a HUGE JOKE.
"The serenity of open fields, The energy of big city lights, some people
like predictability, Others
thrive on change. Each person is unique, Each has different needs and
desires. For too many
years, the health care industry has told you what works for them. We think
it's time a
health care organization turned that around and asked, "What works for
you?" Granted, this is a
dramatically different approach. But we are committed to improving the
health care experience
for everyone involved-for the employers who purchase health benefits, the
doctors who deliver
the care and most of all the INDIVIDUALS WHO USE THE HEALTH SERVICES". AND
"At
United Health Care, we believe that the people best qualified to make
decisions about health
care are patients and their doctors. We believe that Care Coordination will
promote positive
health experiences for members and restore the joy of practicing medicine
for physicians." If
you look under Invester Relations, the quotes get worse! As you can
imagine, after reading this
on their site, I pretty much wanted to throw up. This is such a lie for
those of us who actually
have to have United Health Care as a provider. The joy hasn't left Abbee's
providers, at least not
until they have to deal with the insurance company. I know that her
therapist AND her
pediatrician love her almost as much as I do. However, people like Davina
(Care Coordinating
Supervisor for UnitedHealthCare 1-800-248-8573), do not think as much of my
daughter. I think
a requirement of being a supervisor for United Health Care is to take a
class called "No
Feelings", because almost every person I have dealt with or anyone else
involved here has dealt
with seem to be made of steel. They are rude and very unprofessional. I've
made up my mind
that the few decent people I have spoken to were the "flunkies" of that
class.
The following is quoted from the Early Intervention web page as one of their
so-called
objectives: "enhance the capacity of state and local agencies and service
providers to meet the
needs of historically under served populations, such as minorities,
low-income, etc.. and
facilitate the coordination of payment for early intervention services from
federal, state,
local and private sources (including public and private insurance coverage)"
Again, I am
physically ill reading this.
And last, but not least, I found the following quote on the BCMH page: "The
Bureau promotes
early identification of children with handicapping conditions and treatment
of those children by
appropriate health care providers. ....funding services for the
diagnosis/treatment of medically
eligible conditions...collaborating with public health nurses/departments to
assist in increasing
access to care...... and assisting families to access and utilize
appropriate sources of payment for
services for their child."
Well as you might have guessed, none of the items quoted in any of these
paragraphs are
actually happening. I think the comments are there strictly for the
auditor's benefit or just for
show, because they certainly do NOT do what they say they are doing. I am
living proof of that
and there are about 300 other families in my county alone that are in the
very same situation.
I however, WILL NOT cave in to the biases/discrimination being inflicted on
me because my
daughter happens to qualify for Medicaid. I am not jeopardizing her
well-being because some
idiot sitting in an office decided that only people who are Medicaid AND
BCMH certified can
see her. Brenda knows what she is doing and more importantly has the
repoire with Abbee
to get her to cooperate and get her to do it. With Abbee--that is 1/2 the
battle!
I think that one of you needs to do something about this. Does anyone of
you besides me, feel
that it is ludicrous that I have three routes of payment and need to get out
a checkbook?????? I
would suggest you that are lawmakers look at this letter carefully. I can
assure you that I am
a very, very vocal advocate when it comes to my children. I can also assure
you that if I don't get
satisfactory results, I WILL do everything in my power to see that you are
not re-elected or
appointed. I know everyone in this town and many in many others as well as
being very
experienced updating my web page. I'll put so many signs on my house, in my
yard and on my
web page that I'll have the news team here within a day. I do know how to
get my point across.
How dare you people be allowed to tell me how much therapy is enough for my
daughter? Only
her doctor has the right to say that and you or anyone should never have the
right to override that
decision. What if one of your family members had cancer and I was able to
come in and say
"OK, we're only going to pay for 4 chemo treatments--you pay for the rest!"
What would you
do? You'd be doing the same thing I am doing right now. I guarantee it!
I would also like to say at this time that the Governor's office and Rep.
Hottinger's office has
already been made aware of this problem by Abbee's therapist, Brenda George
Brodbeck. So as
far as I am concerned, you have already had your chance and blew it and now
ought to really
look at the situation this time and fix it!!!! Brenda is very professional
about everything she
does, whether it is therapy, talking on the phone, etc. I however am
Abbee's mom and I WILL
NOT REST UNTIL I SEE RESULTS. Please do not think for a minute that I will
let this lay. I
will keep emailing and pushing and shoving and calling and getting home
phone numbers until
I get what so many of us in this county and I am sure in other counties,
need. That is to be
treated equally as consumers--not penalized because we happen to qualify for
some kind of
assistance.
