LTE 2.0

[DukieInKansas]

I want to go to Paris. Mr. Windsor doesn't travel. Anyone want to go?

Me, me, me! I've never been to Europe, but I studied French in high school and college.

Oooh - CTN trip to Paris! Sounds great. If you go, consider renting an apartment as opposed to a hotel. Allows for some meals in. It was fun to stop and shop for dinner as we returned to our 'hood. Mostly ate breakfast in but did one dinner.

[windsor]

I want to go to Paris. Mr. Windsor doesn't travel. Anyone want to go?

Me, me, me! I've never been to Europe, but I studied French in high school and college.

That could be a PLAN!

[lawgrad91]

Pointy-toed shin kicks to Anthem Blue Cross Blue Shield and Corey C., case manager for Christian. Normally I wouldn't mention a name, but this asshole deserves all the approbation he can get, and should be in a lower circle of hell than the child molesters I have to meet at work. If I had a last name and address, I would give it.

Yesterday, around 5:15pm, Christian's nursing home was informed that insurance would no longer pay for his stay as of midnight. (Thank God I was in there when the woman from billing arrived. I guess she would have told him and been on her way without ever noticing ANYTHING about his level of cognition.)

Eric, the first POA, is beyond pissed. Should the peer-to-peer review with Dr. Friedman not be good enough for Anthem, he has an injunction ready for one our Circuit Court judges to sign, forcing them to pay until all reviews are exhausted.

[DukePA]

Pointy-toed shin kicks to Anthem Blue Cross Blue Shield and Corey C., case manager for Christian. Normally I wouldn't mention a name, but this asshole deserves all the approbation he can get, and should be in a lower circle of hell than the child molesters I have to meet at work. If I had a last name and address, I would give it.

Yesterday, around 5:15pm, Christian's nursing home was informed that insurance would no longer pay for his stay as of midnight. (Thank God I was in there when the woman from billing arrived. I guess she would have told him and been on her way without ever noticing ANYTHING about his level of cognition.)

Eric, the first POA, is beyond pissed. Should the peer-to-peer review with Dr. Friedman not be good enough for Anthem, he has an injunction ready for one our Circuit Court judges to sign, forcing them to pay until all reviews are exhausted.

Holy shit. Corey C. can go to hell.

[IowaDevil]

What DPA said! Don't we all love this new improved insurance coverage for all of us?

[windsor]

What DPA said! Don't we all love this new improved insurance coverage for all of us?

Uh...hell no, 'new' has nothing to do with it.

This is old school 'Blues' behavior from way back (yes....I have been on the IT side of health insurance and TPAs for north of 20years)
The Blues were the biggest boys on the block for a lot of years. They were also one of the few who would write individual policies for those without company coverage for ages.
They are accustomed to getting providers - particularly institutional providers - to bow to their bidding. They are also accustomed to the consumer having no recourse but to take their crap.
If anything, a wider market dilutes their power AND the risk balancing from the exchanges should substantially decrease this kind of behavior.

I also doubt his coverage is through ACA. What I expect is that you have a case manager under a incentive plan that pays him for meeting certain 'guidelines' of care and keeps inpatient days below their threshold. The Blues are one of the last companies to pay this way. Aetna does not. Also, the HEDIS incentives inside ACA would actually penalize a pattern of behavior like that.

The cases manager is an asshole. The person with the POA should ask for another one. Immediately.

[windsor]

What DPA said! Don't we all love this new improved insurance coverage for all of us?

Uh...hell no, 'new' has nothing to do with it.

This is old school 'Blues' behavior from way back (yes....I have been on the IT side of health insurance and TPAs for north of 20years)
The Blues were the biggest boys on the block for a lot of years. They were also one of the few who would write individual policies for those without company coverage for ages.
They are accustomed to getting providers - particularly institutional providers - to bow to their bidding. They are also accustomed to the consumer having no recourse but to take their crap.
If anything, a wider market dilutes their power AND the risk balancing from the exchanges should substantially decrease this kind of behavior.

I also doubt his coverage is through ACA. What I expect is that you have a case manager under a incentive plan that pays him for meeting certain 'guidelines' of care and keeps inpatient days below their threshold. The Blues are one of the last companies to pay this way. Aetna does not. Also, the HEDIS incentives inside ACA would actually penalize a pattern of behavior like that.

The cases manager is an asshole. The person with the POA should ask for another one. Immediately.

...and one more thing...I would wave the Litigation flag high and proud. THAT will get their attention.

[DukieInKansas]

Pointy-toed shin kicks to Anthem Blue Cross Blue Shield and Corey C., case manager for Christian. Normally I wouldn't mention a name, but this asshole deserves all the approbation he can get, and should be in a lower circle of hell than the child molesters I have to meet at work. If I had a last name and address, I would give it.

Yesterday, around 5:15pm, Christian's nursing home was informed that insurance would no longer pay for his stay as of midnight. (Thank God I was in there when the woman from billing arrived. I guess she would have told him and been on her way without ever noticing ANYTHING about his level of cognition.)

Eric, the first POA, is beyond pissed. Should the peer-to-peer review with Dr. Friedman not be good enough for Anthem, he has an injunction ready for one our Circuit Court judges to sign, forcing them to pay until all reviews are exhausted.

