Poverty and Health Insurance Corruption

Poverty and Insurance Corruption: Is There a Causal Relationship?

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

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

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

It is time.

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

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

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

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

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

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

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

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

Health Care Dilemma – Who’s Telling the Truth?

Tuesday's Tirade

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

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

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

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

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

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

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

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

~ Washington Business Journal - by Tucker Echols Staff Reporter


Coventry's work comp financial results - stellar

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

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

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

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

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

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

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

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

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


My Experience as a Coventy Consumer

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

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

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

Tuesday’s Tale
All Eyes are on West Virginia

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

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

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

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

The Dark Days of Health Care

Tuesday's Tirade

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

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

Adolf Hitler murdered millions of Jews.

Wall Street financial institutions committed crimes that wiped out millions.

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

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

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

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

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

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

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

Tuesday’s Tale
WV PEIA’s Plight

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

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

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

Here’s just one of many reports:

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

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

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

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

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

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

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

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

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

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

Senator Max Baucus “tries” to Restore Order

Tuesday’s Tale

More Questionable Actions of Senator Max Baucus

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

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

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

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

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

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

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

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

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

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

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

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

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

Now it's the Baucus 13.

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

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

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

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

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

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

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

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

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

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

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

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

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

Ponder this definition and count your blessings:

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

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

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

Dying for Lack of Insurance

Tuesday’s Tirade
Dying for Lack of Insurance

Americans want the right kind of health care reform, and they want their elected officials to deliver it NOW.

My personal journey through the health care system with former Fortune 500 Company Coventry Health Care Inc of Bethesda MD is frightening. It reveals a private for-profit network of choices that prey on consumers. Spinning the truth by employing a variety of tactics to fool the public into a false sense of security comes naturally.

Investigation of the health insurance industry describes companies who are willing to let a consumer die by denying a life-giving, rightful benefit. Daily it is reported that health plans intentionally deny quality life to someone. For example, Coventry delayed authorization of my medically necessary surgery for twenty-three months. Any real concern about my welfare? I had to fight (figuratively) every step of the way. I was my only advocate.

On the national front there is much discussion about health care reform. New ads appear daily promoting conflicting interests. Confusion results. I trust very few of these ads but I have learned a lot about the health care system from former Senator Tom Daschle who has devoted a lifetime to health care reform.

When Tom Daschle writes that “nearly 50% of all Americans don’t have the coverage they expect to have when they seek the care they need,” my anger explodes. I know this to be the truth. Tom Daschle knows this to be truth. Heck, my doctors admit to me that they do not tell their patients that a benefit may have been wrongly denied. Insurance plans know that the consumer cannot advocate for himself and the doctors have limited time to pursue a claim.

You and your family may be facing some hard times ahead. You have a 50-50 chance of receiving life-giving benefits. Are you comfortable with those odds? Let Tom Daschle speak to you directly about your options in his recent Newsweek article.

I have baseball on my mind: It is spring, the teams are on the field, the season has begun. It seems to me that winning the health-care debate is a lot like the Chicago Cubs' winning the World Series—it hasn't happened in forever, and some proponents are hearing the same old refrain of "Wait till next year."

This is usually a safe bet; we have never won the World Series of health care. The last time we even won a big game was in 1997, with the passage of the Children's Health Insurance Plan. Before that, you have to go back to 1965, when we won Medicare and Medicaid.

Those were hard-fought victories, and the opposition then is familiar now. Our current debate has focused on whether reform should offer the choice of a public health-insurance plan. Many of the same arguments against a government-sponsored plan were used at that time, too—chiefly, that a public program will lead to a single-payer health-care system. The claim was nonsense, and nothing more than a shortsighted tactic. Fortunately, Congress didn't fall for it. Medicare is arguably one of the most popular government programs on the books today.

A growing number of Americans already get their health care from a public plan, including Medicare, Medicaid and the Children's Health Insurance Plan (the Department of Veterans Affairs, of course, also provides benefits). There are public-private hybrids as well, like state employee health plans where the government assumes the risk and insurance companies are responsible for the management. The use of a public plan as it is currently proposed is simply an extension of what we have already done in public policy during the last 50 years. We just have to circle the bases.

You get a free pass to first. Americans of all political affiliations overwhelmingly support a public plan. Part of the reason for this is because these plans have a proven track record of offering a far greater choice of doctors than private plans do.

Read the rest of the Tom Daschle’s article in Newsweek at http://www.newsweek.com/id/195672/page/2

Tuesday’s Tale
“Coventry Speak"

Over the past four years I have read many marketing pieces that Coventry has distributed, listened to countless positive messages on the phone while I awaited service, and, sadly, experienced Coventry in action, more correctly, in inaction. What has been my personal experience? Deception. Hypocrisy. Even fraud, it appears.

Here is a side of Coventry Health Care, Inc. that the public rarely, if ever, sees. Let’s begin with the following spin from Coventry:

Your Opinion Matters to Us

We work hard to provide the best care and service.

Our goal is to ensure our members receive the quality and service they expect from a health care insurer. To meet this goal, we annually survey our members to make sure they are satisfied with the quality of care and service they receive. We perform this annual member satisfaction survey through a third-party firm certified the National Committee on Quality Assurance (NCQA).

Member satisfaction is measured in two areas: quality of health care and quality of service. Health care quality is measured by overall satisfaction with health care, personal physician care, and getting needed care. Health care service is measured through satisfaction with the health plan, customer service, and claims processing.

Using the latest technology in processing claims, expanding our online capabilities to put more information at your fingertips and continuously enhancing our provider network are just a few examples of our dedication to quality.

Flashback to February 2005. I had been warned by my surgeon, Dr. Bernard J. Costello, of the University of Pittsburgh, that Coventry would initially deny my medically necessary surgery, counter to what the majority of health plans were doing at that time. Damn. Dr. Costello was right. Coventry was not telling the truth.

It took four appeals directed to the Appeals Department to address Dr. Costello’s request for reconsideration first transmitted in May 2005. Four appeals added to countless telephone conversations to locate an employee who cared about someone’s medically necessary surgery. Three months…long months, being led in circles.

It slowly dawned on me. Did Coventry ever have an intention of authorizing this surgery? It now appears that Coventry intentionally deceived me, hoping that I would go away. Providing the treatment Dr. Costello requested might set a costly precedent so the incentive was there to deny. Coventry kept building new walls and creating new excuses for the delays. But remember:

Your Opinion Matters to Us. We work hard to provide the best care and service.

Better yet, here a mission statement promoted online:

Coventry (Carelink) Vision Statement

We intend to revolutionize the health care industry in our markets through innovation, technology, quality performance, and commitment to our customers and constituents. Our aim is to offer products and services that will responsibly improve the quality of life of all we serve. We will conduct our business affairs in an ethical and financially prudent manner through employee development, involvement and empowerment, while demonstrating compassion to our members and setting a standard for all others to achieve.

And…

“We deliver exceptional value every day, driving solutions that help people enjoy optimal health.”

Ugh! How can an insurance plan operate in defiance of its own governance regulations and advertising? It is one of the greatest injustices in health care.

Carelink is an H.M.O. The federal law E.R.I.S.A. prohibits the vast majority of legal claims against a Health Maintenance Organization. For over 60 million people who are insured under an HMO, Coventry and other H.M.O.s can claim to provide high quality care but in truth deny basic consumer rights and hide under the E.R.I.S.A. They smile all the way to the bank.

For what it's worth, you do have Coventry’s word on all this. Sleep well. They do.

Coventry Health Care, Inc. Exposed Again

Tuesday’s Tirade

Deceptive Marketing or Fraud?

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

—Martin Luther King, Jr.

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

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

THE COVENTRY HEALTH CARE DIFFERENCE IN WEST VIRGINIA

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

Committed to Unparalleled Service

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


The reality, however, is shocking and disturbing.

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

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

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

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

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

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

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

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

Join me today in making a difference.

Tuesday's Tale

A Milestone

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

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

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

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

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

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

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

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

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

And, yes, the jury will be shocked.

Who Does Max Baucus Really Represent?

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

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

~ Maggie Mahar , Health Beat

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

It’s called influence peddling. Legalized bribery.

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

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

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

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

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

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

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

Tuesday’s Tale
Citizen Journalism

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

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

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

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

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

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

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

Max Baucus A Pathetic Statesman?

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

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

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

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

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

Stop HMO $ From Gutting Obama-Care

Christine :

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

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

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

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

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

Thanks for all that you do.

Jamie Court

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

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

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

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

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

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

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

Tuesday’s Tale
Flashback December 11, 2005

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

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

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

Miracles

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

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

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

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

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

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

Please pray for Liberty and Justice for all.

Health Care Reform and Regulation

Tuesday’s Tirade
Masked Justice by Insurance Regulators

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday’s Tale
Polishing the Bottom Line

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

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

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

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

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

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

Coventry Health Care Wars against Regulation

Tuesday’s Tirade
Fraud at High Corporate Levels

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

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

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

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

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

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

WILLIAM BLACK: Yes.

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

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

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

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

WILLIAM BLACK: Oh, absolutely.

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

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

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

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

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

Fraud, I believe, is at the heart of the operation of Coventry Health Care, Inc. of Bethesda MD and likely other large health plans. It suggests wholesale greed. Brazen transgressions. Fraud. Misrepresenting oneself falsely. Does it not? Read on.

The alarming news about our financial institutions creates wider, serious implications for the health care industry. Consider a few of the injustices I uncovered during my four year investigation of Coventry and you might just connect the dots. Did Coventry executives knowingly set into place policies that harm the consumer? Awfully suspicious.

Let’s take a quick tour of some of the fraudulent activities I have uncovered within Coventry Health Care Inc, the former "Darling of Wall Street."

“Coventry Health Care Inc. and Humana Inc., two of the largest providers of U.S.-subsidized health plans, were fined by Medicare for improperly marketing the policies to the elderly and disabled. Coventry, based in Bethesda, received a civil penalty of $264,000, while Louisville, Ky.- based Humana will pay $75,000, according to Medicare officials. State health regulators and patients have told congressional committees that elderly people who aren’t competent, can’t read or don’t speak fluent English have been pressured into joining the plans, known as Medicare Advantage.” ~The Reluctant Regulator

An investigation into the questionable activities of Appeals Dept Head Patrick Quinn was filed away with no consequence to Quinn.

Patrick W. Dowd, former, CEO of Carelink, falsely accused me of fraud, someone who lives with a mental illness, someone who might be especially vulnerable to tactics such as this bizarre accusation.

Carelink CEO Cosby M. Davis, III provided partial information to insurance Regulator NCQA and based on the volunteer information was awarded a rating of excellent in December 2007. Not only did West Virginia Insurance Commissioner Jane Cline accuse Carlink of egregious deeds committed in the appeals process during 2005, but Carelink was ordered to radically change the way they executed their business. This was December 14, 2006 and Carelink has defied this Final Order.

How long will America permit this outlandish activity by health care plans? How much longer will we individuals stand quietly by as others lose their benefits and sometimes their lives?

Calculated dishonesty? What a messy situation!


Tuesday’s Tale
Violence in America

PITTSBURGH – A 911 call that brought two police officers to a home where they were ambushed, and where a third was also later killed during a four-hour siege, was precipitated by a fight between the gunman and his mother over a dog urinating in the house.

The Saturday argument between Margaret and Richard Poplawski escalated to the point that she threatened to kick him out and she called police to do it, according to a 12-page criminal complaint and affidavit filed late Saturday.

When officers Paul Sciullo III and Stephen Mayhle arrived, Margaret Poplawski opened the door and told them to come in and take her 23-year-old son, apparently unaware he was standing behind her with a rifle, the affidavit said. Hearing gunshots, she spun around to see her son with the gun and ran to the basement.

"What the hell have you done?" she shouted.

The mother told police her son had been stockpiling guns and ammunition "because he believed that as a result of economic collapse, the police were no longer able to protect society," the affidavit said.

Friends have said Poplawski was concerned about his weapons being seized during Barack Obama's presidency, and friends said he owned several handguns and an AK-47 assault rifle. Police have not said, specifically, what weapons were used to kill the officers.

By JOE MANDAK, Associated Press Writer Joe Mandak, Associated Press Writer – Sun Apr 5, 4:25 pm ET

In the last month alone there have been seven incidents of multiple murders, leaving forty-eight people dead. These incidents are not isolated. In the latest incident, a sick mind took the lives of three police officers in Pittsburgh PA. The accuser remains in the mental ward of the jail at this time.

Wake up, America! Take note of these senseless killings and begin to question a health care system in crisis. Why is the mass murderer so enraged? Does this type of rage fester within other Americans, awaiting something to snap?

It is too early to tell if many of the killers in the recent massacres were mentally ill. But history tells a tragic story of the ravaged mind of the mentally ill. One incident after another. The killers at Columbine and Virginia Tech? They were mentally ill individuals who needed a great deal of help and it was denied them. Denied by health plans? Nothing would surprise me.

This is a dangerous time. Anger grows as we learn of the fraudulent activities of large financial institutions which have left many destitute. Today we learn about secret, illegal activities to grow wealth of a few. Tomorrow the spotlight will be on health reform.

Soon Americans will be furious to learn of the degree of fraud within the health care industry. There will be very disturbing information revealed about the greedy operations of health plans. We all will cry for swift justice for those who are frustrated by health plans to care for the mentally ill and the elderly, society's most vunlerable.

Do not be shocked by the mass murders that have increased in 2009. It’s beginning to be a weekly news item, is it not? The sad news? If greed were not part of the corporate picture in health care, some of these killings may never have happened.

We’ve got to figure a way to deal with this senseless violence.

Coventry Health Care and Irreparable Harm

Tuesday’s Tale
A Daughter’s Voice for Justice

“Courts agree that denying medical benefits constitutes irreparable harm." (Erissa Litigation, 2008)

Sunday, March 29, 2009.

I thought about Dad today. A lot. He, too, was abused by an unjust system. He, too, suffered with bipolar illness. Injustice drove him deeper into his insanity and forty-four years ago today, Dad held a gun to his head and killed himself. I am his voice for justice.

My father was a hero to many. A lawyer who was born into a prominent West Virginia family, Dad applied his knowledge to reach out to those “little people” who most needed his services but could not pay him. He had much for which to live: a beautiful family whose children were already showing signs of bright futures, a rich spiritual life, and a hideaway, “Camp,” which became his retreat. Over many years it was his beloved Camp that comforted and restored him. Dad, too, had discovered grave injustices in the legal system. Camp was Dad’s “almost heaven.”

As Dad’s bipolar illness unleashed its ugliness on Dad’s mind, he learned that the West Virginia Department of Highways needed some of his twenty-eight acres of camp property for a new interstate to be built. Some say Eminent Domain is an abuse of powers. But, in 1964, a very troubled soul who lived with excruciating emotional pain did not have the will to fight.

It was a last minute change in the route of Interstate 70 through Dad’s property that stabbed the heart of a man who was already vulnerable. Records at the West Virginia Department of Highways reveal that a coal company, I believe Valley Camp Coal, had contacted the White House. Within a short time, the route was changed. The consequences of that call shattered Dad.

Living with a mental illness, bipolar illness, has reminded me of just how challenging it has been to seek justice. How many people living with a mental illness could tolerate the corruption and obstacles within our court system? Fighting a former Fortune 500 company that is filled with deceptions, evasiveness, relentless questions, intimidation and discrimination. It has been a painful four years, but images of my loving father inspired me to relentlessly pursue my rights.

This past Friday Carelink attorney Grant Shuman deposed me. Under oath, I gave oral testimony to the events of this past four years in answer to Shuman’s questions. This was not so much about me and my evidence as about evidence that might put Carelink actions in a positive light.

Three hours of testimony. Mr. Shuman was kind and very considerate, but too many times I felt like my back was against the wall. Shumen would rephrase questions until, it appeared, he was satisfied with my answers. That happened many times, but as he might say, “That’s my job.” Personally, I found the process legally manipulative.

Flashback 2005 and 2006.

I spoke with Ruthie Simpson, Carelink customer service representative at 11:00 am on October 27, 2005. I was frustrated by the many attempts by Carelink to block my medically necessary surgery. By October 2005, I was especially frustrated as a key person to this process, Patrick Quinn, Head of the Appeals Department, would not take my phone calls.

My spiritual director, in encouraging me to fight for justice told me I must be ingenious. “Is writing a blog ingenious?” He gently nodded and United4justice.blogspot.com was born in the fall of 2005.

When I spoke with Ruthie, she appeared to be very understanding and cooperative, as I had experienced on prior calls with her. Although mad internally, I was not angry with Ruthie and my records show that I did not demonstrate anger, only frustration. I asked Ruthie to phone Quinn and request, for the fourth time, that he phone me about my appeal. I added what now appears to have been threatening information, “Tell Patrick that I am writing a blog about Carelink.” Ruthie promised to phone Quinn. It was my understanding that the phone call would be made immediately.

By November 1, 2005, irreparable harms due to the denial of my medical treatment had taken its toll. While my benefits would be authorized in April 2007, the damage emotionally had been done. It gets far worse.

In an act of discrimination and intimidation, former CEO Patrick Dowd accused me of fraud on November 1, 2005, In a despicable act against someone living with a severe mental illness, Dowd, I believe, wanted to terminate me.

In his letter, Dowd portrays Ruthie as having received a call from me where I may have presented myself as West Virginia Insurance Commission agent, Dena Wildman. If true, the action is fraud and termination would result.

Why this desparate act? Dowd likely had the knowledge that my investigation of Carelink revealed serious activities and I would be describing these activities in a blog. Like so many others, Dowd had little understanding that those with mental illness do recover to lead full lives as I.

On Friday I was shocked to learn of the existence of a document that details Ruthie’s e-mails that day. Ruthie allegedly sent an e-mail to Quinn advising him of a phone call from “Diane” Wildman with the insinuation that I placed that call. It was about 11:20 a.m.

This is not the Ruthie I experienced on several prior calls. However, it is within what I believe to be the devious mind of Quinn to orchestrate this accusation. Is it real? In the form of a piece of paper with words on it, I had to agree to Shuman’s question, that certain words did appear on a record. But, we all know there are many ways to manufacture records.

It is public record, however, that Carelink went to objectionable means to limit my access over several years, further discriminating and intimidating me. Thus I look forward to meeting Quinn and Ruthie again in the Court of Ohio County, before jurors, where it will be my word against Patrick’s. I believe Quinn’s record of deceit and evasiveness will indict him in the eyes of the jury.

I believe Ohio Country jurors will find Carelink and Dowd guily on all counts, including discrimination against someone with a disability and intimidation.

Before that there will be a lot of questions. A few come to mind: Would Ruthie not have contacted Quinn about this urgent matter within minutes of ending our conversation? Would not a top notch CSO question how I could lie when it my name and policy number is on the screen when she took the call? And how could Ruthie get Dena’s name wrong, identifying her as “Diane?” Why did not Ruthie take this problem to her supervisor first? Why did the supervisor discuss Dowd’s accusation in her office? Why did legal, as of that date, limit my access to speaking only with the supervisor?

It is Carelink Health Plans Inc of West Virginia who is on trial.

Fortunately, it may well be my word against Carelink’s word. My evidence from the administrative hearing before the West Virginia Insurance Commission in August 2006 that was not challenged by Carelink. There are incriminating documents. And there will be witnesses, at least one, I suspect, whose conscience will lead them to avoid perjury or additional perjury. A Coventry employee, I believe, will listen to his conscience and reveal Truth. I have no doubt of this.

Yet, the jury must listen to Carelink attorneys attempt to spin the facts and plant doubt about my integrity. And then it will be fun for me. Like Dad, I have devoted numerous hours to helping people in need in our community:

Founder of the Odyssey of the Mind program at St. Michael’s School, a program that over ten years was a force to develop knowledge, teamwork, and self-confidence in our young people.

Founder of “The Little Rock Bible Study” that developed group studies of the Bible in seven different locations and developed strong leaders for the church.

Founder of the first West Virginia chapter of DBSA (the 46th state to form a chapter) and facilitation of DBSA of the Ohio Valley for six years. Today there are 10 new groups in our state; hundreds of people living in darkness with a mental illness have found a home that uplifts and supports recovery.

As I walked through my life, I would not have envisioned my role in health care reform. Yet, it’s all so natural to me and I have received abundant graces from God. I desire to help people have a much better life which means access to quality health care. No. This lawsuit has never been about me. Nothing ever has been about me. It’s about the mentally ill who if given the right health care have an 85% chance of recovery. Understand the power of recovery on our communities and country. Then ponder irreparable harm when that care is denied a mentally ill person.

What price will an Ohio County jury place on irreparable harm?

Tuesday's Tale

Prologue to My Father's Legacy: Voices for Justice

The day began as the day before it and the day before that one. A black hole, so deep he wondered if he could climb out of bed. ‘I’m only a shadow of myself,’ he thought. Was this just an evil trick of his brain or had he changed so much? When did his present struggles begin? His mind raced upon awakening. No stopping the noise. Now he was afraid of himself.

This day would be different, he reminded himself. He had plans. He knew there was a way out.

Dressing for the day, he chose a blue suit with white shirt and a favorite red tie. It was too obvious that he had lost weight. He didn’t dare stare too hard in the mirror. The reflection suggested worry and weariness.

His financial problems began when he left the family law firm. It appeared to be a positive move, founding another firm with two of his friends. But something snapped. His life was a whirlwind of activity and creative ideas. He was empowered and moved mountains, spreading joy to those he met. Or so he thought.

But then he suddenly fell into a dark chasm of depression. No choice but to go to the hospital for psychiatric care. Six long weeks. People shuffling around like zombies most of the day. Sleepless nights. Gray days. Too dark to move.

His doctor prescribed medication that would bring him back to reality. That’s what the doctor had said. Only he had to be patient. “It takes time for medication to work,” the psychiatrist told him. “It takes time for the medication to be effective. But it will be better…someday.”

And so he waited in darkness for three months. Despair. Deep despair. His thoughts drifted to “what-ifs.”

What if he could return to his family’s law firm? What if he did not have such deep financial problems? What if the State Road Commission of West Virginia had not seized his beloved camp of 20 years though eminent domain, in his eyes an abuse of power that took a slice of his heart? What if his new law partners would allow him to come back to the firm now instead of waiting for a complete recovery? No, No. No…This is madness.

Breakfast was simple: a bowl of shredded wheat, milk, O.J. He had little appetite of late. Nor interest in conversation. He said nothing to his wife. His three children had already left for school. He sat and remembered. He cried within. No one understood his pain. No one understood his behavior. There were snickers and hushed talk on the rare occasions he left his safe house.

He kissed his wife goodbye that Monday morning. The signs of spring were in the air as he drove his Chevrolet up the avenue. Instead of turning left as was his routine of late, he turned right. The car knew the way. Although he might be missed at the bank where he did routine legal work for half a day, people would know: it’s another bleak day.

There was no flash of better times, no signs of new life that he saw out his window. There was irony. Springtime is a time of new beginnings, of hope, of desire. In his depressed state of mind spring reminded him of the what-ifs, and he continued driving without thought, only darkness.

Many factors triggered his gloom. He had begun to deteriorate rapidly. He fought to save his Camp as best he could in his crippled mental state. Camp was not only home to him; it was respite from the ills he experienced daily, the imbalance in the legal system he had so proudly represented. He wept at the injustice done to many and rejoiced in the success of a few. Camp was his piece of heaven, where he enjoyed peace and solace.

Justice was on his mind that Monday morning. He was obsessed with visiting the Camp one last time before it was torn down for the new Interstate. Justice? There had been a last minute maneuvering, a change in routes for the planned Interstate. The State Road Commission of West Virginia chose a second option, one that would destroy Camp. He no longer had the energy to fight, but he had plans.

It was a late Monday morning when he drove off the country road and onto his property. Camp appeared sad and naked. Everything had been removed the day before except for a few items. He felt empty as he thought back to November. He had taken a stance: Justice in the guise of a stop sign. He impaled the sign in the ground in a futile attempt to stop people from trespassing. Or was it a futile attempt? Maybe it was an act of defiance by a deeply troubled but just man. Someone had removed the stop sign. He had no voice.

He proceeded into the now empty house and walked with purpose to the closet. A “what-if” came to his mind. What if the family had not left the guns yesterday when they cleaned out the Camp? Sick in mind, body, and spirit, he slowly walked up the steps to the attic. With no more thought he aimed the gun at his head and pulled the trigger. He found his way out. He quit.

On a dreary Monday in March 1965, he left a legacy. A rich legacy. One that continues as his spirit rises from ashes and guides others today. It’s quite simple. Stop: it’s time for all of this to change. It matters what we leave behind. Justice is attainable. Our lives do make the difference.

Now it’s my turn for I am my father’s daughter. I am involved in a legal battle against a giant in the insurance industry, who made the big mistake of not understanding my roots nor appreciating the nature of mental illness. Additionally, I have filed a claim against the WV Insurance Commission for damages for obstruction of justice. No time for “what-ifs.” In West Virginia we are “Open for business.” Well, I have business to do, too, as I have discovered that just maybe West Virginia is a little too open to business.

Dad’s stop sign is now replaced with this book. My work is words and the truth will set us free.

The Special Interests of Coventry Health Care Inc of Bethesda MD

Tuesday’s Tirade
Throw the Rascals Out

"You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time." ~Abraham Lincoln (attributed)

Today, America rages against financial institutions and rightly so. Does greed ruin lives? I believe so. The next waterloo may well be health insurance plans. For me personally, that time will not arrive soon enough.

Deceitful people can be really cruel and despicable. Spin can be just as morally reprehensible as spin limits the truth. Coventry Health Care, Inc. of Bethesda MD believes that their personnel can lie and get away with it. They believe that solely by moving key employees out of their positions, they can forget many conversations and happenings about my case and state under oath, “I don’t remember Penny Stenger.” Will this fool a jury? Not in Ohio County, I believe.

Truth is always available. While it may be difficult at times to uncover truth, patience and faith lights the way. And then there will be no place to hide.

Coventry deceived me time after time. There’s a pattern. The evidence exists with witnesses to support my testimony. After four years of investigation, Coventry well knows my determination to hold them accountable. But pride has a way of blinding people, so Coventry may not believe that it will ever have to publicly face the possible consequences of its abusive treatment of me and others, including the many who were denied life.

Coventry has attempted to manipulate me many times over four years. I am the David in the story of David and Goliath. What are my stones? Blogging. Letters and e-mails. Lobbying. Uniting with watchdog groups. While some advocacy catches on, at times I have hit a roadblock. Then it takes dedication, courage, and perseverance to continue.

