Speaking truth to power

All day yesterday I stewed about the inappropriate and inaccurate response I received from Senator Hutchison's office. At first, I didn't have any plans to send another message to her, but the more I thought about it, the more it bothered me. I am one of her constituents, after all, and I do have the right to have my voice be heard, even if I don't agree with her position.

Last night I went back to her online message form, and sent the following:

Last week I contacted Senator Hutchison about problems I am having with my insurance company and expressing support for health care reform measures currently being considered by Congress.

In response, I got a form letter that made it very obvious that no one on Senator Hutchison's staff even read what I wrote. Her response doesn't address my concerns and ignores completely that I don't support Senator Hutchison's actions. I wrote to the senator hoping that my voice would be heard, and it's obvious that it wasn't at all.

You ought to be embarrassed at providing such poor service to your constituents. I used to supervise the Citizens' Assistance center for a statewide elected official, and I would have NEVER allowed such an inappropriate response to be sent.

Shame on you.

I'll be interested to see what kind of response, if any, I get back. Who wants to bet that I'll get the very same form letter again?

Constituent response - FAIL

Last week I sent messages to Senator John Cornyn, Senator Kay Bailey Hutchison, and Congressman Michael McCaul about issues with BlueCross BlueShield. I explained my situation and expressed my support for the health care reform bill currently working its way through the legislative process. I told each that I was writing because I wanted them to know that not all of their constituents are anti-reform.

I got immediate form e-mails back from Cornyn and McCaul thanking me for writing, and I haven't heard anything from either since. Last night I got a response from Senator Hutchison, and it's obvious that the person at her office responsible for handling constituent inquiries just looked at the subject line of the form I submitted and sent a standard response.

The e-mail thanks me for contacting the senator and then launches into an explanation of everything she is doing to prevent passage of the health care reform bill in the Senate and lists the "advantages" of the bills she is sponsoring. The e-mail closes with this:

You are among thousands of concerned Texans who have written to express their views on this topic. You may be assured that as health care reform legislation comes for consideration before the full Senate, I will continue fighting against the Democrats’ proposal to enact a government takeover of our health care system.

And that's the part that really pisses me off.

In my life prior to being a freelance writer and editor, I worked for the Texas Attorney General's office (back in the day when Senator Cornyn was the attorney general and Congressman McCaul worked for him; I've actually met both men). One of the many hats I wore was supervisor of the Citizens' Assistance Section. The AG's office received tens of thousands of letters and e-mails every year, and our section responded to all of them that weren't related to consumer protection issues and child support collection - other sections handled those.

I would have NEVER allowed a response like the one I received to be sent. Never.

People wrongly assume that the Attorney General of Texas is the attorney for the people of Texas. Instead, he is the attorney for the State of Texas. But people would write to us looking for legal advice, asking for referrals to attorneys, asking for help with landlords or doctors or whatever. And every single response we sent was appropriate to the request. If we couldn't directly help the letter writer, we'd supply a referral to someone who could, whether it was another state agencyor the writer's state legislator or a lawyer referral service or a tenants' rights group.

And if a constituent sent a letter with an opinion that was contrary to the attorney general's, we'd at least acknowledge that the person had an opposing viewpoint. The staff worked very hard to make it clear that we really did read each and every letter and e-mail that was sent. We also kept stats on the number of messages we got on either side of issues and reported them to the attorney general.

That's what makes me so mad about the e-mail from Hutchison's office. There's not even the pretense of having read my message. There is no recognition that I hold a different point of view or that I don't support her efforts.

I sent the message in the hopes of having my voice heard, and it is apparent that it wasn't at all.

Ladybug

And now back to our regularly scheduled Halloween costume posts . . . if I have to write or think any more about the BlueCross BlueShield insurance fight, I'll start crying again. Thank you to everyone for your comments and e-mails of support. They have helped.

Here's a cute baby to make everyone feel better. Elizabeth dressed as a little ladybug for Halloween. Lily wore this same costume when she was Elizabeth's size. There's a hat that goes with it, but Elizabeth refused to keep it on.





Before we went trick-or-treating, we had our annual pot-luck with several other families. The big kids left a whole row of empty juice and milk boxes on one of the benches. Elizabeth cruised along the bench, testing each box to see if she could slurp up any of the remnants. She was so proud of herself that she kept giving us huge grins and showing off her one tooth.

Elizabeth hung out in her stroller while we trick-or-treated, content to watch the kids run back and forth. Next year, though, she'll be toddling right along behind them.

