Our goal is to help reform the health insurance
industry by identifying individual and systematic patient abuse that helps
carriers dodge their responsibilities, deny benefits and delay payments. We want
to empower patients and give them a voice, especially cancer patients and others
with chronic or terminal illnesses.
_____________________________
We envision a health insurance
industry whose primary mission is the health
and well-being of the people who keep insurance carriers alive -- the policyholders!
__________________________________
This sounds like common sense, but it is far from common practice.*
The insurance lobby is strong, so patients must unite to be effective.Strong leadership and stronger oversight are
needed to foment this "common sense" change in attitude. Abuse
has become institutionalized, even enshrined in U.S. law.**
In my
case, it has threatened my life and extended across three generations. My daughter, Joanna Joshua, talks about my grandson's story in a new expose on United Healthcare, "Health Insurance Lies," the second video below in the "Sick for Profit" series from Brave New Films.
NEW! "Sick for Profit" Video "The Health Insurance Racket" Find
out how CIGNA disenfranchised me as a cancer patient, and why I'm
calling for a criminal investigation by the Justice Department of
abusive practices. If we are serious about healthcare reform, we must clean up health insurance.
Health Insurance Reform
The "Code Blue" Movement
United Patients of America believes that holding up health insurance abuse -- large and small -- to greater public scrutiny will encourage carriers to change their behavior. We believe that those carriers whose corporate policies most align with this mission will also be the most successful, and will be rewarded by a growing base of loyal customers. Just as the "green movement" encourages green suppliers, and volume helps lower costs of green products, we believe that this "Code Blue" movement, which emphasizes the health and well being of patients, will ultimately benefit shareholders and policyholders alike. Toward this end:
We
encourage government leaders at the local, state and federal levels to help institute insurance reforms and safeguards that put
patients first, that close loopholes, establish clear guidelines, and clear penalties for patient abuse.
We encourage Consumer Reports and consumer health advocates
to develop a consistent performance rating system so that benefit managers and
consumers can more objectively evaluate health insurance carriers on quality of
service. As
an issue of life and death, this information must be transparent.
We encourage
patients to speak out to elected representatives, and
to share news and information on this site and beyond.We also welcome financial contributions to help further our mission. ...
By Jo Joshua Godfrey, United Patients of America | July 11, 2011 at 09:12 PM EDT | No Comments
Many health insurance companies seem to be in business not to insure policyholders but to deny coverage for any legal reason possible, and if they must cover, to delay. One of the biggest offenders among these "Deny and Delay" companies in my experience is CIGNA insurance.Science does not seem to matter much, and compassion less still.
It may take a national class action lawsuit to get CIGNA to change its longstanding policy that denies coverage for most Applied Behavior Analysis (ABA) therapy.ABA therapy is an important treatment for autism spectrum disorders (ASDs). Applied behavior analysis uses modern behavioral learning theory to modify overt behaviors. The science focuses on the observable relationship of behavior to the environment. (1)
Autism spectrum disorders are typically marked by speech and behavioral dysfunction.So therapies that focus on changing behavior are critical as more families seek effective treatment options.The U.S. Centers for Disease Control and Prevention estimate the incidence of autism spectrum disorders at 1 in 110 children, though the actual rate may be much higher.(2)
Behavioral science is not new.More than 60 years ago, B.F. Skinner, one of the most influential psychologist of the 20th Century, experimented with rats to develop the science of behavioral conditioning.His pioneering work helped spawn a range of behavioral modification approaches, and ABA therapies have been successfully used for more than 50 years. Yet CIGNA attempts to exclude ABA therapies where possible with medical policy language like this: "Many benefit plans specifically exclude behavioral training or services that are considered educational and/or training in nature. In benefit plans where this exclusion is present, services that are considered behavioral training or such as intensive behavioral interventions would not be covered." (3)
A federal court in Philadelphia is now reviewing a motion for a class action lawsuit brought by the father of an autistic child against CIGNA for denying ABA therapy.The plaintiff, Kristopher Churchill, claims that the classification of ABA therapy as experimental violates federal laws governing insurance plans.