Last January I wrote to Senator Max Baucus of Montana who has a strong interest in passing health care reform legislation. I detailed my unique story about Carelink, my former HMO and its parent company, Coventry Health Care. Senator Baucus promised to respond within six weeks. But Baucus did not hold this promise sacred.

In yet another twist of fate, I recently learned that Senator Baucus knows how to “spin” the truth. The real truth? It is likely that Senator Baucus is interested in only part of heath care reform.

Last week I received a letter from consumerwatchdog.org of which I am a member:

Stop HMO $ From Gutting Obama-Care

Christine —

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

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

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

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

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

Thanks for all that you do,

Jamie Court

Words are obviously cheap. While my former HMO thinks in dollars, I think in heartbeats.

Tuesday’s Tale
Flashback

Veterans Day: A time to reflect...
November 11, 2005

Today is Veterans Day and we honor those who offer their lives so that we might enjoy all the freedoms that are uniquely American. We are proud today and the Pledge of Allegiance takes on fuller meaning.

Let's reflect again on this powerful pledge of freedoms:

"I pledge allegiance to the Flag
of the United States of America
and to the Republic for which it stands,
one nation under God, indivisible,
with liberty and justice for all.”

Over the centuries our veterans have fought valiantly to insure the rights of Americans. No one has the right to deny us a life without threats, to deny us a life without fear or to deny us a life without intimidation. Additionally, each of us deserves to be treated with dignity and with fairness by all.

It's Veterans Day. Maybe on this day, November 11, 2005, it might just be our turn to unite to further these freedoms. Not abroad in far off lands, but here on our hallowed ground. For together we will be victorious.

May God bless each of us with Liberty and Justice!

In 2005, I was urged by my spiritual director to fight for justice. Father warned me that I must be ingenious. “Is writing a blog ingenious?,” I asked. Father smiled and quietly said, “Yes.”

I began writing my blog on November 11, 2005, ten days after Carelink’s CEO, Patrick Dowd, accused me of fraud. It appears that Dowd’s letter was precipitated by a communication I had five days before when I spoke with Carelink Customer Service.

Does it not seem extreme to falsely accuse someone of fraud? Even irrational and confrontational? I believe so.

Here are the details of the conversation I had on October 25, 2005, with “Ruthie.” That was the last contact I had with Carelink for many months, as barriers were imposed.

I asked Ruthie to contact Patrick Quinn’s office about decision regarding my grievance. She will contact him.

I explained the deceit (four appeals, a serious complaint that went from Supervisor to Patrick Quinn to Corporate Legal to Supervisor for likely a “deep six” filing) that has gone on and my desire to fight for access with my blog. Ruthie kept apologizing. I told her that it was a systems problem and I expect an apology from someone higher up. Ruthie is the customer service representative who was so understanding when I requested and was initially denied my first c-pap.

RUTHIE SAID THAT IT WAS AN INTERNAL PROCEDURE NOT TO GIVE OUT E-MAIL ADDRESSES.

Ruthie will contact both Patrick and Nancy Phillips (Appeals Department). She will phone me this afternoon.

I must practice the need to know with each contact and conversation….


And people wonder why, at times, I appear so angry. What part of deceit don’t they get? Are they aware that there are many others who are likewise angry? My sleep apnea specialist later would describe Dowd’s action in falsely accusing a person living with a mental illness as “despicable.” My surgeon likewise expressed intense anger. I am by no means alone.

Coventry Health Care Matters

Tuesday’s Tirade
Anger is Growing

"Injustice anywhere is a threat to justice everywhere." ~Martin Luther King Jr.

It is estimated that mental illness affects 1 in 5 families in America. Shocking statistics considering the suffering of the mentally ill, their family, friends, and business associates. While the best treatments for serious mental illnesses today are highly effective, it is unconscionable that many mentally ill are denied the necessary health care by their for profit health plans.

It was in July 2005 when I first learned of a secret agenda of my HMO, Carelink Health Plans Inc, to deny me my rights under my contract. It was in May 2005 that Carelink, an affiliate of Coventry Health Care, Inc of Bethesda, MD, denied my specialist’s request for medically necessary surgery. Since then my single goal has been to expose their despicable, abusive activities.

Today I advocate for quality health benefits for the mentally ill, the most vulnerable in our society. I have investigated Coventry Health Care, Inc of Bethesda MD for over three years and have discovered shocking, bizarre behavior described in this blog.

Anger drives my passion. Anger that Coventry continued to deny life-saving benefits to subscribers including Ivyl Garnes, Julia Slaven, Mary Casey, Lisa Howard, Tracey Pierce, Dale Fausset, and Nathan Crabtree. Anger that Coventry denied life-saving treatments as corporate revenues increased year after year:

“Return on equity is an eye-popping 33%.” Courtney Smith and Company, September 4, 2004

“…(Coventry reported “it made $147.5 million, or 92 cents a share, compared $133.1, or 81 cents a share, in the third quarter of 2005. Revenue jumped 14% to $1.91 billion.”
MarketWatch, Oct 27, 2006

Coventry Health Plan’s “ Medical Loss Ratio (MLR)((1)). Health plan commercial group MLR was 78.4% in the first quarter, a 50 basis point improvement over the prior year quarter.”…” * Medical Loss Ratio (MLR). Medicare Advantage MLR of 82.3% increased 40 basis points over the prior year quarter driven by the new Private-Fee-For-Service business. Medicare Part D MLR of 94.7% improved 330 basis points over the prior year quarter and Medicaid risk MLR of 86.5% increased 260 basis points over the prior year quarter.” BNET April 2007

Greed likely fueled one of the highest salary packages for a CEO of a US corporation in 2004. As is widely reported, former Coventry CEO Dale Wolf earned an obscene salary package of $32,000,000.00.

As a scholar of biblical history would note, anger is a positive emotion when it spotlights serious issues such as that noted in the following New York Times News Analysis by Adam Nagourney:

Obama Braces for a Backlash Over Wall Street Bailouts

WASHINGTON — The Obama administration is increasingly concerned about a populist backlash against banks and Wall Street, worried that anger at financial institutions could also end up being directed at Congress and the White House and could complicate President Obama’s agenda.

…“We’ve got enormous problems that need to be addressed,” David Axelrod, Mr. Obama’s senior adviser, said in an interview. “And it’s hard to address because there’s a lot of anger about the irresponsibility that led us to this point.”“This has been welling up for a long time,” he said.

What has been the response of the public to this NY Times news analysis?

“…I wouldn't call this a populist revolt. I'd call it a revolt of common sense.” ~Rowerin V, Washington, DC

“…Please, Mr. President! I implore you. Arrest these criminals! Prosecute them! replace all the execs at these banks, insurance companies, stock brokerages! Break them up and re-open them as honest businesses, with all the proper regulations and safeguards in place. Please, Mr. Obama.” ~ davekliman, Glen Cove, NY

“…They're right to worry about a backlash. Warmer weather is coming, and with it will come hoards of angry and disgusted taxpayers carrying signs. We've had enough! What's that address for AIG again? Anybody have a list of their affiliates? ~ BG in NC, North Carolina”

Many Americans are seeing a very dark cloud looming in their future. Daily, Americans awaken to more frightening news about an unprecedented economic crisis and about the intense suffering of innocent Americans. It’s a time of turbulence, apprehension, and alarm.

Many also believe that there is a dark cloud hanging over the health care industry, too. Politicians and health care advocates say that the under regulated system is broken. As we begin to ponder the cost to the consumer, we, too, grow angry. We demand answers.

Health care does matter. It’s our right. Never forget this.

Tuesday’s Tale
Don’t Let the Bastards Wear You Down

There's an old story about union boss Jimmy Hoffa who was frequently indicted by the government for alleged illegal activities. To keep himself balanced, Jimmy had a plaque placed on his desk. It read: "Illegitimi Non Carborundum (Don't let the bastards wear you down").

Carelink Health Plans, Inc. of West Virginia and its affiliate Coventry Health Care, Inc. of Bethesda MD have created a trail of lies. Their nearly impenetrable system of deceit was not fully protected from my lengthy investigation as published in my blog.

It was May 2005. Dr. Bernard Costello, my surgeon, requested Carelink’s authorization for medically necessary surgery. On July 29, 2005, Carelink denied my appeal for this benefit citing the requirement that our company purchase a rider as stated in our policy.

My husband Tom contacted his Carelink Sales Representative Michelle Gill to discuss this exclusion. Gill innocently told Tom that there never was such a rider, that this nonexistent rider could be part of a future appeal.

Just words in a policy. More of the same. Tactics to deny. Deceitful abuses. It took Carelink twenty-two months to authorize my surgery. One legal maneuver after another. From May 2005 until April 12, 2007.

There is something very wrong with this system. Time equals $ to Coventry. Time equals life to me.

On March 27, 2009, I will experience being deposed by Carelink’s legal team in preparation for my civil lawsuit Christine Stenger v. Carelink Health Plans, Inc and Patrick Dowd (former CEO). My conscience is clear. There's a smile followed by a sensation of peace, as I begin to experience a small taste of victory, for I am winning.

Illegitimi Non Carborundum.

Fighting Coventry, the Darling of Wall Street

Tuesday’s Tirade
On Being an Underdog

"I never expect to lose. Even when I'm the underdog, I still prepare a victory speech." ~Author H. Jackson Browne

Flashback: August 16, 2005

My husband Tom and I arrived home from visiting our son Allen, who lives in Washington D.C. I had a lot of downtime during the visit, so I used it well, searching the internet for information about my HMO, Carelink Health Plans, Inc of West Virginia, as well as other available resources related to my investigation of Carelink.

I located a sizeable volume of pertinent data. Of interest is that there are many sites linking to Carelink that are no longer available (AWOL). Very suspicious. Maybe the truth hurt just a little too much. I suspect there was manipulation. Funny though. Nothing is ever lost on the internet. I have learned ways to retrieve all the files.

This project has begun to take on the dimensions of writing a research paper. A critical paper on the health care crisis. My internet sources will provide the body of the paper; my sizeable evidence will be noted as addendums.

During our visit at Sunday liturgy that weekend, the homilist shared his perspective on HOPE. Hope means trust that God will do his sizeable part. I choose to hope. As the woman in the biblical story who never gave up seeking a cure for her daughter, God will reward me for my persistence. That's His promise.

What occurs to me today is that I am dealing with real people who must have hearts and concerns about office procedures, but mostly people in the lower ranks of the organization, maybe with little post high school education. Do they care about justice? Yes, many do, but most excuse Carelink’s policies as they must have no idea of the grave injustice done to consumers at the other end of the phone.

Do some fear for their jobs? Are they permitted to ask questions? Do they ever stand up for the consumer? Afraid not. Good people turning their backs on wrongdoing. Where is our moral conscience?

What does this all mean? I am the underdog. The good news is that underdogs can operate under the radar and tools exist to help me. One of these tools, I thought, is URAC, an accreditation agency of health plans. I was sadly mistaken.

URAC, is purported to be an independent, nonprofit organization that is well-known as a leader in promoting health care quality through its accreditation and certification programs. A vast number of health insurance companies are accredited by URAC. In my case, I have a right to file a complaint with this agency against my health plan to be investigated by them. It "appears" that the investigations are to meet high standards. Wrong again.

Yet another roadblock. In 2005, I wrote to URAC asking for direction in filing a complaint against Carelink. No response. Do they have the same problem as Carelink in losing records of communications?

I later learned that an executive officer of Carelink’s parent company, Coventry Health Care Inc of Bethesda MD, was co-director of the Board of Directors of URAC at that time I sought assistance. Bernard Masheim, M.D. was the Executive Medical Director of Coventry. Coincidence? I think not, but who knows? Conflict of interest? I believe so.

Times change and events happen. Someday I will no longer be the underdog. A role reversal will occur. Carelink will become the underdog.

Update as of Tuesday, March 10, 2009

I have increased the scope of my investigation against Coventry in the last three and a half years. I am confident that I will write that victory speech someday. For today, I present yet another indictment of a system that needs more regulation and transparency to insure consumers receive justice.

The following is the current description of a “person of interest” who now chairs the Board of Directors of URAC:

Bernard Mansheim, MD named chairman

Washington, D.C. May 28, 2008 - Today URAC announced that Bernard Mansheim, MD, has been elected to serve as chairman of URAC's Board of Directors.

Mansheim has served on URAC's Board of Directors since 2005. He is a physician and is board certified in internal medicine and infectious diseases. He worked in academic medicine for three years and then in private practice for another decade, and has worked in medical management for more than 15 years.

Where is the mention of Mansheim’s long affiliation with Coventry Health Care, Inc. of Bethesda MD as the former Vice President of Coventry Health Care? Who are these people trying to fool?

We know the answer. It is the many physicians, consumers, and legislators, who do not have the time, the knowledge or the passion to investigate organizations whose marketing plans somehow fail to tell all the truth.

Here’s a juicy link to the make-up of the Board of Directors of URAC today. Just how many people are part of Carelink’s grand scheme? Ponder my rejection by URAC in 2005. Ponder the policies that might just be adopted by URAC because people who have invested interests in their own health plan benefits are members of a governing body. Ponder why I am the underdog.

URAC Board of Directors

http://www.freewebs.com/courageoffaith/Accreditation%20Agency%20URAC%20Board%20of%20Directors.mht

Tuesday’s Tale
Justice Delayed

Few people know that I live with a serious medical problem which left untreated could cause a stroke or heart attack at any moment. As justice continues to elude me, my treatments have been delayed.

On , December 14, 2006, the West Virginia Insurance Commission enacted Final Order 06-AP-024, that ordered Carelink to authorize my medically necessary surgery to treat my severe sleep apnea . Following one Carelink delay in court after another, I received Carelink’s authorization on April 19, 2007.

Prior to this, on January 23, 2007, my specialist contacted Carelink to request an alternative treatment, one that neither required invasive surgery nor cost Carelink much. Records indicate that the specialist's representative Sarah Hamilton spoke to Lewis T, a customer service rep with Carelink. Hamilton was told on the spot that this was not one of my benefits. Just like my surgeon Dr. Bernard Costello was wrongly told in May 2005 and later proved to be an error.

Final Order 06-AP-024 also mandated that each requested procedure be thoroughly investigated by Carelink before a decision. Justice was delayed once again January 23, 2007. I am still waiting. Did the West Virginia Insurance Commission enforce the order so I could avoid life threatening effects? No. Justice delayed.

On May 17, 2007, I met with Dr. Bernard Costello, the surgeon who was to perform my authorized, expensive procedure of maxillofacial surgery to treat my medical problem. We discussed the great stress under which I was living, chiefly due to my relationship with Carelink. Dr. Costello advised me to delay the surgery until these difficulties were behind me. He ordered another sleep study. Again, I wait for delayed justice.

Justice now awaits the prosecution of my civil lawsuit against Carelink and former CEO Patrick Dowd for alleged discrimination and intimidation that will take place in two to three years in Ohio County, West Virginia. Ohio Country jurors have the distinction of awarding the highest damages in the U.S. Not necessarily a coveted distinction, but …

Will I live to witness the final victory? Who knows? I have always suspected that Careink would rather I die so I’ll go away, like Ivyl Garnes, Tracey Pierce, Dale Fausset, and Nathan Crabtree. Whether present or not, my evidence is my condemnation.

I begin to outline my victory speech and it feels sweet.

Carelink Delays Yet Again

Tuesday's Tirade

The Extreme Test of Justice

A day can be an eternity when a person faces a hardship. It has been one thousand, four hundred and seventy-one days since I scheduled medically necessary surgery with Pittsburgh specialists Dr. Shelley McQuone and Dr. Bernard J. Costello. Despite receiving authorization for treatment, justice has eluded me for 1,471 days of my life. That is 35, 304 hours. 2,118, 240 seconds.

Waiting to hold former “darling of Wall Street” Coventry Health Care, Inc of Bethesda MD accountable for egregious deeds has been difficult to endure at times, for I live with what has been described as a major mental disorder, bipolar disorder.

Living with bipolar disorder at its best allows for creative genius to flow, but at its worse is not only insufferable for me but for those around me. And imagine the stressors associated with fighting a giant in the health care industry coupled with the normal daily stressors. Just imagine: 2, 118, 240 seconds of delays and, at times, intolerable, emotional pain.

While I have won my benefits from my former HMO via West Virginia Insurance Commission’s Final Order 06-AP-024, I am seeking damages as the plaintiff in a civil lawsuit against Carelink and former CEO Patrick Dowd. Carelink is a subsidiary of Coventry Health Care, Inc of Bethesda MD. I seek damages for alleged discrimination and intimidation by Carelink.

Now as the clock continues to slowly tick, I again wait by the phone for word of movement in my lawsuit. There has been yet another disturbing delay. My deposition will be have been postponed by sixty days.

For thirty days in late December 2008 and January, I lived with anticipating a very difficult, challenging deposition from Mr. Grant P. H Schuman, Carelink counsel, then scheduled for January 27, 2009. Although I should have anticipated possible trickery, I was not prepared to hear that Mr. Schuman was involved in a car accident on the day he drove to Wheeling for the deposition.

Mr. Schumann walked away from the accident. He hired a company to tow his car. Why has it taken Mr. Schuman sixty days to reschedule his deposition? 1,440 hours of my life this winter. Gone. Incredible but this stuff is fair game amongst many attorneys, I am told.

More shocking are the stories of the following human beings who also were denied urgent health care from Coventry. Just google and take notice.

Ivyl Garnes, cancer of the esophagus treatment approved and then denied, Coventry Health Care of IOWA

Julia Slaven, aggressive cancer, after public protest, Coventry’s experiemental treatment authorized, Coventry Health Care of Kansas

Mary Casey, breast cancer, Coventry Health Care of Kansas

Lisa Howard, treatment rejected although authorized initially for Mayo Clinic, Coventry of Iowa

Tracey Pierce, 37, denied life, 2006, First Health Coventry

Dale Fausset, denied life, 2008, Coventry Health Care of Nebraska

Nathan Crabtree, lengthy process of denial, denied life, First Health Coventry

Why is the upcoming trial against Carelink so important to me?

Because victories against health insurance companies are rare.

Because Carelink not only has been delinquent in their duties to me, they have despicably discriminated against me and intimidated me, a person with a mental illness. My lawsuit will raise awareness.

Because in the 1,714 days since I began this journey, I have discovered dark truths about the way Coventry does business and few really know the depth of the evil.

Because no one hears from those like Ivyl Garnes, Mary Casey, Julia Slaven, Tracey Pierce, Dale Fossett, Lisa Howard, and Nathan Crabtree because many elderly and mentally ill have no voice. I represent their only chance to be heard. And I take my role as advocate very seriously.

America hears daily about a health care crisis in our country, but there are few human faces upon which to gaze in the news. We cannot even begin to understand the plight of likely thousands of others mistreated by their health plans.

My lawsuit is a rare opportunity to reveal a lot more than discrimination and intimidation against a handicapped individual by a health care giant. Most importantly, I believe, it will be the beginning of a spotlight on the horror of how Carelink Health Plans, Inc. executes its business plan. Has there not always been a hidden agenda with Carelink?

While we wait for justice, ponder this loathsome reality: For every day I have suffered as I have waited for justice, former Coventry CEO Dale B. Wolf earned $21,753.00 a day as part of a salary package that was awarded him for one year.

I am angry. My anger fuels my passion.

Tuesday's Tale
Employees of Coventry Health Care Tell All

Coventry Health Care avoids publicity, preferring to operate in the dark. Their employees remain tight-lipped. But every now and then one discovers that the internet tells all.

Glassdoor.com is a website that records what employees are saying about their employers. While two people spoke a kind word about Coventry Health Care, Inc., more replies describe an intolerable workplace.

"Extreme salary disparities between people doing the same job. Concentra legacy nurses were promised by senior mgmt to be brought up to par with newly-hired Coventry nurses doing the same job, in 2007. Never happened. We are talking $7K - $15K difference here. There are few advancement opportunities unless you go back to school. So far, mgmt has not been flexible with student/worker schedules. There are no concrete guarantees from mgmt if you get a higher degree, your salary will go up to match that of the new hires."

“If you want to enter into the Business Analysis field, this might be your start!”

“If you enjoy being a Corporate slave this is the job for you.”

“As some one else mentioned - Coventry is soul-crushing.”

“Soul-crushing drudgery, Office politics, and Incompetent management ... every day is a real-life Dilbert cartoon.”

“Coventry is almost as bad as United Healthcare”

“Glad to be gone.”

“Great Place to be”

“Employer is okay but avoid the Medicaid related projects as they are low bid and you work a lot of overtime.”

Is this all about disgruntled employees? No. It describes badly managed care not only for the consumer but for employees.

Tuesday’s Tirade
Is U.S. News and World Report Misleading the Public?

“If you're sloppy or you're unethical and you're exempt from so many of the regulations, it's easy to cover your tracks for a while. But sooner or later, these things come out.”

~Paul Nelson, Philosopher and Scientist

Corporations are unraveling with astonishing quickness around us. Today, Coventry Health Care, Inc. of Bethesda MD, former “Darling of Wall Street,” sees its empire crumbling. Sadly, while Coventry is fighting for its life, it still falsely portrays itself as an “Excellent” insurance plan. Is U.S. News and World Report involved in this false advertising?

I met Carelink Health Plans, Inc., a Coventry subsidiary, in 2005, when Carelink denied me a medically necessary benefit. I made a choice then to investigate. My discoveries are shocking.

Judge Jack Debolt presided over my administrative hearing before the WV Insurance Commission against Carelink in August 2006. He was outraged by the evidence. Judge Debolt and the West Virginia Insurance Commissioner signed the fourteen-page Final Order 06-AP-024 against Carelink in December 2006.

It is concluded that it is appropriate for the Commissioner to issue a cease and desist order to Carelink under the provisions of 33-25A-23(4)(a) of the code to require it to consider all aspects of a claim both upon initial consideration and upon internal appeal (my emphasis).

In 2007, three personal physicians requested treatments for me from Carelink. Each request was denied on the spot! Unlike the honorable insurance commissions in Kentucky, Alabama, Kansas, and Delaware who enforce final orders, the West Virginia Insurance Commission refused.

But nothing prepared me for the knowledge that Carelink received an “Excellent” accreditation from a regulatory agency NCQA in early 2008. What! How? Why? In the face of evidence that proves that Carelink is anything but honest and law-abiding, their reward was an “Excellent” rating.

Are you sitting down?

NCQA was organized in 1979 by trade associations for managed care (HMOs). NCQA was founded to counter government’s attempts to oversee the HMOs, like the fox guarding the hen house!

Big mistake made in West Virginia. Not only is there the public record of my administrative hearing and the Final Order that discusses “egregious” deeds by Carelink, there is also a civil lawsuit pending with evidence that Carelink discriminated against and intimidated me.

It only gets worse. NCQA uses “voluntary information” from the health plan that requests accreditation. It is grossly outrageous and intolerable that U.S. News and World Report relies on NCQA’s evaluation to determine its top health plans each year.

Cost plays a large role in plan choice, of course. But data analyzed by NCQA and provided to U.S. News about hundreds of plans permit quality to be considered as well. The rankings, at health.usnews.com/healthplans, show how well plans do at preventing and treating illness and providing consumer services to members.

~U S News and World Report

While Coventry’s empire continues to collapse and U.S. News and World Report promotes health plans using volunteer information, decisions are being made about real lives by, what I believe to be, a phantom corporation. These real lives are suffering.

“Sooner or later,” Paul Nelson writes, “these things will come out.” Hope sustains me as the unraveling continues.

Tuesday’s Tale
The Legislative Branch: Making Laws to Protect Us

“The way to secure liberty is to place it in the people's hands, that is, to give them the power at all times to defend it in the legislature and in the courts of justice”

~John Adams

There is a deep sorrow that comes from knowing about the injustice of Carelink Health Plans, Inc. of West Virginia, my former HMO. For four years my goal has been to make the public aware of the potential for deceit and harm to health care consumers in West Virginia.

Last week I participated in the Catholic Diocese of Wheeling Charleston’s days of lobbying our West Virginia legislators at our State Capitol in Charleston, West Virginia. While it is sometimes difficult to fight the status quo, it was as if I was led by some divine force to meet two legislators of courage, integrity and honor.

I first introduced myself to Delegate John Frazier. “It’s gotten ugly,” I announced as I began to discuss real concerns about Carelink and the health insurance regulatory agency NCQA. Delegate Frazier, a former judge of twenty-five years and a church elder, focused intensely on my words as my truth impacts all health insurance consumers in West Virginia.

My message was obviously powerful for when I prepared to leave, Delegate Frazier stood up and looked at me directly as he stated: “I am on the insurance committee. We might be able to discuss this issue in committee.”

Later, I wandered into the office of Delegate Larry Williams, the Chair of the Senior Citizens Issues Committee. He was very busy but when I opened my mouth, I caused a response. “You mean to say that the same company that owns Carelink Health Plans owns the Medicare supplementary company that is administered by WV PEIA?” “Yes, sir,” I smiled inwardly.

Delegate Williams discussed the West Virginia “PEIA mess” with me. Too many of his constituents have called for an investigation. They are alarmed as are the many others with whom I spoke at the Capitol. No one was amused as we share a heavy burden.

The West Virginia legislature has the power to create and amend laws, to study significant issues facing citizens. My presence made a positive impression on both Delegates Frazier and Williams.

“I will investigate this,” Delegate Williams promised me.

Lobbying was fun and I proved to be a natural advocate. Once I had someone’s attention, I kept it. I have only begun to explore this avenue to secure justice, to hold Coventry Health Care, Inc. and associates accountable for corporate wrongdoing. I will demand it of those in authority. It’s such a bizarre tale of abuse and corruption.

What does this mean? One person, dedicated to a great cause, can bring about positive change. It takes time and perseverance and a Faith that believes that all things are possible with God. You, too, can make a difference. Your voice is needed. Now.

Stigma and the Pittsburgh Post-Gazette

Tuesday’s Tirade
Monitoring the Media

We will never be able to fix a problem unless it is on the table. Does living with a mental illness discredit the truth? Sadly, at times it does.

What happens to the truth when it is spoken by a person with a mental illness? Place yourself in the position of Tom Birdsong, Assistant Managing Editor of the Pittsburgh Post-Gazette. He is on the other end of the phone and hears me speak the truth, only he does not appear to recognize it. Why? Six words, I believe, “I live with a mental illness.”

What does this mean? Our society has yet another huge problem. Because of perceptions, I, and millions of others, live with an unavoidable danger of being judged by our illnesses. Stigma destroys lives. It results when people are not informed of the reality behind a situation.