Where are Abbee's rights being met here? Where are her choices?
I am supposed to "roll over" and go to the therapist/agency that the state
determines so they can
get their kickback! First of all, I will not take my Abbee to a "facility"
for her therapy as it
endangers her immune systems which is already compromised, not to mention
that I don't
have to, since Brenda makes home visits. Second of all, no matter the cost,
I do not jeopardize
my daughter's well being for anyone and lastly, NOBODY tells me who/where to
take my
daughter for her medical treatment. I DECIDE THAT AND ALWAYS WILL. MAKE NO
MISTAKE ABOUT IT. If that means more money out of our pockets, so be it!
I will be anxious to see also, just how many "real" responses I do receive
to this plea for help.
I hope that all of you take a good look at your "healthy" children and thank
God that you are not
having to deal with the "mess" that I am that was created by those of you
who sit behind a desk
and dictate other people's lives without talking to them first and getting
their input and/or ideas
or ever having a real "clue" as to what life with a "disadvantaged" child is
like.
I guess there is not any more I can say at this point except that I will
keep pushing this issue from
all aspects until there is a change made.
Respectfully,
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
CERTIFYING INDEPENDENT THERAPISTS THROUGH MEDICAID(STATE AGENCY),
SINCE BCMH (STATE AGENCY) ALREADY DOES WOULD SOLVE THIS PROBLEM.
ONE STATE AGENCY SHOULD CERTIFY WHAT THE OTHER DOES!!!!!!!!!!!!!
The following is my response to a letter received from BCMH signed by Mr.
Bryant, Director.
I wanted to let you know about a couple of things. First of all, I don't
believe Abbee's BPD is
severe enough to see a pulmonologist, or I would have been there by now.
She should be on the
program for cerebral palsy.
As far as the required paperwork from Dr. Strominger's office, he advised me
he would be
sending the paperwork the same week we saw him and I am sure he did so,
which was the week
of April 18, 2001. No one told me that anything other than what he had sent
you was necessary.
I spoke with someone in your office back in early March and they said I
needed to take Abbee to
a BCMH provider and have cerebral palsy either excluded or verified, which
is what I did. I
have done what I was asked to do and for that I get "At this time, Abigail
is not enrolled on the
BCMH treatment program". If there was something else I needed to turn in,
don't you think once
Dr. Strominger sent in whatever it was he did, you would've contacted
someone by now? Better
yet, wouldn't he have the paperwork you are requesting. Dr. Strominger, in
my opinion, did a
very thorough exam and only confirmed what we already knew.
As far as Early Intervention is concerned--yes, they did provide us with I
believe Abbee's initial
four visits and that is where we began obtaining Brenda's services. I
notice that you, like others
that have been in contact with Ms. Shaffer, feel that this all falls on the
individual provider--that
Brenda should shoulder the burden here. THIS IS NOT ABOUT BRENDA, THIS IS
ABOUT
ABBEE. Abbee's needs have been identified, by Brenda, not Ms. Shaffer, as
well as by her
pediatrician and Dr. Strominger. She NEEDS therapy and she NEEDS one of her
three methods
of payment to step up to the plate and make payment to her therapist.
Having talked with Ms.
Shafer about this once already, I can tell you what that call will entail.
It will entail her saying,
again, that Brenda could bill through someone. I am not a stupid person and
I already know that.
It will also entail her saying that I can take Abbee through the MRDD
program, which is an
option that I am presently not interested in. It's obvious she didn't make
you aware that
Abbee was terminated from Early Intervention services, once I said I would
like to keep Brenda
as Abbee's therapist. I am not saying that Early Intervention never helped
Abbee as they did
provide us with Brenda and for that I'll be forever grateful. However, I
don't feel that this ball
should entirely land in Brenda's lap, or for that matter, any other
provider's lap. What is supposed
to be everyone's concern here is Abbee's quality of care and presently she
is getting the best
quality of care around, there is just nobody willing to take responsibility
for making sure that
provider is properly reimbursed. I am not going to have my child "corralled"
into the system. I
want her provider to come here to work with her because A: she does her
best in her own
environment, B: she is medically fragile in that a cold/virus for her is a
major event and by
taking her to the center, she is subjected to just that many more germs, C:
I want Brenda to
continue to be her therapist.
