My Father's Legacy: Voices for Justice: 2008

Tuesday, November 18, 2008

Coventry Health Care Inc of Bethesda MA False Promises

The wicked worketh a deceitful work: but to him that soweth righteousness shall be a sure reward. ~Proverbs 11:18

Coventry Health Care Tumbles after Cutting Forecast http://www.freewebs.com/courageoffaith/Coventry%20Healthcare%20tumbles%20after%20cutting%20forecast.mht

What Happened to Coventry
http://www.freewebs.com/courageoffaith/Coventry%20Managed%20Care%20Matters%20-%20What%20happened%20at%20Coventry.mht

Fitch Places Coventry Health Care's IDR of 'BBB' on Watch Negative After Acquisition Announcement .......Strangely, this link is not availble; this is not an isolated happening. Google "Fitch Places Coventry Health Care's IDR of 'BBB' on Watch Negative After Acquisition Announcement" and this story is available.

Coventry Newsletter Doctors Make Decisions
http://www.freewebs.com/courageoffaith/Coventry%20Doctors%20Make%20Decisions%20Newsletter.pdf

Dr. Bernard J. Costello's Appeal http://www.freewebs.com/courageoffaith/2005%205%2016%20Dr.%20Costello

WV Insurance Commission Final Order 06-AP-024 http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

COVENTRY HEALTH CARE COMPLIANCE AND ETHICS PROGRAM
http://www.freewebs.com/courageoffaith/COVENTRY%20HEALTH%20CARE%20Compliance%20and%20Ethics%20Program.doc

Civil Action against Carelink http://www.freewebs.com/courageoffaith/Coventry%20Carelink%20sued.pdf

Lorraine Summer sues Carelink Health Plans, Inc. of West Virginia

This report went missing from the internet. As I mentioned earlier, this is not an isolated incident as I have discovered, in my three and a half year investigation, way too many documents "not available." Unusual and suspicious.

Lorraine Summer does exist. Her case was thrown out of the circuit court in West Virginia having determined it to be an Erisa issue. Much more about Summer and Erissa in furture tirades.

One other key note, it appears that Summer was taking Carelink to court to pay for the services they authorized. I'll be taking you down this road, also, as I was shocked to see the wording of Carelink's authorization to me, giving them plenty of wiggle room.

Tuesday, November 11, 2008

Coventry Health Care's Attempt to Limit Pre-Trial

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

False Accusation of Fraud by former Carelink Health Plan, Inc. of West Virginia CEO
http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

My Response to false Accusation and Intimidation
http://www.freewebs.com/courageoffaith/2005%2011%204%20My%20Response%20to%20Patrick%20Dowd

Plaintiff's Memorandum in Opposition to Defendants' Motion to Limit Pre Trial Publicity in Connection with Civil Action Number 07-C-466, Christine Stenger v. Carelink Health Plans, Inc. and Dowd

http://www.freewebs.com/courageoffaith/2005%2011%204%20My%20Response%20to%20Patrick%20Dowd

Biography of Plaintiff's attorney, Mr. Paul Tucker of Bachmann, Hess, Bachmann and Garden, P.L.L.C.

Tuesday, November 4, 2008

Carelink Health Plans Loses in Federal Court

Tuesday's Tirade

No More Deadly Delays

"Never separate the life you live from the words you speak." ~Paul Wellstone

Opinon of federal Judge Frederick Stamp re motion of Carelink Health Plans to have this case tried in federal court http://www.freewebs.com/courageoffith/2008%209%2026%20Federal%20Judge%20F%20Stamp%20Motion%20to%20Remand.pdf

Accusation of Fraud by Patrick Dowd

http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

Tuesday, October 28, 2008

Insurance Commissioner Jane Cline: A Shameful Situation

There is such a web of injustice and corruption in our state and other states. It is cruel and painful to experience. I just keep writing, believing that some day others will look at their images in the mirror and see the cries of our poor.

NAIC Website

http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

Claims Made Against WV Insurance Commission
Formal complaint filed with the West Virginia Court of Claims
January 18, 2008

1. West Virginia Insurance Commissioner Examiner Dena Wildman illegally sent my private papers to Carelink, compromising my case.

2. Wildman made a final judgement, siding with Carelink in the Grievance process, without thorough investigation of the rider that was key to dismissal of grievance and which a Carelink employee told me NEVER existed. Wildman was aware of this inconsistency.