I have lived with bipolar illness for over forty years. I am not my illness.

While there were devastating times in the early years and great harm done me by Carelink Health Plans, Inc. of West Virginia, I am not broken. Nor was I exposed to stigma and discrimination until my involvement with Carelink in 2005 and later with the West Virginia Insurance Commission. My children are leading fulfilling, successful lives as an attorney and a doctor. My husband Tom, a small business owner, supports my efforts to write and to advocate.

Over the years I have responded well to treatment and developed important disciplines that have led to my leading a new healthy lifestyle and to a new career. Others, I am told, have not received the consideration and the understanding that each person deserves when dealing with a mood disorder.

Counter to experiencing stigma, I have experienced gratitude and unconditional love since becoming transparent about my illness in 1995. At that time my success story was published twice by the local newspaper as a way to inform and educate others about rich possibilities.
Today, while I passionately investigate Coventry Health Care, Inc. for abusive behavior on behalf of the most vulnerable, the mentally ill and the elderly, Tom leads a state-wide effort to develop and support new DBSA (Depression Bipolar Support Alliance) support groups. DBSA gives new courage to people who feel diminished and worthless as they try to relate in a world that does not always understand the significant contributions they can make to society. Today ten DBSA groups operate in West Virginia, a dramatic increase from the first one we began in 2001.

People who live with bipolar illness can and do contribute to society as the following sampling of people suggest:

Dick Cavett, television journalist
Francis Scott Key Fitzgerald, writer
William Faulkner, writer
Stephen Foster, songwriter
Kay Redfield Jamison, PhD., Johns Hopkins University School of Medicine Faculty
Rep. Patrick J. Kennedy
Sir Isaac Newton
Jane Pauley, TV presenter and journalist
Mark Twain, Author
Ben Stiller, Actor
Robin Williams, Actor
Winston Churchill, Statesman
Ted Turner, media giant
Theodore Roosevelt, President of the United States


People, who know of my bold goal to hold Coventry Health Care, Inc. accountable, have called me a “voice for others,” a “passionate, persevering individual” who promotes a “great cause.” No one will distort this truth. It has been a journey through intimidation and discrimination as Coventry and the West Virginia Insurance Commission play their games and manipulate the truth about me, but a great cause is just that, a great cause.

It is of no significance to many that I happen to live with a mental illness, just like Winston Churchill, Mark Twain, or Ted Turner. Each of these people has a creative genius that is part of living with bipolar illness. Stigma has no place here!

Tuesday’s Tale
Building a Blog Community for Health Reform

There are so many ways to skin a cat.

One of the easiest ways to promote your message and increase traffic to your blog site, is to make comments on another blog. It’s astonishing to me that as I daily leave comments about my experience with Coventry Health Care Inc of Bethesda MD on the sites of important health blogs, my traffic multiplies significantly.

I have found my voice and it is far reaching.

Here are a couple of highlights.

There is one very significant part of Coventry’s business plan that requires attention. Now. Coventry does not consistently provide quality health care as promised. Coventry consumers are not satisfied with Coventry's service as first reported by Washington Post Columnist Steven Pearlstein in 2005: "Coventry's rankings on consumer surveys, not surprisingly, are less than spectacular, running from slightly above average in western Pennsylvania to slightly below in Kansas City."

Maybe the $37 million value salary package paid to former CEO Dale B. Wolf in 2004 could have been better utilized.

.....................................................................................................................................................

Every patient must learn about the unethical tactics employed by many health plans to control costs. Media does not usually report the truth about managed care. Blogs speak truth to power. My 4 year investigation reveals shocking details.

.....................................................................................................................................................

Subject: Abuse & WV State Corruption

After four years of fighting for justice, (tuesdaytiradesandtales.blogspot.com) soon I will have my day in court against an HMO who is a subsidiary of a Fortune 500 Company. Bye, bye ERISA. It will be new law, applying a WV state law that prohits discrimination against someone with a disability. To date no traditional media has been interested in my story. Hoping you will link to me (as I have linked to you). The WV Insurance Commission has failed to enforce Final Order 06-AP-024 it signed that mandates Carelink thoroughly review initial requests for health care benefits. Both the Commission and Carelink are acting in defiance of this order as they believe they are invincible.


Never forget this reality: in the blogosphere we each can be an investigative reporter. We each can make an impact. Our world so desperately needs the truth.

Beware, Coventry, America Rages

Tuesday’s Tirade

The Likes of Coventry and Bernard Madoff

Whistleblower Harry Markopolos tried to report the illegal scam of Wall Street financier Bernard Madoff for a decade to the SEC. On December 11, 2008, the FBI arrested Bernard Madoff and charged him with what may be the largest fraud ever. As wealthy victims raged, others asked, “What took our government so long?”

Markopolos recently gave a highly disturbing testimony before a House Financial Services subcommittee hearing:

"(The SEC is) captive to the industry it regulates and is afraid" to bring big cases against prominent individuals,” Markopolos said. … He and his colleagues avoided taking their allegations to the industry self-regulatory agency, now called Finra, he said in the statement, because he believed Mr. Madoff and his brother, Peter B. Madoff, wielded too much power with that organization.
Read more at http://www.freewebs.com/courageoffaith/Madoff%20SEC%20Hinders%20Case.doc

In my four year investigation into the unjust and illegal practices of Coventry Health Care, Inc. of Bethesda MD, I have met like resistance. Since January 2007, the West Virginia Insurance Commission has refused to enforce Final Order 02-AP-064 dated December 14, 2006, and signed by the Insurance Commissioner against Carelink Health Plans, a subsidiary of Coventry. This order mandated radical change in how HMOs do business in West Virginia.

Frank Hartman, former Chief Advocate for the Office of Consumer Advocacy, represented me at the formal hearing before Judge Jack Debolt. Hartman forcefully explained the significance of this order:

A few of the reasons your case is so important:

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

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

Read Post http://www.freewebs.com/courageoffaith/2007%204%204%20Frank%20Hartman

Last year, in an intolerable situation, the health insurance regulatory agency NCQA rated my former HMO as “excellent” despite the final order and the filing of a civil law suit (Christine Stenger v. Carelink Health Plans and Patrick Dowd with allegations of discrimination against someone with a disability). Greatly disturbing, NCQA based its evaluation solely on voluntary information provided by the health insurance plan.

Some day the truth will set us free. There will be consequences; it is inevitable. America will demand the truth about how HMOs operate under the radar and destroy lives. West Virginians will demand the truth about West Virginia’s captivity to special interests.

In the meantime, no one should be surprised at the growing discord and raging storms. As government fails to listen to the frustrated voices of ordinary citizens a growing storm rises. How much more can we endure? No one has the answer.

Tuesday’s Tale

Coventry: There’s no place to hide.

Our country desperately needs people to rail against injustice. The internet is a source of ideas and supporting evidence that will help inform people’s consciences. That will create change.

Coventry Health Care, Inc. of Bethesda MD wears a public and private face. It is the private face that interests the consumer. Rules of Governance? Stellar operation? Just “google” Coventry and read of real problems. Serious problems, according to some experts.

For the third quarter in a row, unexpectedly high medical costs appear to have taken the management of Coventry Health Care by surprise. The cost, this time, was severe: shares of the health-insurance firm lost more than half their value today, meaning that while Coventry was worth more than $4 billion yesterday, today it’s valued at only a little more than $2 billion.
~Coventry Health Suddenly Looks Like a Target — If Anyone is Buying October 22nd, 2008, By David P. Hamilton

Here's the ugly truth - and it reflects not on you (Coventry employees), but on Coventry management. Their arrogance and hubris has been the cause of their downfall. So confident were they in their abilities that they ignored the basics of the business - issue cards on time, monitor IBNRs, track medical trend and all its components, stick to what you know, treat customers as you would like to be treated. Now that it's too late, we finally hear a chastened, perhaps even humble tone from Coventry management.

~Managed Care Matters, 2009

"Allen Wise earned a strong reputation for leading Coventry Health Care Inc. (CVH) through a turnaround years ago, and now the struggling managed-care company's board is looking for him to stage a repeat performance. With the industry facing a host of economic, cyclical and political pressures, the job may be more challenging this time…While Wise is highly respected in the managed-care industry and helped deliver strong results during his earlier tenure as chief executive, the analyst said, he faces the task of "turning the company around in the middle of a brutal recession as well as a much tighter current industry pricing environment than we saw during 1999-2005."

~Easybourse January 27, 2009

There are still examples of eyebrow-raising paydays, including the options valued at $37.5 million that Coventry Health Care gave incoming CEO Dale B. Wolf, making him Maryland’s highest-paid chief executive.
~U.S. ‘Not Getting What We Pay For’: Many Experts Sa Health-Care System is Inefficient by Ceci Connolly, Washington Post, Sunday, November 30, 2008;

Blogs are democracy in action and the revolution is now. We will never be the same. Nor will those who operate in darkness. Bloggers are making an impact. Today.

INDIFFERENCE OF THE WASHINGTON POST

Tuesday’s Tirade

The Washington Post and Indifference to Suffering

In a simple twist of fate, I spoke with Washington Post reporter Steven Pearlstein on May 20, 2008. Pearlstein is a Pulitzer Prize winning commentator who writes about business and finance.

With a penchant for accuracy and fairness, the Post usually has a great nose for stories. But that nose was stuffed up the day I phoned Pearlstein with questions about his article about Coventry Health Care, Inc. of Bethesda MD:

Coventry’s Profitability Prescription
October 7, 2005

As corporate addresses go, there's no better in the Washington area than Bethesda's Rockledge Drive. Lockheed Martin. Marriott. Coventry Health Care.

Never heard of Coventry? You're not alone. This company has operated under the radar for many years, running HMOs and health insurance plans under a variety of names. The presence of its 220-person headquarters in Bethesda is an accidental legacy of a long-ago merger. Its top executives are some of the highest-paid in the region but are virtual unknowns, rarely taking visible roles in civic affairs or even industry conferences. And Coventry's idea of corporate media relations is to refuse to respond to reporters' inquiries.

Where Coventry is well known, however, is on Wall Street, where it has become a darling of analysts and institutional investors. Over the past five years, while an investment in the S&P 500 index would have lost 7 percent, investors in Coventry enjoyed a total return of 753.1 percent, making it one of the market's top performers among large companies.
Read Post Coventry's Profitability Prescription http://www.freewebs.com/courageoffaith/Coventry

Coventry’s Profitability Prescription details the success of the former health care giant Coventry Health Care, Inc. In 2005, Coventry produced remarkable growth. Impressive financials. Lowest of “loss ratios” and highly paid executives. In Pearlstein’s words they were “a master of skills” to control costs. Picture looks bright? Only one disquieting truth as Pearlstein noted: their customers are not very happy.

Like radio legend Paul Harvey frequently said, “Here’s the rest of the story.” It goes like this: We are experiencing a major health care crisis in our country and there is no transparency for the very health plans that literally control our lives and deaths. While mainstream media ignores many HMO horror stories, the problem remains a silent cry for help to this day.

Pearlstein? He answers his phone. He hears my description of a different face of Coventry Health Care, Inc. and answers the e-mail I sent him attaching evidence of Carelink abuses. Evidence that demonstrates that benefits are rejected that should be authorized under consumers’ benefit’s packages.

Pearlstein listened. He reflected. He makes a decision.

Pearlstein was not interested in the rest of the story. He remained silent as have so many others who are in a position to expose the truth.

Pearlstein e-mailed me the next day:
"Honestly, this is not something I'm going to pursue. I'm not an investigative reporter, we're not in West Virginia and Coventry has o visibility (and very few people) in the Washington headquarters. I'm sorry."

No, Sir, it is I who am sorry. Many families of those who were abused by a heartless system are sorry. Only many of them can no longer tell their stories. They are dead.

Why not google ‘Steven Pearlstein’ and draw your own conclusion about the investigative nature of some of his articles? In my eyes, as Pearlstein was playing games with me, a valiant man lost his life. He was no ordinary man. He had, unlike Pearlstein, devoted his life to saving the lives of others, as a firefighter for the city of Omaha Nebraska. Coventry Health Care, Inc. first rejected the doctors’ pleas for a medically necessary treatment. He died before receiving his benefits Coventry in time authorized:

Coventry, the city's health benefits manager, finally agreed to pay for the procedure after an appeal by Fausset, his family, and his union. "It was a very big extended period of time,” says Bates. “We have been fighting this for a very extended period of time. We were fighting for weeks to get him coverage for the bone marrow transplant."
Read Post Ailing Firefighter Dies
http://www.freewebs.com/courageoffaith/Horror%20Story%20Coventry%20Health%20Care%20Refuses%20Rightful%20Benefit%20May%202008.mht

Mr. Steven Pearlstein, in light of the limited investigation into the grave abuses of HMOs I have made, I have learned an important fact: it does not take an investigative reporter to report the real story about Coventry. It takes passion and courage and a real concern about the suffering of those who have no voice against the grave injustices of our health care system.

Where is your conscience, Mr. Pearlstein?

Tuesday’s Tale
The Amazing Potential of Blogs

The thing about Coventry is that, unless you are "inside" in some way, or have some way to monitor SEC filings instantaneously, you'll never have any transparency into what the company is doing at any one time because they are the only major insurer that has a strict policy of no media interviews of any kind at any time. They are transparent to Wall Street analysts, regulators, and no one else. At all. Ever.
Managed Care Matters, January 28, 2009

As you have read with the Washington Post, many times the news is just one subjective choice after another of what to cover by a news organization. Oftentimes, the concrete newsworthy happenings of individuals may never be reported.

Blogs equalize the playing field.

In June of 2008, I visited my spiritual director. We had been meeting since 2005 when he encouraged me to take on my former HMO, Carelink Health Care, Inc., to hold them accountable for injustices committed against me and to publish the results of my investigation.

My spiritual director is a quiet, unassuming, humble yet wise priest. But we were both surprised that mainstream media was not interested in my story of the greed and corruption within my state. That June day, with a sense of urgency, he encouraged me to write a blog .

On June 10, 2008, Tuesday’s Tirades and Tales was born. Since then I have had great success in publishing my bizarre story. A lesson for we who are advocates: blogs have power to inform and persuade when other media fear the story.

While the Steven Pearlsteins dismiss the serious “news” I have uncovered, my blog reaches people across the USA. Last week was a turning point. Providentially, I discovered the following blog that enjoys high traffic:

A Letter to Coventry Employees …. Here's the ugly truth - and it reflects not on you, but on Coventry management. Their arrogance and hubris has been the cause of their downfall. So confident were they in their abilities that they ignored the basics of the business - issue cards on time, monitor IBNRs, track medical trend and all its components, stick to what you know, treat customers as you would like to be treated. Now that it's too late, we finally hear a chastened, perhaps even humble tone from Coventry management. Fortunately the experts on Wall Street finally removed their heads from wherever they were storing them and figured out these guys (and they are almost all guys) didn't have a grasp on their business. There's plenty of talent at Coventry, and whatever happens to the company, that is recognized in the industry.
Read Post Manage Care Matters Open Letter to Coventry Employees http://www.freewebs.com/courageoffaith/Managed%20Care%20Matters%20Coventry%20Employees.mht

My personal experience is that “blogs do speak the truth to power.” Since June 2008, not one of the six major news media I contacted has reported my story. Since June 2008, my blog has reached 418 unique visitors who paid 915 visits viewing 4,810 pages of Tuesday's Tirades and Tales. That's a five page average per each visit.

But seldom do people visit my blog outside of Tuesdays. Until, that is, I left a comment on a popular blog. Due to new interest, there have been 46 additional visitors, making 55 visits, viewing 230 pages.

Time remains on my side. It only takes one right visitor with an informed conscience to ignite a fire that can quickly spread to other health care reformers.

My spiritual director led me to dream the impossible, believing that one person can make a difference in helping to create change. Any surprise here? Father's wisdom is from the Bible. While the bible informs one about Truth; blogs, written with honesty, can spread the truth that will set us all free. Spread it all over this country where there remains an outcry for health care reform.

Yes we can.

Ogden Newspapers Inc. A Call for the Truth

Tuesday’s Tirade
Ogden Newspapers Inc Helps Me Find My Voice

Few will have the greatness to bend history itself; but each of us can work to change a small portion of events, and in the total of all those acts will be written the history of this generation. ~Robert Kennedy

On Tuesday, January 20, 2009, President Barack Obama became our nation’s 44th president. President Obama was direct in speaking of the alarming situation in which our country now finds itself. He reminded each of us of the grave responsibility of those who are in authority who wield power:

And those of us who manage the public's knowledge will be held to account, to spend wisely, reform bad habits, and do our business in the light of day, because only then can we restore the vital trust between a people and their government.

Last Tuesday in my Tirade entitled Freedom of the People vs. Responsibility of the Press, I discussed the management of Ogden Newspapers, Inc. of Wheeling West Virginia. In an act of irresponsibility, Ogden refused to print a significant story about injustice and corruption in health care in West Virginia.

And so, on October 29, 2008, I turned to my neighbor, Mr. Ogden Nutting, former CEO of Ogden Newspapers, Inc.

Mr. Nutting and I spoke at length about health issues, but our focus was my concern that my letter to the editor was not published. This letter, with supportive evidence, informed the public of the egregious deeds of my former HMO, Carelink Health Plans, Inc of West Virginia, a subsidiary of Fortune 500 company Coventry Health Care, Inc of Bethesda MD. The letter also described the injustice of the West Virginia Insurance Commission’s decision not to enforce Final Order 06-AP-024 that would put an end to severe abuses by my HMO.

Ogden Nutting may be a distinguished West Virginian, but Mr. Nutting never returned the phone call which he twice promised to do. I hesitate here. Do not gentlemen always keep their word?

In 1890 the founders of Ogden Newspapers Inc were described as men of integrity and honor, men who accepted their responsibility to speak with moral clarity, addressing the issues of justice and truth. Sadly, today, the newspaper is run by the fourth generation of the Ogden family, Robert and William Nutting, and apparently they are unaware of the rights of citizenry to expect their voices be included in the history of the times.

The Ogden Newspaper Inc. website promises dedication “to those communities and the organizations, governments and businesses that support them.” When will management address this mission with passion and honesty? Unfortunately, too late for some who may have been harmed when Carelink and the WV Insurance Commission defied Final Order 06-AP-024.

Fast forward to today. Traditional media like Ogden Newspapers Inc. are under siege today by blogs. The customary business model no longer works as advertising revenues plummet and bankruptcies of large newspapers point to a new trend. There is no going back and there will be no more phone calls.

A deep sigh. It is very bleak outside today.

Tuesday’s Tale
Everyone Can Be a Reporter

“If you want something done right, do it yourself.”
~an old adage

Justice will come even if has been delayed for four years.

It has been over three and a half long years since I first sought the assistance of an attorney to represent me against my former HMO Carelink Health Plans Inc of West Virginia. Finally, this week I will experience my first deposition. It is somewhat daunting that I will be the only reporter in the room. A rare opportunity for the public to experience the mechanics of fighting for one’s rights in our court system.

I look forward to my new role, as I believe everyone can be a reporter. We certainly need more eyes on this process. My notes, as always, will be thorough, and my analysis of events in depth. My experience will be unique.
This is a big week for me, a victory of sorts. While one media after another, one West Virginia department after another, one regulatory agency after another failed me, the citizens of Ohio County, where this lawsuit will be prosecuted, will not.

Today, Brenda Gettings, a paralegal with the law firm of Bachmann, Hess, Bachmann & Garden, P.L.L.C, who represents me, will gather pertinent files together for the defense attorney to review tomorrow.

My files are voluminous and organized on different media. Four years worth of materials gathered in support of my belief that Coventry Health Care Inc discriminated against me, committed egregious deeds of which many are unaware, and behaved in a criminal manner.

My deposition will be a positive experience. I have nothing to hide. I have always spoken the truth with no hesitancy. As I live with a mental illness and am suing Carelink for discrimination against someone with a disability, I expect to be treated with kindness and consideration by the defense attorney.

There have been numerous motions and counter motions since I began in earnest in August 2006 to hold Carelink accountable for what I consider to be unconscionable, unscrupulous actions that violated the basic principles of justice. To date I am winning as Carelink has lost every motion of any consequence. Determination and faith has brought me to this day, with no expenses.

Finally, it’s been a big news day for Coventry Health Care. Actually, the news has been intriguing during the past four years:

Coventry Health Care Inc. announced the resignation effective January 30, 2009, of CEO Dale Wolf. No reason was offered for the departure. I will offer my opinion: Coventry lost 74 percent of its value in New York Stock Exchange trading in the past 12 months, compared with the 49 percent decline in the six-member Standard & Poor's 500 Managed Health Care Index. The shares have not recovered since. Surely you remember that Coventry rewarded Wolf for his leadership in 2004 with a salary package of $32,000,000. That’s thirty-two million dollars!

In 2007 Coventry Health Care Inc of Bethesda MA, one of the largest providers of U.S.-subsidized health plans, was fined $264,000 for improperly marketing the policies to the elderly and disabled.

Dale Wolf, CEO, 2005- January 30, 2009

In 2005 Delaware Insurance Commissioner Alfred W. Redmer resigned to run the Delaware operations of health insurer Coventry Health Care.

Thou shalt not be a victim. Thou shalt not be a perpetrator. Above all, thou shalt not be a bystander. ~Holocaust Museum, Washington, DC

Is Ogden Newspapers Inc. Stifling the Truth about Carelink Health Plans, Inc.

Tuesday’s Tirade
Freedom of the People vs. Responsibility of the Press

The Universal Declaration of Human Rights states:

"Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference, and impart information and ideas through any media regardless of frontiers." ~General Assembly of the United Nations

Public pressure is building. It is the public who will eventually overpower the lobbying of the managed care industry. Incessant voices calling for more transparency, calling for change.

President Barack Obama, in his address before the Lincoln Memorial on Sunday, January 18, 2009, described the hope he has in our citizens:

You proved once more that people who love this country can change it. And as I prepare to assume the presidency, yours are the voices I will take with me every day I walk into that Oval Office - the voices of men and women who have different stories but hold common hopes; who ask only for what was promised us as Americans - that we might make of our lives what we will and see our children climb higher than we did.

It is this thread that binds us together in common effort; that runs through every memorial on this mall; that connects us to all those who struggled and sacrificed and stood here before.

It is how this nation has overcome the greatest differences and the longest odds - because there is no obstacle that can stand in the way of millions of voices calling for change.

There is no better place to begin the search for transparency than with mainstream media. Although I will have my day in court soon in my civil lawsuit against Carelink Health Plans, Inc (HMO) of West Virginia, the many media I contacted chose to ignore my story, despite the fact that the abuse continues along with the harm to many West Virginians.

In 2006, Judge Jack Debolt and the West Virginia Insurance Commissioner Jane Cline issued a FINAL Order (06-AP-024) that mandated Carelink Health Care, Inc of West Virginia (HMO) to “thoroughly” review each request for a health benefit from a physician in its network before Carelink makes a determination. Judge Debolt was so shocked by the disregard of Carelink of the appeals process that he became indignant at their “egregious behavior” and issued this unprecedented order.

How did the press handle the story I brought to their attention with a sense of urgency? They did not. One MSN (main stream media) after another shunned me. So I will now use my blog, the "new media", to give an accounting of each contact I made over the past few years.

It is right to begin my accounting of MSN, by writing about Ogden Newspapers Inc., a conglomerate of media and holdings that is headquartered in my hometown,Wheeling WV. It is an unusual story of one prominent West Virginia family member speaking the truth to the power of another prominent West Virginia family.

Tuesday's Tale
The Blatant Disregard for Truth

It might have been an ordinary phone call under other circumstances. One neighbor seeking another’s assistance. Only this time it was a grave matter and the neighbor’s family owned a major conglomerate of newspaper media, property and assorted significant investments.

It was October 12, 2008. I telephoned Mr. Ogden Nutting, my neighbor and former CEO of Ogden Newspapers, Inc. and I left a message for him to phone me. I believed Nutting to be a gentleman who as an elder in his church would surely have concerns about the corruption I had discovered in West Virginia.

Flashback to November 14, 2007. I contacted Mike Myer, the Editor of the Wheeling News Register, an Ogden newspaper, to request a story about the abuses of my HMO, Carelink Health Plans of West Virginia. Over the past five years Myer has been very supportive of my advocacy on behalf of the mentally ill. He quietly listened. He would assign a top reporter, Betsy Bethel, to cover this story. Myer’s final words were, “Thank you.”

The interview with Bethel was in early 2008 at my home. A lengthy discussion. Bethel, too, thanked me as she left, having assured me that she would write several stories once she collected and sorted her notes. It was not until April 21, 2008, that Bethel e-mailed me apologetically about the delay, with new assurances of a story.

About this time I spoke again with Mike Myer, discussing a letter to the editor I wrote and e-mailed to him, which he stated that he received. The letter concerned the decision by the WV Insurance Commission not to enforce Final Order 06-AP-024 that would enable consumers to receive better service from their HMO.

My “incessant voice” fell on deaf ears. Bethel never contacted me. Myer never published this letter. What happened? Nothing. What had changed?

It was the January 4, 2009, edition of the Wheeling News Register that highlighted a new publication by two Wheeling authors about old Wheeling families. The book is entitled "The Wheeling Family: A Celebration of Immigrants and Their Neighborhoods" and focused on the history of thirty-five Wheeling families. Ironically, the editorial board chose as its one picture, to give interest to the story, that of the “O’Brien Clan,” my family, as it shed the spotlight on a little of Wheeling’s history.

In the book, the authors describe the Patriarch of the O’Briens, Colonel Thomas O’Brien, as exemplary for his desire “to do right.” He was “a valiant and influential advocate.” O’Brien, my great-grandfather, spoke of character as the main ingredient to leadership.

As I have interacted over the past four years with the newspaper staff of the Wheeling News Register, one of many Ogden holdings, I do now wonder at the character of the present generation, a member of the fourth generation like me, Robert Nutting, the present publisher.

How could I not have serious doubts about "Bob" Nutting? Has he wandered too far astray from the strong core values of decency and integrity that were established by his own great-grandfather? Why no story? What are the implications for me and the many others who have no voice and depend on our local newspapers to report the truth, both sides of the truth?

The answer is obvious. We each begin to blog and unite with other bloggers who desire free press. (see the link to freepress.net)

Today I write a tale of two Wheeling generations, both of whom come from an illustrious past. It is in living our todays, however, that "Bob" and I are ever so different.

We’ll chat some more about this misfortunate indifference to the suffering of others and about MSN, what some people write is a dying media.

