Part I: Insurance Department: File Number #95-192-1535
I would like to review the merits of an Insurance Investigation that ultimately ruled in my favor that concluded on April 16, 1996. File No. 95192-07586
Unfortunately, this is a very complicated case that involves tax and insurance fraud, because I recently learned that for the last 14 years, my parents have been using my social security number to claim as (1) an employee -- thus covered under an ERISA beneficiary plan that I have never been able to access and (2) was claimed as a dependent on my mother's NY State tax return for many years making impossible for me to file taxes or obtain insurance, disability benefits, or student financial aid since neither parent is willing to release a copy of their return.
I filed a complaint with the Pennsylvania Insurance Department in 1995, and received response six moths after the policy had expired. Despite the considerable evidence I provided to the Insurance Dept. and Pennsylvania Blue Shield, I was told that despite the overwhelming evidence that I provided, Blue Shield / Insurance Dept.] did not have the authority to override the terms of the contract. I did not collect any damages of mandatory federal fines, because I could not do that without legal assistance.
Since ERISA mandates that all beneficiaries (including insured dependents) be given a copy of the policy (among other forms of insurance identification, e.g., EOBs, Insurance ID C, and a copy of the policy, my requests for ERISA mandated materials were repeatedly denied until Jason Manne made a Title IV-D request from the Pennsylvania Dept. of Public Welfare. After sending a letter to Pensylvania Blue Shield, my insurance carrier to inform them that they in accordance with federal law, they must honor my request for a copy of the insurance policy.
The insurance Department came to the same conclusion: that my rights under federal law had been violated, but because this situation was unprecedented in the state of Pennsylvania, it took approximately 9 months before BCBS decided to send me the necessary documentation. In addition, my plan had expired, and BCBS refused to honor my request for COBRA continuation (which would have been extended from 18 months to 36 since I was disabled at the time of the qualifying event plan supporting my initial request for federally mandated information in accordance with ERISA 4236.
Blue Shield refused to honor my request for COBRA continuation and / or a reassignment of benefits so those providers could be reimbursed directly. According to their attorney, Tija Hilton-Phillips, they had no obligation to provide me with any information about COBRA continuation and shifted the burden of responsibility onto the plan administrator and/or fiduciary. In addition to having the terms of my policy falsified in writing, I was unable to identify the plan administrator of fiduciary. Since federal law requires that all plans be filed with the Dept. of Labor, I contacted them on multiple occasions and wrote several letters requesting a copy of claims made under the policy, the plan fiduciary, administrator, and the specific type of ERISA plan (e.g., self-insured) that was on filed in accordance with federal law. Again, my verbal requests were denied. I then sent a written request to the regional office in Philadelphia but again, received no response.
Washington requests in Washington in accordance with federal law. , e.g., self-insured, their assistance in (with information Furthermore, the Dept. of Labor requesting this information were never answered. I never found out the name of the plan administrator or the fiduciary, and was never offered COBRA continuation, and then BCBS refused to let me continue under COBRA, claiming they were not obligated to offer it to... so who is ultimately held accountable in these situations.
When I first filed this complaint against BCBS, each agency denied responsibility despite the overwhelming evidence that I had provided. Although I was only 22 at the time, I spent my days and nights reading up on insurance, labor and employment law, and subsequently came to believe that aside from violating my natural rights, I had been denied due process protections and requested legal assistance from advocacy organizations in New York, Pennsylvania and Tennessee. I was unable to find any one who would take my claims seriously, and could not find anyone to take my case pro-bono or on contingency. Eventually, I moved to Nashville, TN and tried to recover from the physical injuries and the new emotional scars that left me cynical and bitter about a judicial system that consistently fails to enforce natural and human rights.
Everyone I spoken to thus far reiterates the same statement-- practically verbatim, "I sympathize with your dilemma, yet, as you know, our office does not have the jurisdiction to assist you in this matter." I sought the assistance of an attorney at Shnaeder Harrison years ago (regarding Pennsylvania Act 62) and Jason Manne in the Dept. of Public Welfare.
Although I may be biased, I believe this case has substantial social merit and long standing implications for children in the state of Pennsylvania. I am a reputable witness, and have 5 years of doctoral studies under my belt in the field of social policy.