3. State statute was ignored...grievance process took too long. Filed complaint on September 29, 2005. Ruling made January 2006. State law requires speedy decision, made more urgent by my surgeon Dr. Bernard Costello’s request for rapid decision.

4. At two different times my individual requests for two different hearings were “stuck” in system. They were not discovered until I called attention to the problem. In one case it was weeks later.

5. State statute was ignored. It took too long to process one claim; to this date I have never received a formal reply to the second one.

6. Appeal to the West Virginia Court of Appeals paperwork was lost for five months. Head of the legal department Mary Jane Pickens admitted the error.

7. The Commission does not publicize final orders. Final Order 06-AP-024 dated December 14, 2006, establishes a precedent for HMOs to reasonably research requests for procedures. WV citizens must learn that this rule exists for justice to be served them and the health care received for which we pay dearly. The internet is full of factual stories of HMOs denying first and asking questions later. Sadly, too few doctors and consumers have the time or are educated to fight for these rights. I have been in contact with an official in the Governor’s office regarding this very questionable lack of following through with process to insure consumers receive health care to which they are entitled.

8. The Commission has refused to enforce the very order it signed. This order was signed by Ms. Cline on December 14, 2006 and will radically change the way HMOs do business in our state,. Since 2006 the lace of enforcement has potentially compromised the health of hundreds and hundreds of citizens, who likely had requests unfairly rejected as I.

9. Carelink and the West Virginia Insurance Commission reached an agreement behind closed doors and Carelink withdraw their appeal regarding this issue. See January 2, 2008 Defense Response, page 4.

10. The Commission stopped my challenge of discrimination by Patrick Dowd, former CEO of Carelink, from begin brought up at my administrative hearing on August 10, 2006. This greatly compromised my hearing. Additionally, an allegation was subsequently made in a document associated with the civil lawsuit Christine Stenger vs. Carelink Health Plans, Inc. and Patrick Dowd which suggested that I was not concerned enough about the discrimination to bring it up at my hearing. This false allegation was made to the federal court of Judge Frederick Stamp.

See page four of the Defenants' Response to Plaintiff's Motion to Remand:

http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

NAIC Website

http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

Final Order of the Office of West Virginia Insurance Commissioner 12 6 05

http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

Letter to the President of the National Association of Insurance

Commissioners

October 13, 2008

Sandy Praeger, NAIC President Commissioner Kansas Department of Insurance
NAIC Executive Headquarters
2301 McGee Street, Suite 800
Kansas City MO 64108-2662

Dear Ms. Praeger:

I am contacting you as an advocate for the mentally ill and a committee member of the Catholic Diocese of Wheeling Charleston Council for Disabilities in West Virginia. I believe that there is much corruption in the Office of the West Virginia Insurance Commissioner. This corruption contributes to the grave health care crisis in one of the poorest of states.

In the past if anyone would have told me about the widespread corruption in the West Virginia Insurance Commission, I would have told them that they were misinformed. Unfortunately, I, and others, will testify to the grave injustices.

Much of my story is told at www.tuesdaytiradesandtales.blogspot.com. I believe that there is more than enough evidence to indict Jane Cline, Commissioner of the West Virginia Insurance Commission and President elect of NAIC.

While there may not have been a high level of scrutiny about this internal corruption and collusion with my HMO, Carelink Health Plans, Inc. of West Virginia, Americans are now more closely watching regulatory agencies. With the very difficult economic times we are experiencing, we are being made aware of the depth of scandals within corporations and government.

And we are angry.

My accusations are very serious, Ms. Praeger, and I must assert that there be a thorough investigation of Ms. Cline without delay. I personally shudder to think of the hypocrisy were Ms. Cline to represent the high principles of NAIC as President in 2009.

Thank you for your attention to this very serious matter. I look forward to your reply and a just resolution to this problem.

Sincerely,
Christine O’Brien Stenger

Tuesday, October 14, 2008

West Virginia: Insurance Regulation AWOL

Monday, October 6, 2008

Carelink (HMO) loses in Federal Court of West Virginia

Tuesday's Tale

Carelink, My HMO, Cannot Duck Responsibility

Following the links to my court documents re Christine Stenger vs. Carelink Health Plans, Inc. and Patrick W. Dowd is the complete text of Sunday's 60 Minutes with Steve Kroft.

civil lawsuit october 15, 2007
http://www.freewebs.com/courageoffaith/2007%2010%2015%20Civil%20Lawsuit%20Filed%20Stenger%20v.%20Carelink.pdf

January 18, 2008 Tucker Response to Defendants
http://www.freewebs.com/courageoffaith/2008%201%2015%20%20Tucker%20Responses%20Defendants

September 26, 2008 Federal Judge Motion to Remand
http://www.freewebs.com/courageoffaith/2008%209%2026%20Federal%20Judge%20F%20Stamp%20Motion%20to%20Remand.pdf

60 Minutes, October 5, 2008, with Steve Kroft

(CBS) On Friday 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.