Numerous authorities and organizations have supported using ABA therapies to treat autism, including the U.S. Surgeon General and the National Institute of Mental Health. Also, the American Academy of Pediatrics states that the effectiveness of ABA "has been well documented through 5 decades of research." Moreover, 26 states, including Pennsylvania, mandate insurance coverage for ABA-type autism treatments. (4)
Churchill is represented by Gerard Mantese and John Conway of Michigan, and Greg Heller of Pennsylvania. Mantese and Conway are counsel in several cases seeking insurance coverage for ABA therapy. Last year, they obtained final approval of a class action against Blue Cross Blue Shield of Michigan requiring payment of approximately $1 million in claims for ABA.
Mantese and Conway, and former Michigan State Senator, David Honigman, are also representing thousands of military beneficiaries seeking coverage of ABA therapy from the Department of Defense and its insurer, TRICARE. In March 2011, a federal court in Washington D.C. granted class action status to the military beneficiaries in that case, Berge v Department of Defense, et al. (4)
Of course, CIGNA could decide to do the right thing for subscribers and modify its business practices ahead of the court action.But given CIGNA's past behavior, that seems as unlikely as a rat giving up its chase for cheese.
By Jo Joshua Godfrey, United Patients of America | January 02, 2011 at 02:41 PM EST | No Comments
My daughter, Joanna Joshua, was recently featured in a story in the L.A. Times that highlights the plight of many young women whose insurance does not cover pregnancy.(1) (In California, the cost of childbirth averages nearly $13,000.)
In 2010, only 12 states mandated maternity coverage in the individual insurance market, and only 17 in the small group market. In 2014, Under Obamacare, all policies will be required to cover maternity expenses as an essential health benefit. (2). That only makes sense Insurance companies should not be able to deny coverage for pregnancy any more than for cancer treatment. No baby asks to be born, and pre-natal and childbirth coverage help ensure healthier children which benefits society as a whole.
Allowing insurance companies to exclude certain types of health conditions defeats the purpose of insurance. If people can opt-out of pregnancy coverage (because they can't or won't likely become pregnant), then surely they should be able to opt-out of coverage for AIDs or sickle-cell anemia because they deem it highly unlikely that they will contract these diseases. But then who picks up the tab? There is still an "elephant in the room" that no one is talking about.
Of course, the insurance companies win either way. They can play shell games to hold down costs while championing the majority, or they can pass on the increased costs to policyholders. Obamacare rightfully tries to eliminate the shell game but rewards insurance companies with new reasons to raise rates. But healthcare reform without cost containment is anemic at best.
Consider that a normal caesarean -section costs significantly more than normal childbirth. So why are C-sections now at an all-time high?(3) How many C-sections are performed for the health of the baby, and how many for the convenience of the mother or the obstetrician?
What is missing are real reforms aimed at holding the line on burgeoning costs -- and insurance profits.
By Jo Joshua Godfrey, United Patients of America | September 16, 2010 at 05:29 PM EDT | No Comments
The following 9/7 posting by Linda Lou on Health Blog says it all. And this is just one insurance company in one state. We should padlock such insurance companies now, and put these scoundrels on trial for what they have done and are doing to the American people. -- Jo Joshua Godfrey
The story and the facts: Fool me once, shame on you! Fool me one million times, you owe $9.92 billion dollars!
The Los Angeles Times reports that PacifiCare faces fines up to $9.92 billion dollars for close to 1 million incidences of mismanaging medical claims, refusing to pay for covered benefits, losing thousands of patient records, and failure to pay claims to doctors. Furthermore, state regulators at the Department of Insurance received countless complaints that the company ignored consumers’ requests for help. The $9.92 billion fine is based on a $10,000 penalty for each of the 992,936 violations that regulators have investigated and validated. (Read the whole article: http://www.latimes.com/business/la-fi-pacificare-unitedhealth-20100908,0,6380098.)
One of the provisions of the Federal Health reform law that goes into effect on September 23, 2010 (read more at healthcare.gov) provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Clearly, no such system was in effect for the 1 million consumers who suffered at the hands of PacifiCare, now owned by United Health, the very same United Health that raked in $81 billion in profits last year. For any who still believe that the free market can take care of the problems in our health care system, I present 1 million witnesses to the contrary.
The California Legislature ended its recent session with mixed results, passing some insurance regulation bills, but rejecting others. ( Learn more: http://blog.health-access.org/2010/09/on-governors-desk.html.) This month, Governor Schwarzenegger has the opportunity to sign these bills into law, and making California a safer place to be insured.
