Do you know anyone who can help my baby?

	SEARCH 1,000 stories, 75 discussions BROWSE 75 contents pages SUBSCRIBE to free e-mail digest
ARCHIVES \| BOOKS \| CRITERIA \| DIGEST \| HOME \| LINKS \| MAP \| MISSION \| ONGOING DISCUSSIONS \| RULES

Name: Christy Ford
Email: cford@fairfieldi.com
Date: 02 Sep 2001
Time: 10:49:49
Remote Name: smod075.fairfieldi.com

Story

Below is my original letter, now gaining national attention and also my response to BCMH, as well as two responses to the Ohio Department of Insurance which does not want to accept my complaint against United Health Care!

This letter may sound like I am attacking and I am! Most mothers do when their child is being denied basic rights and medically necessary treatment! A condensed version is not available as I cannot condense the atrocities of what is happening to my baby!

This letter is drawing attention. We just finished a spot on WBNS TV that was aired yesterday with Maureen Kocot here in Columbus, Ohio. Abbee's story was published at www.fairfielddailypost.com. A copy can be obtained by writing to editor@fairfielddailypost.com. Also, there is a newsletter at www.insurancejustice.com that has an excellent review of my letter. You can also go to medicalreporter.health.org and see my letter to the editor! 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. I also received a call from Margaret Mahoney, MD author of the book Saving the Soul of Medicine who is involved with the National Organization of Physicians Who Care. 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

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.

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.

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.

The Families USA report says that William McGuire, chief executive officer of one of the biggest managed-care companies in the nation, UnitedHealth Group, received $54 million in salary and other compensation in 2000, not counting unexercised stock options. Those options were valued at $357.9 million.

Roger Crozen, a UnitedHealth spokesman, said the $54 million included a one-time exercise of stock options. He said the company, which is based in Minneapolis and provides coverage to 16 million Americans, has voluntarily granted its members many of the medical guarantees in the bill.

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!

Please let me clarify the correspondence below. We understand that you have initiated the appeal process, however it is not completed at this time. As stated below, we are forwarding this information directly to United Healthcare in order to assist you in continuing this process. If you have any questions, please do not hesitate to call. Sincerely,

Julie Phillips, FLMI, ACS, AIE Analyst Supervisor, Health Unit Ohio Department of Insurance 2100 Stella Court Columbus, OH 43215-1067 (614) 644-3411 voice (614) 995-7123 fax julie.phillips@ins.state.oh.us www.ohioinsurance.gov

> -----Original Message----- > From: Julie Phillips > Sent: Monday, June 18, 2001 4:09 PM > To: 'cford@fairfieldi.com' > Cc: Lee Covington; John Pouliot > Subject: Re: CSD-1076871 Abbee Ford v United Healthcare of Ohio > > June 18, 2001 (614) 644-2673 > (800) 686-1526 > > > CHRISTINE FORD > 114 HOLDER RD > BALTIMORE, OH 43105 > > RE: Our File Number CSD-1076871 > > > Dear Mrs. Ford: > > We have received your most recent email correspondence of June 14, 2001, > regarding your healthcare complaint with United Healthcare of Ohio. > > We have been advised that you have not completed the internal appeal > process outlined in your member handbook/certificate. While we > understand your frustration, you must first complete this process. > > In order to assist you, we are forwarding a copy of your complaint to > United Healthcare and ask that they initiate the internal appeal process > on your behalf. > > If upon completion of the internal appeal process, you are not satisfied, > please contact this Department again for further investigation. > According to recent legislation, you may be entitled to an additional > review. Please be sure to include: > > * A copy of the final response from the Appeals Committee > * A copy of your certificate of coverage > > Again, we hope this matter will be resolved to your satisfaction. > > Sincerely, > > > Julie Phillips, FLMI, ACS, AIE > Analyst Supervisor, Health Unit > Office of Consumer Services > Julie.phillips@ins.state.oh.us > (614) 644-3411 voice > (614) 995-7123 fax > > > Cc: Holly Robertson, United Healthcare of Ohio > J. Lee Covington, Director, Department of Insurance > John Pouliot, General Counsel, Ohio Department of Insurance > > June 19, 2001

I am faxing a copy of the complaint procedures that are in our plan booklet. The internal process IS COMPLETE. There is nothing else for them to do that I see in this plan. We have went through Section 5.1. Requesting a hearing according to Section 5.1, is not possible if the issue is related to quality of care and treatment. Therefore, we are at the paragraph where it says you have the right to take your grievance to the Ohio Department of Insurance!

I am now clarifying for you the following: I don't know what they are telling you, but I am telling you that I CAN READ and that you are being advised incorrectly! And according to my certificate of coverage I have done everything I should do and am now waiting on the Ohio Department of Insurance to do their job!

I am beginning to see that your organization doesn't really regulate the insurance companies. It appears to me that they aid the insurance companies in trying to get people to back off from claiming. That may work with other people, but not with me. I have had to spend hours just on this aspect of the appeals process because I can't make you see that my filing a claim with you was justified at this time.

