Carelink Health Plans Inc. Corporate Irresponsibility

Tuesday's Tale

The Private Face of the "Darling of Wallstreet"

For three long years I have been investigating Carelink Health Plans, Inc. of West Virginia and their parent company Coventry Health Care, Inc. of Bethesda MD, a Fortune 500 Company.

A social justice advocate and a respected physician described Carelink's actions towards me in November 2005 as ruthless and despicable. "How can this be?" many might ask. The answer is really quite simple. Coventry is the “darling of Wall Street” according to Washington Post columnist and Pulitzer Prize winner Steven Pearlstein. How are people duped? Coventry remains “under the radar.”

It appears that even Coventry CEO Dale B. Wolfe shuns press coverage. He oversees corporate governance of Coventry and its affiliates. In one article on the internet there is a place for his image with the statement “photo not available.” It appears that there may be more than a picture missing; I suspect his conscience may be awol.

In December 14, 2006, Jane Cline, Commissioner of the West Virginia Insurance Commission, signed Final Order 06-AP-024. Frank Hartman, Director of the Office of Consumer Advocacy represented me against Carelink.

In the following link, Mr. Hartman testifies to the significance of the final order and the overbearing pride and insolence of Carelink Health Plans, Inc. of West Virginia: http://www.freewebs.com/courageoffaith/2007%204%204%20Frank%20Hartman%27s%20Discussion%20of%20Facts.doc

A deep sigh. It has been too long of a journey to today, one step in boldness after another. Not easy. But the alternative is to let this corrupt system do business as usual. I cannot turn my back on pain and suffering of others. And so I write.

I link as I have done here to the complete WV Insurance Commission Final Order 06-AP-024. http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

Many people advised me over the months that I must not name Carelink and Coventry in any public writing. That even though I speak the truth, Coventry may employ a tactic of suing me for speaking out. The tactic oftentimes works. Intimidation. Threats of losing possessions. Just plain fear stops good people from pursing their God-given rights.

Well, I have already lost too much in life to injustice. Naming my enemy may be the only way to gain public acknowledgement of how they run their business. I have many documents that prove every allegation I make. Carelink and Coventry have unwittingly provided me with a lot of ammunition.

So following my attorney's advice to speak the truth supported by many documented records, here's more: Christine Stenger v. Carelink Health Plans, Inc. and Patrick W. Dowd, http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

As you have read, Carelink is a defendant in a civil lawsuit I filed against them in October 2007. It is alleged that Carelink broke a state law which forbids any company doing business in the state of West Virginia from denying access to a person with a disability. The lawsuit cites a letter dated November 1, 2005, which I received from the then CEO of Carelink Patrick W. Dowd. It's not easy being at the receiving end of a letter like this: http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

Yes. There were "countless" contacts with Carelink and Coventry, all recorded. Those identified here represent only a beginning. Had one responsible individual of Coventry followed the rules of corporate governance and the patient's bill of rights as published by Coventry Health Care, Inc., neither my health plan nor myself would be involved in a lawsuit.

Carelink made a critical error on November 1, 2005. Carelink neither understood that my roots are in social justice nor did they appreciate that perseverance is my strength. Today I remain just as strong and committed as I was in June 2005. Passion and enthusiasm drive me. On November 4, 2005, I quickly countered Mr. Dowd’s false allegations with the truth. My son, an attorney, dictated my response to me within minutes of opening Dowd's letter. The case was dropped.

Tuesday's response: Guilty as charged.

If the lives of real people did not depend on receiving an "excellent" response from health care organizations...If Carelink had only failed once to act consistent to their corporate advertising...if customer surveys were taken seriously...if indifference to suffering did not play a role in Carelink's decision-making...so shocking.

My mind goes to the Virginia Tech massacre. One sick individual. Help could be available. Were there some of the same roadblocks Carelink placed in my path in the way of that young man's receiving the help that might have made some difference? One wonders.

They just don't get it, do they? It's called corporate responsibility.

Tuesday's Tale

Randy Calad, Victim

SUGAR LAND, Texas -- Leading up to her hysterectomy about five years ago, Ruby Calad thought she understood all the insurance bureaucracy involving her HMO.

"I'd done my homework," the suburban Houston woman said.But the day after her operation, she was told by a Houston-area hospital she had to be released because her HMO, Cigna Healthcare of Texas Inc., would approve no additional expenses. She was discharged prematurely, then wound up in an emergency room a few days later, she said.

"(It) ended up costing them more money," Calad, 50, recalled Monday, a few hours after learning the U.S. Supreme Court had ruled against her in a lawsuit stemming from her HMO's decision.

"The court essentially looked the other way on the issue of the HMO abuse," she said. The court said HMOs are shielded from lawsuits in state courts, where juries are more apt to side with victims and recommend multimillion-dollar judgments from insurance companies.

Justice Clarence Thomas, who wrote Monday's ruling, relied on a federal pension benefit law that predates the rise of managed care and said patients may pursue claims only in federal courts, where awards are capped at only the cost of medical services the HMO would not cover.

The ruling means patients like Calad can't seek hefty damage awards in court if their HMOs refuse to pay for doctor-recommended medical care. The unanimous decision rejected arguments that the threat of multimillion-dollar lawsuits keeps insurance companies honest, invalidated an important part of patient rights laws in several states and tossed a political hot potato back to Congress, where lawmakers repeatedly have tried and failed to pass national patient protections.

"I hope this ruling breathes new life into the patients' bill of rights debate in Congress," Calad said. "I'm also hoping they do not just sweep this under the rug and completely forget about it.

"The ruling, in a pair of cases filed by Calad and Juan Davila, also of Texas, affects the roughly 72 million people covered by HMOs.

The Texas cases were filed under a patients' rights law passed when President George W. Bush was governor. When Bush was running for president four years ago, he took credit for the law, but his administration sided with insurance carriers when the two cases reached the high court.

In their arguments to the court, lawyers for Cigna noted that Calad's health care plan at the time, like most other health benefit plans, "does not promise to cover any and all health care sought or desired by beneficiaries.

"The Supreme Court did not decide whether the plaintiffs deserved better, only whether and where they could sue. "As far as I know, it's dead," Calad said of her legal challenge. "I would do it again. it was worth the fight."

Associated Press Writer Anne Gearan in Washington contributed to this report. Reported in Topix: California Insurance Industry