And as correspondent Steve Kroft reports, it's far from being over.

It started out 16 months ago as a mortgage crisis, and then slowly evolved into a credit crisis. Now it's something entirely different and much more serious.

What kind of crisis it is today?

"This is a full-blown financial storm and one that comes around perhaps once every 50 or 100 years. This is the real thing," says Jim Grant, the editor of "Grant's Interest Rate Observer."

Grant is one of the country’s foremost experts on credit markets. He says it didn't have to happen, that this disaster was created entirely by Wall Street itself, during a time of relative prosperity. And they did it by placing a trillion dollar bet, with mostly borrowed money, that the riskiest mortgages in the country could be turned into gold-plated investments.

"If you look at how this started with the subprime crisis, it doesn't seem to be a good bet to put your money behind the idea that people with the lowest income and the poorest credit ratings are gonna be able to pay off their mortgages," Kroft points out.

"The idea that you could lend money to someone who couldn't pay it back is not an inherently attractive idea to the layman, right. However, it seemed to fly with people who were making $10 million a year," Grant says.

With its clients clamoring for safe investments with above average return, the big Wall Street investment houses bought up millions of the least dependable mortgages, chopped them up into tiny bits and pieces, and repackaged them as exotic investment securities that hardly anyone could understand.

60 Minutes looked at one of the selling documents of such a security with Frank Partnoy, a former derivatives broker and corporate securities attorney, who now teaches law at the University of San Diego.

"It's hundreds and hundreds of pages of very small print, a lot of detail here," Partnoy explains.

Asked if he thinks anyone ever reads all this fine-print, Partnoy says, "I doubt many people read it."

These complex financial instruments were actually designed by mathematicians and physicists, who used algorithms and computer models to reconstitute the unreliable loans in a way that was supposed to eliminate most of the risk.

"Obviously they turned out to be wrong," Partnoy says.

Asked why, he says, "Because you can't model human behavior with math."

"How much of this catastrophe had to do with the instruments that Wall Street created and chose to buy…and sell?" Kroft asks Jim Grant.

"The instruments themselves are at the heart of this mess," Grant says. "They are complex, in effect, mortgage science projects devised by these Nobel-tracked physicists who came to work on Wall Street for the very purpose of creating complex instruments with all manner of detailed protocols, and who gets paid when and how much. And the complexity of the structures is at the very center of the crisis of credit today."

"People don't know what they're made up of, how they're gonna behave," Kroft remarks. "

Right," Grant replies.

But it didn't stop ratings agencies, like Standard & Poor's and Moody's, from certifying the dodgy securities investment grade, and it didn't stop Wall Street from making billions of dollars selling them to banks, pension funds, and other institutional investors all over the world. But that was just the beginning of the crisis.

What most people outside of Wall Street and Washington don't know is that a lot of people who bought these risky mortgage securities also went out and bought even more arcane investments that Wall Street was peddling called "credit default swaps." And they have turned out to be a much bigger problem.

They are private and largely undisclosed contracts that mortgage investors entered into to protect themselves against losses if the investments went bad. And they are part of a huge unregulated market that has already helped bring down three of the largest firms on Wall Street, and still threaten the ones that are left.

Before your eyes glaze over, Michael Greenberger, a law professor at the University of Maryland and a former director of trading and markets for the Commodities Futures Trading Commission, says they are much simpler than they sound. "A credit default swap is a contract between two people, one of whom is giving insurance to the other that he will be paid in the event that a financial institution, or a financial instrument, fails," he explains.

"It is an insurance contract, but they've been very careful not to call it that because if it were insurance, it would be regulated. So they use a magic substitute word called a 'swap,' which by virtue of federal law is deregulated," Greenberger adds.

"So anybody who was nervous about buying these mortgage-backed securities, these CDOs, they would be sold a credit default swap as sort of an insurance policy?" Kroft asks.