By Jo Joshua Godfrey, United Patients of America | December 10, 2009 at 06:20 PM EST | No Comments
A reader alerted me to the following story which further illustrates the insensitivity endemic in the health insurance industry alluded to in my previous post. While CIGNA puts up roadblocks, a child goes deaf. In this case, you can do something about it: Simply click on the link below and sign the petition.
-- Jo Joshua Godfrey
Dear Friends,
The petition I have started is for Madison Leuchtmann, a 6 year old girl who has been denied by CIGNA the ability to hear. If she does not receive the hearing implant soon, she may be permanently deaf.
Yet, CIGNA, her carrier, is sponsoring an event at Walt Disney World, a company that makes all its money from producing and promoting healthy entertainment for children.
Please let Disney know we will boycott all products until they drop CIGNA's sponsorship or CIGNA agrees to pay for her implant. The link to the petition is here and thank you very much,
By Jo Joshua Godfrey, United Patients of America | December 07, 2009 at 12:54 PM EST | No Comments
I don't care what version of the Health Care bill passes in Congress, but I do care about people... It is unfortunate that many insurance companies do not live up to the public trust, and put the emphasis on mining loopholes, splitting legal hairs and delay rather than simply providing the coverage that policyholders expect.
We are heartened by provisions in the Affordable Health Care Reform Act (HR 3962) that would make health insurance more accessible and affordable -- and keep insurance companies from turning down those with pre-existing conditions. But at the same time we wonder about how a purely profit-driven insurance system can balance the growing cost of healthcare with the growing number of people needing care while maintaining a high level of quality for those who need it most. Too often those with cancer or debilitating illnesses get treated like second-class citizens.
Compare their plight with a child in a Third World country who is blind from cataracts or who has diabetes -- but no insurance.A $2000 operation could restore sight; $50 a month could control the diabetes.We would say that is a small price to pay to save a life, but the families can not afford it.The cancer patient in this country is no better off if the insurance company refuses to pay for treatment in a timely manner.In fact, they are worse off, because they have been paying premiums but did not get the coverage they expected when they most needed it.
HR 3962 contains new marketiplace provisionsintended to foster competition. Unfortunately, greater competition may not help.It may bring down prices, but what we really need is improvements in care and outcomes.When health insurance companies are run like car insurance companies, care becomes reduced to the least common denominator, the lowest rate.Replacing a kidney or heart is not the same as replacing a fender or carburetor.Costs can be averaged, but there is no set price.
While many of us are uncomfortable with government regulating morality, greed has too often pushed out ethical considerations in private insurance enterprise. (See above videos.) Whether reforms come from inside the industry or out, they are sorely needed to lead to more ethical decisions and more compassionate treatment of policyholders.
By Jo Joshua Godfrey, United Patients of America | October 30, 2009 at 03:03 PM EDT | No Comments
The grassroots movement to reform the health insurance industry has begun. In cities across America, people are speaking out -- and getting arrested -- to protest the social injustice that passes for insurance in this country. Systematic abuse of people who are ill and dying and need treatment is an outrage. We call it criminal.
Check out this link for the latest health insurance protests this week: Physician and Six Activits Arrested at Cigna's Headquarters If you scroll down the page, you'll see my daughter, Lillian, holding a green sign that says: CIGNA CRIMINALS MUST GO TO JAIL - Three Generations of Abuse!
We are gratified that the word is spreading. Many organizations are contacting us and people are telling our story., including this piece from Anna Grady of Morganton, NC, titled Money Over People (http://www.the-signal.com/news/article/20106/). We understand the letter has been distributed to newspapers across the country, as well as several national magazines.
Ms. Grady points out:
Insurance monopolies are shielded against damages for wrongful death or injury through legal loopholes and they are also exempt from federal anti-trust laws. These immunities need to be amended, or more people will be hurt. Godfrey started United Patients of America to spotlight abuse and support reform. We must demand accountability and regulations for monopolies profiteering from people’s health.
Today there is another big protest in Los Angeles. More events are planned leading into next week. We invite you to add your voice to the growing chorus for desperately needed insurance reform.
By Jo Joshua Godfrey, United Patients of America | October 01, 2009 at 11:50 AM EDT | No Comments
In the story below, journalist KJ Mullins gives readers the most in-depth look yet into the long pattern of abuse that my family has sufferred at the hands of health insurers. Unfortunately, we are not alone, in large part, because there is little or no oversight on the health insurance industry.
