Category Archives: Commentary

A Whistleblower’s Profile In Courage

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Obamacare threatens to maim and kill innocent people in the name of furthering the bottom line for the insurance companies. Obamacare contains the heinous specter of death panels. We are all at risk and certainly Obamacare represents yet another form of wealth distribution. However, the people should know that help is on the way.

Dr Linda PeenoDr. Linda Peeno contacted me two weeks ago and informed me that she is reinserting herself into her advocacy work on behalf of all patients who are trapped in a corrupt medical system.

If you don’t know who Linda Peeno is, the following profile should inspire all to become a force for positive change. If you remember Dr. Peeno, you will find the following information to be a welcome update on one of America’s most courageous whistleblowers.

Of all the interviews that I have conducted over the years, there is one interview which still troubles me to this day. Almost five years ago, I interviewed managed health care whistleblower, Dr. Linda Peeno, her revelations have haunted me in the years following the interview. I am haunted because Dr. Peeno gave so much to the people of America and lost nearly everything in return.

What started out as an interview with the objective consisting of presenting the listening audience with an expose on the inherent evils of health care, the interview turned into what John F. Kennedy would refer to as a shining example of a “profile in courage.” Yet, it is a profile in courage that has neither been championed or rewarded. Rather, Peeno’s statements and actions have been met with denial, derision, disdain and a highly effective and destructive retaliation.

Certainly, Linda Peeno’s trip down whistleblower lane appeared promising when the her Congressional testimony was prominently portrayed in Michael Moore’s movie, Sicko, as Peeno told Congress the following:

“I wish to begin by making a public confession: In the spring of 1987, as a physician, I caused the death of a man. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was “rewarded” for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the “good” company doctor: I saved a half million dollars. I contend that “managed care,” as we currently know it, is inherently unethical in its organization and operation. Furthermore, I maintain that we have an industry which can exist only through flagrant ethical violations against individuals and the public.”

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A Whistleblower’s Profile In Courage

Former Marine now battling Medicare for life-saving surgery

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Robert Zurheide asking if they are waiting for him to dieTUCSON- A Tucson man and former Marine says his life is in limbo, caught between the need for life-saving surgery and a Medicare Advantage plan that will not cover the procedure. Robert Zurheide went on disability after he was injured in 2002 while working as a corrections officer in Florence. He has been battling chronic pancreatitis for nearly three years and says doctors at UAMC recommended a pancreas transplant as soon as possible. That was more than eight months ago.

“I love my country to the core, it’s in the core of me,” said Zurheide.

Military service is more than a passion for the Zurheide family, it is a way of life. Robert’s son Graham is a 1st Lieutenant in the Marines and his younger son has plans to join. However it is a tradition that claimed the life of Zurheide’s oldest son, 20-year-old Robert Zurheide Jr., who was killed while serving in Iraq in 2004.

“He came over, he gave me that big hug and he went back around to the car, got in and they drove off, and I never saw him again,” Zurheide said.

Nearly ten years after his son’s death, Zurheide says he is now fighting for his own life. He spends hours, even days in the hospital as his pancreas continues to fail.

“Worst pain I’ve ever felt in my life, and it could kill me,” he said.

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Former Marine now battling Medicare for life-saving surgery

Insurance Giant Abruptly Withdraws Cheaper Plan

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Get Gephardt ABoT(KUTV) Natasha Sponbeck runs a small business called Zap Electric. Natasha says the company has always offered health insurance to its employees.

“That is a great benefit to recruit people,” she said. “They want to go work somewhere where they get benefits.”

Zap Electric’s coverage has been through Humana. Natasha says she was concerned about changes coming because of the Affordable Care Act until she got a letter in the mail.

“I got a letter from Humana stating I could keep my grandfathered plan,” she said.

Natasha agreed. But week later, her insurance agent discovered Humana has already switched Zap Electric over to a new, Affordable Care Act approved plan. The new plan will cost roughly $12-thousand more per year.

“It’s a lot more money for way worse coverage,” Natasha said.

Natasha contacted Humana to complain, and was sent an email that said, “…there has been a lot of miscommunication and errors in letters.”

And the email says, indeed “Zap Electric is going to have to change to an [Affordable Care Act] compliant plan.”

But Natasha suspects that the miscommunication may have been deliberate. She says that if she hadn’t been proactive she would not have discovered the error before the bills went up.

“If this was a mistake, why have they not sent all of us letters letting us know this is a mistake?” she asked.

Natasha says she tried to work out a deal with Humana but the insurance giant wouldn’t budge.

Natasha turned to the Utah Department of Insurance to file a complaint but she cannot get a return call.

Frustrated and not wanting to pay for the more expensive plan, she decided to Get Gephardt.

Get Gephardt began our investigation with the Affordable Care Act signed into law nearly four years ago. In the act we found a paragraph that talks about modifications to plans. It says that if a change is made to a plan then the insurance company has to “provide notice” to the customer. The act also says the insurance provider must give a 60 days notice of such changes so the customer can to decide if they want to stay or go.

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Insurance Giant Abruptly Withdraws Cheaper Plan

Humana Used Obamacare as Club Against Policyholders, Class Claims

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KANSAS CITY, Mo. (CN) – A federal class action claims Humana jacked up its health insurance premiums to coincide with Obamacare, while failing to give policy holders a reasonable way to cancel policies.

Lead plaintiff Daniel L. Doyle sued Kentucky-based Humana on Tuesday.

Doyle says he received a letter from Humana in August stating that his policy would be canceled on Dec. 31, 2013 and replaced with a new one, to coincide with the Affordable Health Care Act.

