Saturday, October 17, 2009

Reform Requires Regulation: ERISA, COBRA & Federal Law

For anyone who would like to know why I feel so strongly that any reform that does not address the issue of regulation, oversight and enforcement... perhaps my experience will serve as an example of how the judicial system fails to protect those who so desperately need help to fight injustice, inequity and corruption in the United States of America.

At twenty-two…

At 22 I was diagnosed with a degenerative spinal condition. Yes, there are times when the pain is so terrible, I cannot lifet myself out pf ed or tie my shoes. But far worse is having the knowledge that the level of damage to my spinal cord could have been stopped had I received adequate health care.

Yes, I had insurance. But who was there to make them pay???

14 years later, I finally received surgical intervention, and can feel my hands again-- and as a writer, that has been a miraculous gift.

Through the toughest times in my life, no one told me I was wasting my time and money on an education I would never be able to use.

After all I just wanted a diversion.

Even more disturbing than the damage to my spinal cord, is the realization that I missed mosre than 14 years of my life. So not only did I waste my time and money on an education I will never be able to use, I wasted a window of opportunity. A moment in time when I almost had a world the world at my fingertips.

Without any real place to go after college, I felt I had no other choice than to become a professional student of sorts—you know, the ones who stay in school forever to take advantage of cheap housing, health insurance, and student loans.

Unfortunately, I wandered aimlessly through the system acquiring useless knowledge and letters after my name that do not mean jack in the real world. But it distracted mye from the fact that my spinal cord continued to worsen my physical and emotional health.

So with no prosepects on the horizon-- and so thrilled thto feel my hands today, that the one thing I can do is write. So for now, I write, maybe tomorrow I'll read, but if there is any justice left in this world, maybe someday I will actually live.

Despite having four individual insurance policies including a major plan with Blue Cross Blue Shield for $1,000,000; I still wound up on Medicaid, and eventually welfare and social security with a total income of under $6,000 / year.

The insurance investigators ultimately ruled in my favor, however I was unable to collect any damages for two reasons: Although mandatory federal fines in the amount of $560,000 would require legal assistance and complicated civil litigation that would be timely, costly, and emotionally traumatic. Second, under federal law, grants immunity to ERISA plans: a type of group insurance that is totally untouchable due to federal preemption of state law that leaves the beneficiary without recourse or the ability to collect punitive damages under federal law,

Unfortunately, this was a very complicated case that involved unscrupulous attorneys that involved tax and insurance fraud, and has yet to be resolved despite the overwhelming evidence of fraud and the favorable ruling from the insurance department. It should also be notes that no criminal charges were ever brought against any of the participants, which s even more disturbing if you knew the history of the parties involved, some were arrested for RICO conspiracy, Tax Evasion, Embezzlement, Extortion, and wire fraud. One man actually shot himself in the head one month after the Insurance Dept. opened the investigation.

So one is dead, one got off on a technicality, one was acquitted, and several others were never prosecuted. I however, pay a price for their crimes every day of my life, I now live in a prison of sorts: a prison of poverty, and despair with no real expectation of change on the horizon.


I recently learned that for the last 14 years, my parents used my social security number and that I was claimed as dependent on a NY State tax return. 

To complicate matters, I sit with the reality that I was screwed for life at the tender age of 22 and must somehow balance that knowledge with the ignorance and incompetence that surrounds me in my daily life. 

The country continues to fight a battle that can't be won without people like me who are willing to come forward, call their bluff, and say enough is enough.  Unforunately the country continues to self destruct and the citizens of the world are watching as the all mighty American dream is noting more than myth created by ignorance, propoganda, and elitist politicos that want nothing more than my silence and your ignorance.  Well fuck that, because I'm still here, and this ost will go straight to DC the moment I hit send.  So you can take it down, you can intercept my signal, but the truth is out there and I will not be intimidated or marginalized by the Powers That Beat.  So here we go... again... for the record (if one exists...)  [edd/eds 10.25.2009]

I live with the effects due to federal law (1) As a covered beneficiary under an ERISA plan, I will never be able to access; (2) being claimed as a dependent on my mother's NY State tax return for so many years it is near impossible impossible to go back and set the record straight.  This little factoid made it legally impossible to file taxes, obtain insurance, disability benefits, or student financial aid, and neither parent is willing to compromise.