Let me say also, I am not into the government paying for her therapy by a
long shot. I personally
feel that first of all, United Health Care should pay for what, within
reason, her doctor orders.
However, I was told to apply for medicaid and BCMH the day I left that
hospital without her and
that I wouldn't have to worry about anything that she would ever need,
medically if she were to
become disabled. I think that the walls being thrown up by all three
methods of payment DO
NOT take into account those children who may fall through those cracks or
those children whose
parents believe that they have the most qualified person doing the job and
do not wish to change
and have their child handled by anyone different. I prefer to have someone
who has many years
of experience working with babies, especially preemies, as opposed to
someone who routinely
works with the elderly or older children. I see nothing wrong in me wanting
the most qualified
person for the job of administering therapy to my child. That is exactly
the reason Brenda is her
therapist, Dr. Pope is her pediatrian and Dr. Strominger did her BCMH
evaluation. I only want
those providers who I feel are qualified working with this child. Not the
providers YOU deem
eligible. In your letter you talk about not having any medical information
describing the severity
of Abbee's medical conditions before you can identify the most appropriate
BCMH managing
physician? I DO THE CHOOSING HERE-- AND I CHOSE DR. STROMINGER, someone
that
I was told from YOUR office was a BCMH managing physician! That is who I
choose to be her
managing physician since it cannot be her pediatrian. You should have a
mound of paperwork
from her stay at OSU and you should also have Dr. Strominger's report. What
else exactly do
you need?
In you last paragraph you state that you encourage me to work with the
resources available to me
in order that she receives the therapy that she needs to grow and develop.
What in the world do
you think I am trying to do. I didn't get angry until it became apparent to
me that if a child just
happened to fall through one of the many cracks of the system, nobody in the
system was
available to help or willing to correct the situation. If she were your
daughter, would you expect
nothing less than the best. I think not. So why should you expect me to
react any differently. I
will continue emailing/faxing/mailing my letter to anyone who will listen
until some things in
this system are really looked at. A call from your agency to Early
Intervention in Lancaster and a
"pat" answer might be good enough for you, but not for me. I don't think it
is too much to expect
that if I believe that Abbee has the best therapist for her, I should be
able to have Abbee continue
with her present therapist.
AGAIN, THIS IS ABOUT MY DAUGHTER AND HER RIGHT TO HAVE QUALITY
HEALTHCARE. This is not about who should be billing who or what. Medicaid
and BCMH
say they are to assure that children are insured who are eligible, but at
what cost? You tell me
how it makes sense for me to driver one hour to Children's Hospital, another
major source of
germs, let them administer her therapy, and you and Medicaid are willing to
pay them the
$200-$300 they bill you, but you say you won't pay for her therapist to come
into my home
and pay her $60? Where is that cost effective? Where is that saving the
taxpayers money. I
think any person with half a brain can see that it IS NOT cost effective and
it all comes down to
the kickback portion of my previous letter. I would really like an
explanation to that question by
the way. How is it more cost effective? How is it utilizing the taxpayer's
money more
effectively.
In closing I would like to say that I can see that unless some real pressure
is put on government
officials and especially private insurance companies, there will be problems
with children like
Abbee for many years to come. Let me assure you that I am able to apply
that kind of pressure.
I am not going to be satisfied until something here gets changed. I thank
you for I guess at least
bothering to check into things at all. I also thank Senator Hottinger's
office for at least taking the
time to check into the situation. BUT "CHECKING INTO SOMETHING" AND MAKING
A
POSITIVE CHANGE ARE TWO VERY DIFFERENT THINGS. Making a few simple phone
calls and not getting anything but rhetoric about rules/regulations is not
answer enough.
Rules/regulations sometimes need to be changed when it is discovered that a
child or children's
needs are not being met. I can say for sure that ABBEE'S NEEDS are not
being met by your
agency, Medicaid or Early Intervention.
I am disappointed that children like Abbee, who have already been through so
much, will be
forced to endure even more due to agencies that are politically motivated or
motivated by the
bottom dollar and not by the welfare of the child.