"A credit default swap was available to them, marketed to them as a risk-saving device for buying a risky financial instrument," Greenberger says.

But he says there was a big problem. "The problem was that if it were insurance, or called what it really is, the person who sold the policy would have to have capital reserves to be able to pay in the case the insurance was called upon or triggered. But because it was a swap, and not insurance, there was no requirement that adequate capital reserves be put to the side."

"Now, who was selling these credit default swaps?" Kroft asks.

"Bear Sterns was selling them, Lehman Brothers was selling them, AIG was selling them. You know, the names we hear that are in trouble, Citigroup was selling them," Greenberger says.

"These investment banks were not only selling the securities that turned out to be terrible investments, they were selling insurance on them?" Kroft asks.

"Well, it made it easier to sell the terrible investments if you could convince the buyer that not only were they gonna get the investment, but insurance," Greenberger explains.

But when homeowners began defaulting on their mortgages, and Wall Street's high-risk mortgage backed securities also began to fail, the big investment houses and insurance companies who sold the credit default swaps hadn't set aside the money they needed to pay off their obligations.

Bear Stearns was the first to go under, selling itself to J.P. Morgan for pennies on the dollar. Then, Lehman Brothers declared bankruptcy. And when AIG, the nation's largest insurer, couldn't cover its bad debts, the government stepped in with an $85 billion rescue.

Asked what role the credit default swaps play in this financial disaster, Frank Partnoy tells Kroft, "They were the centerpiece, really. That's why the banks lost all the money. They lost all the money based on those side bets, based on the mortgages."

How big is the market for credit default swaps?

Says Partnoy, "Well, we really don't know. There's this voluntary survey that claims that the market is in the range of 50 to 60 or so trillion dollars. It's sort of alarming that, in a market that big, we don't even know how big it is to within, say, $10 trillion."

"Sixty trillion dollars. I know it seems incredible. It's four times the size of the U.S. debt. But that's the size of the market according to these voluntary reports," says Partnoy.

He says this market is almost entirely unregulated.

The result is a huge shadow market that may control our financial destiny, and yet the details of these private insurance contracts are hidden from the public, from stockholders and federal regulators. No one knows what they cover, who owns them, and whether or not they have the money to pay them off.

One of the few sources of information is the International Swaps and Derivatives Association (ISDA), a trade organization made up the largest financial institutions in the world. Many of them are the very same companies that created the vast shadow market, lobbied to keep it unregulated, and are now drowning because of unanticipated risks.

ISDA's CEO, Robert Pickel, says there is nothing wrong with credit default swaps, and that the problem was with underlying mortgage securities.

"Well, there's clearly something wrong with the system if all of these leveraged bets, hidden leveraged bets, caused a collapse in the financial system," Kroft remarks.

"It is something that we all need to look at and learn lessons from. And we all need to work together to understand that and design a structure in the future that works more effectively," Pickel says.

"My point is, the people that made these mistakes are the people you represent in your organization. And many of them sit on the board. I mean, if they didn't get it right, who would?" Kroft asks.

"These people understand the nature of these products. They understand the risks," Pickel replies.

"Well…they didn't or they wouldn't have bought them. They wouldn't have used them," Kroft says.

"These are very useful transactions. And the people do understand the nature of the risk that they're entering into…but I'm not sure that…," Pickel says.

"Useful?" Kroft interrupts. "How come they brought down the financial system?"

"Because, perhaps they didn't understand the underlying risk, and nobody really saw the effects that were going to flow through from the subprime lending situation," Pickel says.

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

They already dwarf what has been lost on those original risky mortgages. As bad as the mortgage crisis has been, 94 percent of all Americans are still paying off their loans. The problem is Wall Street placed its huge bets and side bets with all of those fancy securities on the 6 percent who are not.

"We wouldn't be in any of this trouble right now if we had just had underlying investments in mortgages. We wouldn't be in any trouble right now," says Partnoy.

He says it’s the side bets.

"You got Wall Street firms, Bear Stearns, Lehman Brothers. You got insurance companies like AIG. Merrill lost a ton of money on this," Kroft says. "Everybody's lost a ton of money. They're supposed to be the smartest investors in the world. And they did it themselves."

"They did it all on their own," Partnoy agrees. "That's the most incredible thing about this crisis is that they pushed the button themselves. They blew themselves up."

