The BCBSM Stone Wall

A law firm that assists clients with public benefits applications frequently runs into boneheaded bureaucrats who consider it their mission to make it as difficult as possible for anyone outside the organization to receive the services they are due. Usually, a supervisor or a representative at a different office or branch can be found who will be more cooperative. Seldom does the law firm find itself trying to transact business with an entire organization of obstinate, discourteous boneheads. Blue Cross Blue Shield of Michigan (BCBSM) is such an organization.

Trying to procure a paper premium statement can take weeks if the insured person is not able to call BCBSM, hang on the line for 30 minutes or more, and explain what is wanted. When the insured is represented by an agent under a durable power of attorney, a retained attorney, or the spouse who pays the premiums, getting a paper premium statement usually involves a lengthy telephone campaign to get permission to mail or fax the power of attorney. Then it is necessary to wait for days for some sort of response.

Bear in mind that the information sought is not confidential medical records covered by HIPAA. It is just a paper premium statement that could be sent to the insured in the normal course of business.

Recently, a client told us that she had been trying for weeks to get a premium statement from BCBSM. She was told that a company release of information would be sent to her. It never came.

Because of past experience, I directed my request for a premium statement to Jeffrey Rumley, General Counsel of BCBSM. I attached the power of attorney signed by the insured appointing his agent. I also attached the release of information and appointment of representative giving me the right to request information and represent the insured. That document was signed by the agent. Nearly every bank, insurance company, real estate agent, brokerage firm, and government agency with which my office deals would honor a request backed up with a power of attorney and release of information. Not BCBSM!

Two days after emailing Mr. Rumley, my office received a call from a BCBSM representative. She stated that BCBSM does not recognize any power of attorney drawn up by an attorney — which is asinine. She stated that to get any information, the insured, who is in a nursing home and incapacitated, must sign a request on BCBSM’s form.

Furthermore, she stated that BCBSM would not fax the form, it would have to be mailed. There was no explanation of why they could not fax the form to my office, despite the fact that it would have no personal information of the insured – or anyone else – on it.

After a second emailed letter to Mr. Rumley, an assistant general counsel finally provided a link to procure the form for an agent under a power of attorney and a dizzying array of similar forms. The forms are, and have been, available to anyone with online access. Why the BCBSM representative was so coy is a mystery.

For BCBSM, which recently inflicted double-digit premium increases on its customers, to make it so difficult for people in nursing homes to get information needed to apply for Medicaid is appalling. There are thousands of BCBSM insureds receiving long-term care. There is no excuse for making it an excruciating ordeal to get premium verification for Department of Health and Human Services. Instead of erecting a bureaucratic brick wall, it should be possible to request that verification be sent to the Medicaid agency with a telephone call:

BCBSM: How may I help you?

Caller: I am applying for Medicaid for my mother, Suzanne Sugerbaker, and I would like insurance coverage and premium verification to give the worker.

BCBSM: We can send that directly to the Medicaid agency if you give me Suzanne’s Blue Cross member number and the case number assigned by Medicaid or her Social Security Number.

Caller: Suzanne’s Blue Cross member number is IDK313250075. Her Medicaid number is 8182850205.

BCBSM: Thanks, I’m sending the information right now.

This should not be difficult. If Google knows that I went to Wendy’s at noon and ate a Double-Double Baconater, then went to Walgreen’s at 2:24 p.m. and bought Nexium, how hard could it be for an IT juggernaut like BCBSM to verify a member’s premium and coverage to a government agency through a data link? I’ll bet that BCBSM already keeps track of how many Baconaters I eat.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2017 John B. Payne, Attorney

Restrict “Choose Life” License Plates to Considerate Drivers

The Michigan Senate and House have both passed bills to create “Choose Life” automobile license plates. This would involve a $35.00 surcharge that would go to a subsidiary of Right to Life of Michigan. I would not pay an extra dime for a special license plate, whether a vanity plate, a college identifier, or just a prettier image. Furthermore, the state should not endorse a religious or political position without allowing equal consideration for the opposite viewpoint. Aside from all that, if the state is going to issue “Choose Life” license plates, it should also require purchasers to sign a vow of consistent humanitarian values.