I have been unsuccessful in my search for a competent litigator (unfortunately, this is an unprecedented case that touches on all the hot issues before the 3rd circuit including ERISA and the State's interest in Equal Educational Opportunity and due process protections for children (and adults) who are "victimized twice... first by their parents, and then, again by a judicial system who fails to protect them" (it's been a while, but I believe that is a paraphrase of the dissenting opinion from Justice Montemuro in Curtis v. Klein.)
In many ways, I feel it is too late for me to recover what I lost due to a snag in the law and a few loopholes in the system. I have collected evidence for over 14 years because I used to believe that justice might prevail.
If she has an interest in looking bold into the face of police corruption, I would like to share my story (and the documents) to be sure no other child in the Commonwealth of Pennsylvania falls victim to such heinous crimes due to legal technicalities from an outdated piece of legislation. It has been 14 years since my case was “abandoned” by the state judicial system in the Philadelphia Court of Common Pleas. It is time to have these loop holes closed for good and ensure equal protection under the law for all children—not just those who are lucky enough to have a fair hearing or be heard before they reach the age of majority.
With the support and inspiration, I received from some very kind and brilliant professors in sociology and social policy, plan to submit a book proposal to document the sequence of events that still astound me and curious onlookers who take a quick peek as they casually pass in and out of my life. You see, it is much like a traffic accident-- people like to take comfort in seeing the tragedy of a broken man and his family demonstrating the social injustices and inequity resulting from a stratified society where only "violent" criminals or those who commit acts that violate or impede the natural rights of others are not taken seriously by the judicial system or the public at large. Unaware of the consequences that arise from dual standards in the worst of academic snobbery and intellectual elitism -- living a lifestyle they might otherwise envy.
I would appreciate assistance in restoring my social security number and account so that I do not have live in constant fear. If that means either relocating to another country and/or having my name and social security number changed or restored, it is probably well worth the inconvenience if it means there is still hope for living a peaceful existence.
Part II: Duplication of Benefits: Medicaid to the Rescue
The Application and Appeal for Disability Benefits
I remember how difficult it was for me to obtain benefits when I first applied several years ago. I am deeply concerned about how the most recent decision to eradicate yet another class of TennCare / Medicaid recipients (the Daniels class made up of SSI recipients by way of a pending federal waiver) will affect the poor and disabled residents in Tennessee. Without my current level of benefits, I simply do not function.
Before my benefits were stabilized, learning to navigate the system consumed every waking moment of my life. I was unable to work or attend school on any substantial level and I am frightened to see at might happen if I were to stray from my established, stabilized, treatment plan. If I lose my benefits, will I still be able to work? To function? To be productive?
Any new public program requires careful planning if it is to be effective. Recent discussions have not focused on the true impact these changes will have on the "street-level."
Has anyone asked recipients how they feel the new program (safety- net) should be designed, implemented, or evaluated? How will this impact the community and other social service or welfare agencies??? I want access, quality, and outcomes. I want... I want... I want!!!
The massive number of people being dis-enrolled or limited in their access to medical care and other social services will no doubt create significant anxiety, confusion, and chaos for everyone involved in the social service and health care industries.
I remember when Mr. Brian Lapps was somewhere very high up on the corporate TennCare ladder in 1999 when they adjusted the prescription formulary over Memorial Day in 1999. I see Mr. Lapps quite frequently since he now works at the local gas station down the street from where I live.
To this day, he insists that cell phones and TennCare are somehow contraindicated. Perhaps he knows nothing of the population he claims to know just all-too-well... housing conditions that may or may not have electricity, broken families-some riddled with community violence and domestic disturbances. In the hood, your cell phone is your very best friend. 9-1-1.
These people plagued by domestic violence and community instability makes a cell phone the only logical option. How can you find a job with out a phone? How can you find a home with out a job? Yet even 6 years later, Mr. Lapps uses cellular phones as an example how the TennCare program is being abused by lazy, cheap, and unscrupulous second hand citizens who are just shiftless lazy bums waiting around for their next free hand-out.