Asked how much of this was incompetence on the part of Wall Street and the people who ran it, Jim Grant tells Kroft, "The truth is that on Wall Street, a lot of people just weren't very good at their jobs. It's as simple as that."

"These people were being paid $50 to $100 million a year. Some of them, the guys that were running the places," Kroft remarks.

"There is no defending," Grant replies. "A trainee making 45,000 a year would have had the common sense not to bet the firm on mortgage contraptions that no one in the firm actually understood. That is not a deep point to comprehend. Somehow, through, I will call it a criminal neglect and incompetence, the people at the top of these firms chose to look away, to take more risk, to enrich themselves and to put the shareholders and, indeed, the country, itself, ultimately, the country's economy at risk. And it is truly not only a shame, it's a crime."

Tuesday, September 30, 2008

Intrigue at West Virginia PEIA

The moment there is suspicion about a person's motives, everything he does becomes tainted. ~Mohandas Gandhi

What else has Mr. Cheatham been up to lately? Well he is a member of the WV Children’s Health Insurance Board. This program is a low cost health care plan for children and teenagers of working families. “Working together, we will make sure your children get the high quality health insurance they need,” a report on the board states.

“High quality health insurance.” Is that something like the “Excellent” accreditation handed to Carelink for their voluntary sharing with NCQA, a business formed in 1976 by HMOs to regulate HMOs?

Reports describe an “evil culture” within Coventry that permeates its practices. Recall the letter sent to me by former CEO Patrick W. Dowd falsely accusing me of fraud. Imagine the implications for each of us who subscribe to Carelink.

Whoa. This gets as scary as our present economic stress. Our children’s lives may be in the hands of Carelink. It’s just a little too crazy, too cozy, don’t you think?

Sadly, there’s much more to come. A lot more.

Governor Appoints Ted Cheatham to serve as PEIA Director
http://www.freewebs.com/courageoffaith/PEIA%20Governor%20Appoints%20Ted%20Cheatham%20To%20Serve%20As%20PEIA%20Director%20-%20News%20Release%20-%20www_WVGov_org.mht

PEIA Selects Coventry Health Carehttp://www.freewebs.com/courageoffaith/PEIA%20Selects%20Coventry%20Health%20Care%20To%20Provide%20Retiree%20Health%20Benefits.mht

State Upholds PEIA's Decision http://www.freewebs.com/courageoffaith/PEIA%20State%20Upholds%20PEIA

The Public Employees Insurance Agency in West Virginia Affirms Insurance Contract Awarded to "Maryland" firm
http://www.freewebs.com/courageoffaith/PEIA%20W_%20Va_%20Agency%20Affirms%20Insurance%20Contract%20Award%20to%20Md_%20Firm.mht

West Virginia PEIA lost backup affects 200,000
http://www.freewebs.com/courageoffaith/West%20Virginia%20PEIA%20lost%20backup%20affects%202%20hundred%20thousand%20people.mht

Angry Retirees Question PEIA Changes
http://www.freewebs.com/courageoffaith/PEIA%20Angry%20Retirees%20Question%20PEIA%20Changes.mht

PEIA enrollee applauded for ‘rocking boat’
http://www.freewebs.com/courageoffaith/PEIA%20enrollee%20applauded%20for%20rocking%20boat%20Runaround.mht

PEIA: What is wrong with this plan?
http://www.freewebs.com/courageoffaith/PEIA%20not%20%20addressing%20the%20ill.mht

PEIA will try to soften impact of 'a bad year'
http://www.freewebs.com/courageoffaith/PEIa%20Unexpected%20Increases.mht

A rocky start for Cheatham, don’t you think? How long will he remain Director of PEIA? Not a day too soon for the growing numbers of retirees who question his judgement.

Monday, September 22, 2008

Exposing Spilman Thomas and Battle PLLC

Tuesday’s Tirade

The Legalese of Dishonor

“Never forget that everything Hitler did in Germany was legal.” ~Martin Luther King, Jr. quotes

For the complete tirade and tale, visit tuesdaytiradesandtales.blogspot.com.

