Day: 04/09/2015

Learn something new every day

One of the visitors to my blog is from:

Wikipedia:  Mayotte is an overseas department and region of France. It consists of a main island, Grande-Terre (or Maore), a smaller island, Petite-Terre (or Pamandzi), and several islets around these two. The archipelago is located in the northern Mozambique Channel in the Indian Ocean off the coast of Southeast Africa, between northwestern Madagascar and northeastern Mozambique.

Fibromyalgia and Anemia

http://www.fibromyalgia-symptoms.org/fibromyalgia_anemia.html

If you have been feeling particularly exhausted lately, it is possible that fibromyalgia isn’t the only culprit behind your fatigue. Many fibromyalgia patients also suffer from anemia, a blood disorder that can cause extreme fatigue and a variety of other complications…

http://chronicfatigue.about.com/b/2012/04/13/anemia-fibromyalgia-hows-your-iron-level.htm

A study published in 2010 showed a significant difference in serum ferritin (iron) levels between healthy people and those with fibromyalgia. Researchers concluded that low iron created a 6.5-fold increase to the risk of fibromyalgia…

http://www.wellnessresources.com/studies/fibromyalgia_associated_with_higher_rate

_of_iron_deficient_anemia/

Fibromyalgia Associated with Higher Rate of Iron Deficient Anemia (2009)

Byron’s Comments:  More evidence linking low iron and pain.

Unum – The History of Roundtables

https://lindanee.wordpress.com/2015/04/08/unum-the-history-of-roundtables-the-development-of-an-important-risk-management-tool/

Interestingly, attendees at roundtables included all of Unum’s “business interests” in making sure claims were terminated including, in-house physicians, vocational reps, RNs, impairment managers and consultants, claims specialists and of course Unum attorneys. Unum counsel often attended roundtables causing the meeting to be “client privileged” which is why records and documentation of roundtables was rarely found in claim file copies…

Functional Capacity Evaluations

https://lindanee.wordpress.com/2015/04/07/friday-q-a-51/

Functional Capacities Evaluations (FCE) have the potential of causing further injury because of the lifting, kneeling, stooping, and stress test aspects it includes. In fact, the purpose of a FCE is to measure functional capacity and physical endurance. It is for this reason that most Physical Therapy facilities that perform FCEs require written prescriptions from physicians before they administer evaluations…

Doctors don’t like being evaluated

http://www.medpagetoday.com/PublicHealthPolicy/Medicare/

Medicare Is Stingy in First Year of Doctor Bonuses
Out of 1,010 groups evaluated, only 14 are getting payment increases.

Losers also are scarce. Only 11 groups will be getting reductions for low quality or high spending…

“Without having any indication that this is improving patient care, they just keep piling on additional requirements,” said Dr. Mark Donnell, an anesthesiologist in Silver City, N.M. Donnell said he only reports a third of the quality measures he is expected to. “So much of what’s done in medicine is only done to meet the requirements,” he said.

The new financial incentive for doctors, called a physician value-based payment modifier, allows the federal government to boost or lower the amount it reimburses doctors based on how they score on quality measures and how much their patients cost Medicare. How doctors rate this year will determine payments for more than 900,000 physicians by 2017…

Ritual, Not Science, Keeps the Annual Physical Alive

http://www.medpagetoday.com/PrimaryCare/PreventiveCare

Vega is one of more than 44 million Americans who is taking part in a medical ritual: visiting the doctor for an annual physical exam. But there’s little evidence that those visits actually do any good for healthy adults…

Hey, Unum, are these annual physicals part of your definition of “Regular Care”?

But the evidence is not on their side. “I would argue that we should move forward with the elimination of the annual physical,” says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School. Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy…

From what I’ve read, there’s no evidence that having an annual colonoscopy is beneficial, either.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults.

Perhaps included in that definition should be patients with chronic conditions for which the medical industry has no solution for.  I’m not sick, I’m disabled, and since doctors can’t help me, what’s the purpose of seeing one, except to throw away more money?

One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but that adds up fast. “We estimate that it’s about $10 billion a year, which is more than how much we spend as a society on breast cancer care,” Mehrotra says. “It’s all a lot of money.”  And then there’s the risk that a doctor will run a test and find a problem that’s not actually there. It’s called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. 

Just like many of the treatments for pain that are expensive, and in the end, just cause more harm.

PT and Surgery Equally Effective for Spinal Stenosis

http://www.medpagetoday.com/PrimaryCare/BackPain

The study is the first to compare surgery and a standardized physical therapy program directly, wrote Anthony Delitto, PT, PhD, associate dean for research in the School of Health and Rehabilitation Sciences at the University of Pittsburgh, in Annals of Internal Medicine. “People need to find a way to truly exhaust their nonsurgical options,” Delitto told MedPage Today…

You mean that insurance companies need to find a way to cover nonsurgical options, and for a longer period of time.

Final Appeal Letter by me

April 10, 2015

VIA FAX 800-447-2498

Mr. Donald Beaudette
Ms. Katherine Durrell
Unum
The Benefits Center
Post Office Box 100158
Columbia, SC 29202-3158

Unum Reference:  Claimant:  Johnna Stahl
Claim No. ***
Policy No. ***
Unum Life Insurance Company of America

Dear Unum:

I am in receipt of two letters dated March 5, 2015, one from Ms. Durrell and one from Mr. Beaudette. Mr. Beaudette’s letter mentions that a copy of my Social Security file was also sent to me, but I did not receive it.  However, I’m also having trouble receiving other mail, like monthly bills, so it’s not just mail from Unum that I haven’t received.

“We decline your request for a list of legally privileged communications and the remainder of your requests.”