Sincerely,
STATISTICS
The Families USA report says that William McGuire, chief executive officer
of one of the
biggest managed-care companies in the nation, UnitedHealth Group, received
$54 million in
salary and other compensation in 2000, not counting unexercised stock
options. Those options
were valued at $357.9 million.
Roger Crozen, a UnitedHealth spokesman, said the $54 million included a
one-time exercise of
stock options. He said the company, which is based in Minneapolis and
provides coverage to 16
million Americans, has voluntarily granted its members many of the medical
guarantees in the
bill.
In response to an email from the Department of Insurance of Ohio!
The following is part of the text I have received from United Health Care,
Holly Robertson, on June 5, 2001:
"In accordance with your Certificate of Coverage, outpatient rehabilitation
services, which includes physical, occupational and speech therapy, is
limited to 20 visits for each therapy per policy year. Therefore, visits
beyond the benefit maximums are not eligible for coverage."
"I understand your frustration, however UHC must be consistent in the
interpretation of their contracts and unfortunately cannot make an exception
in your case."
The appeal procedure was initiated by myself on 5/24/01. It was begun by me
so that Abbee would not have to not have therapy while UHC/Department of
Insurance "jumped their hoops" or "coordinated" their denials of her
rightful, medically necessary coverage. UHC are treating it as such as in
their plan booklet it states on page 14 under Complaint Procedures, "Issues
related to quality of care and treatment will not be addressed through a
complaint hearing, as described in Section 5.2, but will be reviewed by the
appropriate Physician Specialty Panel. The Panel's recommendation will be
forwarded to the Physician's Quality Review Committee. The Covered Person
will be notified in writing, within five days of the final review of the
complaint."
First of all the title of Physician's Specialty Panel or Review Committee is
a joke. Ms. Robertson told me on the phone when we spoke on June 1, 2001
that there were no physicians present at these committees!
She told me that the panel would review it and then I would have a written
DENIAL, not answer, within five days! Obviously, if my letter is dated June
5, 2001 that is what happened. So, I have followed the procedures and
expect the Department of Insurance to act on the complaints I filed against
United Health Care. Anything less than action taken on their part would be
criminal. I am following the correct procedures and UHC is following the
procedures at least as far as my complaint is concerned by answering within
five days. Now it is the Department of Insurance's responsibility to act
upon this situation.
Your website says you are committed, amongst other things, to providing the
highest level of service to Ohioans. How exactly do you propose to do that
if you won't act upon claims made by consumers? It also states that Mr.
Covington worked to pass the Governor's Patient Bill of Rights and initiated
PromptPay! Yet your department is just going to keep putting me off until
they cannot any longer. IF UNITED HEALTH CARE IS TREATING THIS AS A
COMPLAINT (AS INCOMPETENT AS THEY ARE), SO SHOULD YOU!
I will wait for your response. If you would like to provide a fax number, I
can provide you with a copy of that letter. There are several lawyers
gathering information on this case against United Health Care and I'm sure
they'd love to know that the Department of Insurance isn't going to
acknowledge the complaint!
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
Dear Mrs. Ford:
Please let me clarify the correspondence below. We understand that you have
initiated the appeal process, however it is not completed at this time. As
stated below, we are forwarding this information directly to United
Healthcare in order to assist you in continuing this process. If you have
any questions, please do not hesitate to call.
Sincerely,
Julie Phillips, FLMI, ACS, AIE
Analyst Supervisor, Health Unit
Ohio Department of Insurance
2100 Stella Court
Columbus, OH 43215-1067
(614) 644-3411 voice
(614) 995-7123 fax
julie.phillips@ins.state.oh.us www.ohioinsurance.gov (http://www.ohioinsurance.gov)
> -----Original Message-----
> From: Julie Phillips
> Sent: Monday, June 18, 2001 4:09 PM
> To: 'cford@fairfieldi.com'
> Cc: Lee Covington; John Pouliot
> Subject: Re: CSD-1076871 Abbee Ford v United Healthcare of Ohio
>
> June 18, 2001 (614) 644-2673
> (800) 686-1526
>
>
> CHRISTINE FORD
> 114 HOLDER RD
> BALTIMORE, OH 43105
>
> RE: Our File Number CSD-1076871
>
>
> Dear Mrs. Ford:
>
> We have received your most recent email correspondence of June 14, 2001,
> regarding your healthcare complaint with United Healthcare of Ohio.