Tuesday’s Tale

New Opportunities with the Obama Administration

“Never doubt that a
Small group of thoughtful,
Committed citizens can
Change the world.
Indeed it’s the only
Thing that ever has.”
~Margaret Mead

I am only one American, a powerless senior citizen in the eyes of the powerful, but I have found my voice. And it is loud and clear as I attack those who act in darkness at the cost of quality life to others. And the powerful are taking notice.

The process of speaking out begins with dedication to locating the facts, working with like-minded people to form communities, and finding a medium to promote your cause. Blogging is one such powerful tool for change. So is linking to President Barack Obama’s website www.whitehouse.gov.

President Barack Obama seeks to change America but he is not doing this alone. He is challenging us to accept personal responsibility to get involved in the process. Are you really interested in health care reform as I am? Then step out and speak your mind. Do you really care that companies like Coventry Health Care continue to block your receiving your benefits? Then do one thing. Speak out in one way.

It has never been easier to become involved in advancing positive change. Speaking as one is an effective tool to help shape policy that left to the usual process is corrupted by special interests groups.

We each have a story to tell and on www.whitehouse.gov there are several unique opportunities. Recently, the Obama transition team added a new feature. It’s the Citizen’s Briefing Book and President Obama will be reading many of these ideas.

One suggested activity is to invite others into your home or community to discuss the key issues and concerns, to offer suggestions that coupled with other ideas, may become a part of history. The transition team prepared a organizational manual which you can download.

How many of us have allowed bad things to happen to good people? Our apathy has been contagious, as crooked people and institutions expected it to be. But today is a new day, a time for a soul searching and a good place to begin is with www.whitehouse.gov.

My voice began as a whimper. Four years later it is stronger and others support my efforts, giving authority to my actions. Four years ago, when facing the evil of Coventry Health Care, Inc., I was counseled that I had no choice as a Christian, that I must claim my power and fight with determination, ingenuity, and passion. My seventy-seven year-old cleric was right. Light does shine on the darkness, but it is we average citizens who will speak justice to the powerful.

It’s time for change.

Look at yourself in the mirror and you will see where change must begin.

Coventry Health Care, Inc, An Agent of Darkness

Tuesday's Tirade

The Silence that Harms

Darkness and light are universal symbols for good and evil. It is dark outside this January day as America has been engulfed by the evil intentions of large, greedy corporations and unscrupulous, callous individuals. Consider the likes of BARRY MADOFF. FANNIE MAE. FREDDIE MAC. AIG. CITIBANK. LEHMAN BROTHERS.

There’s a revolution in the making, however, a non-violent but angry response to excesses that have done great harm to our country. The financial crisis is revealing cracks in the foundations of companies who sought profit at any cost. It reveals how lax our regulatory agencies were in carrying out their responsibilities to the American public. Today, there are demands for renewed emphasis on regulations, accountability, and transparency. Tragically, a little too late for many.

Speaking of accountability, COVENTRY HEALTH CARE INC OF BETHESDA MD, my former health plan, is being forced out of the shadows. Like other corporate machines, it appears that Coventry made decisions about my health based exclusively on the bottom line. For three and a half years my passion has been to reveal the true, ugly, real face of Coventry through the court system and blogging. My blog is my strong voice in conversation with many like-minded people, sharing tales that outrage and inspire, of unconscionable deeds, deceit, and greed.

Coventry Health Care, Inc., as well as other health plans like them, preys on the most vulnerable in our society. Shocking, unbelievable operations that feed the corporate profit engine at the cost of lives. The lack of regulatory instruments and transparency to date has allowed this former “darling of wall street” to operate in the dark.

Today is a new day for Americans. The grave financial crisis is an opportunity to discover the truth. The truth about Coventry? While Coventry’s promotional materials proudly proclaim excellent, superior service, no deed appears too egregious.

In 2005, Patrick W. Dowd, the former CEO of Coventry’s subsidiary in West Virginia, Carelink Health Plans, Inc., falsely accused me of fraud. My lawsuit is pending against Carelink and Dowd in the 4th District Court of West Virginia, charging them with intimidation and discrimination against someone with a disability.

In 2007, Coventry employed a similar tactic of intimidation, once again attempting to take advantage of the elderly and the disabled. Coventry, one of the largest providers of subsidized health plans, was fined $264,000 by Medicare “for improperly marketing the policies to the elderly and disabled.” The following Testimony of Jonathan M. Smith, Executive Director of Legal Aid Society of the District of Columbia, September 11, 2007, concludes:

Dishonest and deceptive marketing practices have enticed senior citizens and persons with disabilities to inappropriately enroll in Medicare Advantage plans. Of particular concern, plan providers have targeted seniors and others who are dually eligible for Medicaid and Medicare for which Medicare Advantage plans are rarely a good choice. As a result, seniors and peers with disabilities made vulnerable by poverty have been placed at great risk of harm including: loss of long term health care providers, limited options of in-plan physicians and potentially disadvantageous changes in drug benefit coverage.

On September 30, 2008, I penned a blog entitled Intrigue at West Virginia PEIA. I warned that the appointment of a former CEO of a Coventry Health Care subsidiary could prove tragic to West Virginians. The outrage has been building since the announcement in 2008 that PEIA “would increase insurance premiums by 9 percent for active state employees and 11 percent for retirees covered by PEIA beginning July 1, 2009.” http://www.freewebs.com/courageoffaith/PEIA%20200%20People%20Protest%20PEIA%20increase.mht
People are even more vocal about PEIA’s decision to change carriers, selecting “Kentucky-based” Advantra to provide health care coverage for retirees who are eligible for Medicare.

How many West Virginians are aware that Advantra is owned by none other than Coventry Health Care, Inc. of Bethesda MD, the same company that was fined in 2007 for irregularities in providing insurance to the elderly and disabled! Shame. Shame. More games with peoples’ health! Deceptive tactics? Once more, I believe, it is more accurate to describe this operation as a systemic evil.

In conclusion, there is much to fear. The mortgage meltdown, job losses for 2008 at 2.6 million people, and the many global financial failures and companies like Coventry Health Care, Inc. While some media conservatively report harsh damages to our economy, others state that our economy is devastated.

There’s more to this story, I believe. It’s a new opportunity to begin again. While the corporate landscape is changing, transparency and regulations are now the buzzwords of the Obama administration. Change is coming as our country returns to the values upon which we were founded in 1776. Bring on the light so the darkness will finally be revealed and the healing can begin.

Tuesday’s Tale
The Light

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

It has always been the function of the mainstream media to inform. Sadly, I believe, the landscape has changed.

MSM (mainstream media) was never interested in examining the facts and allegations regarding abuses by Coventry Health Care Inc. and the West Virginia Insurance Commission. MSN that includes highly respected media: The Washington Post. The Pittsburgh Post Gazette. PBS. NPR of West Virginia, AP of West Virginia. The Charleston Gazette. Ogden Newspapers of West Virginia.

A shocking response of indifference that effectively closed down my story for too long a time. In rejecting this story, did any one individual consider the well-being of the market area their media serves?

For several years I have attempted to make the public aware of the injustices in West Virginia’s health system and its regulatory agencies. Lead after lead to mainstream media fell on the deaf ears of the powers-to-be who decided which story the newspaper would print and which would be ignored. Why were they ALL silent?

Tuesday’s Tirades and Tales resulted from my frustration with the lack of interest of MSM in shining a light on injustice in West Virginia. Little did I know that I had entered upon a new news media that is fiercely powerful in promoting good. Bloggers who are passionate and determined have changed history. One might think back to the demise of Trent Lott, Dan Rather, John Kerry and many others. There will be more.

With a passion for justice but little direction I developed Tuesday’s Tirades and Tales in June of 2008. I bungled through my mistakes and attracted attention to the issue of the health care crisis and the indifference and corruption of West Virginia public officials. Why the interest in my blog? I had something to say to others who shared similar experiences. The pieces are falling into place.

http://www.huffingtonpost.com/

Recently, I discovered a practical handbook to blogging written by the editors of the Huffington Post with introduction by Arianna Huffington. It is entitled Huffington Post’s Complete Guide to Blogging. It is substantive and offers practical advice to prospective bloggers, insuring that we all will get off the ground running.

In the weeks to come you will discover that the look of my blog will change to allow for more information from a wider range of sources and to incorporate an exchange of experiences, hoping that this blog will become a place to be. Huffington Post’s Complete Guide to Blogging has given me the blueprint to build a community. My goal is to make this blog more of a public face and spotlight the suffering endured by many. It will enlighten others as to the greedy, proud, unscrupulous ways of those who operate in the dark.

My friends, bloggers are moving mountains. We’re the new media. You might just say we are “civic journalists” a concept pioneered by Jay Rosen who founded the blog OfftheBus. Whatever you call us, we are sounding alarms and making big differences. It feels so good…

Yes. The world is still a dangerous place. Today, however, with the power of using our voices to blog about important issues, it’s a little less dark. Sort of like looking outside at 5 p.m. today and seeing that it is still light. Have you noticed? The darkness is already beginning to recede.

Life is a Journey

An Advent Reflection
by Fr. Brian Cavanaugh, TOR

"During Advent opportunities for works of charity abound calling out for Christians from every side: a sack of food for a needy family, money dropped in a Salvation Army kettle, a donation to an Indian school, a toy for ‘Toys-for-Tots,’ etc. Unfortunately, these works of charity so easily can assuage the Christian conscience, while doing nothing to being about a solution to the root causes of the problem.

"Works of justice, on he other hand, follow the road less traveled of Advent’s hope to pursue solutions for difficult problems. Hope comes through works of justice rather than simply performing works of charity."

Here it is December 2008. We are each needy. Our communities are needy. Our world is needy.

For me, there is but one choice: take Advent to prepare for the birth of Jesus in my heart. As He has shown me in my journey towards health care justice, He provides in His time and His way. Have no doubts, my friends, God is control of our world.

In the spirit of Advent and Christmas, I will be focusing on my spiritual walk with God until the Feast of the Epiphany, January 6, 2009. By quieting myself in this way, inspiration will flow as I await synchronicity, the manifestation of the right time, the right place and the right action.

Please return to Tuesday’s Tirades and Tales, on January 13, 2009. Have a blessed holiday season.

Thanksgiving 2008

Fostering Abundance

This is a very special time of year for me. It is during this Season that hope is fostered out of being grateful for what is and not focusing on what is not.

In that rich spirit of Faith, I would like to share a poem and pictures with you.

We are a family very much like each of yours. There are sorrows and joys, endings and beginnings. For all that has not been available to me, I am rich in the loving, caring family and friends who surround me. For this I thank my awesome God, my provider.

A Thanksgiving Day Prayer

Lord, so often times, as any other day

When we sit down to our meal and pray

We hurry along and make fast the blessing

Thanks, amen. Now please pass the dressing

We're slaves to the olfactory overload

We must rush our prayer before the food gets cold

But Lord, I'd like to take a few minutes more

To really give thanks to what I'm thankful for

For my family, my health, a nice soft bed

My friends, my freedom, a roof over my head

I'm thankful right now to be surrounded by those

Whose lives touch me more than they'll ever possibly know

Thankful Lord, that You've blessed me beyond measure

Thankful that in my heart lives life's greatest treasure

That You, dear Jesus, reside in that place

And I'm ever so grateful for Your unending grace

So please, heavenly Father, bless this food You've provided

And bless each and every person invited

Amen
~Scott Wesermann

Coventry Health Care Inc of Bethesda MA False Promises

Before commencing with today’s blog, it’s important to share a few behind the scenes maneuverings of Coventry attorneys. Within the past few weeks Carelink attempted to silence my blog. They did not succeed and it will be the blogosphere that will continue to support my efforts to reveal the truth about Coventry Health Care, Inc. of Bethesda, MA.

While West Virginia State Court Judge, Martin J. Gaughan, who will preside at my upcoming civil lawsuit against Carelink Health Plans, Inc. and Patrick Dowd, recently denied Carelink’s motion, I was asked to refrain from speaking about potential witnesses in this blog and to try to keep my reflections to facts.

I have great respect for the law. There will be a shift in focus for future blogs. We will turn our attention to the “facts” reported on the internet about Coventry Health Care, Inc of Bethesda MA, the parent company of Carelink Health Plans Inc of West Virginia and to primarily developing tirades from this information, at times supported by the facts of my case.

News like the following:

July 10, 2007 news: Fitch Places Coventry Health Care's IDR of 'BBB' on Watch Negative After Acquisition Announcement
June 19, 2008 news story: Coventry Healthcare tumbles after cutting forecast.
June 20, 2008 Managed Care Matters: What happened at Coventry?

Note: Visit unitedforjustice.blogspot.com for links to these articles.

Tuesday’s Tirade
False Advertising or bull shit?

“Genius - the ability to produce fantastic amounts of equally fantastic bullshit that all makes perfect sense” ~Jason Zebehazy

Many may describe Mr. Zebehazy as crude and unrefined. Others may look more kindly upon him and understand the depth of his anger and outrage towards those who choose to deceive.

The internet is bursting with hundreds of websites from Coventry Health Care, Inc. of Bethesda MD, the parent company of Carelink Health Plans, Inc. of West Virginia, my former HMO. Additionally, there is a deluge of printed material describing Coventry’s mission and policies.

Is Coventry Health Care deliberately deceitful in the promotion of its services? Many reasonable people might agree with me that this corporation’s actions do not always match their words. So deceitful that one might describe many of its publications as a “fantastic amount of equally fantastic bullshit.” It’s pretty scary. Take notice.

When one is dealing with a life threatening health problem, it would be comforting to know that the doctors in one’s health plan have the depth of understanding of the procedure that would approximate that of a specialist. Carelink’s Medical Director is a DO. While MDs and DOs have similar training, Osteopathic medical schools emphasize training students to be primary care physicians, those who are the first doctors contacted by a patient, a gate-keeper, of sorts. Because the scope of a doctor’s knowledge greatly varies and may be limited, it is critical that one’s specialists contribute to the process of making the decision about health care coverage, especially in a life and death decision.

Doctors Make The Decisions

Media reports about managed care can be confusing. We want you to know that at Carelink our medical directors, who are doctors, make health care decisions together with you and your doctor. These decisions are based on making sure you get the appropriate care. Carelink prohibits any programs that would give doctors or utilization management professionals financial incentives to deny care. Through our Quality Improvement initiatives, at 1-800-348-2922. We monitor the volume and appropriateness of the care provided to all our members. Your health is important to us. If you have questions about how your doctor is paid, please call us.
~Carelink’s Living Well Magazine, spring 2004

In May 2005, my surgeon, Bernard J. Costello, DMD, M.D., Chief, Division of Craniofacial and Cleft Surgery, UPMC, was denied his request for medically necessary surgery on the spot and without Carelink’s stated policy that they provide consultation with specialists and me. During the internal appeals, Dr. Costello’s written appeal (Link to copy that supports the complexity of this issue) was never reviewed in a speedy determination of my appeal on July 29, 2005 ,by the Medical Director in Charleston West Virginia. Carelink did not provide a peer-to-peer review conversation as internal policy regulates.

You have read what Carelink states is their policy; here is the reality:

A doctor requests a medical procedure on behalf of the consumer. The authorization department, sometimes only a nurse, looks over the request, consults the consumer’s contract to determine if the procedure is for a non-covered benefit, a plan exclusion, and, likely, many times denies the request on the spot. The physician does not have an opportunity to discuss the medically necessary designation.

After the initial denial, the consumer has the right to request an internal appeal. Without the designation of medical necessity at the time a procedure is initially reviewed, the case goes immediately into non-covered benefit status. Appeal denied. No questions asked.

Carelink’s Appeals Department took less than an hour to deny my appeal on July 29, 2005. No one reviewed Dr. Costello’s evidence. (Note that the West Virginia Insurance Commission later agreed and issued Final Order 06-AP-024.) Carelink's doctor did not speak with Dr. Costello. Carelink did not provide my doctor with peer-to-peer consultation.

This is not a fabrication. I have written notes of many conversatoins with Carelink personnel who described this process.

“Do Doctors Make the Decisions?” at Coventry Health Care, Inc., the darling of wall street, whose CEO earned a $32,000,000 salary package in 2004?

One hundred and five words scripted eloquently by Coventry proclaim that doctors do make the decisions. Is what happened to me being repeated over and over in the other Coventry Health Plans? How shameless.

Judge Jack DeBolt, Examiner, West Virginia Insurance Commission, has another word to describe the behavior of my former health plan: egregious”

adjective
conspicuously and outrageously bad or reprehensible; "a crying shame"; "an egregious lie"; "flagrant violation of human rights"; "a glaring error"; "gross ineptitude"; "gross injustice"; "rank treachery"

The health care system is in crisis. Any wonder?

Tuesday’s Tale
Lorraine Summer sues Carelink Health Plans, Inc. of West Virginia

Lorraine Summer is not unlike you and I. When we are sick, we need treatment right away. Our belief is strong: our health care plans are ethical and fair. The reality is far from this the stated rules of governance.

Yes. We have our rights under our health plans. It’s all in those articles of governance and ethics. But actions do not always follow words. What is not known to many is how convoluted, lengthy a process it sometimes is to secure ones' health benefits. Practically impossible, I believe.

While my persistence is beginning to pay dividends, there are too many others who have been crushed by an unjust, sometimes ruthless, industry. Against these powerful forces, we rarely win.

Visit unitedforjustice.blogspot.com for the account of Lorraine Summer’s fight against Carelink.

I leave you with an interesting thought: I have interacted with hundreds of peole about this issue. Honestly sharing my thoughts and feelings. Will not one of them have the courage, outrage and moral fortitude to come forward and be a witness at my lawsuit against Carelink?

It's what I expect.

It's why I write and plant seeds in many places thruoghout our great country.

With perseverance, boldness, and determination, we will continue to win.

Coventry Health Care's Attempt to Limit Pre-Trial Publicity

Tuesday's Tirade

The Freedom of Speech

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

Today is Veterans Day 2008. On my mind are the many men and women who have sacrificed while serving in the armed services of our country. We owe our very freedoms to these dedicated and courageous souls who were willing to sacrifice much, including their lives, so that others would remain free.

Life teaches me that there are other untraditional fields of injustice where many of us are called to fight. For me, I not only represent the most vulnerable in our society, the mentally ill and the elderly, I represent those who fight to insure their 1st Amendment Right to freedom of speech.

This story was not predicable. In fact, in my wildest imaginings I would never have placed myself at the center of a controversy that may lead to regulatory changes in the health insurance industry. I have begun to believe the many people in authority who have told me, “This is really big.”

Why did former Carelink CEO Patrick Dowd falsely accuse me of fraud in November of 2005? Why is Coventry today trying to silence my blog, my very voice?

In October 2005, I had determined that writing a blog, describing my journey investigating my health plan, would be an excellent tool to reach other like-minded advocates. Likely in response to the knowledge that I was writing a blog, Mr. Dowd falsely accused me of fraud as, I was later told, a justification for terminating me. An action that would silence the truth.

In defiance of Carelink, I began to write my blog on November 11, 2005.

Veterans Day: A time to reflect...
November 11, 2005

Today is Veterans Day and we honor those who offer their lives so that we might enjoy all the freedoms that are uniquely American. We are proud today and the Pledge of Allegiance takes on fuller meaning. Let's reflect again on this powerful pledge of freedoms:

"I pledge allegiance to the Flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible,with liberty and justice for all.”

Over the centuries our veterans have fought valiantly to insure the rights of Americans. No one has the right to deny us a life without threats, to deny us a life without fear or to deny us a life without intimidation. Additionally, each of us deserves to be treated with dignity and with fairness by all.

It's Veterans Day. Maybe on this day, November 11, 2005, it might just be our turn to unite to further these freedoms. Not abroad in far off lands, but here on our hallowed ground. For together we will be victorious.

May God bless each of us with Liberty and Justice!

Life has a way of repeating itself. In yet another attempt to silence my voice, Carelink recently filed a Motion to limit pre-trial publicity. Once again, it was my blog that disturbed them. My son’s reaction to my attorney's, Paul Tucker’s, response to Carelink earlier this week: “Hilarious. Perhaps the most incisive reply brief I've ever read. …”

You may read Tucker’s entire Response as well as links to other important documents on unitedforjustice.blogspot.com. As you reflect on Carelink’s position, ponder anew one of the freedoms for which we fight.

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.
~1st Amendment, United States Constitution

And May God bless each of us with Liberty and Justice!

Tuesday’s Tale

Insurance Company Coventry Health Care Resuing to Pay

The Ultimate Rif Off!

Note: This burst of outrage appeared on ripoffreport.com, Report: #288484

We have Health insurance with Coventry Health Care. Recently I believe they may have merged with or been bought out by some one else. In any case we pay $240.00 or more a month & the employer pays the rest which is 1/2 or more than the amount we pay. (Almost 6,000$ a year in insurance premiums paid)

Now that you know the amounts paid to these blood sucker scums every month & year, I'm sure you will realize why we're so pissed. They refused to pay for over $18,000.00 in medical bills that are/were supposed to be covered under their guide lines. The insurance is with my wifes employer & there are over 50% of the work force ( total work force of about 1000+ people) who complain about this to the Insurance company as well the employer to do something about it. NOTHING IS BEING DONE SO FAR!!!

Hum? 1,000 people x $6,000.00= 6,000,000.00 a year 6 Million a year for 1 businesses premiums.

It seems the employer as well Insurance doesn't give a damn about people just how much they can get away with it. So far they didn't pay the last 7 bills (ranged from $24.95 up to $700.00 over 6 month period) until repeated actions of re-submitting claims & fighting with them costing us money as well as the providers & the bastards still refuse to pay for the tests that we are eligible for that will be in excess of 16,000.00 U.S.D. & eligible for.

Coventry keeps denying the precertification for the medical tests that have to be done prior to an important major operation. The operation can't be done with out these tests (MRI, X-rays & other tests).So the operation is on hold now too & the person who needs the operation is in severe pain (my emphasis) daily because they can't get the operation because they refuse to pay.

But then again they don't want to do what they get paid for, that is pay for the provider charges & medical bills as they are under contract to do why the hell would they want to pay for a $50,000.00 operation? It's like they want you to pay them & on time as well every month on time (direct deduction from check on Med. Ins.) & if you need the insurance you paid for, too bad you have to pay the medical bills too on top of the insurance premium. Is it not the reason you pay insurance premiums so that in case something happens you are covered? WHY PAY THEM FOR NOTHING!!!!!

The bastards refuse to pay for the little things as well, like eye glasses & contacts the visits to the doctor the dental all of which is covered under the plan & all gets precertified that has to be by the Doctors & us as well to make sure it's covered but yet they will precertify & then not pay the bill when it is sent into them.

WHAT IS THE POINT OF PAYING FOR INSURANCE THAT YOU CAN NEVER COLLECT ON??????????????????????????

The employer offers no alternative to the employees. It's Coventry only. These employees work between 40 & 60 hrs. every week you would think they would want to take care of them wouldn't you?

You would think an insurance company making 6 million a year from just one of the many companies they cover, with their rate they could afford to pay?

We pay our bills why doesn't COVENTRY HEALTH CARE PAY THEIR BILLS!!!!!!!

JustinNanticoke, Pennsylvania
December 2, 2007
ripoffreport.com

Carelink Health Plan Inc Loses in Federal Court

Tuesday's Tirade
No More Deadly Delays

But then there's West Virginia, where more than 24% of adults under age 65 don't have health insurance. In that state, employer-based insurance premiums account for nearly 20% of a person's paycheck, and nearly 20% of those surveyed in the state have said they couldn't see a doctor because it was too expensive to do so. The state ranks 44th out of 51 (including Washington, D.C.) in terms of overall health care, the Fund says.

A Harris poll compiled on behalf of the U.S. Chamber Institute for Legal Reform shows that five of the 10 states whose legal environments are seen as most inhospitable to business are also among the seven lowest in median income, according to the latest Census Bureau statistics. The five: West Virginia, Mississippi, Arkansas, Louisiana and Alabama. Forbes.com, 2008 and 2007 in Pictures: The Best and Worst States to Get Sued In

There will soon be a very public accounting of my HMO, Carelink Health Plans, Inc of West Virginia at a trial in the Ohio County Circuit Court in Wheeling West Virginia. Carelink did not appeal the decision of federal Judge Frederick Stamp to remand my civil lawsuit to the Circuit Court. See links for documents unitedforjustice.blogspot.com.


Any surprise here? No, given the arguments of Judge Stamp in response to Carelink's request, it was predictable. As one studies this case, there really was nothing to refute. Corporate Legal was silenced.

As one can well imagine, with the negative climate in this state already, there will be a tsunami of outrage against Carelink and anyone who supported their corrupt ways. A public trial by an impartial jury of my peers. It does not get any better in this climate where way too many of the most vulnerable have been denied our rightful health care benefits. West Virginia is a small state...we all know each other.


I remain baffled that Carelink Health Plans, Inc. by their many outrageous actions have dug their own grave. What follows is a reference to only a few of the ruthless behaviors towards me:



On November 1, 2005, CEO Patrick Dowd, knowing that I live with what many psychiatrists would define as a severe mental illness, accused me of fraud in an effort to terminate me. See links to documents in unitedforjustice.blogspot.com.

In the fall of 2005 and again in the spring of 2006, Carelink Quality Control Supervisor Carolyn Westfall, stopped an internal investigation of the unjust actions of a key appeals official of Carelink.

I was not permitted to subpoena former Carelink CEO Patrick Dowd to testify about his alleged discrimination at my Administrative Hearing before Judge Jack DeBolt on August 10, 2006. That one is a little twisted: I was discriminated by Careink and the West Virginia Insurance Commission against even questioning Dowd under oath about his alleged discrimination.

And, most foolhardy of all possible actions, Carelink blocked all contacts with me, a paying subscriber, for months and then established a unique policy whereby I could only speak about health issues with the supervisor of customer service. Oops, some real harm was done when that supervisor went on vacation and I needed immediate attention for serious health problems.

Christine Stenger vs. Carelink Health Plans, Inc of West Virginia and Patrick Dowd (former Carelink CEO) may put a national spotlight on how ruthless one HMO can be. I am told that many across this country have waited for a case like this to go to court. Believe me. I will do all in my power to bring the media with me.

My attorney Paul Tucker of Bachmann, Hess, Garden and Hess and Coventry attorneys will begin to depose witnesses in preparation for the civil lawsuit against Carelink Health Plans. It is then that volumes of records I meticulously kept over three and a half years will be made available. It is damning information supported by physicians and clergy of the Catholic Diocese of Wheeling Charleston who have played a significant role in my success to date.