They will NEVER release a copy of their returns. [edd/eds 10.25.2009]

For historical purposes, let take a trip back to 1995 where I spent most of my time in a state of confusion and completely in the dark about the damage I was to do as an unwilling participant of fraud and abuse in the health care industry... CONTENT WARNING read only if you are prepared to deal with the facts... I invite you to share this truth with whomever you like.  I have no where to run to, no where to hide.  But I will move forward for the sake of my sanity... I know things too... but it is not how well you know the law, iit how well you know the Judge. 

Try to bare with me as my mind is contantly in overdrive and my thought patterns have been altered through years of trauma, accute and chronic stress... so take your time, question authority, question me,  but don't be surprised if I I stfu for as I prepare for the fall out...

But remember this, if what I am saying is true, it is serious.  But even if I am making it all up...  it is still pretty fucking serious!  I can't remove the documents that were already posted, so I can not be held in contempt for something I did in good faith.  So they are probably out there somewhere waiting to reveal this web of deception that can only exist in a corrupt society through a pattern of judicial failure and social injustice:

1995: I filed a complaint with the Pennsylvania Insurance Department in 1995, and received response six months 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, the Insurance Dept. Did not have the authority to override the terms of the contract.

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 Identification Card; a hard copy of the policy) all requests for ERISA mandated materials were repeatedly denied until the Jason Manne from the Dept. of Public Welfare sent a letter to 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  to 36 months 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. 

The Health Insurance Portability Act of 1996 was no help (NY State Public Law Enacted in 1996) and each policy passed me off to the next. Without EOBS or proof of comparable coverage, primary and secondary coverage could not be established and I began a 14 year journey into hell. Being forced to produce paperwork I could not obtain, my dissent into madness took hold of my life, each day a new request feeding my OCD with Ten Day letters, federal mandates and court ordered repetition.

Each company trieds to subrogate the next, and I watched my life: my dreams, my aspirations, my goals get sucked into the vortex of chaos and hell. I will never be free from the madness. The memories are burned into my memory like and I eat, sleep, dream, and search for solutions that never seem to arrive.  

My life is a constant battle to balance the reality of what is, and the hope for a judicial system that could enforce what should be.  The truth is out there in black and white, and I refuse to be silenced by people who simply refuse to take responsibility for their role in creating or feeding the Powers That Beat. Public Record, fucktards. So deal with it or go away. [edd/eds 10.25.2009]

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 obtaining accurate information through the FOIA and the Pennsylvania Right To Know Act. 

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 my complaint against Independence Blue Cross Blue Shield, I had no idea what I was about to uncover.  Each agency denied responsibility despite the overwhelming evidence of fraud that I had provided. I started to receive calls that puzzled me...  and it was only a few years ago that a psychiatrist finally took the time to investigate the facts.  My diagnosis was changed that same day, and never again will I allow "crazy" to be an excuse for any of the guilty parties involved. I don't have to.  I may be crazy, but that does not change the simple truth or the facts of my case. I am not delusional, though I often wish that I were.  I will never wake up to find that this clusterfuck was just a dream or a figment of my imagination.  There is no pill to erase the facts or to drag me out of this rabbit hole.  I am Alice in Blunderland. And we all pay the price.  Red pill or blue pill, the facts remain. So do what you please... but don't blame systemic failure on my state of mind.  Blame it on the state of affairs and social injustice and the lack of enforcement for all things holy in the US of A. [edd/eds 10.25.2009]

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 anyone 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.

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