A few years ago, I saw a skateboarder going south in the right northbound lane of Military Street in Dearborn. He was being approached by a motorist going north, in the same lane. There were no other cars close to the motorist and he could have moved over to avoid hitting the skateboarder. He did not. He did not slow down; his brake lights did not flash. He bore down on the skateboarder, who swerved to the curb to save his life.

The skateboarder was in the wrong. He should not have been in a traffic lane, but such a minor infraction does not authorize a motorist to impose the death penalty.

I am relating this story because the car in question displayed a Right to Life bumper sticker. It also had a plate number that I noted. Since I had access to motor vehicle records at the time, I wrote the motorist a letter condemning his behavior. To be fair, I must mention that I received a reply several years later. He stated that he appreciated my bringing the matter to his attention and he regretted acting in a way that he characterized as “unchristian.”

Some people who would buy a “Choose Life” license plate have a consistent humanitarian ethic and would identify equally with a “Choose Love” license plate (if any organization with a philanthropic ax to grind could convince the state to issue one). They would support food, medical and housing assistance programs for those who need assistance. They would support foreign aid that is not military hardware for despots. They would support rehabilitation instead of incarceration for nonviolent offenses. They would support public education, including free public education from pre-school through at least two years of post-secondary education. Unfortunately, I think they are the minority.

Too many who display Right to Life bumper stickers are only concerned with preventing abortions. They are not concerned with women’s and children’s health except during gestation – and there the concern is exclusively directed at the welfare of the fœtus. They support capital punishment, stand-your-ground, and giving the Pentagon a blank check. They oppose social programs to help the less fortunate, particularly the Affordable Care Act, and contraception in general.

If “Choose Life” plates become available and you are considering making the purchase, look into your philosophy and beliefs. Are you a truly compassionate person with a consistent humanitarian ethic or a Right-to-Lifer who is only concerned with the welfare of the unborn?

What statement are you making if you put “Choose Life” on your car? Does it include a commitment to becoming a more considerate driver? If you are advertising a commitment to value life, take that gun out of your glove box and, if necessary, sign up for an anger-management class so you won’t be susceptible to road rage. Selling “Choose Life” license plates might not be such a bad thing if when you choose to purchase and display one, you also choose love and consideration.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

Vital Information about Medicaid and Long-Term Care

Please read this crucial explanation of the importance of Medicaid to long-term care residents and their families from the Long Term Community Coalition:  ltccc-medicaid-middle-class

Repealing the Affordable Care Act

Without spin or editorializing on the issue, here are some facts from The Center for Medicare Advocacy, medicareadvocacy.org, about the program Congress plans to repeal:

  • The uninsured percentage of Americans under 65 is the currently the lowest in decades. Beginning in 2014, the rate dropped from 16.6% to 10.5%.
  • As of March 31, 2016, 11.1 million people have coverage through the ACA Marketplace.
  • As of 2015, 11 million people in 31 states and the District of Columbia had coverage through Medicaid expansion under ACA, out of a total of 81 million on Medicaid.
  • There are 19 states that did not expand Medicaid: Alabama, Florida, Georgia, Kansas, Idaho, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, Utah, Virginia, Wisconsin and Wyoming.
  • However, the ACA resulted in 16,748,000 people becoming eligible for Medicaid as of September 2016.

Congress says it will replace the ACA with something better. Dare we hope?

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2017 John B. Payne, Attorney

Medicare is Fiscally Healthy

Once again, Medicare is under attack.  The gaggle of anti-government ideologues who want to privatize Social Security, raise the retirement age and pack heat in church have backed off on repeal of Medicare, but are still determined to curtail it.  They want to “reform” Medicare by shifting more costs onto program members.  Retirees and the disabled need increased health-care costs the way Pres. Obama needs more critics.