At war with BCBS

I know I said that I'd have a post about the cutest lady bug ever today, but I'm going to have to delay that until tomorrow.

A few weeks ago I wrote about my ongoing fight with BlueCross BlueShield of Texas to get Elizabeth's delivery covered. Yesterday I went another round with the insurance company.

I received a letter in the mail telling me that my appeal had been denied because my situation didn't match any of the items on their list that would allow them to pay for the delivery. So I girded my loins and called BCBS. As soon as I got a human on the phone, I asked for a supervisor. I had the bad luck of being connected to Kelly C.

Here's where having a photographic memory for conversations comes in handy.

****

Me: I'm calling about my claim, which was denied.
KC: That's right. Your condition doesn't meet any of our requirements for being covered.
Me: Can you explain that please?
KC: We will pay for treating complications of pregnancy, but we won't pay for delivery.
Me: Did you get the letter from my doctor?
KC: Yes, we have it. But doctor's letters don't matter. Only medical records matter, and yours don't show that we should cover the delivery.
Me: When my son was born three years ago, you paid for his delivery because he was breech.
KC: We've gone back and reviewed claims, and it turns out the company paid for a lot of claims it shouldn't have. You son's delivery probably shouldn't have been paid, but we're not going to try and recover the payments.
Me: With this delivery, you paid for the claim from the anesthesiologist.
KC: That was a mistake, and if you ask for a review of this claim, we could end up reversing that decision.
Me: So I'd have to pay back the payment to the anesthesiologist?
KC: That's correct.
Yes, she did essentially threaten that if I pursued this they might make me pay more money.
Me: As my next step I'm going to be contacting the Department of Insurance, an attorney and my legislators.
KC: You can do that, but it won't do any good. No one in medical review is going to approve this claim.
Me: How can you work there and still sleep at night?
KC: If you're going to attack me personally, I'm going to terminate this call.
Me: Please put your supervisor on the line.
KC: There's no one higher than me.
Me: Bullshit. I want to talk to your supervisor.
KC: No one here is going to approve this claim.
Me: I don't care. Put someone else on the phone now. I'm finished talking to you.

After a few more back and forths where she claimed there was no one else to talk to and I told her I didn't care and that she needed to find someone immediately, she put me on hold. I sat there crying while listening to perky, cheerful hold music.

After about 10 minutes, Tanika got on the phone.

Me: Kelly told me that BCBS would pay to treat complications of pregnancy but not delivery. My complication was five weeks' pre-term labor with fetal distress. Now I'm not a medical person, but it seems to me that the treatment for that complication is to deliver the baby.
T: I'm not a medical person, so I can't explain why the medical section made this decision. But that seems reasonable.
Me: BCBS also paid for my anesthesiology bill without any protest. It was just paid automatically.
T: That's odd, because medical review says no claims from this date of service should have been paid.
Me: What do I do next?
T: You can file a second appeal - you're allowed two appeals. (Something KC never told me.) When you file your second appeal you need to include any other information that you feel is relevant, and have your doctor do the same. Anything you can give us that would help your case. After that, you can also contact TDI for help appealing this.
Me: Thank you so much for at least listening to me. Kelly C wouldn't even do that.

I felt like Tanika was sort of telling me, without actually telling me, how to get the claim paid. Kind of like the scene in "The Incredibles" when Bob Parr tells the little old lady exactly what forms she needs to file. And while Tanika didn't approve my claim, she did at least listen to me without being rude or telling me that the claim would never be paid.

*****
After I spent about 15 minutes sobbing on the kitchen floor with Campbell asking, "Why you sad mommom?" I pulled myself together enough to call my doctor's office. The woman who deals with the insurance companies wasn't in, so I left a message for her to call me today. Maybe she has some further thoughts.

After I got off the phone with the doctor's office I cried some more. This has just worn me out. I feel helpless and out of control dealing with this immense company. I know the medical review section is nothing more than pencil pushers going through checklists without putting any thought into whether their decision actually make any sense. There is no reasoning with people who can only see checklists.

But yesterday also made me mad, not angry, MAD. I'm going to fight this as far as I can. BCBS has stolen my time, energy and joy at having a new baby from me, and that's what really upsets me.

I also truly believe that anyone who thinks our health care system is fine the way it is has never had to pay for his or her own health insurance and has also never had a claim denied. Anyone who has had to fight with an insurance company should know that the system is broken.

Tomorrow, a cute ladybug. I hope.