The premium for the new policy would be $395.97 a month, significantly (73%) higher than the $229.30 a month Doyle had been paying.

Doyle says he received another letter on Oct. 24, 2013 with clarification to the August letter. He then found a better policy with another provider and wanted to cancel his policy with Humana.

“On or about November 20, 2013, Mr. Doyle was notified that he had new insurance coverage with Blue Cross Blue Shield beginning December 1, 2013,” the complaint states.

“Plaintiff then immediately attempted to contact Humana to cancel his policy but was unable to reach anyone who could assist him to cancel.

“Plaintiff again tried to cancel two to three days later. He again was unable to reach anyone at Humana who could assist him in cancelling his policy.

“On numerous occasions, Mr. Doyle unsuccessfully attempted to cancel his policy by calling the toll-free number listed in the October 24, 2013 letter. Whenever Mr. Doyle called the toll-free number, he encountered an automated call system that would not enable him to speak to a person.

“Frustrated with the significant hold times and inability to speak with a human being, Mr. Doyle contacted his Blue Cross representative, who provided a fax number for Humana which he was unable to locate on Humana’s website.

“On or about November 25, 2013, Mr. Doyle sent a facsimile to Humana providing Human with written cancellation of his policy.

“Humana refused to respond to Mr. Doyle’s written cancellation request.

“On or about January 7, 2014, Mr. Doyle sent a letter to Humana enclosing his November 25, 2013 cancellation request. The letter also demanded that Humana stop deducting the premium from Mr. Doyle’s checking account and return money taken by Humana after Mr. Doyle’s cancellation request.

“Humana refused to respond to Mr. Doyle’s January 7, 2014 letter.

“Plaintiff continued his attempts to call Humana several more times. On or about January 10, 2014, plaintiff was, for the first time, able to speak with an individual after waiting for approximately 20 minutes. But after getting through to a representative, the representative informed plaintiff that the representative did not have the authority to cancel plaintiff’s policy.”

The class consists of all Humana policyholders in the United States who have been billed for insurance premiums on policies which were canceled by Humana on or before Dec. 31, 2013 and/or after the class member tried to cancel the policy.

Doyle seeks class certification, wants Humana enjoined from continuing its practices, disgorgement of profits from the scheme and actual and punitive damages for violations of the Kentucky Consumer Protection Act.

He is represented by Eric L. Dirks with Williams Dirks.

Humana is one of the largest health insurers in the country, with more than $13 billion in revenue in 2013, according to the lawsuit.

Full Article & Source:
Humana Used Obamacare as Club Against Policyholders, Class Claims

Patients urged to contact Humana regarding decision to cover only one Alpha-1 therapy

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One of the country’s largest health insurers, Humana, recently made a policy decision that can adversely affect many people with Alpha-1.

Humana now restricts augmentation therapy for Alpha-1 patients to a single product. The critical therapy is available in four formulations that, as biologicals, are not considered generically equivalent.

Humana and other insurance companies make decisions about what they will reimburse, and publish this information for their insurance beneficiaries in what is called a formulary. This decision by Humana indicates to the Alpha-1 Foundation and Alpha-1 Association what may become a serious trend that will adversely affect all who rely on life sustaining infusions.

Below are ways that Alpha-1 patients and members of the Alpha-1 community can help protect and educate themselves and family members:

SHARE YOUR STORY

Alpha-1 patients and their families are encouraged to share their experiences, especially if you have been or are being required to switch augmentation therapy. Were you forced to switch from an augmentation product you were tolerating well to one you never used before? How might it affect your health and care if you were forced to switch? Have you needed to switch augmentation products because of side effects or other issues? If so, email your experiences to ProtectYourTherapy@alpha-1foundation.org.

KNOW THE PROCESS TO ASK FOR CHANGE

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions. If you choose to appeal a coverage denial, there are several strategies that can bolster your case. Click here for the Appeals and Grievances section of the Alpha-1 Association’s Private Health Insurance Toolkit (PHIT). Click here for Humana’s web portal relating to exceptions and appeals.

URGE HUMANA TO REVERSE ITS DECISION TO COVER ONLY ONE AUGMENTATION THERAPY

Humana’s recent formulary policy decision can adversely affect thousands of patients, including many with Alpha-1, as well as more than 3,000 hospitals and nearly 50,000 pharmacies across the country. Its decision implements a formulary limiting alpha-1 antitrypsin augmentation to one product.

It is simple to take action: contact Jack McKnight, Humana’s director of pharmacy clinical strategies, at jmcknight1@humana.com.

Make sure to state:

  • You are a patient living with Alpha-1 Antitrypsin Deficiency, a rare, inherited condition that can cause serious and chronic lung disease (or liver) disease.
  • There is no cure for Alpha-1 lung disease, but treatments are available.
  • Your treatment consists of weekly IV infusions of alpha-1 antitrypsin derived from human plasma.
  • You have arrived at the product you currently use because it is best tolerated by you and prescribed by your physician.
  • Humana’s recent policy to cover only one augmentation therapy product for Alpha-1-related lung disease may disrupt your current medical treatment and possibly threaten your life.
  • Urge Human to reverse its decision to cover only one augmentation therapy product for Alpha-1-related lung disease.

 

Read complete coverage of the Humana decision, the Foundation’s response and Alpha-1 patient reactions at Don’t Let Insurers Decide.

Full Article & Source:
Patients urged to contact Humana regarding decision to cover only one Alpha-1 therapy