Many insurers have abused patients and the public trust, and proven they are no better able to ethically govern themselves than the financial industry. Life-and-death decisions are made based on prrofit and greed. While our health care might be the best in the world, imsurers are the gatekeepers, and they have turned access to care into a cat-and-mouse game with a license to kill.
By Jo Joshua Godfrey, United Patients of America | September 29, 2009 at 10:08 PM EDT | No Comments
Don't let anyone tell you the fight for health insurance reform is over. September has been a whirlwind and new doors are opening for the "Code Blue" movement.
Brave New Films released its latest salvo about the health insurance industry, this one focused on Cigna. The insuirer's abusive practices nearly cost me my life, and I tell my story at the beginning of the film. (See the first video above.)
I also told my story to a crowd in Seattle and led a protest march of 500 to Cigna's headquarters there. You can read more about this at this link: SEIU Rally Airs Health-Care Horror Stories http://publicola.net/?p=14099
For those not familiar with my family's story, check out our About Us page for a synopsis, which led to the genesis of United Patients of America. There is another chapter, this one about my husband that I recount in a blog posting on Campus Progress last week: Please, Sir, I'd Like Another Gold Plated Jet Plane Please http://www.campusprogress.org/page/community/post/jblumgart/C2p3
By Jo Joshua Godfrey, United Patients of America | August 29, 2009 at 10:48 AM EDT | No Comments
Senator Ted Kennedy was a compassionate man who fought hard for health care reform for much of his life. He was Irish, like me, and we Irish believe in setting things right.
In his spirit, we at United Patients of America, carry on the fight for meaningful healthcare and insurance reform -- reform that exposes greed, eliminates waste and patient abuse, and fairly compensates those who deliver effective health care.
By Jo Joshua Godfrey, United Patients of America | August 29, 2009 at 10:44 AM EDT | No Comments
I wrote this "vent" a few years ago, but in the context of the current debate on health insurance reform, it is still pertinent:
All health Insurance companies like Cigna care about is the BOTTOM LINE.$$$$$Profit, profit, profit, no matter WHAT they have to do to get it.
They are wasting health care dollars all around, cheating patients and physicians alike. I hear the doctors crying constantly: "For God's sake, what about the poor patients?" Shame on all of you, only thinking about yourselves, and the monetary rewards. What about these people who are suffering, and fighting for their lives?
Does this make any sense, or have we lost all sense and sanity? Let's really do some SOUL SREARCHING. Companies such as Cigna actually employ an army of people to keep you from getting care.
Ask any physician what dollars are being wasted trying to get referrals for treatment that never materializes, and while these sick patients are waiting, they could die, and they are suffering. Or ask anyone in need of care, who has had to battle for months to get it.
Would someone please tell me, if a person needs to be followed by let's say an oncologist, why would they need to see a gatekeeper doctor and pay an extra co-pay?And then Cigna pays that gatekeeper doctor, who has to get authorization from Cigna's Case Manager or someone similar, and pay that Case Manager. Will someone for GOD's SAKE wise up, and let's put an end to the abuse of consumers, and abuse of good physicians.
It's a total waste of our health care dollars to let these companies run to the bank with OUR MONEY needed for health care of sick people. We.do not need added layers, so bureaucrats can delay care while stuffing more dollars in their "PIGGY BANKs."Medicine is not a commodity that should be traded on the Stock Exchange.
By Jo Joshua Godfrey, United Patients of America | August 12, 2009 at 12:54 PM EDT | No Comments
In large group events, medical volunteers are doling out free health care services to uninsured and underinsured people who can’t afford to see a doctor. Sounds like a magnanimous gesture by well-meaning professionals, but is this quality care?
In rural Virgina, patients waited for treatment in cattle stalls. Now Tennessee-based Remote Area Medical (RAM) is taking it to urban centers, beginning with a massive, eight-day event in L.A. Stadium. RAM was founded to provide medical aid in the Third World. But creating a carnival-like atmosphere for "Third World" care in the U.S. is truly appalling.
Are we Americans or are we animals? When we have reached the point of delivering medical care in cattle pens, that really tells the world something about us. Shameful! We are a sick nation if we would allow this to continue. Patient abuse is what turned Wendall Potter, formerly of Cigna, into an insurance whistleblower. He wants White House officials to attend to see what this kind of care looks like.