So, Unum is making a claim of privileged communications. Tell me, are the photos that your field investigator took of the inside of my apartment considered privileged?  How about the reports on me mentioned in Unum’s notes in my file, but not included in the copy Unum sent me?  And if I could afford to retain an attorney, would that person be able to have access to Unum’s allegedly privileged communications?  In other words, do I have to sue Unum to get a complete copy of my file(s)?

“With respect to the remaining remarks in your letter, we believe we have fully explained our position in our prior communications and refer you to those letters.”

And I beg to differ.  As just one example, Unum still has not provided a definition of “Regular Care” specifically for a 30-year intractable pain patient.

“We refer you to www.unum.com/claimant, which will allow you to see certain communications pertaining to your claim online.”

It will also allow Unum the opportunity to put cookies on my computer and follow my every move on the internet.  Thanks, but no thanks.

“We understand from your November 29, 2014, letter that you have not yet requested an appeal.”

From that very same letter:

1. Response to Ms. Durrell’s letter dated 10/28/2014:

“You will need to submit a written letter of appeal outlining the basis of your disagreement.”

The reason my letter indicated an “intent” to appeal instead of the actual appeal letter is because it was my initial response after my benefits were terminated. Since there seems to be a question of my not having submitted a basis for the numerous disagreements I have with Unum: At this time, I am requesting that Unum consider all of my correspondence, including my Notice of Intent to Appeal, as part of my final appeal letter, and I incorporate same herein for all intents and purposes. (Forever and ever, amen.)

I’m not sure how I can be more plain, but maybe Unum is waiting for my “final” appeal letter, which I guess is this one.  So, without further ado:

THIS IS A FORMAL REQUEST FOR AN APPEAL OF THE UNFAIR, ARBITRARY, AND CAPRICIOUS TERMINATION OF MY BENEFITS BY UNUM.

“You will need to submit a written letter of appeal outlining the basis of your disagreement.  Please include any additional information you would like considered with your letter of appeal.”

As indicated above, all of my letters to Unum should be considered part of my appeal and a part of the basis for every single one of my disagreements.  Also, this will notify Unum of the additional information I would like considered with my letters regarding my claim, including its current status in your Appeals Unit:

1. Every post I made under “painkills2” at nmcannabisreview.com.

2. All posts on my blog, All Things Chronic, at wordpress.painkills2.com.  (I suggest you start with the post entitled “This Is What Desperation Looks Like.”)

3. All posts on Linda Nee’s website, lindanee.wordpress.com, including language like this:

“Failure to evaluate the totality of the claimant’s medical condition; and an inappropriate burden placed on claimants to justify eligibility for benefits.”

“As indicated in our October 28, 2014 letter, enclosed, the appeal timeframe is mandated by ERISA. However, due to the delay in fully responding to the inquiries in your November 29, 2014 letter, we are granting you an additional 30 days beyond the current appeal timeframe to submit your appeal.”

Interesting.  So, the appeal timeframe is mandated by ERISA, but only when Unum wants it to be. Only when Unum hasn’t made any mistakes, like not responding to my November 29, 2014 letter until March 5, 2015.  I wonder how many other mistakes will be found that can negatively affect Unum’s position on the denial of my benefits?  Until I receive a full copy of my file from both Unum and Social Security, along with the agency’s answers to my questions and requests outlined in my March 2, 2015 letter, that question cannot be answered and I cannot fully represent myself in this matter.

This will formally notify Unum that within the copy of my claim file, it also sent copies of some of Eileen Lisker’s hospital bills from Frick Hospital.  I tried to reach out to Ms. Lisker through a relative and was told the message would be passed along, but I have not received any further communications from the Lisker family.  I believe it is Unum’s duty to notify its claimants of any HIPAA violations and ask that you do so.

“If we do not receive your formal written appeal and supporting documentation by April 10, 2015, we will be unable to complete an appeal review and the determination on your claim will be final.”

C’mon, who’s kidding who?  Unum has already decided that its termination of my claim is final.  It hopes that I won’t find an attorney to take my case, and since I can’t fight back, that will be that. It’s a very uneven fight:  Unum, a massive corporation, against one disabled and poor individual. Doesn’t seem quite fair, does it?

This letter is not meant to regurgitate every one of my questions to Unum that remain unanswered — it is not a full and complete account of all of my disagreements.  (For some reason, I feel like I have to add this language, as Unum appears to have difficulty understanding English, picking and choosing which words of mine it wants to use against me.)

Linda Nee says that I shouldn’t take Unum’s attack on me personally, but considering the additional pain and agony Unum has caused me, that’s very hard to do.  I have never wished a life of chronic pain on anyone, even DEA agents, as it’s something that no one should have to suffer from, even the employees of evil corporations.  And until I sat down to type this letter, I wouldn’t have considered myself a vengeful person…

But here I am, in the middle of a pain storm, trying to concentrate on what this letter should include, and I can’t help wishing that every Unum employee included in this attack against me suffer as I have suffered — and will continue to suffer at Unum’s hands.  If there is such a thing as an evil curse — kharma, if you will — then I hereby ask the powers that be to deliver some justice for me.   In the alternative, my blog and Linda Nee’s website will have to do.  Because no matter what happens, Unum will always be on my shit list.  I will not be satisfied — justice will not be served — until Unum is taken to task for every illegal thing that it does.  For every disabled person it has harmed.   A person cannot suffer as Unum has made me suffer and just leave those consequences to kharma.

Even though I haven’t slept in over 24 hours, the left side of my face is swollen, my current pain level is creeping up to a 9, and the light hurts my eyes, I’m now going to get into my car, drive to the UPS Store, and pay to have this fax sent.

Ya’ll have a nice day.

Johnna Stahl