>
> We have been advised that you have not completed the internal appeal
> process outlined in your member handbook/certificate. While we
> understand your frustration, you must first complete this process.
>
> In order to assist you, we are forwarding a copy of your complaint to
> United Healthcare and ask that they initiate the internal appeal process
> on your behalf.
>
> If upon completion of the internal appeal process, you are not satisfied,
> please contact this Department again for further investigation.
> According to recent legislation, you may be entitled to an additional
> review. Please be sure to include:
>
> * A copy of the final response from the Appeals Committee
> * A copy of your certificate of coverage
>
> Again, we hope this matter will be resolved to your satisfaction.
>
> Sincerely,
>
>
> Julie Phillips, FLMI, ACS, AIE
> Analyst Supervisor, Health Unit
> Office of Consumer Services
> Julie.phillips@ins.state.oh.us
> (614) 644-3411 voice
> (614) 995-7123 fax
>
>
> Cc: Holly Robertson, United Healthcare of Ohio
> J. Lee Covington, Director, Department of Insurance
> John Pouliot, General Counsel, Ohio Department of Insurance
>
>
June 19, 2001
Dear Ms. Phillips:
I am faxing a copy of the complaint procedures that are in our plan booklet.
The internal process IS COMPLETE. There is nothing else for them to do that
I see in this plan. We have went through Section 5.1. Requesting a hearing
according to Section 5.1, is not possible if the issue is related to quality
of care and treatment. Therefore, we are at the paragraph where it says you
have the right to take your grievance to the Ohio Department of Insurance!
I am now clarifying for you the following: I don't know what they are
telling you, but I am telling you that I CAN READ and that you are being
advised incorrectly! And according to my certificate of coverage I have
done everything I should do and am now waiting on the Ohio Department of
Insurance to do their job!
I am beginning to see that your organization doesn't really regulate the
insurance companies. It appears to me that they aid the insurance companies
in trying to get people to back off from claiming. That may work with other
people, but not with me. I have had to spend hours just on this aspect of
the appeals process because I can't make you see that my filing a claim with
you was justified at this time.
Please take two minutes and read the pages I faxed and hold United Health
Care accountable.
Respectfully,
Christy Ford
114 Holder Road
Baltimore, OH 43105
740-862-5352
Dear Ms. Robertson:
I am writing this letter in response to your letter dated June 20, 2001
where you again deny my daughter's medical treatments.
First let me tell you, I made this appeal, therefore you will direct any
further correspondence directly to me and not dance around me to my husband.
How dare you address your correspondence to him when it was my name on ALL
correspondence you have received. I WILL NOT BE IGNORED! I can assure you
he feels as passionate as I do that UHC should be paying for her medical
treatments. He has a job to do for a living and needs to devote his time to
that. THIS IS MY JOB NOW! I am acting on Abigail's behalf. You will note
on the bottom of this letter, Steve has signed this letter and has made me
his "designated representative".
In your first paragraph, you say I am requesting additional physical therapy
visits beyond the benefit maximum. First of all, Brenda, for your
information, is an occupational therapist, not a physical therapist and in
my original complaint, it states this plainly. Secondly, we are requesting
that you pay for Abbee's medically necessary treatments that her physician
has
prescribed and ordered. There is nothing in my certificate of coverage that
denies her medically necessary treatment.
In your second paragraph, you state due to this benefit limit, the question
of medical necessity is not considered in our decision. Let me tell you
something that obviously UHC is not seeing here: her medical treatments are
medically necessary and do address her quality of care, as they are being
ordered and prescribed by her
physician. Medical necessity and quality of care is at the bottom of this
issue--IT IS THIS
ISSUE! You are denying this child the medical treatments she needs to get
Better and that are not excluded in your contract. That is the bottom line
here!
At one place in the "process", and I use that term very loosely, you treat
my original complaint as in section 5.1 (page 14) with issues related to
quality of care and treatment. You yourself told me on the phone that I
would have an answer within five days and I did. You also informed me, when
asked directly, that even though the panel is called the Physician Specialty
Panel, it had no physicians or nurses serving on it! Of course medical
necessity is not considered in your decision. That is because there is no
one qualified on the panel to make that kind of determination.