Anyone who has EVER applied for or relied upon any kind of government subsidy to have their basic needs met, e.g., food, shelter, medical care, dental treatment, etc... let me personally assure you that there has never been a single time where I felt I was "pulling one over" on the government. I am not just one of the poor saps who believed what they told me they in school, I bought it hook, line, and sinker for the mere price of $152,718.130 and not a shred of financial security to show for it.
Even after consolidating my student loans, the interest alone is $10 less than my monthly income from social security.
Tennessee is in the process of applying for yet ANOTHER federal waiver to eliminate the "Daniels" class of Medicaid recipients-- the poorest and sickest of all. SSI Recipients. Can you live on $623.00 / month? Can anyone?
So what happens now that the state of Tennessee will begin to cut off social security recipients from TennCare? I honestly do not think I can survive yet another re-certification process-- God knows the first one almost killed me. After three years of appeals, my condition had deteriorated so severely that I was forced to drop out of school, lost my home, lost my sanity, and lost hope. In short-- I lost my dignity and my belief in the social welfare system.
By the time my benefits were approved, I had already checked myself in to NYU Psych Ward because simply could not cope with the reality of what my life I had become. I weighed 94 pounds and suffered in excruciating pain that has only gotten worse with time. My extremities were ice cold, and my hands were numb since I went without medical treatment for the spinal injury that was first discovered when I was 22.
I am now 36 years old. My spinal cord is now damaged from years of delayed, sub-standard medical treatment. I owe the federal government $179,982.00 in student loans and when I am able to work, I make $10.46 / hour as a substitute teacher in an urban school district. That job comes with no security and no benefits. It does however offer the flexibility I need to receive the bi-monthly epidural injections and other procedures necessary to manage my pain and alleviate the numbness I feel because of the damage to my nerves. And even though I cannot afford the gas money to get my appointments, pay for all of my medication, or even to get back and forth to work, it does allow me a few weeks of mobility so I can drive, use my mouse or hold a pen.
I have an advanced master's degree from an Ivy League Institution. I am 12 credits shy of a PhD in public policy. And despite maintaining a 3.83 grade point average while completing an advanced masters in social and educational policy at an, "Ivy League" institution; a 3.2 GPA during the 3 years I spent working on my doctorate at a not-quite-so-prestigious Graduate School; The Powers That Beat in that damn Ivory Tower don't will not grant me any leniency by extending the amount or time permitted to complete my degree-- a rule that was changed while I was on a formal leave of absence tending to my health (and my Medicaid appeals!). Not only did they decide 8 years was the rule instead of the 10 it had been previously, I was also told that I could not even transfer the credits I had earned toward a different degree towards another program at the same institution. It has been just over ten years since I first enrolled. What a mistake that was!
The "Harvard of the South" no longer officers the degree to which I was admitted-- and enrolled so they actually suggested that I pay for a 3rd application to the school (I was admitted into two degrees-- the MPP as well as the PhD program in a separate college) requiring two independent applications, fees, transcripts, test scores, even way back when I was still considered a promising candidate. Now "they" think it is reasonable to ask that I do it all over again??? It goes without saying that I do not have the financial resources available to finish my last semester, take the GREs or GMATs one more time, or even the money to release my transcripts from the Graduate School into any other program at the same University, I guess I am just shit out of luck.
To be clear, WE ARE ALL PAYING for that student debt because I can assure you that their endowment is far greater than any income or earning potential I have given my current financial status and student loan debt! To be clear, YOU ARE ALL PAYING to keep me on Welfare. Yes, all of us are paying some price..... We I want to work. I want to be productive. I want to be a part of something greater than myself. I want to share what I've learned.
So throughout the years I struggled to stay in school, believing somehow that social justice would prevail, and my heart and dedication towards the greater good would show through to whomever, wherever, or whatever that could make my degree worth while-- the Medicaid and disability applications managed to take front seat. So as I filed appeal after appeal after appeal, I managed to acquire well over 1/4 million (yes-- MILLION) dollars in debt due to uninsured medical expenses and student loans. Despite having 3 Major Medical insurance policies, I still went bankrupt applying for Medicaid. Morally Bankrupt.
