HMO's (disabled rights denied) Anyone have any ideas?

[cford]

Emailed daily since 5/24/00 to ALL OFFICIALS AT FEDERAL AND STATE LEVELS!

IF YOU HAVE A NEWSLETTER/NEWSPAPER, PLEASE PRINT ME!

Just wanted everyone to know that Abbee's story is being featured on the front page of the

Fairfield Daily Post. You can see it by going to www.fairfielddailypost.com. They are

beginning an ad campaign on Monday or Thursday. Commercials will air on USA,

Nickolodeon, VH1, CNN, Headline news. The editor's name is Mr. Cummins and he can be

emailed at [email protected]. I'm sure once the article is up and running,

he'd love to hear from you! This letter is drawing attention. Also, there is a newsletter at www.insurancejustice.com that has an excellent review of my letter. There are several other

newsletters that have picked this up as well as several medical journals, as well as many

websites relating to Health Care mismanagement, etc. 10,000 EMAILS SINCE 5/24/01 AND

STILL GOING! Emailed daily to all members of House and Senate!

Also, TO DATE, I HAVE ONLY RECEIVED 2 RESPONSES FROM AN ELECTED

OFFICIAL. That is Mr. Hottinger. However, I've only gotten an email and very little action. He

did place a call evidently and BCMH in turn wrote me a letter (my response below) but changes

have not been made! And Mr. McCain, who wrote via US Mail and said he was forwarding a

copy to Mr. DeWine and that was it. (This is even though I voted for him AND he is sponsoring

one of the Patient Bill of Rights

Also, WTOV in Steubenville, Ohio is going to do a story about Abbee as well.

To Whom It May Concern:

My name is Christy Ford. My daughter's name is Abigail (Abbee) Ford and she was born

3/29/00 at OSU Medical Center in Columbus, Ohio at 23 weeks gestation weighing only 1 lb and

6 oz and being 12 inches long. She is the light of my life! She spent 100 days in the NICU

there. She developed alot of the "normal preemie problems" such as Respiratory Distress

Syndrome, BronchioPulmonary Dysplasia, Retinopathy of Prematurity, Reflux, etc...

She was diagnosed about one month ago with Cerebral Palsy as well. I am sure most of you

have children, but cannot imagine the heartache that going through an ordeal such as we have

had with Abbee, only to have her diagnosed with cerebral palsy, has brought into our lives.

Worse than that heartache, however, is the complete ignorance we are having to deal with in

regards to getting this child the therapy she so desperately needs. We have United Health Care

as a first insurance, Medicaid (Healthy Start) as a second and BCMH as a third. The problem

lies in the fact that first of all, I think United Health Care, as her primary insurance company

should pay for the "prescribed" therapy, as her doctor see's fit, just as if it were an antibiotic.

They say they will only pay for 20 visits, or at least some representatives say that. Some say you

can extend her services. Some are rude and hang up on you, etc... We have an occupational

therapist, Brenda Brodbeck, who has been one of the few people Abbee will let handle her.

Brenda has many years of experience and is trained/qualified to deal with 23 week preemie

babies. Others in our county only deal with older children/adults. Half of the battle with Abbee

is getting someone that SHE will allow to touch them. This child has been through enough and

I WILL NOT subject her to any more than she absolutely needs to be subjected to. The

problem lies in the fact that Brenda is a BCMH provider but CANNOT become Medicaid

certified. My daughter has three routes of payment and now that her 20 visits are up with

United Health Care, my husband is looking at getting a second job to pay for therapy that she

needs. THIS DOES NOT INCLUDE PHYSICAL OR FEEDING THERAPY.

I wonder, if your child was in the same position, would this outrage you! Although I am sure

you make quite alot more than my husband does for sitting in those offices and "laying down the

law"; maybe it wouldn't be so traumatic in your case. I want most of you to remember one

thing--you are elected officials or appointed to your posts. You are put there for a reason and

that is to work for consumers. I am a consumer and I DEMAND better treatment and

options than what I presently have. The following is a quote on the home page for United Health

Care which I find a HUGE JOKE.