Best of all, there will be many subpoenas. This time Carelink cannot run and hide as they did in my administrative hearing. Yes, likely there will be contradictory testimonies, but there is no real concern here either. There has been a pattern of deceit that began in May in 2005 through the present. Yes, Carelink and Coventry Health Care, Inc. have dug their own grave.

Irony or providence? Ohio Country juries are noted for awarding some of the highest damages in the United States.

Irony or providence? The woman scorned is the daughter of a man of integrity who committed suicide in 1965, in large part, because of injustice in health care.

Dale Wolf

Irony or providence? This case will be tried at a time when the general public is denouncing high executive pays like that earned by Coventry CEO Dale Wolf, in a $32 million salary packing in 2004?

A tsunami of outrage? That’s a very interesting thought.

Tuesday’s Tale

Mother Jones Speaks Out

Note: Mother Jones is an independent nonprofit whose roots lie in a commitment to social justice implemented through first rate investigative reporting.

HMO Pays Staffers to Drop Sick People

Virtually all the Democrats running for president have endorsed health care proposals that maintain a major role for private insurance companies. Much of their rhetoric suggests that if we could just get everyone health insurance, then all will be well. But the debate continues to ignore the horror stories like the one reported in the L.A. Times Friday.

A private insurer paid $20,000 in bonuses to an underwriter for dropping coverage for sick people, including a hairdresser who was half way through chemo treatments for cancer. She was left with $200,000 in medical bills as a result. Meanwhile, the company, Health Net, saved $35 million by cutting off 1,600 people who had made a major medical claim. Built into the system were performance bonuses for employees who dropped the most and the sickest patients. The widespread practice suggests that Americans need a lot more than an insurance card to guarantee access to medical care when they most need it.

Comments:
HMO/PPO's s/b abolished. They provide no services. Doctors and other health care providers could easily submit claims via computer to one central health care payment computer, just like an income tax return. The central computer could reimburse the filer within seconds directly to bank accounts. Post-audits could be made by computer, then, selectively, by human auditors. Cheating health care providers would be maximally punished. The one payer would negotiate how much it will pay for Rx's. Today's system is fraught with politics, begs for scams, and has almost nothing to do with our national health. Rod Ruguer

So what is new? This has been going on since the inception of insurance. And they only want to insure the healthy and young. Many of us in healthcare, have seen the results of this on both ourselves & our pts.Yet most of Americans just want to scream about socialized medicine. That is, until it happens to them. S.D. Huff

Health care even when you have it, is a laugh. My last job went from an 80/20 plan to 60/40. That is not care of any kind. It’s what private equity firms do to a company. That was before the layoff.Universal health care cannot include the hmo's and ppo's of today and it must include dental also. You can tell a person is part of the working poor by their teeth! Cherry Crum

And the REALLY EVIL thing? Those same companies are very actively "consulting" China and India to adopt their "obviously superior" healthcare model. 2007

Insurance Commissioner Jane Cline: A Shameful Situation

Tuesday’s Tirade
An infestation of poisonous snakes

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

The state government of West Virginia is allowing a large health care insurer to rip off the public. West Virginians suffer. Our state has the highest rate of depression and obesity, among many other ills.

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

See unitedforjustice.blogspot.com for a partial list of grave allegations I make in a claim filed on January 18, 2008 against the Commission at the West Virginia Court of Claims.


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


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

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

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

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

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

Dale B Wolf, CEO Coventry Health Care, Inc of Bethesda Maryland

We West Virginians have poisonous snakes in our midst. Snakes that control our health care so CEO’s like Coventry’s Dale Wolf can earn a $32 million salary package in 2004 while consumers are blocked from receiving their rightful benefits. You read it correctly - Thirty Two Million Dollars!

Snakes that have so infested government, business and professional leaders in West Virginia that we must carefully and cautiously remove them one by one. Many times in the last three years I have heard the outcry, “the West Virginia Insurance Commission is owned by the insurance industry.”

And now a poisonous snake is infesting yet another regulatory agency, an agency that is formed to provide protection to the consumer.

And, herein lays a perplexing problem.

In an improbable twist of fate, Jane L. Cline is the President-elect for 2009 of NAIC. Yes, a Commissioner who refuses to enforce a significant final order she signed in 2006 to regulate how HMOs must now do business in the state of West Virginia, will wield her power and control over a national body of regulators. Is there a national scheme of the special interest groups supporting the insurance industry to get away with murder? This alarming news has dreaded ramifications.

Two weeks ago I wrote the President of NAIC, Ms. Sandy Praeger, a certified letter requesting an investigation of Jane Cline. To date I have received no reply. (You may read my letter on unitedforjustice.blogspot.com) Have the snakes already poisoned NAIC?

Unbelievable. Incredible. Shocking. What next?

Good news I believe. The troubling news about our economy brings with it some good news. Lack of government oversight is being blamed for much of our economic collapse. The future will demand much more regulation over the present display of self interest at the cost of the common good. In time, the light of justice will shine on Cline. It has to. The public will learn the truth and at that time our many, many voices will be loud, clear, and demanding.

The tide is changing. It has to.

Tuesday’s Tale
Insurance Horror Stories

“When Steve and Leslie Shaeffer’s daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.” But “shortly after Selah’s medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively.”

So begins a recent report in The Los Angeles Times titled “Sick but Insured? Think Again,” which offers a series of similar horror stories, and suggests that these stories represent a growing trend: more and more health insurers are finding ways to yank your insurance when you get sick.

This trend helps explain something that has been puzzling me: why is the health insurance industry growing rapidly, even as it covers fewer Americans?

Between 2000 and 2005, the number of Americans with private health insurance coverage fell by 1 percent. But over the same period, employment at health insurance companies rose a remarkable 32 percent. What are all those extra employees doing?

Now we know at least part of the answer: they’re working harder than ever at identifying people who really need medical care, and ensuring that they don’t get it. In the past, they mainly concentrated on screening out applicants likely to get sick. Now, it seems, they’re also devoting a lot of effort to finding pretexts for revoking insurance after they’ve already granted it. They typically do this by claiming that they weren’t notified about some pre-existing condition, even if the insured wasn’t aware of that condition when he or she bought the policy.

… The fact is that cruelty and injustice are the inevitable result of the current rules of the game. Blue Shield of California is a nonprofit insurance provider, yet as a spokesman put it, if his organization doesn’t follow the for-profit practice of selectively covering only the healthiest people, “we will end up with all the high-risk people.”

~Economist Paul Krugman, New York Times, September 22, 2006

A Real Close Look at West Virginia

Tuesday's Tirade

First, Do No Harm

The care of human life and happiness, and not their destruction, is the first and only object of good government. ~Thomas Jefferson

Joe Manchin, III is West Virginia’s 34th Governor. Manchin has been a popular governor for four years. Charismatic. Handsome. Articulate. Determined. Ambitious. His speeches resound with promises of “responsible leadership” and improving West Virginia’s economic climate. It’s been all about jobs.

Take a listen to a sampling of Governor Manchin’s persuasive language:

State of the State Address, 2008

Our most immediate task was to demonstrate to everyone in this state and across this nation that West Virginia was not only serious about getting its house in order but was also committed to retaining and creating the good jobs with benefits that our people and their families deserve.

Democratic National Convention 2008

Governor Manchin, who addressed members of the U.S. House Democratic caucus this week, also highlights the success of Democratic policies in retaining and creating good jobs in West Virginia: “Governors work across party lines to get things done. We’re held accountable each and every day for finding ways to solve our states’ most pressing problems.

The 2008 Gubernatorial Debate

Manchin stated that West Virginia has done the right things and has positioned itself to better handle an economic crisis.

Governor Manchin is tackling the tough job of the economy. It’s been all about jobs, responsible leadership and solving “our most pressing problems.”

But many West Virginians are concerned about fundamental services that are the foundation of health and happiness. We feel a little more stressed today. Our general welfare is much more than, “It’s all about jobs.”

Are you aware that a majority of the new jobs in the U.S. economy are in industries and occupations at the lower end of the wage scale -- restaurant workers, for example? Are you aware that today West Virginia has one of the highest rates of poverty?

How many West Virginians know that our state received the 2007 distinction of being “the dirtiest state” in the union? That statistics on obesity, depression and smoking place us in very, very poor light? We rank 44th for the overall health of our citizens and received a poor rating for educational opportunities.

West Virginia’s failures overshadow her successes. Sadly West Virginians are so poor and illiterate, in such bad health, that they falsely believe it will all be better if we only have jobs. We so want to have confidence in the assertions of our heroes.

There’s an alarming trend in West Virginia. We have been losing ground and it is a disheartening experience.

Visit unitedforjustice.blogspot.com for links to all sources.

Today’s Tale
She Did Everything Right but….

Sometimes even healthy people can't get a company to sell them a policy
Msmbc.com, Oct. 6, 2008
Jacqueline Ruess was lying on a bed inside a hospital in Boca Raton, Florida, still woozy from anesthesia but hoping that, maybe just this once, she'd caught a break.

She'd had laparoscopic surgery in order to examine a growth her gynecologist thought might be ovarian cancer. Ruess, who was 34 at the time, in the fall of 2001, feared that her two young boys, whose father died from a congenital heart defect three years earlier, were on the verge of losing her as well.

"It was probably the darkest week of my life since my husband passed away," she recalls.

But as Ruess regained consciousness, she saw her own mother at her bedside, looking relieved. She began to process what she was hearing: You're going to be OK. The growth was on the fallopian tube, not her ovary — a far less worrisome situation. Soon after, a pathology report would confirm that the tumor itself was benign.

"The only thing I could think about was my boys," Ruess says, "and the great relief in knowing I was going to be around to raise them after all.

"But four months after Ruess's medical crisis passed, she faced a financial one. The Insurers Administrative Corporation (IAC), the company in Phoenix that managed Ruess's health care policy, completed what it says was a routine review of her records and discovered what it called evidence of a preexisting gynecological condition.

Because Ruess had not disclosed the symptom on her application, her insurer said she had never been eligible for coverage of gynecological problems. The result: Ruess was on the hook for the cost of her surgery, which, including doctor and hospital bills, amounted to more than $15,000.

Ruess was flabbergasted. "I was — please forgive me for lack of a better term — pissed off," she says. What IAC called a preexisting condition was a one-time notation in her file regarding "dysfunctional uterine bleeding" — that is, irregular periods, a common issue that at some point affects between 10 percent and 30 percent of women in their reproductive years. At the time she experienced erratic periods, Ruess had lost her husband and her father had died, too, which is why her doctor attributed the symptom to stress.

Reassured that there was nothing medically wrong, Ruess quickly put the problem out of her mind and didn't even bother to fill the prescription for the birth control pills her doctor had given her to regulate her cycle. Even though there was a question on her insurance application about "abnormal menstruation" in the past seven years, she didn't think it applied to her because her symptom hadn't been attributed to an underlying medical problem.

"It never crossed my mind to mention it on the form," Ruess says, noting that she'd been forthright about a more serious issue, her son's asthma, when she applied to another insurer for a policy for him. She'd correctly predicted that he would be declined coverage because of it. "If I was going to hold back anything," she says, "I would have held back that information."

Here, too, she'd acted in good faith, she explained to IAC. Her irregular periods had nothing to do with the growth on her fallopian tube. The insurer, she felt, was simply looking for an excuse to avoid paying her bills. But IAC wouldn't budge and further informed Ruess she actually owed a few hundred dollars to her insurer, because her premiums should have been higher. Frantic, Ruess contacted attorneys, journalists, even the governor of Florida.

"I am a healthy and honest 34-year-old widow raising two small children alone," she wrote in a formal complaint to the Arizona Department of Insurance in April 2002. "I am desperate." (A spokesman for IAC says that had the information on Ruess's application been "complete and accurate," she'd have been advised that the policy would have limitations, and she could have opted to apply elsewhere.)

1 in 4 Americans lack adequate coverage
Ruess never expected to find herself in such a circumstance. She'd grown up in a comfortable, middle-class household; even after her husband died in 1998, she was able to remain an at-home mom because of his generous life insurance policy. She'd taken pains to make sure she and her sons were insured, first with a policy carried over from her husband's job (the federal COBRA law allows a spouse to continue coverage for three years after a death), and then by carefully researching and purchasing insurance at a cost of $350 a month for her and one of her sons. (She was able to get coverage for her asthmatic son from the state.)

In other words, she did everything right.

Yet she was facing major debt and was soon to be without thorough coverage altogether. Ruess says she told a supervisor in IAC's underwriting department that she hoped he'd never find himself or a family member in a similar situation.

"I couldn't believe that I was an American citizen," she says. "As a middle-class woman who was more than willing to pay for my medical benefits, I was getting the short end of the stick." And the statistics suggest that women such as Ruess, who buy their insurance on their own, are particularly vulnerable to winding up in similar straits.

…To exclude people they deem poor risks, insurers today use sophisticated techniques. They can tap into databases that reveal your past prescriptions and use "predictive modeling" — a complex, computerized algorithm — to estimate how likely it is that your medical bills will exceed the amount you pay in premiums. Every insurer has its own list of medical conditions for which it may charge higher premiums (have you ever been treated for anxiety, an eating disorder, an ulcer, fibroids or even irritable bowel syndrome?) or, in some cases, nix coverage.

West Virginia: Insurance Regulation AWOL

Tuesday’s Tirade
Who is Jane Cline?

West Virginia is a small state. Everyone knows one another. No one wants the other to step on toes. Politics and corruption abound. ~West Virginia Public Official

Jane Cline is the Commissioner of the West Virginia Insurance Commission, an agency that oversees the insurance industry doing business in West Virginia to insure that our health plans follow the rules and that we get what we pay for.

In 2005, I was unjustly denied medically necessary surgery by my HMO, Carelink Health Plans, Inc. of West Virginia. My surgeon, Dr. Bernard Costello, of the University of Pittsburgh Medical Center, was denied on the spot despite the urgency to his request.

In July of 2005, I appealed Carelink’s decision internally. Once again, an automatic denial without Carelink’s consulting the “experts” as state law requires.

I persisted and I then filed a formal grievance with the West Virginia Insurance Commission against Carelink on September 27, 2005. That grievance took over three and a half months to be processed, with the West Virginia Insurance Commission’s abusing the laws that mandate quick turnaround to resolve claims of an urgent nature.

What required such a lengthy time to draw a conclusion?

In 2006, I was told by Dena Wildman, Examiner of the West Virginia Insurance Commission who processed grievances, that Carelink was attempting to terminate me. They had falsely accused me of fraud and wanted to use that allegation as a means to deny me access to my insurance. And the Commission did not know what to do with me, so they put my case on hold.

They put my medically necessary surgery on a long hold. It took my contact with the Commission in early 2006 to force a decision. And that’s a story in itself.

There followed an administrative hearing before Examiner Judge Jack DeBolt in Charleston WV on August 10, 2006. What should have been a resolution has become a travesty of justice, not only to me but to the hundreds of consumers who have requested a service from their HMO in West Virginia and been denied automatically since December 14, 2006.

Judge JackDeBolt, West Virginia Insurance Examiner, wrote Final Order 06-AP-024 and described Carelink’s treatment of me as “egregious. ” Judge DeBolt mandated that all HMOs fully investigate physician requests for patient services BEFORE the HMO is permitted to deny a claim. Commissioner Jane Cline signed the order on December 14, 2006.

In part Judge DeBolt strongly rebukes Carelink as follows:

Carelink has badly botched it obligation to provide an effective grievance procedure.

One very troubling aspect of Carelink’s procedure revealed in this proceeding is its practice of not addressing all issues necessary to decide to a finality whether or not a proposed procedure is covered.

Carelink should be forewarned that it will be expected in future to acquire sufficient determination for initial determination to be bound by grounds for denial asserted. Any lessening of this requirement violates both the spirit of the EOC and the letter of 333-25A-12 of the Code.

There has been no enforcement of this order. Why? And what about that agreement made in 2007 behind closed doors between Carelink and the Commission? Is it politics and corruption as more than a few public officials have quietly told me?

Did Cline move to order a rehearing of my claims? No! To the contrary, on February 26, 2007, Jane Cline denied Carelink’s own Request for a Rehearing.

On March 27, 2007, Carelink filed an appeal to the Kanawha County Circuit Court.

Not only did Cline not enforce Final Order 06-AP-024 during this period, but, once again, the Commission overlooked procedures and failed to file the related paperwork with the Kanawha County Circuit Court. Failed to act for five long months.

Carelink finally authorized my medically necessary surgery in April of 2007, almost two years after this “urgent” surgery was requested. Unfortunately, by that time Dr. Bernard Costello advised me to postpone the surgery (See letter to West Virginia Insurance Commission).

I subsequently requested that Carelink authorize a $3000 oral appliance to address the severe sleep apnea, recommended by Pittsburgh sleep apnea specialist, Dr. Maria Sunseri. This request was denied on the spot, not by a medical specialist, but by a customer service representative! Troubling. Very troubling.

What do other state insurance commissions do with final orders? I contacted attorneys at four different state insurance commissions who told me that they do regulate the insurance industry doing business within their states. The attorneys at these four commissions were unanimous: Final orders must be enforced. In fact they appeared incredulous to learn that Jane Cline, West Virginia Insurance Commissioner, acted to counter the Final Order 06-AP-024.

Carelink continues to do business as usual in West Virginia as the West Virginia Insurance Commission continues to look the other way. Folks, we have a problem here. A big problem.

Carelink, and likely other HMOs, are playing the same games with West Virginians today, and consumers are being denied on the spot, without the HMO’s investigating each claim thoroughly to avoid duplicating the unjust consequences of my 2005 claim. More horror stories? Likely.

What do I think? I believe that Jane Cline’s lack of aggressive action regrading Final Order 06-AP-024 contributes to the present health crisis in West Virginia. Not only does it appear that she does not want to regulate, it appears that she is aware of the ruthless hold insurance companies have on her department. Is Cline sensitive to the many poor people in West Virginia who have no idea as to how to help themselves? Poor people who are unable to fight a bureaucracy that is determined to place obstacles in the way of justice? No!

What do I think? I question if Jane Cline sees the oncoming train.

This is all so distressing. It’s all so embarrassing to the state of West Virginia.
Please visit unitedforjustice.blogspot.com for full disclosure of documentation.

Tuesday’s Tale
Texas Jury Finds Humana HMO Liable in Wrongful Death Lawsuit
July 21, 2005

A local jury in San Antonio, Texas, on July 1 awarded $7.4 million in actual damages in a wrongful death lawsuit against the health maintenance organization Humana Health Plan of Texas Inc., a physician, and his physicians group under contract to provide health care services, according to the Powell Law Firm, which represented the plaintiffs in the case.

Jurors were to consider punitive damages in the second phase of the trial, but attorneys for Humana and the plaintiffs reached an out-of-court agreement that capped those damages at $1.6 million, bringing the total amount of damages to $9 million. Humana will be liable for 35 percent of the $7.4 million in actual damages and the entire $1.6 million in punitive damages after all appeals are exhausted.

The plaintiff's attorneys said that in the lawsuit, John Smelik and his two adult children accused Humana and others of negligence in the June 1, 2001, death of Joan Smelik, John's wife of 47 years. Brant Mittler, a practicing cardiologist, and a lawyer represented the Smeliks along with lead plaintiffs' attorney Jon Powell, and Renee F. McElhaney, appellate counsel for the case from Cox Smith Matthews Incorporated, the largest law firm in San Antonio.

Testifying as an expert witness for the plaintiff in this case was Dr. Linda Peeno, the internationally recognized patients' rights activist and former Humana Medical Reviewer.

Humana was represented by Wilson, Elser, Moskowitz, Edelman & Dicker, based in New York City.

The jury decision came after nearly three days of deliberation, culminating a three-week trial presided over by 224th District Judge Rene Diaz, a conservative Republican recently appointed to the bench by Texas Gov. Rick Perry. Judge Diaz most recently comes from an insurance defense background prior to being appointed to the bench.

In the statement announcing the judgment, the Powell Law Firm noted that Mrs. Joan Smelik was a complex patient who according to Humana never hit the "triggers" to qualify for case management. Humana's own computer records for Mrs. Smelik showed that Humana knew of her diseases even down to the size of each of her small kidneys, which were indicative of "chronic" kidney disease.

Ms. Smelik had a documented episode of acute renal failure attributed in part to the effects on her kidneys of a combination of three drugs, specifically a NSAID agent (non-steroidal anti-inflammatory drug), a diuretic, and an ACE inhibitor in September 2000. Then, Humana approved Vioxx, an NSAID type drug, in January 2001, and later approved the purchases of the exact same three-drug toxic cocktail of prescription drugs that had put Joan Smelik into renal failure five months earlier. Mrs. Smelik died from complications of renal failure requiring emergency dialysis in May 2001.

Ten of the 12 jurors did agree that Humana was among three of the named defendants who bore responsibility for Joan Smelik's death. The plaintiffs alleged that Joan Smelik did not receive the health care promised by Humana's own written policies and standards.

Specifically, the plaintiffs demonstrated through testimony that Mrs. Smelik was suffering from emphysema, kidney disease, and a circulatory condition that affected the kidneys and should have been closely monitored in the months before her death.

Along with Humana, the lawsuit named as defendants two doctors, Dr. Michael W. Mann and Dr. Fred C. Campbell Jr., and the Alamo City Medical Group, P.A., which was Mann's employer and the corporate health care provider under contract to Humana. Campbell cared for Mrs. Smelik under another health insurance provider.

Prior to the trial, which began June 13, all the defendants had agreed to out-of-court settlements with the Smelik family, except for Humana. The earlier settlements totaled $602,000.

Nonetheless, jurors were required by law to attribute blame for the negligence among all the defendants. Specifically, the jury found that Humana was 35 percent responsible, Mann was 50 percent responsible and Alamo City Medical Group was 15 percent responsible. Campbell was not assessed any blame by the jury.

A 2004 U.S. Supreme Court decision in Aetna vs. Davila made it more difficult for disgruntled patients to sue HMOs, such as Humana, in cases where plaintiffs who receive their health plans from employers are claiming a denial of medical care. The high court ruled those cases fall under the Federal Employee Retirement Income Security Act (ERISA), which applies to most of the millions who receive HMO care through their employers and limits the amount of damages that can be recovered in a negligence lawsuit to actual losses.

The law firm said Smelik v. Humana was pleaded as a mismanaged managed care case. The Smelik verdict potentially gives new hope to HMO enrollees who are under ERISA and believe that Aetna v. Davila pre-empts their ability to sue their HMO when HMOs demonstrate negligence, fraud, substandard care or denial of benefits, the attorneys said.

The Smeliks alleged that the care delivered by Humana and its physicians to Joan Smelik was substandard. Testimony showed that Mrs. Smelik had been under case management when Humana had outsourced that service to another health care provider. But when that contract ended and Humana began handling case management on its own, Mrs. Smelik's case reportedly was not given the necessary extra oversight.

Previously, employer based HMOs' denial of health care benefits had been largely shielded from regulation by state legislatures with the Supreme Court decision in Aetna v. Davila. Now, the Smelik verdict empowers individuals to fight against HMOs when the HMOs are focused more on saving dollars than on saving lives, the law firm said.

Insurance Journal, July 2005

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

Join us at United for Justice. If you do not act now, when will you do it? What each of us choose to do or not to do affects our communities. That's a heavy responsibility, but it is the truth.

Coventry Health Care Subsidiary loses in Federal Court of West Virginia

Tuesday's Tale

Carelink, My HMO, Cannot Duck Responsibility

A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history. ~Mohandas Gandhi

Friday, September 26, 2008. A banner day.

“I’m ecstatic!” Paul Tucker, my attorney with Bachmann Hess Bachmann and Garden, P.L.L.C. of Wheeling West Virginia, exclaimed. Moments before Tucker had learned that Federal Judge Frederick W. Stamp, of the Northern District Court of West Virginia, granted my motion to remand my civil lawsuit, Christine Stenger vs. Carelink Health Plans, Inc and Patrick W. Dowd (former Carelink CEO) to Ohio County Circuit Court.

This is huge. If you visit unitedforjustice.blogspot.com there are links to copies of significant court documents that track a rare win against an HMO in the federal court.

Paul Tucker is beginning his preparation for the next legal battle against Carelink. I have no doubts that he will prove that Carelink Health Plans, Inc. gravely injured me as a part of a ruthless scheme to intimidate and discriminate against me. My voluminous records provide evidence of a widely corrupt system.

There is celebration but it is a sobering one. In America we consumers have rights, but there is no guarantee that we have affordable remedies. No remedy for the thousands of people with health insurance whose health plans will continue to do business as usual, denying and delaying their rightful claims.

Delaying is one of the many ruthless tactics employed by health plans. Delaying until it is too late for some. Dena Wildman, speaking with the experience of working for the West Virginia Insurance Commission once casually told me “that many times they (health plans) deny, deny and wait for appeal…hoping you will go away. Many,” Wildman believed, “do give up.”

Ours is not only a culture of deceit; it is a culture of greed. How can the conscience of health insurance executives be so twisted that they only hear what they want to hear? With the present financial crisis, it may be time that they begin to listen to the truth.

Did you happen to watch 60 Minutes on Sunday evening? Steve Kroft hosted an expose about the crimes of Wall Street:

Congress finally passed - and President Bush signed into law - a financial rescue package in which the taxpayers will buy up Wall Street's bad investments.

The numbers are staggering, but they don't begin to explain the greed and incompetence that created this mess.

It began with a terrible bet that was magnified by reckless borrowing, complex securities, and a vast, unregulated shadow market worth nearly $60 trillion that hid the risks until it was too late to do anything about them.

That chapter is not over, and there is much suspense and fear on Wall Street that there are other big losses out there that have yet to be disclosed…

Suspicions are being raised about all Wall Street companies who too often hide facts and avoid transparancy. Facts hidden from the public, from the stockholders, from federal regulators.

Coventry Health Care, Inc. of Bethesda MD has been described as the “darling of Wall Street.” Hmm. From what I have discovered of secret dealings, it would not surprise me to learn that Coventry may be the subject of a federal investigation in the future.

No. It would not surprise me one bit. For those of us who have a strong foundation in Faith, we need only turn to the many writings in the Bible, where God promises:

Then one day I went into God’s sanctuary to meditate and thought about the future of these evil men. What a slippery path they are on --- suddenly God will send them sliding over the edge of the cliff and down to their destruction: an instant end to all their happiness, an eternity of terror. Their present life is only a dream. They will awaken to the truth as one awakens from a dream of things that never really were. ~Psalms 73: 17-20

Public judgement lies ahead for HMOs. It may not be next week, but it may be next year. But until then, they will begin to live with doubts about their futures. About the future of their families. About the wrath and the anger of Americans who, for years, have had to pay a large price for their despicable actions. Much too high a price for many.