My life will never be the same. My heart will never be the same. I want to pay my bills on time. I want to get off welfare, but no one ever taught me how to be poor.
So after all this-- now I face losing my healthcare once again? Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point spending so much on an education that will never be utilized? I understand the how; I just don't understand why.
Maybe one of these days Vanderbilt University or and the Department of Education will realize it might just be cheaper to hire me that harass me, because unless I find a real paying job soon, their collections department will no longer be able to reach me on that extravagant lifeline my friend, Brian Lapps, refers to as a luxury.
If anyone on your staff would like to "trade places" with me for one month-I will gladly assume his/her responsibilities for that position if you can find a writer who is willing to endure and write about the reality of social services in our fine state. I do not want a paycheck from your organization; I just want the opportunity to put the myth of freeloading welfare mother s to rest. Live in my shoes for 30 days. Can you find the out? Can you balance my budget and make it work? Can you get the bill collectors of my back? Can you afford Internet service to file state job applications and apply for services online? Can you maintain pride and dignity without feeling the least bit sorry for yourself and the choices you have made?
When I go to the pharmacy, I am humiliated that I do not have the $3.00 necessary for the co-pay on my covered TennCare prescriptions. At least when it was $40 dollars, I was not so damn embarrassed by my lack of funds.
Remind me again why I went to school. Remind me once more why I bother to speak out. Then remind me right now that that there is somebody listening. I cannot be the only one who actually gives a crap. My contact information is listed below.
Part III: The Final Appeal: While Frozen in Time My Life Comes to Halt
An Appalling Appeal: It Was Never Reviewed: Appeal Filed September 11, 2009
Today I was finally able to submit handed in the appeal I waited over three years to submit. And it is just an APPEAL!
Not even a decision. Not a win, but also not a loss.
The APPEAL has given me the strength to keep going. In part because it shows that I haven't lost and in part because it means that somebody actually listening.
So listen carefully, my friends. It was not too long ago that I had almost everything a young person needs to succeed in this world.
Or maybe not.
As for my most current insurance dispute... I feel that I have done everything humanly possible to be sympathetic towards health care provider who is NOT providing care. I cannot sacrifice my own well being for every bright eyed bushy tailed wanna be who is too stupid to see that I am far from.
I had such a battle this week. It culminated in the end like every other battle I have taken on. I only won because ultimately but we are all losing.
For every underqualifed, health care provider who has NOT provided the adequate, there are many more like me. Alienated just enough to give up on fashion, etiquette and social norms, but not enough to walk from it all.
We are keeping watch. We are taking names, and I for one do not give a rat's ass about "keeping the peace."
Having been on both sides if the proverbial couch, I have the perspective is both enlightening and scary at the same time. I look back and want to say shout "told you so" from the nearest roof top.
Crazy is crazy does... out loud. I may be enjoying this just a little too much.
Sometimes I try to look at this fight, (I meant to say this life) objectively.
I can see my own future, and I can see where it is taking me. I know how it will end it I don't keep up the pace.
It is amazing at how far we will go to have nothing at all.
I have come this far, and on some level I almost enjoy the dance. No. On some level, I actually love the dance.
No. I won't give up now. Because without this turmoil, this means to an end, this demonstration project of futility and determination, and without it, I am nothing at all. I can't lose what I never had. I won’t be another sell-out-- mostly because I don't know how.
I am then the voice of perseverance. I am one voice of perseverance. I am one of 47 million Americans. And today I am I am still fighting the good fight.
This battle; this challenge; this half won war this fight has come to define me. And without that, I am not really much of anything at all...
As someone once told me, if you don’t stand for something, you will fall for anything. I've already fallen, but I sure as shit stand for something.
"... so for now, I write. Maybe later listen. And if there is any justice left in this world, maybe someday, I'll actually live. "
Good night, folks. It is time for that break.
Part IV: The Final Outcome
Where I Stand Today? I Have No Fucking Idea
Social Security Informed Me My Coverage Will End Today, July 1, 2009.
This letter was written, at 4:33 EST. Over and Out.
I just received a letter from the United States Congress.
Please summon the angels. I need some good news.
Elyssa Durant, Ed.M.
Nashville, Tennessee, USA