Appealing the Appalling: 9 Months Later

Appealing the Appalling

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.

Elyssa Durant
Nashville, Tennessee

Identity Theft or TennCare Fraud?

There are a lot of things in the financial world that do not make sense. Such as having my tax return rejected from the IRS because someone had filed a tax return using my social security number.

Countless calls to the IRS, and although they were able to identify the person who had used my number fraudulently, they would not release that information to me so I could file a police report for identity theft (as I was instructed to do by regulatory authorities.) It took the IRS 9 months to send my refund, something that most people receive in less than 2 weeks.

So, after about a decade of this situation, and going through the motions year after year, to provide alternative forms of Income verification, I think I am well within my rights to be a little agitated.

This year I will be fling for an extension, as other related issues are currently under investigation.

Now I don't have much money, in fact I don't have any, but I find white collar crime despicable and repulsive.

When taken into account the substantial cost to society, not to mention the havoc it wreaked on my life, I respectfully think that maybe you should not assume that someone is making false claims just because you don't think it sounds "right."

Lots of things don't "sound right" however that doesn't mean they aren't true. Gotta go now, I have a date with eBay to auction my social security card
To the highest bidder. Clearly, it is not worth anything to me so long as the authorities fail to do their part in ENFORCING the laws associated with Identity theft. Sure, it is easy to blame the victim as being irresponsible or somehow negligent in these situations, however I will refer you to some fascinating research that has been done on the emotional consequences of Identity theft. The cost is far more than just an issue of financial discomfort, it is something that can ultimately leave you questioning your own identity.

It should be noted that Identity theft is a criminal matter, so whatever costs associated with such events, the victim is not reimbursed for any of the costs associated with having their life disrupted by something that is ultimately completely beyond their control.

It happens more often than you think, and it is a complicated, intricate, and time intensive to resolve such crimes, are in more complicated... To be continued...

Edd, Ed.M.
Sent via BlackBerry from T-Mobile

Hey Seigenthaler? Can I go for Free?

Sorry Folks... I heard the sub-title I spent an bitching about got cut off in the middle. Maybe I'll apply for a scholarship to one of those technical schools. Can't hurt-- my graduate degrees aren't worth Jack anyway!! Here's the link... I hope you can see the article and the HIPPA violation Loud and Clear!

From

If Sex Sells like Crazy: Crazy sells better!

"Good Fences"


The editor felt compelled to modify the title without my approval, authorization, consent or knowledge.

The story was not about being sick. It was about how important critical it is getting well and how labels hold us back.

How can you take THIS essay and stigmatize me for writing it? I may not be perfect, but there are many more like me who are just "differently" abled.

Thanks for the label, Mr. Editor~ next time, don't print my words if you intend to write me off.

From

I want a Do-over

I would like to review the merits of a insurance investigation that ultimately ruled in my favor, however I did not collect any damages of mandatory federal fines, because I could not do that without legal assistance. 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.

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 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 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.