The recurrent refrain of the Medicare doomflacks is that Medicare will go bankrupt in a few years due to the increase in members as Baby Boomers retire.  In reality, Medicare cannot go bankrupt because the Medicare Trust Fund is continually replenished by the Medicare employment tax.  Furthermore, the Medicare Trust Fund, which is a part of the Old-Age, Survivors and Disability Insurance Trust Fund, ebbs and flows in response to the U.S. economy.

Those who are covered by Medicare know what a wonderful program it is.  But for Medicare, most retirees in the United States would be forced to choose between medical care and food.  Having paid taxes for their entire working lives, retirees deserve the opportunity to see a doctor when necessary and to have hospitalization coverage.

Now that 28 states have adopted health care under the Affordable Care Act for their citizens, it would be a cruel joke on our senior population to jack up the cost of Medicare.  Drop a dime on your U.S. senator and representative.  Let her or him know that you do not support cutbacks in Medicare.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2015 John B. Payne, Attorney

Open Letter to Governor Snyder About Email Malfeasance

Dear Governor Snyder:

You campaign on your business acumen, but your business leadership is not reflected in the operation of Department of Human Services.  Medicaid applications for nursing home residents can languish for months, despite the urgency of determining eligibility.  The 45-day standard of promptness is like “fresh fish” in a supermarket.  It is advertised as “fresh fish” and they say that the fish they are selling is fresh, but you sure as Hell don’t see it very often.

When families and facilities have unreasonably long waits for eligibility to be determined, both sides are injured.  Families are traumatized by rejections for residency and eviction threats.  They are often forced into undesirable placements.  Care at the facilities is impaired due to lack of payment for residents.  Facilities try to deal with the problem by illegally turning away “Medicaid-pending” applicants.

DHS is understaffed due to budget cuts, but that only goes so far as an excuse for failing to perform the mission.  Furthermore, there is no uniformity in how various offices handle the workload.  In some offices, cases languish for months, ignored by workers who claim they are unable to get to them.  In other offices workers subject applications to withering examination, demanding five years of bank statements and flyspecking the transactions to punish the applicant for giving her grandchildren birthday presents or tithing.

Department of Human Services workers have no respect for deadlines, but they will deny an application if the applicant misses by a day the due date for submitting a document.  This is especially problematic when a request for verification, which is supposed to have a ten-day window, is not mailed for three or four days after it is dated.  Applicants often have as little as three days to provide a document.

All of the above is “business as usual” at DHS.  If a law firm blew off deadlines and mishandled paperwork they way DHS does, the lawyers would lose their licenses to practice law.  If a hospital operated that way, it would be promptly lose its accreditation.  However, that is not what this letter is about.

This law firm has been handling Medicaid matters for 25 years, but recent problems with emailed and faxed communications set a new standard of bureaucratic malfeasance.  After months of delays, waiting for two particular workers to respond to emailed documents, it was determined that those workers had left the agency months before and nothing was done with their email.  A denial with one worker’s name and contact information on it was mailed out in August, but the worker had left the agency in April.

The email accounts were not even terminated, so there was no notice from the email server to let the sender know the mail was not received.  It was as if the worker had walked off the job and all subsequent mail was shredded.

Email is now official correspondence.  Staff often email requests for verification and other important notices.  For DHS to fail to have a terminated worker’s email forwarded to a successor worker or a clerical worker for forwarding to the proper person is unpardonable.  It especially egregious considering how easy it is to re-route email.

It is also common for email addressed to the wrong person to be ignored.  State employees must be instructed to treat communication from citizens with respect and at least reply with the message that the correspondence was improperly addressed.