I, at 9:30 a.m. on Saturday morning, on your voice mail, requested a formal
hearing with two witnesses standing here. You state in your third paragraph
that you will coordinate the hearing on my behalf. Nobody from UHC is
qualified to represent myself or my daughter. It is obvious that no one
there has this baby's best interests or medical needs and necessities in
mind.
You also state in paragraph four that according to Ohio law, the appeal to
UHC must be completed in 60 days and give me seven days to forward a
request. The day I started this campaign, and I can assure you I will NEVER
forget it, was May 24, 2001. I received a call from your Corporate Public
Relations Manager on the Tuesday following that. So where you are getting
that I only have seven days is beyond me.
I can now see that this entire process is a joke, as I was already advised.
There really ISN'T an appeal process in the State of Ohio. It is just a
series of letters being thrown around. There is no one in charge of what
UHC does. It is supposed to be the Department of Insurance, but they are
holding UHC's hand. As the saying goes "don't bite the hand that feeds
you!"
Lastly I want to quote your website at www.uhc.com (http://www.uhc.com) under Investors. (It is
obvious you save the best comments for those who want to give you money as
opposed to children like Abbee who want to use their benefits!) "In the
face of a child, you see a vision of the future. You see a sense of
potential, a sense of growth and a sense of limitless achievement. We see a
future filled with opportunity as today's potential becomes tomorrow's
success. " How can you possibly deny this child the "opportunity" to live
up to her fullest potential and limitless achievement? This is exactly what
you are doing by denying her medical treatment.
I will assume I will hear from you on Monday morning to set up a hearing. I
WILL BE PRESENT AT THAT HEARING!
Sincerely,
Christine Ford
I am giving my wife the right and responsibility to act in Abigail's behalf
with regard to her appeals to United Health Care, effective June 22, 2001.
She is my "designated representative". However, if you question my feelings
about this issue, you may reach me during daytime hours at 614-833-6655 or
614-679-8266.
Sincerely,
Steve E. Ford
Cc: D. Clay, Lumbercraft
J. Metz, California
R. Hottinger
S. DeWine
S. Voinovich
M. Kocot WBNS
D. Cummins Fairfield Daily News
J. Mooney Insurance Injustice
S. Petty, Ohio Legal Rights
L. Covington Ohio Dept. of Insurance
B. Taft, Governor
W. McGuire CEO UHC
July 21, 2001
Ohio Department of Insurance
Consumer Services Division
2100 Stella Court
Columbus, Ohio 43215-1067
ATTENTION: Mr. Lee Covington
Dear Mr. Covington:
I am filing, again, a complaint with the Ohio Department of Insurance
regarding United Health Care. My daughter's coverage was again denied for
no "legal" reason and for incredibly false advertisement.
In the hearing at United Health Care on July 18, 2001, UHC plainly stated on
tape (copy of which can be provided) that they were denying Abbee's claim
due to benefit maximums of Outpatient Rehabilitation Services of 20 visits
each year for physical, occupational, speech and cardiac/pulmonary.
However, they also stated that nowhere in the certificate of coverage was
there a definition of these services. They then stated that they used CPT
codes to determine the meaning. These CPT codes are not in any certificate
of coverage, nor are they provided to any employer or individual that
purchases their insurance. Therefore, they have denied my daughter's
services based on a definition that myself or anyone else who purchases
their insurance could possibly be aware of. This in my book is DECEPTIVE
advertising. I also requested copies of all their advertising and as I
expected, they have denied that request. I have attached some advertising
that I found on the internet. Most of this comes from their own website or
websites of their subsidiaries. They state in many of their advertising
campaigns that they want the doctor to decide. Abbee's doctor has decided
what is best for her and they are denying her anyway.
The services I am seeking for my daughter and that have been ordered by her
physician are not clearly and unambiguously defined anywhere in the policy
language. It is my understanding that any services that are not clearly and
unambiguously defined by the certificate of coverage are not subject to any
number of visit limitations according to the certificate of coverage and
according to standards applied in a courtroom proceeding. This being the
case, UHC has provided no reason, based on policy language, for denying
Abbee's coverage.