"The serenity of open fields, The energy of big city lights, some people like predictability, Others

thrive on change. Each person is unique, Each has different needs and desires. For too many

years, the health care industry has told you what works for them. We think it's time a

health care organization turned that around and asked, "What works for you?" Granted, this is a

dramatically different approach. But we are committed to improving the health care experience

for everyone involved-for the employers who purchase health benefits, the doctors who deliver

the care and most of all the INDIVIDUALS WHO USE THE HEALTH SERVICES". AND "At

United Health Care, we believe that the people best qualified to make decisions about health

care are patients and their doctors. We believe that Care Coordination will promote positive

health experiences for members and restore the joy of practicing medicine for physicians." If

you look under Invester Relations, the quotes get worse! As you can imagine, after reading this

on their site, I pretty much wanted to throw up. This is such a lie for those of us who actually

have to have United Health Care as a provider. The joy hasn't left Abbee's providers, at least not

until they have to deal with the insurance company. I know that her therapist AND her

pediatrician love her almost as much as I do. However, people like Davina (Care Coordinating

Supervisor for UnitedHealthCare 1-800-248-8573), do not think as much of my daughter. I think

a requirement of being a supervisor for United Health Care is to take a class called "No

Feelings", because almost every person I have dealt with or anyone else involved here has dealt

with seem to be made of steel. They are rude and very unprofessional. I've made up my mind

that the few decent people I have spoken to were the "flunkies" of that class.

The following is quoted from the Early Intervention web page as one of their so-called

objectives: "enhance the capacity of state and local agencies and service providers to meet the

needs of historically under served populations, such as minorities, low-income, etc.. and

facilitate the coordination of payment for early intervention services from federal, state,

local and private sources (including public and private insurance coverage)" Again, I am

physically ill reading this.

And last, but not least, I found the following quote on the BCMH page: "The Bureau promotes

early identification of children with handicapping conditions and treatment of those children by

appropriate health care providers. ....funding services for the diagnosis/treatment of medically

eligible conditions...collaborating with public health nurses/departments to assist in increasing

access to care...... and assisting families to access and utilize appropriate sources of payment for

services for their child."

Well as you might have guessed, none of the items quoted in any of these paragraphs are

actually happening. I think the comments are there strictly for the auditor's benefit or just for

show, because they certainly do NOT do what they say they are doing. I am living proof of that

and there are about 300 other families in my county alone that are in the very same situation.

I however, WILL NOT cave in to the biases/discrimination being inflicted on me because my

daughter happens to qualify for Medicaid. I am not jeopardizing her well-being because some

idiot sitting in an office decided that only people who are Medicaid AND BCMH certified can

see her. Brenda knows what she is doing and more importantly has the repoire with Abbee

to get her to cooperate and get her to do it. With Abbee--that is 1/2 the battle!

I think that one of you needs to do something about this. Does anyone of you besides me, feel

that it is ludicrous that I have three routes of payment and need to get out a checkbook?????? I

would suggest you that are lawmakers look at this letter carefully. I can assure you that I am

a very, very vocal advocate when it comes to my children. I can also assure you that if I don't get

satisfactory results, I WILL do everything in my power to see that you are not re-elected or

appointed. I know everyone in this town and many in many others as well as being very

experienced updating my web page. I'll put so many signs on my house, in my yard and on my

web page that I'll have the news team here within a day. I do know how to get my point across.

How dare you people be allowed to tell me how much therapy is enough for my daughter? Only

her doctor has the right to say that and you or anyone should never have the right to override that

decision. What if one of your family members had cancer and I was able to come in and say

"OK, we're only going to pay for 4 chemo treatments--you pay for the rest!" What would you

do? You'd be doing the same thing I am doing right now. I guarantee it!