There has been a healthcare crisis in America for decades. My case is a very important step to holding managed care responsible for the major role they play in attempting to hide behind the federal law ERISA to deny quality care to the disabled in West Virginia.

But, I cannot delude myself. Our world is spinning out of control. My recent win against Carelink will be of little significance if others do not join together to demand reforms. The economic crisis is linked to the health care crisis.

We literally can no longer afford to stand still. Too much is at stake.

Today’s Tale
A Disastrous Result

Another costly delay by an insurance plan providing the consumer his rightful benefits. This man did not live to enjoy his benefits!

Using the Rev. Martin Luther King's fight for equality as a jumping-off point on what would've been his 79th birthday, members of a nurses' union staged a rally Tuesday in downtown Chicago decrying corporate interference in health care.

The rally organized by the National Nurses Organizing Committee and the California Nurses Association outside of Cigna health care's offices in the 500 block of West Monroe Street featured a Southland mother and daughter waging a battle against the insurance industry.

"While my dad fights, UniCare has failed him, and it has failed my family," Jody Polka told two dozen demonstrators on the frigid afternoon.

Polka's father, Cyril Strezo, 58, of Frankfort, suffers from esophageal cancer that was initially treated with radiation and chemotherapy. When the cancer spread to his liver last fall, his oncologist prescribed two drugs for his treatment.

UniCare declined to pay the cost of the drugs - about $3,000 per week - calling them "experimental and/or investigative," despite the drugs having been approved by the U.S. Food and Drug Administration in the 1990s.

But a recent article in the SouthtownStar spurred state Rep. Mary Flowers (D-Chicago) and the Illinois attorney general's office to bring pressure on UniCare, resulting in the insurer reversing its decision and agreeing to cover the cost of Strezo's drugs.

But the victory may have come too late. The family learned last fall that Strezo's cancer had spread to his brain.

Strezo's family criticized the insurance company for delaying his drug treatment, which they called a private matter.

"My dad's treatment had nothing to do with some lady in a cubicle (at UniCare) who does not have a license to practice medicine," Polka said, standing beside her mother, Terry Strezo.

"The treatment should be between him and his doctor. UniCare decides, based on their financial calculations, who should live and who should not. If you or I made decisions like that, we'd be serving a life sentence on Death Row."

The demonstrators also carried signs showing a photo of Nataline Sarikisyan. The 17-year-old California teen died last month after Cigna, her insurance company, refused to pay for a liver transplant. Cigna later reversed its position, but Sarikisyan was already terminally ill.

"How would you like it if you couldn't call the police because you're not insured?" Flowers asked the crowd.

"You pay your taxes, these are services you deserve. You are paying for your insurance. And if they don't want to be in the business of insuring, they should get out of the business."

Flowers is sponsoring House bills for a single-payer medical program and another that would allow patients to appeal denials of their health benefits by insurers.

Officials at Cigna could not be reached Tuesday for comment.

Polka said she hoped the rally would help publicize the struggle that many patients have with their insurance companies in getting the medical coverage they deserve.

"This is something that affects everybody," she said. "Everybody thinks they can sleep at night because they have insurance, but if you get sick it doesn't matter."

By William LeeSouthtown StarJanuary 16, 2008

Intrigue at West Virginia PEIA

Tuesday's Tale

A Credibility Crisis in West Virginia

Make the lie big, make it simple, keep saying it, and eventually they will believe it. ~Adolph Hitler

Daily the headlines remind each of us that corporate greed has caused fear, panic, loss of jobs, and major distrust. Worse yet it has shaken the very foundations of our stock market.




The New York Times, September 26, 2008
The chairman of the Securities and Exchange Commission, a longtime proponent of deregulation, acknowledged recently, “The last six months have made it abundantly clear that voluntary regulation does not work.”


The New York Times, September 30, 2008
We’re living in an age when a vast excess of capital sloshes around the world fueling cycles of bubble and bust. When the capital floods into a sector or economy, it washes away sober business practices, and habits of discipline and self-denial. Then the money managers panic and it sloshes out, punishing the just and unjust alike.


The Washington Post, September 30, 2007
The leaders of the country said: Trust us. The people said: Not this time.

The news in the financial markets has turned frightening, yet the impact for West Virginians of the appointment in 2006 of a former Carelink CEO to be the Director of the West Virginia state employees’ insurance plans, PEIA, may be tragic.

Following this appointment was the announcement of a questionable awarding of a $55 million a year contract to manage the health insurance program for more than 35,000 retired public employees, teachers, and school service workers to Coventry Health Care, Inc., the former boss of the new Director of PEIA.

How do they do it? How does Carelink Health Plans, Inc. "voluntarily" police themselves and grow their business? It’s with the assistance of unchecked regulatory agencies and a government that apparently assists big business at the cost of the consumer. Special interests just may have a tight hold on our lawmakers, our executive branch and even our judicial branch.

Something sinister in the works? On September 22, 2006, Governor Joe Manchin, appointed Ted Cheatham, former Carelink CEO, to be the Director of PEIA. Cheatham appeared to be a credible choice to be Director of PEIA. A few of us, however, had made a discovery that cast serious doubt.

Apparently, there exists a questionable pattern of behavior on the part of Coventry Health Care Inc. of Bethesda MD to fill important outside and inside positions with “company” people and hired people from the private sector who could likely influence decisions in Coventry’s favor throughout the system.


Of particular importance to me was the appointment of Bernard J. Mansheim, M.D. to be Chairman of the Board of Directors of the insurance regulatory body, URAC. At the time I first contacted URAC in 2005 to look into the questionable business practices of Coventry, I was unaware that this then Vice President of Coventry was appointed Co-Chair of the Board of Directors. URAC never responded to my request and I knew not to waste any more time.

Conflict of interest after conflict of interest. Nasty business tricks. Is this acceptable to us as citizens of West Virginia, a state that is in dire need of quality health care?

Mr. Ted Cheatham, former Carelink CEO, became Director of the PEIA on September 22, 2006. Within a few months, in a very pubic and transparent move, Cheatham awarded a “lucrative” contract to Coventry, his former boss.

“What's this all about?" It may well be Cheatham's connections. The lucrative contract was given to Carelink, despite Carelink's being the highest bidder of three bids. Carelink was higher that Humana. Carelink was higher than Highmark. Incredulously, with apparently little regulation and oversight, Carelink emerged the winner from the fray that ensued. It appears that yet another dark plot was executed before our very eyes.

This is all so messy, is it not?

Do not be fooled. We all will pay for the sins of greed and mismanagement, either in deterioration of our health or losing more of our paychecks. Yet, there's another cost to consider. The cost of more embarrassment to our wonderful state as truth becomes known. The embarrassment to family and friends of those who participated in questionable activities. The cost to our youth whose heroes may be men and women in public office who secretly act in unjust ways.

Time is ticking. A little late for many, but justice will come down hard on those who operate without a conscience. The Corrupt. The Liars. The Greedy. The Indifferent.

With transparency, regulation and accountability all will see the games played in West Virginia.

Please visit uniteforjustice.blogspot.com. Mr. Cheatham’s appointment has made a lot of news on the internet. Not much good news. I have many links that flag subsequent failures and questionable behaviors of the West Virginia PEIA.

Tuesday’s Tale

A Huge Loophole

These tales are tragic and infuriating.

"They let a clerk thousands of miles away make a life-threatening decision about my life and my baby's life without even seeing me and overruled five of my doctors," said Slidell, Louisiana resident Florence Corcoran. It is a story that echoes so many tragedies recounted in this book. But as with many of the other stories, there's a twist — a second tragedy. "They don't get held accountable. And that's what appalls me. I relive that all the time. Insurance companies don't answer to nobody."

Corcoran faced a high-risk pregnancy. Her obstetrician ordered her hospitalized, as she had been in a previous high-risk birth. Yet her managed health care company, United Healthcare, overruled her doctor and denied the hospitalization, even though it had a second opinion agreeing with the doctor's advice. Instead, Corcoran's insurer ordered home nursing for ten hours each day.

During the last month of Corcoran's pregnancy, when no nurse was on duty, the baby went into distress. Denied the monitors and care she would have had in the hospital, Florence Corcoran's baby died.

…"If I go out on the street and murder a person, I am thrown in jail for murder and held accountable," said Corcoran. "What's the difference between me and this clerk thousands of miles away making a life decision which took the life of my baby and she gets off scott-free and keeps her job?"

This is the dirty little secret that lets HMOs walk away from responsibility for denying or interfering with medically appropriate treatment. ~ Making a Killing: HMOs and the Threat to Your Health, Chapter 5

Disclosing Tactics of Spelman Thomas Battle, PLLC

Tuesday’s Tirade
The Legalese of Dishonor

“Never forget that everything Hitler did in Germany was legal.”

~Martin Luther King, Jr.

Legalese is an English term for writing pertaining to law that is difficult to read and understand. There’s an implication in this style: the more the writing is esoteric the higher the fees and the untrained mind will be excluded from the legal process.

I believe that Spilman Thomas and Battle, PLLC, the prestigious law firm defending Carelink Health Plans, Inc. of West Virginia in my civil lawsuit, may have engaged in some very questionable practices. Yet from a purely institution perspective, Spilman may have represented Carelink well.

It is the not only law that is the subject here. It is lawyers representing justice, fairness, integrity. Practicing law can be a world of deceit. Will one apparently faulty factual premise made by Spilman, Thomas and Battle PLLC influence a critical judgement now before the court of Judge Frederick P. Stamp, Jr. from the West Virginia Northern District Court?

Many authorities believe that there is a law against such posturing:

Active misrepresentations by an attorney to opposing counsel by deliberately failing to state a material fact "falls short of the honesty and integrity required of an attorney at law in the performance of his professional duties." (Coviello v. State Bar (1955) 45 Cal.2d 57, 65-66 [286 P.2d 357].) The State Bar of California Standing Committee on Professional Responsibility and Conduct.

It is professional misconduct for a lawyer to:(c) engage in conduct involving dishonesty, fraud, deceit or misrepresentation;(d) engage in conduct that is prejudicial to the administration of justice;(e) state or imply an ability to influence improperly a government agency or official;
(West Virginia State Bar Rule 8.4. Misconduct)

The ASHA Code of Ethics prohibits "engaging in . . . a misrepresentation …."¹ This general prohibition is not limited to intentional misrepresentations. A misrepresentation is any statement by words or other conduct that, under the circumstances, amounts to an assertion that is false or erroneous, i.e., not in accordance with the facts.² A misrepresentation, therefore, may be intentional or negligent, i.e., a "fraudulent misrepresentation" or a negligent misrepresentation." By Judson R. Garrett, Jr.

In my blog unitedforjustice.blogspot.com, Disclosing Tactics of Spilman Thomas and Battle PLLC, I link to crucial documents associated with my formal claims of discrimination and intimidation by my HMO. Likely, you may find all the documents very interesting, but it is Spilman’s allegation on page four of Defendants’ Response to Plaintiff’s Motion to Remand that will create a lot of discussion: “At no time during the course of the hearing did Plaintiff or her counsel indicate that any discrimination was taking place.”

My civil case is predicated on discrimination and intimidation deliberately inflicted on me, a disabled person, by a business doing business in West Virginia. Carelink is attempting to justify moving the case to federal court where no damages can be awarded. It appears that Defense Counsel is suggesting in Carelink’s Response, dated January 2, 2008, that I was indifferent about this grave issue at the time of my hearing.

I was anything but quiet about this discrimination. Before filing a civil lawsuit, I had submitted a formal claim on March 10, 2006, against Carelink to the “regulatory agency” of our state, the West Virginia Insurance Commission. My complaint cites discriminatory actions and intimidation against someone with a disability.

I requested a formal hearing before an administrative judge. My complaint set off a scramble of activity that left former Carelink CEO Patrick Dowd without a job and me without any recourse. The “state insurance regulatory” agency did not desire to regulate this issue. Their lack of action speaks to the heart of the problem. Corruption.

Additionally, I contacted the West Virginia Human Rights Commission as they, too, “regulate” insurance matters against anyone with a disability. For two months this “regulatory” agency did its job. Then my case was turned over to the attorneys and I no longer existed in their eyes.

Here’s the kicker. It was August 10, 2006, only minutes before my administrative hearing on a claim before the West Virginia Insurance Commission to seek my benefits under law. My Counsel was the Director of the Office of Consumer Advocacy. His name Frank Hartman.

Hartman took this brief moment to inform me, as we walked to the courtroom, that “one of those deals behind closed doors” had been worked out without my consent and we were directed to keep our mouths shut about the “open” complaint against Carelink for discrimination. How’s that for intimidation?

And in January 2008 Spillman Thomas Battle PLLC had the audacity to point out that neither my counsel or myself had brought up the discrimination at the August 10, 2006, hearing. Were they not privy to the behind the scenes manipulations? Shameful. Judge Frederick Stamp of the 1st District Court is reviewing all documents now. Is this justice? Has my integrity been impugned?

Yes, we live in a world of questionable scruples. Lethal legalese manipulated to present a false portrayal. Taking advantage of the uneducated and less sophisiticated.

Yes, lawyers have a bad reputation. Some might say that this profession is the cause of our world’s problems. Any wonder Spillman attorneys are practicing in one of the most universally despised professions? Do they damage the many fine, honest men and women who daily expose truth in our courtrooms?

Just posing a few questions that may raise serious issues about legal representation. You see, I have no money to retain an attorney. Like so many other harmed Americans, I do not have access to the power attorneys, the ones who are paid handsomely to pull rabbits out of their hats.

I just sit back in amazement and do what I now do best. Write in the hope others will recognize the ancient deceptions of these conjurers.

What's the root of my problems in West Virginia? Corruption. Someone not only needs to look at regulatory agencies in West Virginia, some law firms need to look at their corporate conscience.

Tuesday’s Tale
BiPolar Illness: My Best Friend

For forty years I have lived with a serious mental illness, Bipolar Illness. After years of personal medecine, therapy and medication, I have been symptom free for several years. Ironically, my freedom occurred the very same month, May 2005, that Carelink Health Plans, Inc. denied me my rightful benefits.

It would be a few months later, before I received the ruthless letter from former CEO Patrick W. Dowd, that I was speaking with my spiritual director about how to proceed against Carelink. If to proceed. Father’s wisdom was once again prophetic: ”Penny, maybe God wanted to heal you so you could fight for justice.” The battle began that day in earnest.

It’s neither the time nor place to describe the years of great anguish I experienced since 2005, the courage it took to take each step along the way. The humility to face false accusations of being violent and dangerous, of being accused of seeking justice with Coventry legal just a little too many times.

It was my psychiatrist’s words to me when I sought her opinion of what to do that propelled me: “It’s not just the mentally ill that are vulnerable to greedy insurance companies, it’s the elderly.”

I have been transparent about living with bipolar illness for over ten years. The local newspaper promoted me as a positive face of the illness in two significant articles. Bipolar has become my best friend for I have been led to a rich life of writing, painting, and advocacy that offers me a new career at age 60.

People have always greeted my admission with love and acceptance. Many times I have opened the door for others to share their own troubles. But, it was meeting Carelink and their ruthless business tactics that made me a lot more cautious.

On November 1, 2005, former CEO Patrick W. Dowd, likely not acting alone, falsely accused me of fraud in an attempt to terminate me. He was ever so aware of how far into the Carelink system I had entered. What is most despicable is that Mr. Dowd acted with the knowledge of my living with a severe mental illness. Likely, he thought that I would be paralyzed by my illness.

So while I continued to investigate Carelink and Coventry’s business practices, they continued to deny those with emotional problems much needed care. And here lies damnable actions. And the apparent reprehensible manipulation of the facts by Spilman Thomas and Battle PLLC.

I am not alone as I fight a giant in the insurance industry. I am part of the many who have lived with bipolar illness who have come before me. Courageous men and women who by their living a full, rich life with a chronic illness, have opened possibilities for me to confront evil and win.

Edgar Allen Poe

Mark Twain
Patty Duke

Carrie Fisher

Connie Francis

Moss Hart

Mariette Hartley

Margot Kidder

Vivien Leigh

Ben Stiller

Lili Taylor

Robin Williams

Jonathon Winters
Lord Byron
Dick Cavett
William Faulkner
Patrick J. Kennedy
Sir Isaac Newton
Florence Nighengale
Emily Post
Ludwig Von Beethoven

Francis Ford Coppola

George Fredrick Handel

Joshua Logan

Vincent Van Gogh

Gustav Mahier

Ted Turner
Buzz Aldrin

Sol Wachtier
Rosemary Clooney

Oscar Levant

Townes Van Zandt
Robert Lowell
Winston Churchill

Lynne Rivers

Theodore Roosevelt
Ilie Nastase

Dick Cavett

Jane Pauley
Honors de Balzac

Art Buchwald

Johann Goethe

Graham Greene

Kay Redfield Jamison

EXPOSING NCQA

Tuesday's Tirade

NCQA ..."Those fuckingWeasels!"

Yesterday's economic news was very bleak. Today it is even bleaker. Now it is one of the world’s largest insurance company AIG who is struggling for its life. Listening to PBS News Hour with Jim Lehrer about the demise of Leyman Brothers and the continuing problems of insurance giant AIG causes great anxiety. What's gone wrong? Why? As many lose their savings and jobs, we ask instinctively, "Where are we headed?"

Analysts are quick to use terms like heavily leveraged. Under regulated. Wall Street shift. Privatizing profits at the cost of socializing losses. Draconian crisis. Gripped by fear. Loosened oversight....the list goes on.

What do our presidential candidates think? Knowing what I know about Coventry Health Care, Inc. of Bethesda, MD, the "darling of wall street" whose very own Wolf earned an obscene salary package of $32 million dollars in 2004, I would put my money on Obama with respect to this one issue.

September 15. 2008

"The challenges facing our financial system today are more evidence that too many folks in Washington and on Wall Street weren't minding the store," Obama stated in his first written statement on the crisis:

"Eight years of policies that have shredded consumer protections, loosened oversight and regulation, and encouraged outsized bonuses to CEOs while ignoring middle-class Americans have brought us to the most serious financial crisis since the Great Depression," he said.

While many may place the blame for this continuing meltdown on the unstable housing market, there are others who have spoken with far deeper insight. One hotspot, analysts believe, is the unbridled growth of markets without corresponding regulation. Too much freedom along with less regulation results in the perfect storm. A storm that has begun to develop in the insurance industry. Today AIG. Tomorrow, one might even consider Coventry Health Care, Inc., the real Coventry, a possible candidate.

If any news should cause serious protests, it will be learning of the reportedly deceitful, repugnant tactics of NCQA, a company whom people have trusted with there lives to offer honest evaluations of health care plans.

In 2006 the West Virginia Insurance Commission came down hard against Carelink Health Plans, Inc. of West Virginia. Carelink's response? They created legal juggernauts that caused evermore lengthy delays.

There was one lie after another, one more bold-faced than the next. The mother lode of lies was told in spring of 2008 when Carelink revealed its “Excellent” Accreditation from The National Committee for Quality Assurance, NCQA, headquartered in Washington D.C.

Consider these three facts and ask, “Is this an HMO with whom I would trust my health care and that of my family?”

1. Carelink knowingly inflicted great harm on me. Return to the ruthless letter sent me by Patrick Dowd, former CEO of Carelink, just one of many examples.

Here is the link to Mr. Dowd’s correspondence to me:
http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

2. The West Virginia Insurance Commission issued Final Order 06-AP-024 against Carelink on December 14, 2006. This order describes Carelink’s “egregious” behavior and mandates radical change in how they do business so future abuses will be stopped. Carelink continues to ignore the order.

Here is the link to Final Order 06-AP-024 dated December 14, 2006. http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

3. I filed a civil lawsuit for lack of public accommodation for a person with a disability against Carelink on October 2007. My lawsuit cites a West Virginia law that prohibits anyone doing business in this state from discrimination against someone with a disability. While Carelink would like one to believe otherwise, they were first a business in West Virginia and then a health plan.

Here is the link to the civil lawsuit Christine Stenger v. Carelink Health Plans, Inc. of West Virginia and Patrick Dowd dated October 2007:
http://www.freewebs.com/courageoffaith/2007%2010%2015%20Civil%20Lawsuit%20Filed%20Stenger%20v.%20Carelink.pdf

Did NCQA have its head buried in the sand when Carelink's accreditation application was processed? Worse yet, how can NCQA effectively evaluate a health care plan using VOLUNTARY INFORMATION? Even worse, US News and World Report relies partly on the NCQA's accreditations to determine the top 100 health plans each year. And people wonder why we have a health care crisis.

Isn’t that sweet?

According to NCQA’s website:

The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.

Measuring and reporting on health care quality is extremely important; it gives consumers and employers the ability to make informed choices and pursue the best available care.

NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval.

NCQA accreditation, according to one HMO’s advertising materials, is like the Good Housekeeping Seal of Approval. NCQA admits that they are a “private, not-for-profit organization.” Now strike out every other assertion. I repeat. Strike out every other assertion as what I tell you next will cast doubt on NCQA’s motives.

I believe that NCQA is yet another one of those organizations who are good at painting pictures. Rosy ones. Only these roses have thorns. Unfortunately, there is an unsuspecting public, a public that is duped despite their desire to locate an "excellent" health plan for themselves and their families.

Upon learning of Carelink's "excellent" accreditation, I contacted NCQA directly with a lot of questions. It was a very strange phone call and the information offered made me even more suspicious of NCQA.

The receptionist told me that she was taking thorough notes of my complaint to provide the complaint department. However, I was informed, I would have to make a formal complaint for any action to be taken. Sensing that my complaint would be a formality only, I closed this chapter. For a time.

Does NCQA think we John Does are all dummies and will go quietly away? I may not be the smartest person alive but I know enough to ask this question:

"How does an independent organizaton develop 'rigorous standards' by employing voluntary information and get away with it all these years?"

And am I smart enough to turn once again to the internet to locate answers? Yes. The search lasted less than five minutes and there is was. Bingo!

What a bold move on the part of managed care as reported in the expose Making a Killing, Chapter 6: HMOs and the Thread to Your Health by Jamie Court.

NCQA was formed in 1979 by the trade associations for the managed care industry — the American Managed Care and Review Association and the Group Health Association of America. The group was founded, in fact, to counter the federal government's attempts to monitor HMOs. The main funding source for NCQA continues to be HMOs, although the group is seeking to diversify its funding to appear more independent… And private report cards are maintained by industry-sponsored groups such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and National Committee For Quality Assurance (NCQA).

Here's essential reading for you: http://www.freewebs.com/courageoffaith/MAKING%20A%20KILLING%20-%20Chapter%206%20-%20The%20Battle%20to%20Make%20Health%20Care%20Work.mht

Coventry Health Care, Inc., NCQA, the West Virginia Insurance Commission and the West Virginia Human Rights Commission will soon receive their own report cards. Over 900 visits were made to this site since its inception in early June. I have personally met others who plan to provide their own "voluntary information" to rate their health plans.

Recently I returned home from a national conference that focused on advocacy and self-help. No interest in the seminars. My only goal was to speak privately with the leaders of our association, advocacy leaders from around this country, and leave them with my a copy of this blog. I succeeded.

I brought up health care to a Canadian who had a key role to play in the convention. He knew about problems with health care as his sister-in-law lives in NY. When she suddenly became paralyzed from the chest down, problems receiving rightful benefits occurred with her health plan.

It was this gentleman who, upon reading a copy of today’s blog, exclaimed "Those fucking weasels! Excuse my French."

Dictionary.com defines a weasel as following:

1. cunning, sneaky person
2. a person who is regarded as treacherous or sneaky
3. They have a slender, elongated body, and are noted for the quickness of their movements and for their bloodthirsty habit in destroying poultry, rats, etc.
4. to use weasel words; be ambiguous; mislead

Take your pick.

It's time for more transparancy. Let’s hear more about the officers of Coventry Health Care, Inc. of Bethesda MD and study their personal business practices.

Where is this all leading? Look at today’s news. Wall Street is put on notice that it will be held accountable. Unfortunately, the public is losing much equity due to questionable business practices. That makes the public only angrier.


What was that fellow’s name? Oh, that’s right, Mr. Jeffrey Skilling. This Enron CEO was a little too arrogant. Like Coventry Health Care, Inc. of Bethesda MD, Enron was “a darling of Wall Street.” Look what happened to Enron. Is there another Enron out there where disclosure will reveal missteps, serious missteps? Is Coventry duplicating any of these types of tactics? Nothing would surprise me these days.

Tuesday’s Tale
David and Goliath

Find out just what people will submit to, and you have found out the exact amount of injustice and wrong which will be imposed upon them; and these will continue until they are resisted with either words or blows, or both. The limits of tyrants are prescribed by the endurance of those whom they oppress. ~Frederick Douglass:

A little over two weeks ago I visited my spiritual director, a diocesan priest with the Catholic Diocese of Wheeling Charleston (West Virginia). Father’s first words were, “I want you to reread the bible story of David and Goliath.” I smiled. “Father, I know the story well. For over two years I have had a small stone next to my computer, a reminder of God’s great power.”

What drives me day after day to fight for the rights of the poor against an evil health plan? Simply, Justice.

We know there is a systemic problem that weaves its way through the hearts and minds of good people whose conscience is misinformed. Through one entity after another, infiltrating the offices of those entrusted with public trust. Through regulatory agencies whose mission is to insure health insurance laws are followed by each insurance company that does business in a state. To the media whose choice of "no comment" by their very nature supports evil. And, yes, likely to the law firms that represent them, using legal means to stretch the truth, what some may call misrepresentation. More about this soon. Real soon.

Why did I think I could make a difference? From the moment Carelink Health Plans, Inc. of West Virginia denied me my rightful benefits, I have had honest, God-fearing men at my back. Doctors. Attorneys. And, most importantly, Catholic priests from the Catholic Diocese of Wheeling Charleston. One Franciscan Hermit. Two Jesuits, social activists. A diocesan priest. A Passionist priest.

Nothing surprised these men. They simply prayed harder. Encouraged and empowered more. And wisely blessed and advised me how to defeat Goliath. And while I have confronted fear and indifference from others, the clergy have never failed me these three, long, difficult years.

Their advice was always to keep on telling my story. Their belief is that one person can make a difference, that one by one others will begin to ask questions, to educate and inform their consciences. Change will occur slowly, but it is inevitable they tell me.

