Saturday, March 28, 2009

TIME ISSUES: The Powers That Tweet

March 24, 2009

Dear Representatives:

Thank you so much for your time and thoughtful consideration of the I do hope that people can learn from the mistakes of the past and perhaps realize that while matters of law should be consistent and rules are important for children, not all children respond to the same set of rules.

I attaching three documents to this e-mail that I hope will demonstrate how child custody can eventually become a very adult matter. Unfortunately, custody disputes and child arrangements can have some unintended consequences. In my case, the primary insurance company, Pennsylvania Blue Cross Blue Shield demanded a QMCSO (Qualified Medical Child Support Order) before they would provide me with a copy of my plan benefits plan, insurance identification card, and EOBs (explanation of benefits) They attorney for Blue Cross Blue Shield waited exactly 6 months 15 days after my 23rd birthday before mailing this information. Conveniently, two weeks after the terminal liability clause ran out.
Make no mistake. Denying a beneficiary of information regarding policy benefits and claims is a blatant violation of federal law. It comes under a class of civil litigation that has been historically difficult to win, and it is near impossible to collect ERISA claims. By the time I had received the information about my benefits, my condition deteriorated so quickly that I wound up in the emrgency room wiith bone spurs and even that calim was never paid.
Although it was determined that Pennsylvania Blue Shield was in violation of both state and federal law, I was so exhausted by the whole process that I never bothered never collected the penalty fees of $100 per day that were confirmed by the Pennsylvania Department of Public Welfare and the Pennsylvania Insurance Department.
It would have been near impossible to file a claim against Blue Cross Blue Shield, especially in the 3rd Circuit.

When I asked about COBRA benefits, Penna BCBS claimed it was the responsibility of the plan administrator and/or fiduciary to offer and extend COBRA. The paln admistrator must notify you in writing within two weeks of the qualifying event (in my case, my 23rd birthday)
Again, Pennsylvania BlCBS denied my rquests for informtion. They refused to honor a request for COBRA continuation, and argued that any requests for COBRA continuation must be directed towards the plan fiduciary or plan administrator.
Of course, that information was not made available to me, and Iever received a response from the Department of Labor in Washington, DC. To this day, March 28, 2009, I do not know the name of the Plan Fiduciary.
The next insurance company (Chickering / Aetna US HealthScare) claimed that Penna BCBS had terminal liability since I was disabled at the time of the qualifying event (my 23rd birthday)

The third insurance company (Oxford Health Insurance, an HMO in New York State) told me that as the third payor in line, I could only submit claims after providing them with proof that the claim had beendenied under the Penna BCBS terminal liability clause, and the Graduate Student Health Insurance at Columbia University.
So despite paying several hundred dollars each month, they ultimately covered little more than a limited number of visits to a primary care provider, and one trip to the ob/gyn for an annual exam.

When I moved to Tennessee in 1996, I had no idea that I would be sitting here almost 15 years later waiting on prior-authorizations, pharmacy overrides, and appealing and filing the same paper work for TennCare that I submitted back in '96.
Because I had received a full scholarship into a PhD program in Public Policy, I intended to purchase the Graduate Student Health Insurance through Vanderbilt University and expected a seamless transition since Ihad maintained contimuous coverage.