March 10, 2006 Formal Complaint to the West Virginia Insurance Commission Supporting Claims v. Carelink Health Plans of West Virginia for Discrimination and Intimidation: http://www.freewebs.com/courageoffaith/Formal%20Complaint%20to%20WV%20Insurance%20Commission%20March%2010%202006.doc

Judge DeBolt's reference to Discrimination Issue:
http://www.freewebs.com/courageoffaith/Testimony%20Hearing%20Judge%20Debolt%20Handcuffs.pdf

Civil Lawsuit
http://www.freewebs.com/courageoffaith/2007%2010%2015%20Civil%20Lawsuit%20Filed%20Stenger%20v.%20Carelink.pdf

11 14 2007 Tucker Motion to Stay
http://www.freewebs.com/courageoffaith/2007%2012%2014%20Tucker%20Motion%20to%20Stay%20and%20or%20Enlarge%20re%20Defendants%20Motion%20to%20Dismiss.pdf

11 19 07 Plaintiff's Motion in Support of Motion to Remand
http://www.freewebs.com/courageoffaith/2007%2012%2019%20Tucker%20Memorandum%20in%20support%20of%20C.%20Stenger%20Motion%20to%20Remand.pdf

1 2 2008 Defendants' Response to Plaintiff's Motion to Remand
http://www.freewebs.com/courageoffaith/2008%201%202%20Defendants%20Response%20to%20Remand%20Motion.pdf

1 14 2008 Plaintiff's Reply Memorandum in Support of Motion to Remand
http://www.freewebs.com/courageoffaith/2008%201%2015%20%20Tucker%20Responses%20Defendants

Tuesday’s Tale
BiPolar Illness: My Best Friend

Tuesday, September 9, 2008

West Virginia Fails Citizens

America deserves and demands a government that serves the country, not itself. Most people believe that elected leaders are more interested in the perks and privileges of office than in public service, and that too often the special interest lobbyists with the fattest wallets and best access carry the day when issues of public policy are being decided. ~JohnMcCain.com

Collusion of the West Virginia Human Rights Commission

September 9, 2008

http://www.tuesdaytiradesandtales.blogspot.com/

There has never been a need for greater transpareny and accountability of West Virginia officials than today.

Today when pubic faith in government is at an all time low. On July 30, 2006, I spoke with James Slack, Intake Officer with the West Virginia

Human Rights Commission. We spoke many times and often Slack would express his personal admiration for my fighting the injustice of my HMO. That is until the day Slack did not remember me.

Link to my workbook, a record of all contacts made with the West Virginia Insurance Commission regarding lack of public accommodation on the part of my HMO, Carelink Health Plans, Inc. of West Virginia:

http://www.freewebs.com/courageoffaith/WV%20Human%20Rights%20Word%20Document%20of%20Workbook.doc

Thursday, September 4, 2008

Carelink Health Plans Inc. Corporate Irresponsibility

Tuesday's Tale

The Private Face of the "Darling of Wallstreet"

For three long years I have been investigating Carelink Health Plans, Inc. of West Virginia and their parent company Coventry Health Care, Inc. of Bethesda MD, a Fortune 500 Company.

A social justice advocate and a respected physician described Carelink's actions towards me in November 2005 as ruthless and despicable. "How can this be?" many might ask. The answer is really quite simple. Coventry is the “darling of Wall Street” according to Washington Post columnist and Pulitzer Prize winner Steven Pearlstein. How are people duped? Coventry remains “under the radar.”

It appears that even Coventry CEO Dale B. Wolfe shuns press coverage. He oversees corporate governance of Coventry and its affiliates. In one article on the internet there is a place for his image with the statement “photo not available.” It appears that there may be more than a picture missing; I suspect his conscience may be awol.

In December 14, 2006, Jane Cline, Commissioner of the West Virginia Insurance Commission, signed Final Order 06-AP-024. Frank Hartman, Director of the Office of Consumer Advocacy represented me against Carelink.

In the following link, Mr. Hartman testifies to the significance of the final order and the overbearing pride and insolence of Carelink Health Plans, Inc. of West Virginia: http://www.freewebs.com/courageoffaith/2007%204%204%20Frank%20Hartman%27s%20Discussion%20of%20Facts.doc

A deep sigh. It has been too long of a journey to today, one step in boldness after another. Not easy. But the alternative is to let this corrupt system do business as usual. I cannot turn my back on pain and suffering of others. And so I write.

I link as I have done here to the complete WV Insurance Commission Final Order 06-AP-024. http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

Many people advised me over the months that I must not name Carelink and Coventry in any public writing. That even though I speak the truth, Coventry may employ a tactic of suing me for speaking out. The tactic oftentimes works. Intimidation. Threats of losing possessions. Just plain fear stops good people from pursing their God-given rights.