There is a crisis in health care in this country. The injustice I experienced is, sadly, a national issue. It must be a "WE" effort to advocate for others. Only together will we realize justice in health care. And then, the politically powerful will begin to face the anger of hardworking, faith filled Americans.

It’s about time, don’t you think?

West Virginia Fails Citizens

Tuesday's Tirade
Collusion of the West Virginia Human Rights Commission

“I've fought corruption, and it didn't matter if the culprits were Democrats or Republicans. They violated their public trust and had to be held accountable.” ~John McCain, Republican National Convention


Sadly, there is much depth and breadth to the corruption in health care in West Virginia and elsewhere. Depravity of public officials who have been entrusted to serve the public interest. The corrupt acts and moral perversion of ordinary, otherwise good people.

Every day, like a storm surge striking a beach, quality health care is eroded. Our basic freedoms diminished.




From the very beginning I just wanted one person to really listen to how ruthlessly my HMO, Carelink Health Plans, Inc. of West Virginia, treated me. I just wanted one person to thoroughly investigate Carelink's business practices.

Let’s get real now and face the cold, hard facts: We are facing one of the worst health care crises our country has ever experienced and West Virginia officials are working in secret to deny consumers the benefits to which they are entitled by law.

Did I get anywhere? Yes, I did. For while state officials were wrongly denying me access to my basic rights, I was busily taking notes. Thorough, incriminating notes. I was collecting certified mail receipts and e-mails that today provide a rich account of wide-spread collusion. I was talking to one official after another and hearing conflicting stories. Shocking stories.

Let me now introduce you to the West Virginia Human Rights Division. No pride here. Only disdain.

It was summer 2006 when I began a series of telephone exchanges with James Slack, Intake Officer for the commission. For almost two months I regularly communicated with Slack about my formal complaint against Carelink Health Plans, Inc. of West Virginia, filed at the West Virginia Human Rights Commission on August 22, 2006, for failure to grant public accommodation to someone with a disability.

As with any of my formal claims that have been processed to date, I attached volumes of records that would prove criminal behavior. By certified mail. I have over seven pages of typed notes about the issues. There was never anything to suggest that Slack and I were not on track to have this complaint filed in this agency and prosecuted. That was until October 15, 2006.

James Slack placed a phone call that day. Oddly it was not to me. It was to my attorney, Mr. Paul Tucker of Bachmann, Hess, Bachmann and Garden of Wheeling, West Virginia. Tucker represents me in my civil lawsuit against Carelink and former Carelink CEO Patrick W. Dowd. Here are my notes about the conversation:

Paul has spoken with James Slack on several different times, receiving conflicting info. Slack does not remember me. Paul was told that I never filed a formal complaint. There is nothing entered into the system. They are sending out a no cause letter.

The almighty dollar has a grasp on our state leaders. Some might say that that’s the way it always has been and that's the way it always will be. I dare you to excuse this evil to Sarah Palin or John McCain. Or Barack Obama. Joe Biden. Don’t dare challenge their principles, as you will likely find them showing up in Charleston, our state capitol, demanding to speak with Governor Joe Manchin.

John McCain believes that “In America, we change things that need to be changed.” Barrack Obama promises to make sure insurance companies "stop discriminating against those who are sick and need care the most." It's our time folks.

There are powerful, corrupt forces in my state and, likely, within the very regulatory agencies that are entrusted to regulate health plans in our country. We plan to win that battle. It's a noble cause, our finest hour.

For more details and documents that support the allegations of today's tirade, visit http://www.myfatherslegacy.blogspot.com/.

Tuesday's Tale
And yet another Coventry Bad Guy story

My personal thoughts and convictions:

I have suffered through the lengthy process of Coventry's schemes. I have experienced two different Carelink doctors', "so called experts," rejecting my specialist's request for medically necessary surgery. Almost two years later, Carelink was finally forced to authorize the surgery. Not without a lengthy fight that cost me valuable time and adversely affected my health.

Well, I have lived through the "excellent" health care plan of a Coventry subsidiary. It is at best a very unpleasant, humiliating and intimidating experience. Some doctors testify that cases like mine and Tracy Pierce (see below) repeat a scenario that happens all too often -- patients are denied critical medical care because health insurance companies care only about profits.

Once again an opportunity to broadcast the 2004 obscene salary package of Coventry CEO, Dale B. Wolfe. $32 million dollars. An irony lies with Mr. Wolfe's family name.



Pay attention now. This is life and death stuff.

KANSAS CITY, Mo. -- KMBC-TV
Dying Of Cancer

Tracy Pierce, 37, of Shawnee, is dying of cancer and isn't expected to live another year. He said his insurance company, First Health-Coventry, is doing nothing to stop it.

"I have no treatment -- three months have gone by and I'm getting no treatment," Pierce said.

Every time his doctor attempts to treat him, the claim is rejected. Pierce's wife, Julie, is a health care professional and cannot believe what's happening.

"Everything the doctor prescribes -- they've shot down," Julie Pierce said.

The family's doctor has written letters to First Health-Coventry, asking the company to approve payment for two drugs for Tracy: Tarceva and Avastin. Clinical studies showed that the drugs stop renal cell cancer in 70 percent of cases.

The insurance company rejected the claim, saying the drugs were not a medical necessity.

A life-saving bone marrow transplant was also rejected by First Health-Coventry, even though a donor match was found. "(Tracy's) youngest brother came back from college, got tested, and he was a perfect match. They submitted it to (the insurance company) -- they denied it," Julie Pierce said.

The insurance company said the transplant was experimental and could not be covered.


The alarms continue to be sound here. When will we begin to listen? Really listen? Tomorrow's Tracey Pierces desperately need us.

Almost Heaven? A West Virginian Lives through Hell

Tuesday's Tirade
Aiding the Enemy

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” ~Martin Luther King, Jr.

"Denial" stamped by Carelink Health Plans, Inc. of West Virginia on my fourth appeal for medically necessary surgery on July 29, 2005. Yes, it took sending four different appeals before one was stamped as received! A badly, broken system.

Where does one turn? Struggle to locate legal representation. No knowledge of insurance law. Not one person to assist me.

What does the average citizen do? Likely give up at this point. Who would blame them? And the blatant abuse of power continues to the next victim. And the next. And the next. That is until people become angry enough to move on out. Move out in numbers. Move out with loud voices. With determination and passion.

Coventry Health Care, Inc. of Bethesda, “the darling of wall street” and parent company of Carelink Health Plans, Inc. of West Virginia, is unusually good at making profits out of its products. What helps them succeed, it appears, is a state insurance commission who works too hard to insure business remains in West Virginia while the consumer suffers the consequences. Without a real challenge to corporate power and corruption in the West Virginia Insurance Commission, abuses continue.

West Virginia usually finds itself at the bottom of most national rankings: 47th in child poverty, 49th (2006) in the smartest state award, 49th for most obese state, 44th in the USA Health Ratings and 50th in depression. Alarming? A fire is raging in my state. It is out of control.

Considering the dire statistics about West Virginia, it is abhorrent for Coventry to become rich due in part to state government that is working against us.

Government, Senator Barrack Obama exclaimed loudly at the Democratic National Convention should, “help us, not hurt us.” The West Virginia Insurance Commission has not heard that message. They greatly harmed me. No not just once, but again and again.

There is a systemic problem in West Virginia that permeates many offices. What I discovered these past three years is a serious matter.


On January 18, 2008, I filed a claim with the West Virginia Court of Claims against the West Virginia Insurance Commission for obstruction of justice. I cited eleven different serious offenses made against me beginning October of 2005 and continuing to the present. My day in court is will begin on October 10, 2008. I will keep you posted.

Here's a link to the Court of Claims’ response to my legal action: http://www.freewebs.com/courageoffaith/2008%201%2031%20Court%20of%20Claims%20Response.pdf

Complaint One of Eleven Complaints: HIPPA law violated.

Following procedures of state law, on September 29, 2005, I mailed my formal grievance against my HMO to the West Virginia Insurance Commission. With 21 years experience, Dena Wildman is the Examiner in the West Virginia Insurance Commission; it is Wildman's job is to investigate grievances against an HMO.

Wildman and I spoke on the 27th of September, two days before my mailing the complaint to the Commission. Here is my record of our conversation:

Dena is in agreement that insurance companies look at the bottom line as they are a business and as such make a profit. I questioned if a 70% profit (for one quarter) is justified. Wildman replied that many times insurance companies deny and deny and wait for an appeal, hoping “you” will go away. Many people, Wildman believes, do give up.

In 1996 The United States passed a law (HIPPA) which mandates mechanisms be standardized to insure the security of private health information. This information is to be carefully monitored for confidentiality and data integrity for any information that identifies an individual. Keeping your information safe is one of government's most important duties.

On September 28, 2005, I filed a grievance with the West Virginia Insurance Commission against Carelink Health Plans, Inc. Examiner Wildman released all my private documents to Carelink without my authorization.

Without my consent over eighty pages of personal records were sent to Carelink. Records that in the hands of Carelink will compromise my case and any future case. Records of private conversations with others who entrusted me to keep silent about my source.

On June I, 2006, I spoke with Andrew Pauley, Legal Division of the Commission about this travesty of justice. These are my notes of our conversation:

Upon answering the phone, Pauley asked if I was the one who believed the commission erred in handling my case. My answer was ‘yes.’

According to Pauley, there is a place on the complaint form I signed where I can sign that I do not want private information released. Pauley promised to look into this to insure my rights were not violated. Unless this is signed, my information becomes “public” and it’s open to all parties for review.

Pauley never phoned me. I reviewed a copy of the complaint form I completed. It did not request a waiver, as Pauley had believed. It is noteworthy that the complaint form has been edited to today include a waiver of rights. Too late for me. My rights were violated. Yet another case of “Maybe she will go away.”


Link to newly designed West Virginia Insurance Commission Complaint Form:
http://www.freewebs.com/courageoffaith/New%20Complaint%20Form.pdf
At the Democratic National Convention threats to the basic rights of US citizens were affirmed. It was Senator Dick Durbin of Illinois who reminded the 40 million people watching "that we should never risk our freedoms and privacy to the overreaching hand of government.”

An overreaching government. It almost sounds like a description from the cold war era. Yet, that is just what I am experiencing in my beloved state. A state in Appalachia, which suffers greatly from a variety of sources already, is compromising private papers.

Health care injustice is shocking. But something is stirring across this country. Once again, it was at the Democratic National Convention when Virginia Governor Tim Kane’s rousing speech called us to “feel the energy of change built upon a faith that “moves mountains.” That change will reach into the very systems that have believed themselves to be beyond the law.

There are many other "faith-filled" people, like myself, who are not keeping silent. They, too, are speaking out in boldness and with passion. Now it is different. There is a new, vital audience that is eager to lead us to victory.

Tuesday’s Tale
Another Coventry Victim Lost the Fight of his Life

As you read today’s tale, remember that this victim and many other victims of our broken health care system, are ordinary people, rich and poor. When serious health problems strike, the system does not rationalize, “This is for a community leader. Let’s provide this benefit.”

You will be evaluated just like the rest of us. A few simple questions will be asked, “Do we want to pay for this expensive procedure?” “Can we escape without harming our image?” “Our business? “How likely is it that this doctor will not go along with us and will test the system?" "How busy is this doctor? "

When you hear those words, “Denied,” and you or someone you love will likely hear them, we will be there to support you. Sooner or later. We will be there. Hopefully, it will not be too late.

It’s too late, however, for Dale Fausset. I am numbed by this story. It could have been me.

WOWT Omaha, April 2008

Dale Fausset dedicated his career to saving lives and now he's fighting for his own.

That survival depends on money and on a decision to authorize the funds but no one at city hall will say who is making the decision.

Transplanted lungs gave Dale new life but they are now trying to kill him.

The donor organs are attacking his bone marrow and he needs a bone marrow transplant from his brother.

But Dale's son and the Omaha Firefighters Union have been notified that the city, which is self-insured, won't pay for the $150,000 procedure.
The family has been told the decision was made by Coventry, the company that administers city benefits.

Coventry won't comment.

Dale's son, Tyler Fausset says, "How it can be considered experimental is unknown to me. It doesn't make any sense, especially when somebody's life is on the line. How experimental can that be? That's what's frustrating."

While Dale battles for his life at a Denver transplant center, doctors’ reports are gathered for an appeal.

Dale spent 27 years as a firefighter and paramedic. He had to make quick decisions to save lives and now he needs one in return.

Zach Ryan, with the firefighters union, says, "The importance of this appeal is paramount to Dale because if it's not overturned Dale will not survive."

For 27 years Dale risked his life for others and his family says the city's insurance company needs to take a risk and pay for his bone marrow transplant.

Tyler says, "For a person who commits his life to helping others, he needs one decision by an insurance company to save his life."

The Omaha Firefighters Union said Thursday night that the appeal had been denied. Neither Coventry nor the city will say who made that decision. An appeal will now go to the City Disputes Board.

An unfortunate update: WT Omaha, May 18, 2008

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

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

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

But when he needed the bone marrow transplant, his doctors fought with the city's insurance, which called it experimental. He waited nearly three weeks before the city agreed to the procedure.

"During the time that Dale was waiting for approval of the transplant, during that extended period of time, he contracted an infection," says Darren Bates with the Omaha Firefighters Union.

Six On Your Side (Omaha’s television station, WOWT-TV) had previously reported about Fausset’s struggle. When he retired his health deteriorated.

"He really never got an opportunity to enjoy his retirement," says Bates. "He got sick before he left the job."

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

Coventry, the city's health benefits manager, finally agreed to pay for the procedure after an appeal by Fausset, his family, and his union.

"It was a very big extended period of time,” says Bates. “We have been fighting this for a very extended period of time. We were fighting for weeks to get him coverage for the bone marrow transplant."

Others provided chartered flights and fundraisers to offset medical expenses not paid by Coventry.

His brother agreed to donate the bone marrow, but infection took over his body before the bone marrow could take effect.

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

Does Coventry really care or it just a public face, a busines decision? Fausset died awaiting authorization for a bone marrow transplant that ought to have been authorized immediately. Authorization did come as was due, but it took so long that Fausset died.

Remember the words of the Examiner of the West Virginia Insurance Commission?

Wildman replied that many times insurance companies deny and deny and wait for an appeal, hoping you will go away. Many people, Wildman believes, do give up.

And some of them die waiting for the benefits they deserved at the very moment the request was made. Shameless. Vile. Evil. Any person who cooperates with this system, no matter to what degree, deserves a prison sentence. That day, I believe, now awaits some.

Before I close today, just ponder how twisted the legal system can be, especially for the poorest of the poor.

On August 10, 2006, I was in the courtroom confronting the evil of Coventry. Only then I did not recognize Coventry’s behavior as such.

Here’s a link to the testimony of Carelink’s Medical Director, Dr. Rod McKinney, D.O. as questioned by Coventry corporate attorney
Jonathan Weinberg Esquire:

http://www.freewebs.com/courageoffaith/Testimony%20of%20Dr.%20Rod%20McKinney.pdf

Weinberg was questioning Carelink's medical director about the effects on me were I not to have the requested surgery (page 143).

W. In the event that a severe obstructive sleep apnea disorder goes untreated, what are the possible results for the patient?

M. Daytime somnolence and eventually cardiac dysrhythmias, congestive heart failure and things along that line.

W. It is not beyond the realm of possibility that this could be fatal if left untreated?

M. If left untreated for a long period of time, yes.

Skip to Page 166 - a piece of information Weinberg's wants on record:

W. Let me ask you one more question just so we understand it and we're clear....Do you get into-- I mean, would you assume that this is an important procedure to Ms. Stenger?

M. I don't know the clinical (why not? This is the specialist we are led to believe).

W. But no, I'm saying -- I mean, from her perspective___

M. She suffers from severe sleep apnea and to the point it has failed other therapy and intervention, then this would be an important procedure.

W. So you're not saying not important, we're not - you know, get out of here. You, though, have a job to administer a benefit plan which her husband's employer signed up for?

M. Correct.

Don't you want to jump in here and say, "Cut the theatrics, Weinberg. Stop leading the witness. And what's this about a benifit plan that doesn't allow for this surgery? Aren't you getting ahead of yourself here?"

Yes, there were theatrics in that courtroom in 2006.

Saying 'I am sorry' to me was not in the works that year. I was not dead yet.

I believe that one can be sorry only so many times without a public outcry for change. As I search the internet for legal cases against Coventry, I am becoming aware of just how many times a corporate suit said, “We are sorry.”

Coventry no longer has us fooled. Check out this authorization from Carelink for the benefits that Weinberg stated were not mine:

http://www.freewebs.com/courageoffaith/2007%204%2012%20Authorization%20by%20Carelink.pdf

My rightful benefits were granted on April 4, 2007. That's one year, eleven months and four days from the date I requested medically necessary surgery.

I sense that the gig is up. The curtain, praise God, is beginning to fall on this sorry behavior of health plans and the maneuverings and incomplete facts presented by its highly paid legal departments.

Mr. Dale Wolfe, Coventry CEO made $32 million dollars the year before I was denied my request for medically necessary surgery. Certainly an excess that could have gone to pay for my surgery as well as Mr. Fausset’s comparatively cheap procedure of $150,00.00. Mr. Weinberg, Carelink’s representation, appears to represent Coventry interests across this country. I doubt anyone would be surprised by Weinberg’s salary.

More than enough written for this Tuesday, Setember 2, 2008. My goal was to keep it to two pages. There is so much evidence. We'll be here awile.

Carelink Health Plan Member

Tuesday's Tirade

A Serious Matter: Nefarious Nancy

In their 2007 document on political responsibility, "Faithful Citizenship," the United States Catholic Bishops' Conferance declared:

In the Catholic tradition, responsible citizenship is a virtue, and participation in political life is a moral obligation. This obligation is rooted in our baptismal commitment to follow Jesus Christ and to bear witness in all that we do.

On November 14, 2007, the U.S. Conference of Catholic Bishops approved a new statement on Faithful Citizenship entitled: "Forming Consciences for Faithful Citizenship: A Call to Political Responsibility from the Catholic Bishops of the United States.

One of the issues discussed in depth at the 2007 conference was health care. "Quality health care should be accessible to every person as a part of basic respect for human life and dignity," stated Kathy Saile of the Officre of Domesitc Social Development in the bishops' Department of Justice, Peace and Human Development, in a commentary on healthcare and "Faithful Citizenship."

Cast of Minor Characters

In the real world, minor characters may play a major role in plot development. What begins as an innocent placement of an employee in a position within a small subsidiary takes on major significance as it creates a crack in what was thought to have been a strong foundation.

Unknowingly in the summer of 2005, it was Carelink Appeals Coordinator Nancy Phillips who began to seriously damage Carelink Health Plans, Inc. of West Virginia and its parent company Coventry Health Care, Inc of Bethesda MD. As you will learn, Phillips was incompetent for the position she held. While likely a good person independent of her role with Carelink, the unique circumstances of Phillips' job demanded more than she was able to provide.

Should Phillips be judged harshly? Documents do demonstrate deceit and negligence. And there is the serious question of perjury. However, I personally believe Phillips was an unwitting accomplice in a more sinister plot.

It has been often repeated at business seminars in leadership that if an employee fails, it is the responsibility of that employee's boss. Either the employee should not have been hired in the first place or the employee was not given the necessary training. Phillips was a sitting target.

Why was Phillips employed in a position for which, it appeared, she lacked the qualifications? As I searched the internet for a better understanding of how Coventry Health Care, Inc. of Bethesda, MD does business, I learned a great deal. The internet has much to teach each of us about health care issues.

Study this link to Indeed.com’s forum discussing Coventry Health Care. Then ask yourself, “Does Coventry desire to hire people with qualifications for the job they assume?” http://www.indeed.com/forum/cmp/Coventry-Health-Care/05390c183c137e1b72704304 Note that many of the visitors suggest they have a working knowledge of Coventry Health Plans, Inc. The following comments raise serious issues:

Anonymous in Burlingame, California reports:
Coventry had a great job fair recently in Scottsdale Az. I was very impressed by their logistics, professionalism, approach etc.

However, I was most dissapointed by the fact that although I had an excellent screening, and was enthusiastically promised a follow-up interview, I have heard NOTHING. Worse yet, I had applied online for one of the positions, and received the thanks no thanks and all the jobs are filled form letter. Yet, all those jobs are STILL posted on their website. One hand not talking to the other apparently....

Darnell in Harrisburg, Pennsylvania 14 months ago
Be prepared to work and put your family second. It is a very fast-paced, highly competitive environment. The healthcare industry is forcing them to keep costs low, which translates into below average pay. Financially strong company though. Look at analyst stock reports.

Lisa in Etters, Pennsylvania 13 months ago
Below average pay (they display the salary range on the internal job postings, and pay at the lowest salary or below). Obviously not very good for morale, either. It makes you wonder what they REALLY think of you. -Job titles/descriptions are very misleading. You may end up doing something totally different than what you apply/are hired for.

David in Salt Lake City, Utah 13 months ago
I've been a business analysis manager at 2 fortune 500 companies, both with health care specialties, and have not been able to penetrate the Coventry hiring process. My decision was to just give up - sad because I'm good at what I do and I probably could have added value.

The Appeals Coordinator

In 2005, Nancy Philips worked in the Appeals Department of Carelink Health Plans in Charleston, West Virginia. As the Appeals Coordinator, Phillips investigated cases that consumers brought for an internal appeal following a denial of services. One might think that important credentials required for this position would include a working knowledge of medical terminology and an ability to deal with dissatisfied, sometimes irate, consumers. No so with Phillips.

Philips and I connected on the afternoon of July 29, 2005. A fateful day. Phillips denied my doctor's request for medically necessary surgery and sealed her fate. In the spring of 2006, Phillips left Carelink's Appeals Department to work at Carelink as an outreach coordinator for Medicare. Our time together, though brief, was not pleasant, especially for Phillips.

On July 27, 2005, CSO representative Sherry Salopek processed my third appeal to Phillips. In her naivety, Salopek believed Carelink would address any wrongs committed against me. What follows is my account of the events that led up to Carelink's denial of my medically necessary surgery, my conversation with Phillips and my attempt to unsuccessfully reach a department that would address my serious concerns: http://www.freewebs.com/courageoffaith/Time%20Line%20Philips.pdf

There is no doubt in my mind that Nancy Phillips was not qualified for such a critical position in a health plan. My records of a few of the conversatons I had with Phillips on July 29, 2005, follow:

Phillips, despite telling me that she checks her mail messages regularly, never returned one of five phone calls placed to Dr. Bernard Costello’s office. Patty Conrad, Dr. Costello’s receptionist, testified before the West Virginia Insurance Commission in August 2006, to having records that prove Phillips lied.

Dr. Costello's first appeal would have reached the Appeals Department in May of 2005, but it was never stamped. Documents show that neither the second or third appeal was stamped by Appeals. The third appeal was the appeal CSO Salopek personally faxed to Phillips on the 28th of July 2005. The very next day Phillips contacted customer service to state that she had never received an appeal from Dr. Bernard Costello.

Phillips evaded answering my questions and misled me to thinking Patrick Quinn, Appeals Manager, would speak with me at the time.
Phillips rushed through the denial process and was not on top of the necessary paperwork required to make a decision.

Negligence. Incompetence. Deceit. Just keep adding up the one accusation after another. Am I jumping to conclusions? Time is now on my side and I'm willing to patiently wait for public opinion to persuade others.
Does it not raise suspicions that four appeals must be sent to Phillips before she stamped one as entered? And how about the lie that "we have been working on this all day", when CSO Salopik did not fax the fourth appeal to Phillips until mid-afternoon on the 29th of July? Or the letter that was mailed to me the same day as the denial that offered me an opportunity to have qualified specialists discuss my issue with Carelink as is the regulated procedure?

In Carelink's own words: Carelink Awarded EXCELLENT NCQA Accreditation 12/07 FOR IMMEDIATE RELEASE Contact: Mary Sandridge, Public Relations Manager434-951-2433Charleston, WV – December 10, 2007 –-

Carelink Health Plans, Inc. today announced that it has been awarded an accreditation status of Excellent by the National Committee for Quality Assurance (NCQA), an independent, non-profit organization that assesses and reports on the quality of the nation’s managed care plans.

Carelink’s accreditation status – the highest possible level – is based on voluntary review of how a health plan ensures that its members are receiving high quality health care. The Excellent Accreditation applies to Carelink’s HMO/POS plans until September 2010.

“Earning ‘Excellent’ Accreditation reflects a health plan’s ability to work with their members and their physicians to improve the quality of clinical care. It shows that they are building the kind of partnerships that are critical to delivering great care and great service,” according to NCQA President Margaret E. O’Kane.

“We are an organization committed to continuous quality improvement so we are extremely proud of the results of Carelink’s first NCQA review,” said Carelink President and CEO Cosby M. Davis, III.


On August 10, 2006, Nancy Phillips appeared at my formal hearing before the West Virginia Insurance Commission against Carelink Health Plans, Inc. of West Virginia. All my many imaginings and conflicted images of Phillips came together as I met her for the first time in person.

Far from being a "corporate suit" as one might expect, Phillips appeared fearful, feeble, and nervous. She was noticeably shaking while under oath, especially when she acknowledged that she did not remember 'Penny Stenger'.

My husband Tom broke the tension in the air. He nudged me and said, a little too loudly Judge DeBolt thought, "Nobody forgets Penny Stenger!"

Study Nancy Phillips' testimony linked here, page 108, beginning lines 24 through through page 118 line 24. Note that there are four pages of transcript to each page: http://www.freewebs.com/courageoffaith/Testimony%20Nancy%20Phillips%20pp%20110-117.pdf

In the spring of 2006 when both the West Virginia Insurance Commission and Coventry became aware of the serious nature of my issues, several people were removed from key positions. Phillips was one. In her mind, one is permitted to forget any details of my case because she no longer had access to any records.

Did Coventry intentionally move three potential witnesses from positions who might incriminate Coventry in the future in a court of law? Both the CEO Patrick Dowd and Appeals Manager Patrick Quinn “left” Carelink’s employ in the spring of 2006, just after I filed my formal complaint with the West Virginia Insurance Commission. Phillips was moved to another office within Carelink at the same time.

Three people with potentially damaging testimony, no longer must remember any details as they no longer have access to company files. Would a jury believe them? When does a coincidence become a tactic? I am no lawyer, but I know right from wrong.

Unbelievable.

An intimidated Nancy Phillips testified under oath at my hearing in August 2005. Her conflict must have been huge. Tell the truth and face intimidation by Coventry or tell a lie and face penalties. The verdict is out. Will Phillips still have a job with Carelink when the verdict comes in?