Although both Vanderbilt and Columbia Universities used the same insurance company, Chickering / Aetna US HealthCare, they had different group numbers so the policy would not transfer benefits.
Ultimately the state of Tennessee is picking up the tab in every sense of the word. Because the care I received was delayed and did not meet the established standard of care set forth by the medical community.
By the time I started to receive treatment for y physical condition, my mind was so far gone that it I could think of nothing other than ICD-9 codes, reimbursement rates, and preparing for the next round of appeals.
In the most disturbing twist of fate, I learned that Vanderbilt University did not provide mental health treatment for their Graduate Students. So having once, perhaps been of sound mind, I now had developed a full blown case of PTSD.
I was able to gain access to the Chief of Neurology and the Vanderbilt Spine Center through a special process that required considerable planning and persistance. And if nothing else, the one thing I am is persistent.
My neurologist began to notice signs of acute stress and made a referal to a neuropsychologist that he had hand picked, but by that time I simply did not have the strength, the fortitude or the desire to continue spending each and every day filinginsurance claims and appeals, that it was easier to live with the physical pain than be confronted with the emotional trauma each and every day, over, and over, and over again.
I no longer received the most basic of care for an list of diagnoses that seemedto be growing exponentially. I could not focus on anything other than insurance law and policy (which I barely passed) and wondering if I would ever be able to be independent and free from this awful experience, and the answer is an obvious NO.
I stopped applying for prior authorization, overrides, appeals and everything else, and just went through the motions with an occasional visit to the Student Health Center if I needed a flu shot or a throat culture.
I was referred to a specialist in neuropsychology and physiology because by that time, there were systemic changes to my mind and body. My cortisol levels tested below normal which seems odd to anyone under acute stress. What I learned, unfortunately, is that after long term periods of extreme and abnormal trauma and stress, the body and mind become numb and lack critical thinking skills and motivation due to chemical changes that occur over time.
I could read it, I could feel it, I could understand it, but I couild not stop the external forces that contributed to my condition. Do not think for a seconfd that I have an external locus of control, because I do recognize the difference between receiving a letter from the IRS and a coupon promising benefits that are like the Sweepstakes gone bad.
So the so called junk mail piled up, people continued to speculate as to what the ~ was wrong with me, but nobody offered to help.
There are times in life where the failure to act can be just as devistating and harmful to a person as making a bad decision. So nobody took me seriouslym and thought I must be living some fantasy in my head that was some how "controlling" my obsessive need to lock in my personal information and social secutrity number.
Today, I think I may put my Social Security Card on eBay since it is completely useless to me.
You don't to call my parents or call mobile crisis, I am neither homicidal, suicidal or delusional, I'm just determined set the record straight before my internet is terminated and/or I have to find another place to live, which at this point would most like;y be in my car.
I have no worries about anyone getting harmed right nowm because I'm sure that I know the difference between reckless endagerment and criminal negligence. So please don't call me today, I really don't feel like putting a smile for anyone other than myself. Tweet if you must... perhaps I should this post the Powers That Tweet.
I could clearly see the Writing On The Wall , and had littlehope or optisimism that that my situation would improve. One of the most significant factors predicting the outcomes of treatment modalities along with the long term prognosis for treating crazy people like me.
At times I look forward to the final straw that truly does put me over the edge. That way I could stop living my life in a way that focuses only on the physical "chain of evidence"which was exaplained to me last week at the loony bin. I think I am a pretty good judge when it comes to recognizing HIPPA violations and third party disclosure disclosures of legally protected medical information.
But to give an idea about how serious this situation is, I have already scanned in the necessary tax documents to link them back to the original source, but ironically that person does not bother to check their email unless they want something form me.
I won't be speaking today I'm rather more interested in preparing for a trial on April the 1st, and of course Tax Daym again, on the 15th. Yeah, this should be fun.
So do me a favor and DO diligence for once. Do the right thing just for today.
And as much as I hate the fact that my body hurts and I have to find someway to strech eleven dollars over the next two weeks, that I would appreciate a few tweets even though I have no idea how the stupid thjing works on my cell phone.
But whatever, I've got work to do. Catch you later.
Side note: cut and paste... computer off, youtube on. Now I'm smiling...
I doubt anyone who knows me, and I mean actually knows me wants interefere with my ability to write and listen to the Dixie Chicks desire to write. Do you really want to challenge me just for today to stop writing. I do realize the difference between the formal process of communications and the krazy kid talk which scares the bejesus out of people. Whatever... this is up for grabs... I'm going to get a cheeseburger for a buck.
... blah blah blah blah.. blah blah...
informal assessment people make regarding someone's personal information.
Some documents are subject to re-disclosure and medical privacy protectionsm some are not. But recent weeks have shown me the hurtful side of informal assessment and how that can effect a grown person like myself who normally would not give a rat's ass as to what other eople opinions and judgments regarding my character.
Not today. Not right now. If you need clarify any of this I would refer to a graduate level seminar on the Sociology of Evaluation. I'm sure you can find online somewhere. I need a break.
There are times where I wish for that the my body would just go ahread anfd the rest of my adrenaline and cortisol so I cuild be free from the physical pain I feel right now, and theinherent sadness that comes from the realization that you can only do so much for so ling, and the healthy thing is to goive up. I'm still undecided.
Emotionally I cannot process the reason for this madness, and I am not referring to the madness in my head.
~insert figure 1 about here ~
... that of permanet state numbness that comes sustained periods of extrordinary stress and trauma... received gone so long without care, despite have three (overlapping) private health insurance policies I ultimately wound up on TennCare since it was a constant battle to identify the primary payor source responsible for payment. bla, blah, blah...

As a result I have been on TennCare since 1996, and I can assure you that the state is not getting off cheap. Please do not allow the Mandatory Joint Custody Bill to go through. I would not wish this experience on anyone, least of all, a child.

Please feel free to distribute these documents to all members of the Domestic Relations Committee, as they are in no way confidential at this point in time.

Thank you again for your time and consideration.

Sincerely yours,

Elyssa Durant, Ed.M.
Nashville, Tennessee
Cell: (615) 424-8810

"You may not care how much I know, but you don't know how much I care."

-Elyssa D'Educrat

1 comment:

  1. Sweetness~ The very tenants to the evaluation process are such as to make one feel about as small and dirty as a spec of dust~

    I myself did my forth evaluation [in this case for disability that should have been filed 10 yrs ago due to a horrific car accident [broken neck [crumbled C6 and tail of C7 broken off] and THI/TBI from being scalped forehead to neck in a wide "C" & closed head trauma]~

    Since I now no longer have any traces of being maimed, hurt, dead, or disfigured~I am therefore in their eyes just another wanna be blood sucker trying to get $ [that "I" paid into the system] but one would think the $ is being taken personally from their own bank account loll~this last guy made me so mad [and by his very actions was trying to get me to quit the proceedings but I refused] that I full ready to jump over the table and throttle him[I could have beat the wimp too!!!]]~anyways~the system is made to discourage people like us who can actually think but is fully ready to help all who haven't even paid INTO the system!!!!
    What more can I say...I think we should revoke our citizenship, go to Mexico and reenter illegally..loll... PSTD is absolutely no F U N to deal with as I should know [don't ever sneak up behind me~just saying..loll ;))...] and neither is accident related full blown fibromyalgia~
    I gave up on the disability as they knew I even admit that I might be not functioning on a full bowl of oatmeal is enough to make me not want to leave my bed or otherwise engage with society~
    All that being said you can see I know a thing or two about pain and mental suffering having had to reteach myself almost everything I had once known, and I will help you within the best of my abilities for you have joined the sisterhood of the suffering of which there are many~just remember it's what one choses to do with their now enlightened minds that matters and how we may help society itself understand the conundrum we are in here on THIS plane...

    So I am here and will surround you with love and light #love twitterverse & #hugs ;)))



Elyssa D. Durant, Ed.M.