The Department should take immediate steps to ensure that correspondence, including email, addressed to a terminated employee or sent to the wrong employee is properly forwarded or the sender advised of the mistake.  Failure to do so is official misconduct.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2014 John B. Payne, Attorney

Affordable Care Act Mandate

Affordable Care Act Mandate

I subscribe to several listservs where there are conservative and TEA Party members.  The moaning and wailing over the Affordable Care Act individual mandate can be deafening.  It might be helpful to review how the individual mandate will really work.  This flowchart from the Henry J. Kaiser Family Foundation explains who and under what conditions a person might be subject to a penalty for not buying health insurance.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2012 John B. Payne, Attorney
 
 

Ryan Plan to Include “Life Panels”

House Republicans passed congressman Paul Ryan’s deficit-cutting budget plan on Thursday, March 29, 2012, potentially a crucial plank in their election-year campaign platform and a foil for Democratic attacks over the plan’s savings in health care. One little-noticed cost-saving provision establishes an additional hurdle for applicants for Medical Assistance, also known as Medicaid. Under the new requirement, adults must demonstrate a reason to live in order to qualify for Medicaid. Analysts estimate that this could eliminate up to 50% of current and potential adult Medicaid recipients. Savings in federal general fund dollars could exceed $687 billion over 10 years.

Under the proposed policy, individuals must demonstrate a reason to live, by clear and convincing evidence, to be eligible for Medicaid. Acceptable reasons include: a) Objectively measurable artistic ability, b) Ability to engage in aesthetically-pleasing musical, dramatic, or dance performance, c) Significant mathematic, scientific, rhetoric, inventive, religious, or political capacity, or d) Being held in high regard or loved by a significant number of unrelated individuals.

To establish objectively measurable artistic ability, applicants must present critical reviews by three recognized art critics, unless paid by the individual or family members. The reviews do not have to be positive. In the art world negative reviews are considered to be more desirable and reliable than positive reviews.

Ability to engage in aesthetically-pleasing musical, dramatic, or dance performance may be verified by YouTube ratings or participation in juried competition. The individual need not win a competition, but must survive at least first-round elimination for the competition to qualify as clear and convincing evidence of a reason to live. Hip-hop is not considered music under the bill and waiving a sparkler on the Fourth of July is not considered a “dance,” unless the individual is able to wave a flag at the same time, without setting the flag on fire.

To support a finding of a reason to live by reason of mathematic, scientific, rhetoric, or inventive capacity, the individual must demonstrate that he or she is as smart as, but not necessarily smarter than, a fifth-grader. Religious capacity may be shown by a healing or other miracle within the previous 12 months. The individual is considered to have political capacity if supportive of the TEA Party. Liberal political inclinations are automatically disqualifying.

Being held in high regard or loved by a significant number of unrelated individuals may be shown by notarized testimonials of unrelated third parties. Testimonials of relatives are not considered, as relatives are conclusively presumed to be biased in favor of the individual. Paid caregivers, treatment providers, and employees of the institutions where the individual resides are disqualified from attesting to the individual being held in high regard or loved.

The bill would establish a “Life Panel” in each of the 57 states. These life panels would determine whether indigent adults have sufficient reason to live to be granted medical care. According to House Speaker John Boehner, the “life panels” are “totally opposite” to the “death panels” established by Obabamacare. The Speaker stated, “It’s as different as putting your pants on one leg at a time is from putting your legs in your pants one leg at a time. It’s as different as putting your hat on your head is from putting your head in your hat. They are as different as a Xerox machine and a copier.”

Minority Leader Nancy Pelosi responded, “Life panels and death panels are the same thing. The Republicans are imitating us. We call on the President to make them stop imitating us. If they won’t stop imitating us, we will start imitating them. We’ll see how they like it!”

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2012 John B. Payne, Attorney
 
 

Integrated Care Initiative

Michigan’s Medicaid system is involved in a project to better integrate the care provided to Medicaid recipients who also have Medicare coverage. These recipients are referred to as “dually-eligible.”