Please take two minutes and read the pages I faxed and hold United Health Care accountable.

I am writing this letter in response to your letter dated June 20, 2001 where you again deny my daughter's medical treatments.

First let me tell you, I made this appeal, therefore you will direct any further correspondence directly to me and not dance around me to my husband. How dare you address your correspondence to him when it was my name on ALL correspondence you have received. I WILL NOT BE IGNORED! I can assure you he feels as passionate as I do that UHC should be paying for her medical treatments. He has a job to do for a living and needs to devote his time to that. THIS IS MY JOB NOW! I am acting on Abigail's behalf. You will note on the bottom of this letter, Steve has signed this letter and has made me his "designated representative".

In your first paragraph, you say I am requesting additional physical therapy visits beyond the benefit maximum. First of all, Brenda, for your information, is an occupational therapist, not a physical therapist and in my original complaint, it states this plainly. Secondly, we are requesting that you pay for Abbee's medically necessary treatments that her physician has prescribed and ordered. There is nothing in my certificate of coverage that denies her medically necessary treatment.

In your second paragraph, you state due to this benefit limit, the question of medical necessity is not considered in our decision. Let me tell you something that obviously UHC is not seeing here: her medical treatments are medically necessary and do address her quality of care, as they are being ordered and prescribed by her physician. Medical necessity and quality of care is at the bottom of this issue--IT IS THIS ISSUE! You are denying this child the medical treatments she needs to get Better and that are not excluded in your contract. That is the bottom line here!

At one place in the "process", and I use that term very loosely, you treat my original complaint as in section 5.1 (page 14) with issues related to quality of care and treatment. You yourself told me on the phone that I would have an answer within five days and I did. You also informed me, when asked directly, that even though the panel is called the Physician Specialty Panel, it had no physicians or nurses serving on it! Of course medical necessity is not considered in your decision. That is because there is no one qualified on the panel to make that kind of determination.

I, at 9:30 a.m. on Saturday morning, on your voice mail, requested a formal hearing with two witnesses standing here. You state in your third paragraph that you will coordinate the hearing on my behalf. Nobody from UHC is qualified to represent myself or my daughter. It is obvious that no one there has this baby's best interests or medical needs and necessities in mind.

You also state in paragraph four that according to Ohio law, the appeal to UHC must be completed in 60 days and give me seven days to forward a request. The day I started this campaign, and I can assure you I will NEVER forget it, was May 24, 2001. I received a call from your Corporate Public Relations Manager on the Tuesday following that. So where you are getting that I only have seven days is beyond me.

I can now see that this entire process is a joke, as I was already advised. There really ISN'T an appeal process in the State of Ohio. It is just a series of letters being thrown around. There is no one in charge of what UHC does. It is supposed to be the Department of Insurance, but they are holding UHC's hand. As the saying goes "don't bite the hand that feeds you!"

Lastly I want to quote your website at www.uhc.com under Investors. (It is obvious you save the best comments for those who want to give you money as opposed to children like Abbee who want to use their benefits!) "In the face of a child, you see a vision of the future. You see a sense of potential, a sense of growth and a sense of limitless achievement. We see a future filled with opportunity as today's potential becomes tomorrow's success. " How can you possibly deny this child the "opportunity" to live up to her fullest potential and limitless achievement? This is exactly what you are doing by denying her medical treatment.

I will assume I will hear from you on Monday morning to set up a hearing. I WILL BE PRESENT AT THAT HEARING!

I am giving my wife the right and responsibility to act in Abigail's behalf with regard to her appeals to United Health Care, effective June 22, 2001. She is my "designated representative". However, if you question my feelings about this issue, you may reach me during daytime hours at 614-833-6655 or 614-679-8266.

Cc: D. Clay, Lumbercraft J. Metz, California R. Hottinger S. DeWine S. Voinovich M. Kocot WBNS D. Cummins Fairfield Daily News

J. Mooney Insurance Injustice S. Petty, Ohio Legal Rights L. Covington Ohio Dept. of Insurance B. Taft, Governor W. McGuire CEO UHC July 21, 2001

Ohio Department of Insurance Consumer Services Division 2100 Stella Court Columbus, Ohio 43215-1067

I am filing, again, a complaint with the Ohio Department of Insurance regarding United Health Care. My daughter's coverage was again denied for no "legal" reason and for incredibly false advertisement.

In the hearing at United Health Care on July 18, 2001, UHC plainly stated on tape (copy of which can be provided) that they were denying Abbee's claim due to benefit maximums of Outpatient Rehabilitation Services of 20 visits each year for physical, occupational, speech and cardiac/pulmonary. However, they also stated that nowhere in the certificate of coverage was there a definition of these services. They then stated that they used CPT codes to determine the meaning. These CPT codes are not in any certificate of coverage, nor are they provided to any employer or individual that purchases their insurance. Therefore, they have denied my daughter's services based on a definition that myself or anyone else who purchases their insurance could possibly be aware of. This in my book is DECEPTIVE advertising. I also requested copies of all their advertising and as I expected, they have denied that request. I have attached some advertising that I found on the internet. Most of this comes from their own website or websites of their subsidiaries. They state in many of their advertising campaigns that they want the doctor to decide. Abbee's doctor has decided what is best for her and they are denying her anyway.