I would also like to say at this time that the Governor's office and Rep. Hottinger's office has

already been made aware of this problem by Abbee's therapist, Brenda George Brodbeck. So as

far as I am concerned, you have already had your chance and blew it and now ought to really

look at the situation this time and fix it!!!! Brenda is very professional about everything she

does, whether it is therapy, talking on the phone, etc. I however am Abbee's mom and I WILL

NOT REST UNTIL I SEE RESULTS. Please do not think for a minute that I will let this lay. I

will keep emailing and pushing and shoving and calling and getting home phone numbers until

I get what so many of us in this county and I am sure in other counties, need. That is to be

treated equally as consumers--not penalized because we happen to qualify for some kind of

assistance.

Where are Abbee’s rights being met here? Where are her choices?

I am supposed to "roll over" and go to the therapist/agency that the state determines so they can

get their kickback! First of all, I will not take my Abbee to a "facility" for her therapy as it

endangers her immune systems which is already compromised, not to mention that I don't

have to, since Brenda makes home visits. Second of all, no matter the cost, I do not jeopardize

my daughter's well being for anyone and lastly, NOBODY tells me who/where to take my

daughter for her medical treatment. I DECIDE THAT AND ALWAYS WILL. MAKE NO

MISTAKE ABOUT IT. If that means more money out of our pockets, so be it!

I will be anxious to see also, just how many "real" responses I do receive to this plea for help.

I hope that all of you take a good look at your "healthy" children and thank God that you are not

having to deal with the "mess" that I am that was created by those of you who sit behind a desk

and dictate other people's lives without talking to them first and getting their input and/or ideas

or ever having a real "clue" as to what life with a "disadvantaged" child is like.

I guess there is not any more I can say at this point except that I will keep pushing this issue from

all aspects until there is a change made.

Respectfully,

Christy Ford

114 Holder Road

Baltimore, OH 43105

740-862-5352

CERTIFYING INDEPENDENT THERAPISTS THROUGH MEDICAID(STATE AGENCY),

SINCE BCMH (STATE AGENCY) ALREADY DOES WOULD SOLVE THIS PROBLEM.

ONE STATE AGENCY SHOULD CERTIFY WHAT THE OTHER DOES!!!!!!!!!!!!!

The following is my response to a letter received from BCMH signed by Mr. Bryant, Director.

I wanted to let you know about a couple of things. First of all, I don't believe Abbee's BPD is

severe enough to see a pulmonologist, or I would have been there by now. She should be on the

program for cerebral palsy.

As far as the required paperwork from Dr. Strominger's office, he advised me he would be

sending the paperwork the same week we saw him and I am sure he did so, which was the week

of April 18, 2001. No one told me that anything other than what he had sent you was necessary.

I spoke with someone in your office back in early March and they said I needed to take Abbee to

a BCMH provider and have cerebral palsy either excluded or verified, which is what I did. I

have done what I was asked to do and for that I get "At this time, Abigail is not enrolled on the

BCMH treatment program". If there was something else I needed to turn in, don't you think once

Dr. Strominger sent in whatever it was he did, you would've contacted someone by now? Better

yet, wouldn't he have the paperwork you are requesting. Dr. Strominger, in my opinion, did a

very thorough exam and only confirmed what we already knew.

As far as Early Intervention is concerned--yes, they did provide us with I believe Abbee's initial

four visits and that is where we began obtaining Brenda's services. I notice that you, like others

that have been in contact with Ms. Shaffer, feel that this all falls on the individual provider--that

Brenda should shoulder the burden here. THIS IS NOT ABOUT BRENDA, THIS IS ABOUT

ABBEE. Abbee's needs have been identified, by Brenda, not Ms. Shaffer, as well as by her

pediatrician and Dr. Strominger. She NEEDS therapy and she NEEDS one of her three methods

of payment to step up to the plate and make payment to her therapist. Having talked with Ms.

