Attachments for the letter to the A.G.

Attachments to this letter.

#1  The NYS Health insurance Consumer helpline cul du sac

In an attempt to resolve problems with my health insurance I contacted a circuit of government agencies in vain last December.  Here is a summary of that healthcare consumer help cul du sac:

The NYS Department of Financial Services helpline (from dfs.ny.gov) referred me initially to the US Department of Health and Human Services (877-696-6775) which, supposedly, connected me to NYS Health and Human Services, although to an incorrect branch of that agency, the pertinent branch apparently having been merged into the NYS Department of Financial Services which took over all functions of the former NYS Insurance Department as well as oversight of banking and several other discrete and seemingly unrelated areas.  (When I called this number today, it gave me an option, unavailable last time, to press 6 for “consumer problems with the ACA”, and offered a call back in five business days from a representative.)

The New York State Insurance Department, along with other agencies related to healthcare in New York State, was merged into the Department of Financial Services when New York adopted the Patient Protection and Affordable Care Act (“PPACA”).  The New York State Department of Financial Services, it turns out, does not hear consumer fraud complaints against health insurance companies.

I entered this administrative cul du sac in December 2016 after Empire Blue Cross “Health Plus” sent me to two in-network providers for needed medical services, a cardiologist (for follow-up care after a hospitalization for cardiac issues) and a physical therapy facility.  Neither provided me with any service. 

The fraud investigator I eventually spoke to at the NYS Department of Financial Services, at the end of a long chain of calls, could not find a word other than ‘fraud’ to describe the facts I set forth, but urged me to call the NY State Department of Financial Services Consumer Services Hotline.  He assured me that they were the specialists in the area of health insurance.  The recorded menu at the hotline, which I recognized from my first call hours earlier, offers no option for resolving issues with insurance companies of any kind.  

On my original call to the Department of Financial Services, a long wait to speak to a representative yielded the number of the proper federal agency to contact.   Calls to the U.S Department of Health and Human Services are robotically routed to a NY State number that is, sadly, the office of Temporary and Disability Assistance, where a helpful party connects you to a fraud hotline, which turns out to be at the office of the Medicaid Inspector General, where the office of legal affairs is also sympathetic, but unable to help, and so forth.

#2 Permissible grounds for routine denials of purchased healthcare benefits in NYS and limited “appeal” of denials available to New Yorkers

More ominous than the many billing irregularities consumers are left to resolve with the billing parties, a patient can be denied needed medical service without explanation.  Permissible corporate reasons for denying service are things like incorrect site-specific provider NPI number and improper CPT pre-authorization codes.  These valid grounds for denial are unrelated to an individual consumer’s MOOP, which comes into play more for billing.  There is nobody in New York State a patient can appeal these denials of service to, except to the insurance company itself.  

Immediately before I was diagnosed with a serious kidney disease, in January 2017, I attempted to resolve some issues I’d been having with my then insurance provider, Empire Blue Cross. This was before I switched to Healthfirst, which has a series of nephrologists I’d been referred to, listed as ‘in network” who, it turned out, were not.   Here is the slightly overwrought grievance I wrote when I was a customer of Anthem/Empire.  It reflects the frustration of someone caught in this ‘regulatory’ vacuum:

Grievances – Anthem/Empire Blue Cross Blue Shield “Health Plus”

Grievance 1:  lack of internal complaint procedure for aggrieved customers

After being chided by an Empire representative for never filing a written complaint about any of the grievances detailed below, I attempted to do so on-line.  Logged in automatically under my former bronze plan ID there was an on-line complaint form, easily located.  I was unable to update my member ID info.  A web support representative at Empire walked me through changing the new log-in.  On the website for the “Essential” plan there is no complaint form.

I was also told by web-support/claims representative Laurisha that there is no internal mailing address for submitting a written complaint to Empire and that company policy was not to divulge the name or contact information of company executives.   The rep told me she could take my complaint orally over the phone.   I decided to try my luck with the original claims person I’d just spoken to for an hour.  Nobody was able to connect me to her.

