UHC vs UHC, my story

(noon. – promoted by ek hornbeck)

I’ve finally getting some late season head-way on my organic garden. I was pretty much out of it from the end of April to the beginning of July with pneumonia. Add in underlying lifelong asthma and it really slows you down. Today’s the 25th and I’ve had a full eighteen days in a row of health. It feels good.

The increased garden work has allowed me time to follow up on some blatant fraud being committed on me, Jordan Hospital (Plymouth, MA) and Brigham and Women’s Hospital (Boston). United Health Care is committing clear and open fraud in refusing to honor their contract with the hospitals and me and my wife’s employer (our health care insurance source).

A big H/T to D Wreck for the post a few days ago on UHC, the Heritage Foundation, the Lewin Group Study and Ingenix. I had no idea how incestuous the corruption circle can be. I’ve been on the phone to my congressman’s office four times this week wrt the Universal health Care bill. The following is a letter to William Delahunt (D-MA) with some short stories of my plight (only a very small part of it wrt UHC) and some observations from past managerial experience a IBM/Lotus and a look at the opportuinty cost to our national productivity and GDP that is lost to time spet dealing with these intentional fraud artists who claim to be honest corporations offering reasonable health care coverage at competitive prices.

The lies and corruption are beyond comprehension. The letter follows after the jump. Feel free to cut and paste from it, forward it or cross-post it. It is Now or NEVER. I hope you are all doing what you can this week before the bozos go home for vacation. Also, track down any pubic appearances they make in August and be sure to show up and let them know just how you feel. Call their local offices and ask for some face time. Remember, they work for you. They are the paid help. You are the boss. Don’t let them intimidate you.

Change harder! Yell louder! Get right up in their faces! Make it happen! Do not wait for someone else to do this for you! Get off your butts!

Dear Representative Delahunt,

My name is Jim Flynn. I am 60, college-educated and a former Director of Global Engineering at Lotus (Cambridge)/IBM.. I have been a first-hand witness to the ongoing fiasco that is American health care for some decades now. First, I would like to relate a personal experience I am having right now with United Health Care; this will provide consumer level insight. Second, I will provide two, out of innumerable, examples of how the current health care system continuously fails to perform its intended function and finally, I will provide an overview from my personal experience of years as a manager of the impact of the current health care system on American productivity and GDP. The bottomline os that we cannot afford the system we have now. It costs us far more than a trillion dollar taxpayer funded would ever cost.

Let me begin with Untied Health Care. I’ll just give you two minor incidents and spare you the endless, ongoing horror stories of their prescription drug benefit plan, what is and isn’t covered, and the constant barrage of USD 50.00 co-pays. Over the last few months I have been receiving letters from UHC denying coverage for two particular clinical events – the first a blood test dated 13 May 2008 (USD 443.00, Jordan Hospital, Plymouth, MA) and the second a post-surgical office visit to my cancer surgeon at Brigham and Women’s (USD 179.00) dated 24 Sep 2008. In each case, UHC claims that I wasn’t covered under my wife’s plan from her employer. I will not name her employer for fear of retribution against my wife. She has a Masters in Elementary Education but works for a few bucks over minimum wage at a very large retail company which treats its employees as completely expendable and replacable commodities. That narrows the list down to the Fortune 500.

I had the good fortune on Friday, 24 Jul 2009, to speak with an account collection representative at Jordan Hospital. Her name is Peg. It turns out the Peg has also recognized one of the errors with UHC and has been pursuing them for the USD 443.00 for over a year. She has contacted them on four separate occasions to be told, ‘Yes, it’s our error. We will pay this claim right away. Mr. flynn was obviously covered during this time period.’ Peg waits a few months; nothing happens; nothing gets paid, she tries again. The voice mail menu at UHC is a gauntlet in and of itself. More on that in a moment. So Peg’s most recent call to UHC had been just the day before, 23 Jul 2009 – still chasing USD 443.00 that UHC admitted it owed over a year earlier. I’ll call Peg back next week and see if the hospital finally got paid. I doubt this will happen. Immediately after speaking with Peg, I called UHC myself to see what was going on with the non-payment and continuous obfuscation. Plus I had that second bill from BWH to clear up. That should have been a USD 35.00 co-pay on my part – not USD 179.00. To my great non-astonshment, I was told that I was not covered for the time frames mentioned and I would be transferred to the Rapid Resolution Dept at UHC; a misnomer if ever there was one. At the RRD at UHC, their RRD specialist re-iterated that I was not covered those dates. When I explained that Jordan Hospital and UHC had agreed that I was covered, she informed that they were wrong. She would then escalate it to yet another level of claims resolution department. I asked if I could speak to them directly and was given a flat-out NO! Twyle would handle this situation and get back to me in 72 business hours. This translates to next Wednesday. I’ll keep your office up to date on the resolution.