Shafer about this once already, I can tell you what that call will entail. It will entail her saying,

again, that Brenda could bill through someone. I am not a stupid person and I already know that.

It will also entail her saying that I can take Abbee through the MRDD program, which is an

option that I am presently not interested in. It's obvious she didn't make you aware that

Abbee was terminated from Early Intervention services, once I said I would like to keep Brenda

as Abbee's therapist. I am not saying that Early Intervention never helped Abbee as they did

provide us with Brenda and for that I'll be forever grateful. However, I don't feel that this ball

should entirely land in Brenda's lap, or for that matter, any other provider's lap. What is supposed

to be everyone's concern here is Abbee's quality of care and presently she is getting the best

quality of care around, there is just nobody willing to take responsibility for making sure that

provider is properly reimbursed. I am not going to have my child "corralled" into the system. I

want her provider to come here to work with her because A: she does her best in her own

environment, B: she is medically fragile in that a cold/virus for her is a major event and by

taking her to the center, she is subjected to just that many more germs, C: I want Brenda to

continue to be her therapist.

Let me say also, I am not into the government paying for her therapy by a long shot. I personally

feel that first of all, United Health Care should pay for what, within reason, her doctor orders.

However, I was told to apply for medicaid and BCMH the day I left that hospital without her and

that I wouldn't have to worry about anything that she would ever need, medically if she were to

become disabled. I think that the walls being thrown up by all three methods of payment DO

NOT take into account those children who may fall through those cracks or those children whose

parents believe that they have the most qualified person doing the job and do not wish to change

and have their child handled by anyone different. I prefer to have someone who has many years

of experience working with babies, especially preemies, as opposed to someone who routinely

works with the elderly or older children. I see nothing wrong in me wanting the most qualified

person for the job of administering therapy to my child. That is exactly the reason Brenda is her

therapist, Dr. Pope is her pediatrian and Dr. Strominger did her BCMH evaluation. I only want

those providers who I feel are qualified working with this child. Not the providers YOU deem

eligible. In your letter you talk about not having any medical information describing the severity

of Abbee's medical conditions before you can identify the most appropriate BCMH managing

physician? I DO THE CHOOSING HERE-- AND I CHOSE DR. STROMINGER, someone that

I was told from YOUR office was a BCMH managing physician! That is who I choose to be her

managing physician since it cannot be her pediatrian. You should have a mound of paperwork

from her stay at OSU and you should also have Dr. Strominger's report. What else exactly do

you need?

In you last paragraph you state that you encourage me to work with the resources available to me

in order that she receives the therapy that she needs to grow and develop. What in the world do

you think I am trying to do. I didn't get angry until it became apparent to me that if a child just

happened to fall through one of the many cracks of the system, nobody in the system was

available to help or willing to correct the situation. If she were your daughter, would you expect

nothing less than the best. I think not. So why should you expect me to react any differently. I

will continue emailing/faxing/mailing my letter to anyone who will listen until some things in

this system are really looked at. A call from your agency to Early Intervention in Lancaster and a

"pat" answer might be good enough for you, but not for me. I don't think it is too much to expect

that if I believe that Abbee has the best therapist for her, I should be able to have Abbee continue

with her present therapist.

AGAIN, THIS IS ABOUT MY DAUGHTER AND HER RIGHT TO HAVE QUALITY

HEALTHCARE. This is not about who should be billing who or what. Medicaid and BCMH

say they are to assure that children are insured who are eligible, but at what cost? You tell me

how it makes sense for me to driver one hour to Children's Hospital, another major source of

germs, let them administer her therapy, and you and Medicaid are willing to pay them the

$200-$300 they bill you, but you say you won't pay for her therapist to come into my home

and pay her $60? Where is that cost effective? Where is that saving the taxpayers money. I

think any person with half a brain can see that it IS NOT cost effective and it all comes down to

the kickback portion of my previous letter. I would really like an explanation to that question by

the way. How is it more cost effective? How is it utilizing the taxpayer's money more

effectively.