The services I am seeking for my daughter and that have been ordered by her physician are not clearly and unambiguously defined anywhere in the policy language. It is my understanding that any services that are not clearly and unambiguously defined by the certificate of coverage are not subject to any number of visit limitations according to the certificate of coverage and according to standards applied in a courtroom proceeding. This being the case, UHC has provided no reason, based on policy language, for denying Abbee's coverage.

On page iii of my certificate of coverage, UHC states in paragraph five, that Only Medically Necessary services are covered under the policy. Abbee' s physician has already deemed her services medically necessary. (Letter attached) They also state in paragraph seven of the same page that they can provide coverage for services, which would otherwise not be covered.

In Section 1751.01 of the ORC, Basic services are listed that must be provided as well as supplemental services. Occupational therapy is not listed in supplemental services. However, since her physician has deemed these services as medically necessary, they are covered under Section 1751.01 of the ORC and UHC is now in violation of that code. In addition, on page 17 of my certificate of coverage, section 6.12 (Conformity with Statutes) it states that any provision of the policy which, on its effective date, is in conflict with the requirements of state or federal statutes or regulations, is hereby amended to conform to the minimum requirements of such states/regulations. So as I see it, again, UHC is in violation of state law as stated in ORC 1751.02 I as well as ORC 1751.18 Discrimination, and is not adhering to its own statements in my certificate of coverage. It is your job sir, to force UHC to abide by state law. It is now your job to fine UHC up to $100,000 dollars and order them to repair the deficiencies of their certificates of coverage or order them to cease and desist operations in the State of Ohio as stated in ORC 1751.45.

In Section 1751.08 D, it states that you are not to be considered as practicing medicine. However, that is exactly what you are allowing UHC to do in denying my daughter's coverage.

Also in ORC Section 1751.83, UHC is supposed to provide an internal review, which was on 7/18/01 by a "clinical peer". There was no "clinical peer" present at that hearing. There were three voting members, none of whom would be considered clinical peers. After reviewing the audiotape, you will see that I am correct.

If Abbee does not receive these needed medical services; UHC would be bound by Section 1751.14 of the ORC, which would only further their costs, as they would have to continue to cover Abbee beyond the age of 18.

I want to take a moment too and comment on the UHC building in Westerville where I was required to drive for this hearing. I was speechless, looking at the marble floors and restroom facilities the size of rooms in my home. They can afford all of this due to their denials of claims such as Abbee's.

I am now demanding that the Ohio Department of Insurance do their job and make UHC adhere to the laws of this state and to their own promises. If they indeed want to advertise nationally, trying to lure in new employers to "invest" in their company, then they should be made to adhere to those advertisements. Enough is enough.

I want to let you know too, as of Friday, July 20, 2001, I am the official Director of the Ohio Chapter of the World Association of Disabilities, at the request of the International Director. I have their complete support on this issue and the State of Ohio Department of Insurance needs to be aware that all the members of this organization, as well as tens of thousands of others who have backed me in this quest to make UHC to adhere to law, are watching and expect that you only do your job.

Cc: J. Metz NCHCC M. Kocot WBNS D. Cummins Fairfield Daily Post B. Montgomery Attorney General Ohio D. Clay VP Lumbercraft G. Kerford WAPD CEO J. Mooney Insurance Crime Outline A. Archibald WAPD Flordia Chapter D. Belling WAPD Texas Chapter B. Taft Governor State of Ohio M. DeWine Senator State of Ohio G. Voinovich Senator State of Ohio J. Hottinger Representative State of Ohio D. Hobson Representative Ohio

IF YOU DON'T CARE ABOUT WHAT YOUR CONSTITUENTS/CLIENTS NEEDS ARE AND WOULD LIKE TO BE REMOVED FROM THIS LIST, REPLY AND TYPE REMOVE ME IMMEDIATELY IN ALL CAPS AND YOU WILL BE REMOVED AND ADDED TO MY WEB PAGE UNDER THE HEADING "OFFICIALS WHO DON'T GIVE A DAMN ABOUT WHAT THEIR CONSTIUENTS/CLIENTS NEEDS ARE".

Ohio Chapter WAPD (World Association People w/DisAbilities) 114 Holder Road Baltimore, OH 43105 (740) 862-5352 email cford@mail.WAPD.org www.fairfieldi.com\~cford

MSIcmbCpmC

Name: tudgpwasvp
Email: airvdt@ubhlmv.com
Date: 22 May 2008
Time: 05:25:40
Remote Name: 78.129.208.130

Story

Re: What Will Take For Me To Be Vindicated And Receive Justice?

Name:
Email:
Date: 16 Feb 2008
Time: 01:32:52
Remote Name: 198.54.202.82