My personal examples are but two small data samples from a Biblical flood of denial of coverage, payment, payment amounts, procedures, doctors and prescription drugs covered and not covered all at various co-pay rates. If I got into the prescription plan problems, this letter would be a novella.

Here’s a little excerpt from WaPo c/o D Wreck, posting on Docudharma (Wed Jul 22, 2009 at 16:34:29 PDT):

First Rep. Pete Stark (D-CA) released a rebuttal of the Lewin Group study, revealing that the Heritage Foundation paid for study and that UnitedHealthCare owns the Lewin Group(PDF).

Then came a doozy from the Washington Post:

   [T]he Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician’s group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the “usual and customary” doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.

   In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.

Obviously, UHC is not a good corporate citizen. The fines and admissions of guilt do not seem to have slowed them down at all. Which, as a businessman, tells me they built in to their revenue plan a minimum of USD 400,000,000.00 for fines of they got caught. They could also make the fine money back by continuing the same deceitful processes in the future. from my point of  view and experiance, they have done that much at a minimum. So much for my small and very minimal story.

For my second point: two, out of innumerable, examples of how the current health care system continuously fails to perform its intended function. While at Lotus/IBM we went through yearly changes in our health care providers. The trend was always less coverage and greater co-pays. Always. My stories are of one peer manager and one of my leading software architect. Both involved getting care for their children that was desperately needed. I will not go into detail of the diseases other than to say that that were permanent and in one case, an ongoing life or death issue. Each of these highly talented individuals had to spend up to one-half of their woring hours at times dealing with recalcitrant insurers over trivial bills by the insurer’s viewpoint but major by theirs. Coverage and non-coverage issues were emotionally draining for each of these people. After half a day here and there per week they would e emotionally drained, angry, fearful for their children’s well-being and full of anxiety and resentments against both the insurer and their employer for focing such miserable insurance choices on them in the first place. This was a huge drain on their productivity and job satisfaction. Not only would the insurance company waste their time but after each episode they would have to share their experience to see what management could do to help. The answer to that was normally: we’re all in the same boat here. We are all suffering and losing productivity. We are all frustrated and angry and resentful.

I only mention two employees here. This was going on company-wide, which brings me to my third and final point.

There are twenty-two working days in the average calendar month. Leaving out paid holidays, vacation ans sick leave, twe get down to twenty days per month of actual work days. Two of those twenty days were lost on average to dealing with health care and insurers and their deliberate fraud (see Ingenix, the UHC subsidiary above). Two out of twenty is ten percent. TEN PERCENT of our productivity, our American GDP is lost to these near-to-actual criminal insurers. The 1998 US GDP was International Dollars 7,394,598M. A trillion dollars for Universal Health Care is a rounding error in that number. My estimate of 10% lost productivity due to chasing insurers to live up to their contracts is ID 739,460M. To not provide full coverage equal to the coverage that Congress and the Federal Government receive is an absurdity. It is our tax dollars. They should be funding our health care as well as yours. If we can afford welfare for incompetent billionaires (e.g., TARP) the please explain to me why we can’t provide coverage for all Americans from cradle to grave.

The simple boost in productivity of not dealing with the insurers deceit, fraud and corrupting influence would be enormous and more than offset any direct costs. The adversaries of this bill have framedt he discussion as usual. They claim it is government run health care. Don’t any of you have the common sense to frame it as government funded health care. Health care for the taxpayers paid for by the  taxpayers own dollars. Freedom to choose your doctor and direct your own care. This would also level the playing field for small businesses so that they could hire more without the burden of providing health care coverage. Small business is the growth engine of America. It is the birthplace of innovation. It s being crippled and buried by health care costs. We are destroying our own economy and the future of our children and our nation. And the cherry on top is that this is being accomplished by a USD 1.4M spend rate by corporate lobbyists buying – legally – the votes of Republicans and Blue Dogs in particular. Their campaign contribution records are an open book.Do not think that we are illiterate or innumerate or just plain ignorant. The process is as transparent as it is repugnant and corrupt.

Do the right thing, Bill. Do it for the people of your district and not for the corporations, their lobbyists or their campaign funding or opposition advertising. We have your back – if you vote wisely.

Thanks for taking the time to read this. Your people have my contact information if you would like to talk more about this. See you in August – maybe. Enjoy the rest of the summer.

Sincerely,

Jim Flynn

Plymouth, MA