Well, I have already lost too much in life to injustice. Naming my enemy may be the only way to gain public acknowledgement of how they run their business. I have many documents that prove every allegation I make. Carelink and Coventry have unwittingly provided me with a lot of ammunition.

So following my attorney's advice to speak the truth supported by many documented records, here's more: Christine Stenger v. Carelink Health Plans, Inc. and Patrick W. Dowd, http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

As you have read, Carelink is a defendant in a civil lawsuit I filed against them in October 2007. It is alleged that Carelink broke a state law which forbids any company doing business in the state of West Virginia from denying access to a person with a disability. The lawsuit cites a letter dated November 1, 2005, which I received from the then CEO of Carelink Patrick W. Dowd. It's not easy being at the receiving end of a letter like this: http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

Yes. There were "countless" contacts with Carelink and Coventry, all recorded. Those identified here represent only a beginning. Had one responsible individual of Coventry followed the rules of corporate governance and the patient's bill of rights as published by Coventry Health Care, Inc., neither my health plan nor myself would be involved in a lawsuit.

Carelink made a critical error on November 1, 2005. Carelink neither understood that my roots are in social justice nor did they appreciate that perseverance is my strength. Today I remain just as strong and committed as I was in June 2005. Passion and enthusiasm drive me. On November 4, 2005, I quickly countered Mr. Dowd’s false allegations with the truth. My son, an attorney, dictated my response to me within minutes of opening Dowd's letter. The case was dropped.

Tuesday's response: Guilty as charged.

If the lives of real people did not depend on receiving an "excellent" response from health care organizations...If Carelink had only failed once to act consistent to their corporate advertising...if customer surveys were taken seriously...if indifference to suffering did not play a role in Carelink's decision-making...so shocking.

My mind goes to the Virginia Tech massacre. One sick individual. Help could be available. Were there some of the same roadblocks Carelink placed in my path in the way of that young man's receiving the help that might have made some difference? One wonders.

They just don't get it, do they? It's called corporate responsibility.

Tuesday's Tale

Randy Calad, Victim

SUGAR LAND, Texas -- Leading up to her hysterectomy about five years ago, Ruby Calad thought she understood all the insurance bureaucracy involving her HMO.

"I'd done my homework," the suburban Houston woman said.But the day after her operation, she was told by a Houston-area hospital she had to be released because her HMO, Cigna Healthcare of Texas Inc., would approve no additional expenses. She was discharged prematurely, then wound up in an emergency room a few days later, she said.

"(It) ended up costing them more money," Calad, 50, recalled Monday, a few hours after learning the U.S. Supreme Court had ruled against her in a lawsuit stemming from her HMO's decision.

"The court essentially looked the other way on the issue of the HMO abuse," she said. The court said HMOs are shielded from lawsuits in state courts, where juries are more apt to side with victims and recommend multimillion-dollar judgments from insurance companies.

Justice Clarence Thomas, who wrote Monday's ruling, relied on a federal pension benefit law that predates the rise of managed care and said patients may pursue claims only in federal courts, where awards are capped at only the cost of medical services the HMO would not cover.

The ruling means patients like Calad can't seek hefty damage awards in court if their HMOs refuse to pay for doctor-recommended medical care. The unanimous decision rejected arguments that the threat of multimillion-dollar lawsuits keeps insurance companies honest, invalidated an important part of patient rights laws in several states and tossed a political hot potato back to Congress, where lawmakers repeatedly have tried and failed to pass national patient protections.

"I hope this ruling breathes new life into the patients' bill of rights debate in Congress," Calad said. "I'm also hoping they do not just sweep this under the rug and completely forget about it.

"The ruling, in a pair of cases filed by Calad and Juan Davila, also of Texas, affects the roughly 72 million people covered by HMOs.

The Texas cases were filed under a patients' rights law passed when President George W. Bush was governor. When Bush was running for president four years ago, he took credit for the law, but his administration sided with insurance carriers when the two cases reached the high court.

In their arguments to the court, lawyers for Cigna noted that Calad's health care plan at the time, like most other health benefit plans, "does not promise to cover any and all health care sought or desired by beneficiaries.

"The Supreme Court did not decide whether the plaintiffs deserved better, only whether and where they could sue. "As far as I know, it's dead," Calad said of her legal challenge. "I would do it again. it was worth the fight."

Associated Press Writer Anne Gearan in Washington contributed to this report. Reported in Topix: California Insurance Industry

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