As you review the conversation Phillips and I shared on July 29, 2005, consider the irony of Coventry's "tactic" of promoting their image while a consumer is on hold on the telephone. As I awaited recognition by CSO that yet a 4th appeal would be necessary, I heard glowing descriptions of my health care plan. My fury and frustration mounted.

With the passage of years and new knowledge at my fingertips from internet searches, I experienced an intuitive insight recently. Counter to Coventry's advertisement, Carelink, it appears, hires people who will accept low wages and may likely not have the moral courage to do the right thing.

There's dramatic irony with this plot. Nancy Phillips may have been hired to contain costs. Contrary to this intention, her participation in deceit and possibly illegal activities may cause a disastrous outcome for Coventry Health Care, Inc., the "darling of Wall Street."

Crack.

Tuesday’s Tale

Albert Einstein

"The most important human endeavor is the striving for morality in our actions. Our inner balance and even our very existence depend on it. Only morality in our actions can give beauty and dignity to our lives. " ~Albert Einstein

It has been a very difficult road challenging a giant in the health care industry. I have encountered selfishness, egotism, elitism, indifference, fear, corruption, cronyism and ineptitude. It is the wisdom of the men and women of past generations who speak quietly to me. It is these heroes who remind me that I have no option but to continue my fight. Remind me over and over that truth and justice ultimately will win.

It was Carelink’s sales agent who renewed my spirit in early August 2005. My persistence and perseverance paid off. Nancy Phillips had used several faulty justifications to make her determination of a denial. One stated that my huband's employer had not purchased the necessary rider to cover this surgery.

At this point, it's wise to consider that in Coventry's eyes, we are just numbers. Statistics. Or so they think. Pulling a justification out of the hat of tricks may have worked in the past. Not today.

In early August 2005 I learned from Michelle Gill, Carelink’s sales representative that, "There is no rider." Surprised? Gill and I certainly were, for despite a rider's being printed in the document of coverage as required, there is no such rider. More lies.

So bizarre. No riders. No appeals. No phone calls. Few records. No medically necessary surgery. Are you beginning to appreciate how people die without ever receiving their rightful benefits? Doesn't this alarm you?

From 2005 to the present, my HMO has not acted in "good faith." How many other health insurance companies operate this way? If you cannot trust a Fortune 500 company who prides themselves in providing an excellent service to subscribers, who is deserving of our trust? Puzzling to ponder your options.

My HMO's ruthless attack on me is not happening in isolation. I will repeat: this is not happening in isolation. It truly is an invisible evil, one that would have aroused Einstein's fury.

Here are published "alarming" facts: http://www.freewebs.com/courageoffaith/10%20Things%20Your%20HMO%20Doctor%20Won.doc
Finally, next month begins my fourth year of blogging. While my blog has changed form in the last few years, the principles behind blogging remain the same. I blog to persuade, to help shape public opinion about an invisible evil. I am angry. That's good as the angrier, nastier blogs are growing the fastest.

Spread the word. Help us out here. We're in this together. Inform others of this blog. They, too, are likely in the dark.

Coventry Health Care Deceit and Indifference

Tuesday's Tirade

Watch Out! Carelink is at the Controls

What you are about to read should alarm you.

Carelink Health Care, Inc. of West Virginia, and many of its sister companies, publishes a quarterly newsletter LivingWell, ostensibly to help advance quality health of its subscribers. In my mind the newsletter is just another tool of false or misleading advertising. Carelink's words conflict with its actions.

Unfortunately, too many Carelink subscribers believe these promotions. On paper Carelink is an ideal HMO. However, the web of deceit I describe here ought to shake anyone's confidence in Carelink and Coventry. For me, their promises were hollow.


The Summer 2008 issue of Livingwell describes Carelink's concern in improving their services to "meet the high quality standards." It invites the subscriber to participate in insuring these standards through registering complaints. Carelink's goal is "to focus always on quality issues of high importance." Carelink, on record, searches for problem issues.

One line bears repeating: Carelink's goal is "to focus always on quality issues of high importance. "


Here's the link in the Summer 2008 issue of LivingWell entitled Giving You Quality Care at the bottom of page: http://www.freewebs.com/courageoffaith/LivingWell%20Summer%202008%20Q1.pdf

Shock is too tame an emotion to describe my response to opening this summer's LivingWell and reading the headline: Giving You Quality Care. It was a violent blow to me personally as I had struggled daily to receive the quality care from Carelink to which I was entitled. I remain outraged.

Today's Tirade will destroy any confidence one will have in Carelink's honorable intentions.

As an aside, assertions like this are made time and again in Coventry brochures and online tools. How can one not begin to doubt Coventry's motives after reading of my experience and those of many others who never lived to write a line of their trials?

Flashback: Tuesday, September 27, 2005.

The day was a crisp September day. The mail included an unexpected letter from a Carolyn Westfall, Quality Control Coordinator of Carelink Health Plans, Inc. of West Virginia. Westfall signed the letter and expressed an interest in investigating a claim about my concerns regarding lack of quality care. It was a computer generated letter. It may never have been mailed to me otherwise. Here is Westfall's letter: http://www.freewebs.com/courageoffaith/2005%209%2027%20C%20Westfall%20Complaint%20Registered.pdf

"What claim?" I quietly thought to myself. I had many more important concerns on my mind that September day about Carelink. Very serious concerns that I had expressed to many Carelink personnel and to Robin Aronberg of the legal department of Coventry Health Care, Inc.

How foolish man is to think that they are above the law and will never be held accountable. We all will face a higher power someday; know that the higher power seeks justice for the poor. Carolyn Westfall's letter is a testimony to a loving God who desires that the truth be set free.

It was urgent that I receive the medically necessary surgery that months earlier Carelink had denied. Why had the process taken three months? Is there not a regulation that demands speedy decisions especially when the doctor defines the medical necessity of the surgery? What happened to the other three appeals mailed to Nancy Phillips, Appeals Co-ordinator, that Phillips never processed? Why did Phillips lie to me and say thay "we have been working on this all day," when I knew the 4th appeal had only reached her on the afternoon of the day I was denied. How could a decision be made without consulting with my doctors?

Excuses. Excuses and more excuses, different words but the same intentions. And people continue to suffer and even die.

When I finally reached Westfall in late October 2005, she reported that Debi Kalorik, Customer Service Operation Supervisor of Coventry, submitted a claim in my name. Kalorik reported that during the appeals process, the Appeals Department did not respond to any of five phone calls placed to them by my surgeon, Dr. Bernard Costello.

My records are thorough as I daily recorded any conversation I had with Carelink and Coventry personnel. Unlike Carelink's records, my records are not "generic." Read this link to my records which describe a shocking, sinister reality: http://www.freewebs.com/courageoffaith/Westfall%20Investigation.doc

My complaint was sent from Quality Control to Patrick Quinn, the former "Manager" of the Appeals Department for review before he chose to send it to corporate legal in Bethesda MD. Legal returned the original claim to Kalorik, the supervisor who reported the "problem" that Coventry says in its published documents it wants to resolve. The entire incident was meant to vaporize with these actions. But the computer kept kicking out timely responses. Technology at its finest.

Carolyn Westfall never contacted me as promised. She likely thought that she could run from the truth. There was a conspiracy to withhold information from me, an intentional, underhanded plan to deny me access from the same company who broadcasted each chance they had their stellar practices. This truth is highly disturbing.

Today Quinn no longer works for Carelink, but then he was a central figure in my complaint. It was he who had ultimate responsibility for the department's insuring appeals are processed in a timely manner. It would be a few more months before I heard that Patrick Dowd, Carelink CEO, had left his position. Dowd had been Quinn's immediate boss. More intrigue? Definitely.

Westfall's grossly offensive admission to me in the spring of 2005 greatly alarmed me. Westfall answered the phone that day and responded to me, "I thought you were gone." There was tension in the air. The conversation brief. It was all too obvous that Westfall wanted off that phone. Before hanging up, her final words were, "Mrs. Stenger, I have taken this as far as I can."

It was only a few short weeks following Westfall's letter, that I received a survey requesting my thoughts about how Carelink does in providing me care. And I received a second survey. The next day the trash was taken out as usual.

One more twist of fate. Carelink has a satellite office in Wheeling, West Virginia, my home town. Just down the street. How might Westfall react to a surprise visit? Most likely, like Quinn and Phillips under oath, "I don't remember Penny Stenger."

The more interesting question: Will Debi Kalorik, Robin Aronberg, and Westfall receive the same fate as Quinn, Phillips and former CEO Dowd?

The pendulum of justice swings. Justice remains on our sides.

Tuesday's response: Guilty as charged

The complacency and actions of Coventry employees who contribute to this type of scheme must be renounced. Every time someone turns his back when he is part of an injustice, our health care, a basic right, will be diminished. Greatly diminished at times, especially for the most vulnerable, the elderly and the mentally ill.

When the quality of health is at stake, there is no excuse for being involved in questionable acts. How do these people sleep at night? How much more salary does Coventry CEO Dale b Wolfe, have to draw to live his quality life?

To help you remember something I never will forget, here's an interesting link to an article by the Washington Post: http://www.freewebs.com/courageoffaith/Rich%20Rewards%20Corporate%20Elite.pdf

CEO Dale b Wolfe

There needs to be an accounting soon of Mr. Wolfe’s business practices. Waiting another minute is not acceptable. Our collective conscience must move us together towards justice in the name of all those who have been harmed. Forever.

Tuesday's Tale

My Father’s Legacy: Voices for Justice

My parents: Dick and Mary Kay O'Brien, 1960

When did I first sense that I would write a book? It was in the 1980's. I had begun to record my thoughts daily in a journal and developed a physical and emotional regimen to prepare for a successful future. "Why not write a book about this journey?" I asked my self. This question turned into a statement in 2005.

My dear friend, Fr. Michael Greb, O.F.C. directed me to write a book. With surprise, I responded, "About what?" Fr. Mike gently spoke, "About your great faith."

As of today I have written about 60 pages of a powerful story that will touch lives. It begins with the following Prologue that sets its tone. For not only is my book about faith, it is a story of how one person can fight against injustice and make a difference. With patience and perseverance, the way will be lit and the impossible happens.

My Father’s Legacy: Voices for Justice

Prologue

The day began as the day before it and the day before that one. A black hole, so deep he wondered if he could climb out of bed. ‘I’m only a shadow of myself,’ he thought. Was this just an evil trick of his brain or had he changed so much? When did his present struggles begin? His mind raced upon awakening. No stopping the noise. Now he was afraid of himself.

This day would be different, he reminded himself. He had plans. He knew there was a way out.

Dressing for the day, he chose a blue suit with white shirt and a favorite red tie. It was too obvious that he had lost weight. He didn’t dare stare too hard in the mirror. The reflection suggested worry and weariness.

His financial problems began when he left the family law firm. It appeared to be a positive move, founding another firm with two of his friends. But something snapped. His life was a whirlwind of activity and creative ideas. He was empowered and moved mountains, spreading joy to those he met. Or so he thought.

But then he suddenly fell into a dark chasm of depression. No choice but to go to the hospital for psychiatric care. Six long weeks. People shuffling around like zombies most of the day. Sleepless nights. Gray days. Too dark to move.

His doctor prescribed medication that would bring him back to reality. That’s what the doctor had said. Only he had to be patient. “It takes time for medication to work,” the psychiatrist told him. “It takes time for the medication to be effective. But it will be better…someday.”

And so he waited in darkness for three months. Despair. Deep despair. His thoughts drifted to “what-ifs.”

What if he could return to his family’s law firm? What if he did not have such deep financial problems? What if the State Road Commission of West Virginia had not seized his beloved camp of 20 years though eminent domain, in his eyes an abuse of power that took a slice of his heart? What if his new law partners would allow him to come back to the firm now instead of waiting for a complete recovery? No, No. No…This is madness.

Breakfast was simple: a bowl of shredded wheat, milk, O.J. He had little appetite of late. Nor interest in conversation. He said nothing to his wife. His three children had already left for school. He sat and remembered. He cried within. No one understood his pain. No one understood his behavior. There were snickers and hushed talk on the rare occasions he left his safe house.

He kissed his wife goodbye that Monday morning. The signs of spring were in the air as he drove his Chevrolet up the avenue. Instead of turning left as was his routine of late, he turned right. The car knew the way. Although he might be missed at the bank where he did routine legal work for half a day, people would know: it’s another bleak day.

There was no flash of better times, no signs of new life that he saw out his window. There was irony. Springtime is a time of new beginnings, of hope, of desire. In his depressed state of mind spring reminded him of the what-ifs, and he continued driving without thought, only darkness.

Many factors triggered his gloom. He had begun to deteriorate rapidly. He fought to save his Camp as best he could in his crippled mental state. Camp was not only home to him; it was respite from the ills he experienced daily, the imbalance in the legal system he had so proudly represented. He wept at the injustice done to many and rejoiced in the success of a few. Camp was his piece of heaven, where he enjoyed peace and solace.

Justice was on his mind that Monday morning. He was obsessed with visiting the Camp one last time before it was torn down for the new Interstate. Justice? There had been a last minute maneuvering, a change in routes for the planned Interstate. The State Road Commission of West Virginia chose a second option, one that would destroy Camp. He no longer had the energy to fight, but he had plans.

It was a late Monday morning when he drove off the country road and onto his property. Camp appeared sad and naked. Everything had been removed the day before except for a few items. He felt empty as he thought back to November. He had taken a stance: Justice in the guise of a stop sign. He impaled the sign in the ground in a futile attempt to stop people from trespassing. Or was it a futile attempt? Maybe it was an act of defiance by a deeply troubled but just man. Someone had removed the stop sign. He had no voice.

He proceeded into the now empty house and walked with purpose to the closet. A “what-if” came to his mind. What if the family had not left the guns yesterday when they cleaned out the Camp? Sick in mind, body, and spirit, he slowly walked up the steps to the attic. With no more thought he aimed the gun at his head and pulled the trigger. He found his way out. He quit.

On a dreary Monday in March 1965, he left a legacy. A rich legacy. One that continues as his spirit rises from ashes and guides others today. It’s quite simple. Stop: it’s time for all of this to change. It matters what we leave behind. Justice is attainable. Our lives do make the difference.

Now it’s my turn for I am my father’s daughter. I am involved in a legal battle against a giant in the insurance industry, who made the big mistake of neither understanding my roots nor appreciating that one determined, faith-filled individual can accomplish great good. Additionally, I have filed a claim against the WV Insurance Commission for one million dollars damages for obstruction of justice. No time for “what-ifs.” In West Virginia we are “Open for business.” Well, I have business to do, too, as I have discovered that just maybe West Virginia is a little too open to business. Dad’s stop sign is now replaced with this book. My work is words and the truth will set us free.

Tuesday's Tirade
Carelink takes control of A Patient Bill of Rights!

How has the brazen disregard for insurance law and humane treatment of HMO subscribers been tolerated for so many years? Where is our outrage? What are we doing to promote reform? Alas, too little and too late for many.
For years Carelink Health Plans Inc, of West Virginia was my Health Maintenance Organization (HMO). At its best a HMO works with its subscribers to insure that they receive quality health services. Carelink, as an HMO, is expected to follow published rules of Governance as well as adhere to A Patient Bill of Rights. While Coventry Corporate excels at making profits, its behavior can be repugnant. Simply stated, for me it stinks.

In the latter part of the twentieth century, health care organizations began to adopt what is today known as a Patient Bill of Rights. It’s a statement that defines the rights a HMO ought to provide a subscriber.

“The dramatic growth of health maintenance organizations (HMOs) has prompted calls to give patients a stronger voice in decisions about which medical procedures will be covered by insurance.” (Washington Post, Politics: Heath: Patient Bill of Rights)

Here's a link to the Patient Bill of Rights published by my HMO, Carelink Health Plans, Inc. of West Virginia: http://www.freewebs.com/courageoffaith/HMO%20Patient%20Bill%20of%20Rights.pdf

Coventry Health Care, Inc of Bethesda MD, the parent company of Carelink, is a business, a big business. Theodore R. Marmor, professor of public policy and management and political science professor at the Yale School of Management noticed a significant "change in the amount of lives" for which health insurers are responsible. "I think the big story in health insurance is its big business, as you see in the options given to key executives," Marmor says in 2007. That is three years after there appeared published accounts of Coventry’s CEO Dale Wolf's earning an obscene salary package of $32 million. "Thirty years ago nobody expected to get rich that way in the insurance business,” Marmor continued.

Carefully reread Carelink's HMO Patient Bill of Rights (linked above), which is an industry standard for treatment of subscribers by health plans. Coventry Health Care, Inc, a Fortune 500 company, ought to have adopted this standard in each of their dealings with the subscriber.

Instead, Coventry blatantly disregarded this standard time and again in its treatment of me. My treatment was rife with conflicts and intrigue. I was not treated fairly. Period. I fought hard to receive authorization for my rightful benefits according to my plan. Period. I am angry. Period.

Carelink's Patient Bill of Rights includes the following guidelines:

Participation in Treatment Decisions: You have the right to know your treatment options and to take part in decisions about your care.

On July 29, 2005, Nanci Philips of the Appeals Department of Carelink ruled against my appeal. Earlier that day Philips had received what was the 4th appeal for my medically necessary surgery. In a rush to send in the paperwork while I had Philips' attention, I overlooked including Dr. Costello's documented appeal. This essential document was required to make an informed decision. No other appeals were logged into the system by Carelink.

Here's the link to Dr. Costello's appeal: http://www.freewebs.com/courageoffaith/2005%205%2016%20Dr.%20Costello%27s%20Appeal.pdf

This is the first of four appeals either Dr. Costello or I mailed to Carelink in the spring of 2005 to the Appeals Department that described the medical necessity of this treatment. This document was not reviewed by Dr. Rod McKinney, Carelink's Medical Director, as part of the appeal review process.
See this link to Dr. McKinney's sworn testimony at the August 10, 2005, hearing before the West Virginia Insurance Commission, page 139 lines 15 - 24 and page 140 lines 1 -7.
http://www.freewebs.com/courageoffaith/Dr.%20Rod%20McKinney%20Testimony%2C%20139-140.pdf

Nanci Phillips, former Appeals Coordinator, denied my appeal in a very short period of time, without the required medical justification. As governed by law, I received a notice from Carelink advising me of my rights to have my physicians be a part of the appeal process. Unbelievably, the notice is dated July 29, 2005, the same day as Phillips ruled on my appeal.

Link to Nanci Philips' sworn testimony: http://www.freewebs.com/courageoffaith/Testimony%20Nancy%20Phillips%20pp%20110-117.pdf

This testimony is but a small excerpt from Philips’ sworn testimony in a court of law. When compared against the partial sworn testimony by former Appeals "Manager" Patrick Quinn, it raises serious questions and doubts.

Link to Patrick Quinn's sworn tesitimony:
http://www.freewebs.com/courageoffaith/Testmony%20Patrick%20Quinn%20pp%2086-89.pdf

Respect and Non-discrimination: You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you.

There were many instances in 2005 when I was treated with disdain and discrimination. Reread Carelink’s former CEO Patrick W. Dowd’s letter to me dated November 1, 2005.

Link to Patrick Dowd's letter:
http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

Within the hour my son, an attorney, dictated a formal response to Mr. Dowd in response to his ruthless behavior.

Link to my letter to Patrick Dowd:
http://www.freewebs.com/courageoffaith/2005%2011%204%20My%20Response%20to%20Patrick%20Dowd%27s%20November%20Letter.pdf

Complaints and Appeals: You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Chapted 33 of West Virginia code established a code of behavior for all health maintenance organizations doing business in the state.

A part of this declaration is a statement about including physicians in the process:

WV State Code 33(8) The HMO shall have physician involvement in reviewing medically related grievances. Physician involvement in the grievance process should not be limited to the subscriber's primary care physician, but may include at least one other physician;

Additionally the grievance process is to be completed in a reasonable period of time:
(6) The HMO shall process the formal written subscriber grievance through all phases of the grievance procedure in a reasonable length of time not to exceed sixty days, unless the subscriber and HMO mutually agree to extend the ...

In the fall of 2005, Patrick Quinn, former "Manager" of the Appeals Department at Carelink, received a letter from Dena Wildman, the Grievance Examiner with the West Virginia Insurance Commission. I had filed a formal Grievance complaint with the Commission on September 28, 2005, and Examiner Dena Wildman reminded Quinn of my complaint in a letter.

This letter was revealed at the time of my hearing on August 10, 2006. The testimony of Wildman is serious and damaging to both Carelink and the West Virginia Insurance Commission.

There was too much discussion between the Commission and Carelink. Discussion which suggests in this letter that in Dena's mind, I had indeed impersonated her. Discussion about the conversations Carelink must have had as to what to do about me. It took 3 1/2 months to resolve the grievance. Where are my privacy rights? Where are my rights to have a quick response because of the urgency of Dr. Costello's request? Should not this letter be considered a grave indictment of a systemic evil that West Virginians confront?

Read Wildman's letter:
http://www.freewebs.com/courageoffaith/2005%2012%2021%20Wildman%20ultimatum%20to%20Quinn.pdf

Wildman's incriminating letter is a significant piece of evidence.Wildman oversaw a grievance process that began on September 28, 2005, and lasted 3 and 1/2 months. A time when my integrity was once again called into question before the West Virginia State Examiner. I am incensed by the games Carelink continued to play together with the West Virginia Insurance Commission. Games that have cost me dearly.

Sad statement about the dark abuses in West Virginia.

Did I sit quietly and allow this injustice? No. I contacted and re-contacted Carelink headquarters, Supervisor Debi Kalorik. I contacted corporate headquarters, attorney Robyn Aronberg. I contacted the Office of West Virginia Insurance Commission Examiner Dena Wildman. Not one person would take my call. From late October 2005 until January 2006, I was fully blocked from receiving my rightful benefits as a subscriber of Carelink Health Plans, Inc of West Virginia and a citizen of our "wonderful and wild" West Virginia.

There will be a lot of evidence to come that will indict Coventry Health Care, Inc. of Bethesda MD and the West Virginia Insurance Commission and Commissioner Jane Cline. Additionally, there are others who conspired in fraud. Others who created obstables to justice. Others who turned away with indifference.

I am not remaining quiet. My conscience moves me out of my complacency.

Tuesday's Tale
And Who is Telling the Truth, all the truth?

My evidence about my treatment by Coventry Health Care, Inc. is convincing. It will move people to action.

While others wait, ponder this story.

Link to Coventry's Denial of Kansas City Man who now is dead:
http://www.freewebs.com/courageoffaith/Man%20Dies%20After%20Insurance%20Co_%20Great%20Tale%20Coventry%20Refuses%20To%20Cover%20Treatment%20-%20Kansas%20City%20News%20Story%20-%20KMBC%20Kansas%20City.mht

In a press release, Coventry made a statement saying, "All of us at Coventry share a deep concern for Nathan Crabtree and family..." Go back to the evidence in my case. Ask yourself, "Could there be a pattern here? Would the same Coventry who lied to Christine Stenger, a Coventry health plan subscriber, boldly lie again?"

Tracey Pierce died. Lee Crabtree may still have a chance but he was robbed of valuable time. Evil impersonating as a good.

Coventry will someday learn that they made the wrong "business" decisions with Tracey Pierce, with Nathan Crabtree, and with Christine Stenger.

There will be justice. Given the opportunity, I will testify under oath that “There was no deep concern demonstrated by Coventry to Christine Stenger.”

Mark my words. Another episode of my story will be played out in a courtroom in this country. And I will bring my own experts to testify. And others who suffered at the hands of Coventry will be in that courtroom with me.

An Arrangement Behind Closed Doors

Tuesday’s Tirade

Shhh.

A young philosopher once stated to his understudy: “The good man brings forth good things out of the good stored up in his heart, and the evil man brings evil things out of the evil stored up in his heart. For out of the overflow of his heart his mouth speaks.”

Pulitzer Prize—winning journalist and bestselling author Ron Suskind has written a new book, The Way of the World. The dilemma? Who is telling the truth about the reason the USA commenced the war with Iraq on March 20, 2003?

Mr. Suskind has written a startling look at "how America lost its way and at the nation's struggle, day by day, to reclaim the moral authority upon which its survival depends.” The reader must decide if President Bush and company told the truth to the American people in 2002 or if Mr. Suskind’s evidence describes a hidden agenda.

And that’s exactly where you and I are this day. Just who is telling the truth about how health plans perform their functions? Coventry Health Care, Inc. of Bethesda MD or Christine O’Brien Stenger?

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

Do Coventry records of financial success and happy customers speak the truth? Or do the accounts of my experience to which I link evidence, suggest something sinister?

Ultimately, you must choose and be correct. Soon. When it comes to quality health insurance, you better do your homework. Our world suffers while we choose to wait.

Why should you believe me? That is an excellent question. I am not an expert, but I have thoroughly investigated my former HMO, inside and out, for a long, long period of time. Future posts will take you inside corporate headquarters and inside Carelink and Customer Service where I was trusted by key personnel. We both trusted each other. That was then.

There are also many family documents that describe “what’s in my heart.” Here's a newspaper cliping of an interesting story. The text describes my family as being prominent in West Virginia history since the Civil War. It "has contributed doctors, lawyers, judges, and a newspaper editor." My son is the first of the fourth generation of O'Briens to join the honorable profession of law. My daughter is a doctor. http://www.freewebs.com/courageoffaith/O%27Brien%20Family.pdf

The second is a letter of recommendation signed by my friend, the former Bishop Bernard Schmitt of the Catholic Diocese of Wheeling Charleston http://www.freewebs.com/courageoffaith/Bishop%20Schmitt%27s%20Recommendation.pdf followed by an appointment I recently received from the Diocese. http://www.freewebs.com/courageoffaith/Disabilities%20Council.pdf

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

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

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

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

To clarify, Carelink and Coventry challenged the ruling all the way to the Appeals Court in Kanawha County, West Virginia. Final Order 06-AP-024 mandates that Carelink review all initial inquiries, thoroughly review, to avoid the “egregious behavior” towards me being repeated again and again. Once the final order was signed, Carelink was obligated to follow the order. It was then that Carelink began a series of legal maneuvering to get the order reversed.

In a response to a civil lawsuit, Christine O Stenger vs. Carelink Health lans, et al on January 2, 2008, Carelink revealed a secret. Something happened behind closed doors at the Commissioner's office and Carelink dropped their appeal. That was my only notification that Carelink and the Commission had worked out a deal. A document. A copy of a document intended to present Carelink's position in my cival lawsuit.

Nafarious actions? Heinous Crime? Who knows? No one notified me of this key meeting. Don’t know b