In closing I would like to say that I can see that unless some real pressure is put on government

officials and especially private insurance companies, there will be problems with children like

Abbee for many years to come. Let me assure you that I am able to apply that kind of pressure.

I am not going to be satisfied until something here gets changed. I thank you for I guess at least

bothering to check into things at all. I also thank Senator Hottinger's office for at least taking the

time to check into the situation. BUT "CHECKING INTO SOMETHING" AND MAKING A

POSITIVE CHANGE ARE TWO VERY DIFFERENT THINGS. Making a few simple phone

calls and not getting anything but rhetoric about rules/regulations is not answer enough.

Rules/regulations sometimes need to be changed when it is discovered that a child or children's

needs are not being met. I can say for sure that ABBEE'S NEEDS are not being met by your

agency, Medicaid or Early Intervention.

I am disappointed that children like Abbee, who have already been through so much, will be

forced to endure even more due to agencies that are politically motivated or motivated by the

bottom dollar and not by the welfare of the child.

Sincerely,

STATISTICS

Mr. William McGuire, CEO of UHC has unexercised stock options at 50,042,237

Mr. William McGuire, CEO of UHC makes in excess of 4.8 million dollars per year from OUR

MONEY!

In response to an email from the Department of Insurance of Ohio!

The following is part of the text I have received from United Health Care,

Holly Robertson, on June 5, 2001:

"In accordance with your Certificate of Coverage, outpatient rehabilitation

services, which includes physical, occupational and speech therapy, is

limited to 20 visits for each therapy per policy year. Therefore, visits

beyond the benefit maximums are not eligible for coverage."

"I understand your frustration, however UHC must be consistent in the

interpretation of their contracts and unfortunately cannot make an exception

in your case."

The appeal procedure was initiated by myself on 5/24/01. It was begun by me

so that Abbee would not have to not have therapy while UHC/Department of

Insurance "jumped their hoops" or "coordinated" their denials of her

rightful, medically necessary coverage. UHC are treating it as such as in

their plan booklet it states on page 14 under Complaint Procedures, "Issues

related to quality of care and treatment will not be addressed through a

complaint hearing, as described in Section 5.2, but will be reviewed by the

appropriate Physician Specialty Panel. The Panel's recommendation will be

forwarded to the Physician's Quality Review Committee. The Covered Person

will be notified in writing, within five days of the final review of the

complaint."

First of all the title of Physician's Specialty Panel or Review Committee is

a joke. Ms. Robertson told me on the phone when we spoke on June 1, 2001

that there were no physicians present at these committees!

She told me that the panel would review it and then I would have a written

DENIAL, not answer, within five days! Obviously, if my letter is dated June

5, 2001 that is what happened. So, I have followed the procedures and

expect the Department of Insurance to act on the complaints I filed against

United Health Care. Anything less than action taken on their part would be

criminal. I am following the correct procedures and UHC is following the

procedures at least as far as my complaint is concerned by answering within

five days. Now it is the Department of Insurance's responsibility to act

upon this situation.

Your website says you are committed, amongst other things, to providing the

highest level of service to Ohioans. How exactly do you propose to do that

if you won't act upon claims made by consumers? It also states that Mr.

Covington worked to pass the Governor's Patient Bill of Rights and initiated

PromptPay! Yet your department is just going to keep putting me off until

they cannot any longer. IF UNITED HEALTH CARE IS TREATING THIS AS A

COMPLAINT (AS INCOMPETENT AS THEY ARE), SO SHOULD YOU!

I will wait for your response. If you would like to provide a fax number, I

can provide you with a copy of that letter. There are several lawyers

gathering information on this case against United Health Care and I'm sure

they'd love to know that the Department of Insurance isn't going to

acknowledge the complaint!

Christy Ford

114 Holder Road

Baltimore, OH 43105

740-862-5352