By Jo Joshua Godfrey, United Patients of America | July 30, 2009 at 03:14 PM EDT | No Comments
The American Academy of Family Physicians has just weighed in on health care reform with a new VIDEO: HealHealthCareNow.org. And they want people like you to respond. Also see their full press release for an overview: 450,000 Doctors Demand: Heal Healthcare Now. (They are getting so many hits, you may have to try back to give the servers time to breathe.)
While United patients of America is not a political organization, we do support efforts to:
Challenge insurance company abuses so people can no longer be denied coverage or charged exorbitant premiums.
Provide greater public feedback on patient abuse and insurance company policies and practices that impact quality of patient care.
Require insurance companies to spend more of the premiums they collect on patient care (rather than royal CEO salaries).
Do take a moment to take our survey and make your opinions known on our site and beyond. See our Resources page for more links.
By Jo Joshua Godfrey, United Patients of America | July 24, 2009 at 01:23 PM EDT | No Comments
Note: In response to our initial request for a meeting with Senator Feinstein, we received an unrelated form letter about legislation concerning cancer patients.
Dear Senator Feinstein,
I am confused about this correspondence I have received from you, I did not contact you about the matter you stated, but rather to schedule an appointment with your office, and you personally, to discuss the Insurance abuse of patients in the State of California, and across this Nation with seemingly no remedy or consequence in sight, for these abuses and CRIMES..
I am very concerned that while I visited your office in West L.A. years ago with Jamie Court (a Champion of Consumer protection) and dozens of other victims -- with each victim's statement recorded by your staff and sent to you -- you did not have the human decency to acknowledge even one of us.
You have sat by, (and in my opinion) done absolutely nothing to date. I am personally requesting a change, and representation and protection of the people who elected you, I am deeply concerned about the contributions you take from the Insurance Industry.
My Health Plan CIGNA committed crimes against my family, and Consumers in the State of California and across this Nation, with Government cover up and condoning. My family refuses to believe a Nation that touts Human rights across the world has no Human rights or protection at home. I want an Investigation of Corrupt Government offices as well.
As you can see by the groundswell of people, we are sick of the Status Quo. America is not a Nation of Slaves, who will work their best years, lose their homes their lives and everything they own, to this greedy blue Monster we call Insurance, and for the CRIMES committed we expect nothing less than for those CRIMES to be punished. ( I want to insist that your office stop telling me if a crime has been committed that I file a police report).
Our family has now suffered through three generations of health abuses. myself, my husband, my daughter Shannon, and Lillian and my grandson Dylan.
This is a National disgrace, and I am requesting that you carry legislation to fix these injustices. I will look forward to hearing from you at your earliest opportunity.
In closing, America will expect no less than to choose their own Doctor, to stop wasting our Medical dollars on an Army of people whose job it is to stop people from receiving the proper medical care, and their cover up of the abuses against the American people in the name of Medicine.
By Jo Joshua Godfrey, United Patients of America | June 06, 2009 at 05:36 PM EDT | 1 comment
Health insurance is up close and personal when you're sick. I have witnessed insurance abuse firsthand over the past 17 years, and I am sorry to report that it appears to be getting worse.Insurance runarounds and "phantom networks" abound, systematically limiting access to medical attention when people need it most.We continue to hear reports of patients who have been shortchanged or denied coverage altogether.
This is not just smaller health insurers, but major companies, too, like Cigna, Aetna Health and Blue Cross and Blue Shield, to name a few. What is happening is wrong.We do not pay premiums to be disavowed and abused when we're ill. People should not have to work and save all their lives only to lose everything they own to the greedy "blue monster" we call health insurance. As we build visibility and funding for United Patients of America, our ultimate goal is to provide not just moral support but tangible relief for those in dire need.
We believe all patients have an obligation to speak out about insurance abuse happening to them, and we encourage you to lodge complaints here on our blog as well as with appropriate consumer protection agencies and elected officials. As we unite, we stand shoulder to shoulder with you in reporting abuse and learning new ways to help one another. We will point people to helpful resources through our links page. And if you have advice for others on dueling with insurers, please share that, too.
Every voice counts, and together, we can make a difference. If you would like to receive timely updates from us or you would like to connect with others, please take a moment to register and tell us your story.
Copyright 2009-2011. Jo Joshua Godfrey. United Patients of America. Website design and issue management by The Marketing PR Network.