Today's shoes are terribly pointy but do have a nice, solid 3.5 inch heel. I will add a few stomps on his instep to go along with the shin kicks.

[lawgrad91]

What DPA said! Don't we all love this new improved insurance coverage for all of us?

Uh...hell no, 'new' has nothing to do with it.

This is old school 'Blues' behavior from way back (yes....I have been on the IT side of health insurance and TPAs for north of 20years)
The Blues were the biggest boys on the block for a lot of years. They were also one of the few who would write individual policies for those without company coverage for ages.
They are accustomed to getting providers - particularly institutional providers - to bow to their bidding. They are also accustomed to the consumer having no recourse but to take their crap.
If anything, a wider market dilutes their power AND the risk balancing from the exchanges should substantially decrease this kind of behavior.

I also doubt his coverage is through ACA. What I expect is that you have a case manager under a incentive plan that pays him for meeting certain 'guidelines' of care and keeps inpatient days below their threshold. The Blues are one of the last companies to pay this way. Aetna does not. Also, the HEDIS incentives inside ACA would actually penalize a pattern of behavior like that.

The cases manager is an asshole. The person with the POA should ask for another one. Immediately.

You are correct. His insurance is through his employment, the Commonwealth of VA. And Anthem is a for-profit, stock corporation, so their big concern (despite all the nice emails about how they want to help me have wonderful, sparkling health) is the bottom line. Our insurance is also through Anthem, though we don't have as "good" a policy here in Varnish County as the state people have.

I haven't heard anything yet today from Eric, the POA with the injunctions in his back pocket. He actually has a job that doesn't involve taking care of the brain-injured (well, maybe it does; he is the Martinsville city attorney). His wife is managing partner of a bigwig law firm that has a fairly sizable health care practice.

[CathyCA]

Pointy-toed shin kicks to Anthem Blue Cross Blue Shield and Corey C., case manager for Christian. Normally I wouldn't mention a name, but this asshole deserves all the approbation he can get, and should be in a lower circle of hell than the child molesters I have to meet at work. If I had a last name and address, I would give it.

Yesterday, around 5:15pm, Christian's nursing home was informed that insurance would no longer pay for his stay as of midnight. (Thank God I was in there when the woman from billing arrived. I guess she would have told him and been on her way without ever noticing ANYTHING about his level of cognition.)

Eric, the first POA, is beyond pissed. Should the peer-to-peer review with Dr. Friedman not be good enough for Anthem, he has an injunction ready for one our Circuit Court judges to sign, forcing them to pay until all reviews are exhausted.

I think the person with the lower level of cognition is Corey C. Ass.

[lawgrad91]

Eric texted me around 7 to let me know the dumbasses at Anthem denied his appeal sometime after 5 this afternoon. He didn't know any details and was in a meeting.

I don't know anything beyond that, not even what type of appeal it was. I am guessing it was the one where one asshole passes the file to another asshole and says, "here, deny this the way I did" as opposed to anyone actually speaking to Dr. Friedman or his PA.

[lawgrad91]

I hope the facility let Eric know and didn't try to tell Christian. I wasn't over there today to pick up the pieces like I was yesterday.

[Very Duke Blue]

I hated working with Antham. I never felt they cared about patient.

[Very Duke Blue]

I am one week post op for my knee replacement and doing good. I have been in rehab since Fri. Looks like I will be discharged next Tues. Thanks for all the vibes. They sure have and do help.

[lawgrad91]

I hope the facility let Eric know and didn't try to tell Christian. I wasn't over there today to pick up the pieces like I was yesterday.

Wishful thinking. Christian told Eric.

I am surprised he even knew what the business office people were talking about.

[lawgrad91]

I am one week post op for my knee replacement and doing good. I have been in rehab since Fri. Looks like I will be discharged next Tues. Thanks for all the vibes. They sure have and do help.

So glad for your progress, VDB!!!!! Continued vibes and prayers and hugs!

[Very Duke Blue]

I am one week post op for my knee replacement and doing good. I have been in rehab since Fri. Looks like I will be discharged next Tues. Thanks for all the vibes. They sure have and do help.

So glad for your progress, VDB!!!!! Continued vibes and prayers and hugs!

Thank you. I think that is why I am doing so well. Bless you and all my CTN family.

[CathyCA]

I am one week post op for my knee replacement and doing good. I have been in rehab since Fri. Looks like I will be discharged next Tues. Thanks for all the vibes. They sure have and do help.

YAY! Pretty soon you will be dancing!

I'm sending prayers for continued healing!

[ArkieDukie]

I am one week post op for my knee replacement and doing good. I have been in rehab since Fri. Looks like I will be discharged next Tues. Thanks for all the vibes. They sure have and do help.

Glad to hear the recovery is going so well! Here's hoping things continue that way.

[ArkieDukie]

Eric texted me around 7 to let me know the dumbasses at Anthem denied his appeal sometime after 5 this afternoon. He didn't know any details and was in a meeting.

I don't know anything beyond that, not even what type of appeal it was. I am guessing it was the one where one asshole passes the file to another asshole and says, "here, deny this the way I did" as opposed to anyone actually speaking to Dr. Friedman or his PA.

Putting on my pointy-toed cowboy boots and sending lots of shin kicks. Lots and lots of them.

Sending prayers for Christian and his family, too.