Thursday, June 14, 2012


I have a very difficult case -- eating disorder, dissociative identity disorder, PTSD.  Cigna paid for residential treatment, then partial hospital, and then intensive outpatient -- until March, when they decided the patient is cured.  Sadly, this caused major decompensation in the patient, and she currently is suicidal.  We appealed and Cigna denied.  In the denial letter, they said we could file for external review by an Independent Review Organization (IRO) through the Missouri Insurance Department.  So we did, on June 7, asking for expedited review due to the patient's mental/emotional state.  But it turns out that the policy was issued in Ohio, which means the external review should be done in Ohio.  In Ohio, Cigna has to initiate the external review.  Cigna is refusing to do so, arguing that, although Ohio law applies to this policy for all other purposes, they think the Missouri external review process applies because that's where the patient resides.  They are wrong, and they have been told that by two states.  In the meantime, my client is slipping and I'm scared for her.  Today, I will try to pull in the US Department of Labor and see if they will help get Cigna to do the right thing.  But however this is resolved, what should have been an expedited process now has ground to a halt.  Can you imagine a consumer trying to deal with this on her own?  There's no chance someone who doesn't know insurance law could navigate this.  So all the laws in the world simply don't make a difference when a company like Cigna decides to be outrageously and stubbornly wrong.  A travesty.

I don't really think anything in the news will top that story, but here goes.

Mitt Romney has confirmed that his health care plan would NOT eliminate pre-existing condition exclusions.   So really, folks.  Our one and only chance to obtain equal treatment in purchasing insurance is health reform.  Which makes the Supreme Court decision -- along with the next election -- about as high stakes as it can get for people with chronic illnesses.

Broccoli and the Supreme Court.  The libertarian line is that, if the federal government can force us to buy health insurance, then it can force us to buy broccoli.  It's simple and elegant - and wrong!  If people don't buy health insurance and they end up sick or injured and in an emergency room, if they can't pay their bill, the taxpayers bear the cost.  If people don't eat broccoli, well, it doesn't cost the rest of us anything. 

An open letter to the Supreme Court about health reform -- in cartoons!  You don't want to miss this one.

A new report alleges that AHIP -- the association of insurance companies -- gave the US Chamber of Commerce $100 million to fight health reform.  Not surprising, but scandalous, nonetheless.  And there are questions about who financed the National Federation of Independent Business's lawsuit seeking to strike down the law

Meanwhile, Senator Ben Nelson -- who was not exactly enthusiastic about voting for health reform -- has now sounded the alarm about what will happen if the Supreme Court strikes it down. He called the Supreme Court "activist" and warned that losing health reform would pose a threat to the health of all Americans.

Legislation was introduced in Congress yesterday that would remove the phrase "mentally retarded" from US statutes, and provide for additional community supports for people with developmental delays.  Great move!  Now, can it pass?

In a study of 3 Chicago hospitals, doctors admitted to unprofessional behavior -- badmouthing other doctors, trying to avoid patient care.

Those of us with Crohn's disease have been aware for a long time that there are good bacteria that live in our bodies.  The theory is that the reason people in the East don't get Crohn's disease is that their society isn't as antiseptic as ours is. Because we've gotten rid not only of bad bacteria, but also of good bacteria, our immune system isn't up for the fight any more.  It's great to see researchers focusing on the role of bacteria.  It may help them design new treatments.

Have you ever noticed how loud it is in a hospital?  Well, studies now confirm it -- and it's bad for your health.  Some hospitals are trying to change it, but it's a real challenge. 

Here's an interesting story about a woman who got breast cancer in 1971, and who -- radically -- declined to have a mastectomy.  She apparently was the first breast cancer patient to go public, and bucking the medical establishment wasn't popular at the time, either.  She taught us that we need to be active participants in making treatment decisions. 

Women doctors are paid less than men.  Gee -- why am I not surprised?!

And that's about all I have the stomach for today.  I'm off to do battle with Cigna.  Wish me luck -- and have a great day!  Jennifer

No comments:

Post a Comment