In an ideal world, it would not make any difference whether your care were covered by Medicare, Medicaid, or private insurance. If you had an ingrown toenail or a torn ACL, you would go to the same doctors and get the same effective, reasonable treatment. At least that would be my ideal world. Patient Protection and Affordable Care Act (“Obamacare” to the President’s enemies) opponents would define “ideal world” as one in which only those willing and able to pay would get care.

In this world, Medicare and Medicaid are different programs, with different sets of covered services, different financial costs to participants, and different sets of providers – try to find a dentist who accepts Medicaid. One glaring example is long-term care. Medicare covers up to 100 days of rehabilitation or skilled care after a three-day inpatient hospitalization. After that, long-term care in a nursing home is at the patient’s expense unless he or she has long-term care insurance or Medicaid. Basic nursing care is a service that is covered by Medicaid, but not by Medicare. Other services may be covered by both, but there will still be differences in how the services are authorized, provided, and paid.

Think about all the differences between private health insurance plans. What is covered, what the insured pays, and who provides the services can be greatly different depending on whether the patient has a Blue Cross or a Health Alliance Plan card.

The Integrated Care Initiative is an effort by the Centers for Medicare and Medicaid Services (CMS) to integrate care for individuals who have both Medicare and Medicaid. The idea is to provide the full array of Medicare and Medicaid benefits through a single delivery system. CMS hopes that it will be possible to provide quality care to dually eligible beneficiaries, better care coordination and fewer administrative burdens. At least that is the “company line.”

The Initiative may be dismissed as the equivalent of bureaucratic self-abuse by critics who assume that anything the government does will be inefficient, pernicious, misguided, and dysfunctional. Medicare and Medicaid are, by definition, bureaucracies. So are private insurance companies, private telecommunications providers, automobile manufacturers, and banks. Barring a TEA Party sweep of the 2012 elections, Medicare and Medicaid will continue to serve millions of U.S. citizens. The Integrated Care Initiative is an effort at better serving those who are covered by both programs. The Initiative may fail to make any significant improvement, but the fact that CMS is attempting to do its job better should be recognized as a positive development.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2011 John B. Payne, Attorney
 
 

Afford It? We Must!

It is incredible that TEA Partiers and others against universal health care for Americans should claim that we cannot “afford” it. No responsible individual or family would fail to purchase health insurance unless so financially pressed that it came down to a choice between paying for health insurance and paying rent. Health care, like food and shelter, is a necessity for individuals and families and should be a necessity for the government. Everyone needs access to medical care–particularly children. The government cannot budget for defense and transportation and education and other government responsibilities and then say, “Whoops; no money for health care!” President Obama has finally accomplished meaningful health care reform and should be praised, not insulted.

Neo-Cons derogatorily refer to the health care reform act as “Obamacare.” If I were the President I would be proud to have my name associated with the most significant improvement in the nation’s health care system since Medicaid was enacted in 1965. The Patient Protection and Affordable Care Act of 2010 is not perfect, but calls to repeal it are the bleatings of vicious negativists. We cannot call ourselves a civilized society while more than a third of our citizens lack access to health care.

I was talking to a client a couple of years ago. I told him that we need a program of universal health care. He said, “No, that’s socialized medicine. That would be awful.”

“Gary,” I told him, “You are 42 years old, out of work and living with your parents. You have no health insurance. How much worse would socialized medicine be for you?”

Too many people like Gary are swayed by neo-Con and TEA Party rhetoric. We cannot ignore the needs of the uninsured any longer. The health care reform act is a step in the right direction. Neo-Cons and TEA Partiers who say they have a better plan are lying. They just want to leave the uninsured as they are. They have insurance and they have no concern for anyone else’s needs. The United States can afford to ensure that everyone has an affordable health plan. Anything less is uncivilized and ultimately more costly because ailments and injuries that are not treated become more serious and expensive to treat. Without insurance, patients end up visiting the emergency room, the least cost-effective venue to seek medical attention.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2010 John B. Payne, Attorney