On page iii of my certificate of coverage, UHC states in paragraph five,
that Only Medically Necessary services are covered under the policy. Abbee'
s physician has already deemed her services medically necessary. (Letter
attached) They also state in paragraph seven of the same page that they can
provide coverage for services, which would otherwise not be covered.
In Section 1751.01 of the ORC, Basic services are listed that must be
provided as well as supplemental services. Occupational therapy is not
listed in supplemental services. However, since her physician has deemed
these services as medically necessary, they are covered under Section
1751.01 of the ORC and UHC is now in violation of that code. In addition,
on page 17 of my certificate of coverage, section 6.12 (Conformity with
Statutes) it states that any provision of the policy which, on its effective
date, is in conflict with the requirements of state or federal statutes or
regulations, is hereby amended to conform to the minimum requirements of
such states/regulations. So as I see it, again, UHC is in violation of
state law as stated in ORC 1751.02 I as well as ORC 1751.18 Discrimination,
and is not adhering to its own statements in my certificate of coverage. It
is your job sir, to force UHC to abide by state law. It is now your job to
fine UHC up to $100,000 dollars and order them to repair the deficiencies of
their certificates of coverage or order them to cease and desist operations
in the State of Ohio as stated in ORC 1751.45.
In Section 1751.08 D, it states that you are not to be considered as
practicing medicine. However, that is exactly what you are allowing UHC to
do in denying my daughter's coverage.
Also in ORC Section 1751.83, UHC is supposed to provide an internal review,
which was on 7/18/01 by a "clinical peer". There was no "clinical peer"
present at that hearing. There were three voting members, none of whom
would be considered clinical peers. After reviewing the audiotape, you will
see that I am correct.
If Abbee does not receive these needed medical services; UHC would be bound
by Section 1751.14 of the ORC, which would only further their costs, as they
would have to continue to cover Abbee beyond the age of 18.
I want to take a moment too and comment on the UHC building in Westerville
where I was required to drive for this hearing. I was speechless, looking
at the marble floors and restroom facilities the size of rooms in my home.
They can afford all of this due to their denials of claims such as Abbee's.
I am now demanding that the Ohio Department of Insurance do their job and
make UHC adhere to the laws of this state and to their own promises. If
they indeed want to advertise nationally, trying to lure in new employers to
"invest" in their company, then they should be made to adhere to those
advertisements. Enough is enough.
I want to let you know too, as of Friday, July 20, 2001, I am the official
Director of the Ohio Chapter of the World Association of Disabilities, at
the request of the International Director. I have their complete support on
this issue and the State of Ohio Department of Insurance needs to be aware
that all the members of this organization, as well as tens of thousands of
others who have backed me in this quest to make UHC to adhere to law, are
watching and expect that you only do your job.
I will look forward to hearing from you in the near future.
Respectfully,
Christine R. Ford
(Mother to Abigail Rose Ford)
CRF/cf
Cc: J. Metz NCHCC
M. Kocot WBNS
D. Cummins Fairfield Daily Post
B. Montgomery Attorney General Ohio
D. Clay VP Lumbercraft
G. Kerford WAPD CEO
J. Mooney Insurance Crime Outline
A. Archibald WAPD Flordia Chapter
D. Belling WAPD Texas Chapter
B. Taft Governor State of Ohio
M. DeWine Senator State of Ohio
G. Voinovich Senator State of Ohio
J. Hottinger Representative State of Ohio
D. Hobson Representative Ohio
IF YOU DON'T CARE ABOUT WHAT YOUR CONSTITUENTS/CLIENTS NEEDS ARE AND WOULD
LIKE TO BE REMOVED FROM THIS LIST, REPLY AND TYPE REMOVE ME IMMEDIATELY IN
ALL CAPS AND YOU WILL BE REMOVED AND ADDED TO MY WEB PAGE UNDER THE HEADING
"OFFICIALS WHO DON'T GIVE A DAMN ABOUT WHAT THEIR CONSTIUENTS/CLIENTS
NEEDS ARE".
Ohio Chapter WAPD (World Association People w/DisAbilities) 114 Holder Road
Baltimore, OH 43105 (740) 862-5352 email cford@mail.WAPD.org www.fairfieldi.com\~cford (http://www.fairfieldi.com\~cford)
------------------
Ohio Chapter WAPD World Association of People with Disabilities http://www.fairfieldi.com/~cford