More on Insurance Companies

More on Insurance Companies

Jim DeWees

7/17/2008

Thanks to everyone that resonded to my post and send some pretty amazing stories that they have dealt with. There seems to be a lot of issues like this dealing with insurance going....wow, what a suprise...(total sarcasm in my voice).
 
I am trying to think of a way to start collecting the names of the doctors or other medical people that work for Anthem that are responsible for these kinds of denials and the frustrations involved.
 
I have thought about starting a Yahoo group, members only group, where we could share this information and start collecting specific names of the ones that are responsible for these actions, and when enough data or information is collected, there are ways to address these things, and take action personally against a person that is guilty of committing these kinds of problems.
 
For example, the doctor that is responsible for the denial of the prosthetic leg in the case I was talking about earlier, is Dr. Richard Fritz of Wisconsin. I did a google search of this person, and found where his practice is, that he is an Oncologist working with the cancer patients in a certain hospital in Wisconsin. He is also on the board of the Gilda Radner group, which is a support group for cancer survivors and people going through cancer treatments.
 
This is so ironic and a horrible situation, since this doctor is employed by a group that is notorious for denying treatments for cancer and then even denying prosthetic limbs for survivors of osteosarcoma where the patient has lost a limb from cancer.
I did make a phone call to the Gilda foundation and informed them of the fact that this doctor is working for Anthem (probably in the closet) and is one of the responsible people (or an agent of the responsible company) that denies treatments. The person that I spoke with informed me that this is one of their biggest problems that they face. They are constantly trying to fight the insurance companies to provide the treatments, and when they won't budge, then they look for other financial help to provide the patients. She said they will address this issue of this guy working for a company that is constantly a problem.
 
Also, the hospital where he works also has been in battles with Anthem over rates and crazy denials for payments. I imagine that if this hospital knew of this doctor's double life, and that he might be one of the ones that is doing the denying, they might not want him working in that hospital.
 
I have not made a phone call to that hospital over this issue, but it might be something that I should do. If this doctor wants to work for Anthem and get some reward for the number of denials (which many former employees of this insurance company have testified about, getting bonuses based on their denial rate) then I feel it is only fair that others know of his employment. It is not a private or confidential employment. He is not some secret agent that is being outed here. There is nothing that is illegal or unethical for me to write about this, or talk about this doctor.
 
I feel like if we could group together here and see if there are common names of people that have histories of these actions (denials), then it might lead to some major investigation from a government agency to see why this is going on, and what these guys stand to gain from denying so many claims, and see if there is a bigger force over them (like corporate instructions or commands) that would tell them to deny a certain percentage or whatever.
 
 
There is obviously something going on here, and I feel like these doctors and health care people working for the insurance companies need to take personal responsibility for there actions, and have some accountability in their lives.
 
If anyone has any ideas on how to best do this, please let me know. I would be more than happy to be an administrator of a Yahoo group where we can freely post messages about these issues, and specifics of the cases. No patient names or information can be posted of course, but the situations and names of the deniers can be shared freely.
 
This is not just a case with Anthem, it applies to all insurance companies that are guilty of this stuff. There are state departments of insurance that need to be involved, but we need to supply them with several cases that are documented like this to get their attention and get them to work on this issue. I know that in Indiana, the dept. is eager to do something, because they know it is a major problem, and they are not sure what to do about it. I guess the most damaging thing they could do is to revoke the insurance company's license to do business in this state, and put them out of the state. That is a major action, and I don't see that ever happening, but they can investigate, bring charges against them, and then do some big settlement that they would have to pay to the providers for financial damages and for interest on the holding of payments of claims, etc.
 
OK, I have said more than I intended, but fortunately I type very fast and can compose a letter like this in just a few minutes. I hope that everyone can speed read to catch all of my posts....I know they tend to be a little on the long side.
 
Thanks everyone and we need to take some action and make some changes in this process hopefully.
 
Jim DeWees, CP
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