Someone at claims found this answer for me, while looking for the physical mailing address to send a complaint directly to Anthem/Empire.  He told me it was printed in red, as I will reproduce it here:

Essential Plan members do not have a right to file complaint appeal (sic).  If they need assistance filing a grievance or appeal, they may also contact the state independent consumer assistance program at:  Community Health Advocates, 105 E. 22nd Street, NY NY 10010 or 888-614-5400 or email at cha@cssny.org

source:  Anthem’s National Contact Center Document under NY market tab for “Essential” plan updated as of 12-14-16 at 7:56 a.m.

Grievance 2:   unresolvable bill

8/17/16 I went to Madison Avenue Radiology for an x-ray and two sonograms.  I had referrals for all of them.  I got a bill from Madison Avenue for $1,324 for one of the sonograms.   

On 10/19/16 I spoke to a representative at Empire who spoke to the provider, to a person she told me was named Daniel.   I then spoke to Daniel who agreed the $1,342 had been billed in error and told me I’d receive a corrected invoice for the $25 co-pay.  

The next invoice I had, in December, was a third notice from Madison Avenue Radiology that I owed $1,342.  This time Ty at Empire told me she called the provider, who denied ever speaking with me, and that I owed the entire amount, for reasons I could find in the Essential Plan handbook she offered to send me.  She herself did not know the reason a kidney sonogram was covered and a pelvic sonogram was not.  She told me I was responsible to pay the $1,342.  When I asked to speak to a supervisor she told me no supervisor was available.  

(Months later this bill was eventually reduced to a $25 copay)

Grievance 3:   fraudulent referral to cardiologist

I was referred, by Empire, to a cardiologist named David Sahar.  I was given his site-specific NPI number to see him at his 3050 Corlear Avenue office, I sent front and back of my insurance card to his receptionist who confirmed that we were good to go for a December 15 follow-up to my November 18 Emergency Room visit/hospitalization.   Ten minutes into the consultation the nurse who was interviewing me was called away and when she returned she told me Empire had refused to cover the visit. The doctor explained he could not risk not being paid by Empire.

Grievance 4:   fraudulent referral to physical therapy

I was referred by Empire to a facility to continue the Physical Therapy I had begun on 11/1/16 at a facility that treated me once and then informed me that they do not accept the Empire Essential Plan.  I made several calls to Empire to find out how to get them in network, as Empire told me they could enroll by calling 800-454-3730.  After a few weeks calling the PT facility and Empire I gave up.   I requested an in-network PT provider and Empire sent me to an address that turned out to be a nursing home.  It did not offer PT to outpatients.

Grievance 5:   incorrect information; false promises of help from customer service

I called on 12/30/16 in an attempt to resolve these issues, the bill and the two denials of coverage from providers I’d been referred to by Empire. I was told by Joan that the “service not covered” code came up at the cardiologist’s because, likely, an incorrect CPT number had been called in, or possibly the doctor’s office had failed to obtain a prior authorization from Empire’s medical management office, both the fault of the doctor’s office. Empire, I was told, had done nothing wrong.   Joan had no explanation for why I was sent to a nursing home for PT or why the kidney sonogram had been covered and the other one not covered.   She offered to send me the handbook so that I could read it and find out for myself why one body part is covered and another is exempt from coverage for the same diagnostic procedure.  

Joan transferred me to someone who said she was a supervisor.  She identified herself as Julie, at the New York Call Center, assured me she was the only Julie there and that I’d have no trouble finding her.  She noted that I’d never filed a formal complaint about any of these issues and promised to research and get back to me with the answers on Tuesday, 1/3/17 when the office reopened.   Regarding the PT, she gave me a number for a third party vendor called Orthonet.  She incorrectly informed me that they could answer any and all PT-related questions.  When I called Orthonet the receptionist there told me Orthonet’s only role is to authorize services for PT once a provider makes a request to treat a patient.  

When I got no call from Julie at the NY Call Center I attempted to reach her.  Ashanti D, user ID AF09740, was very helpful, even giving me the conversation reference number I52146704.   She told me that without a last initial or employee ID number it would be impossible to look Julie up.  The NY Call Center could not be reached directly by Empire customers, it was an internal number and Ashanti looked it up and transferred me to it.  After a long hold the phone rang three times, then the line went dead.

Grievance 6:  improper billing practices

I received confirmation of my payment for December and January two weeks before this arrived:

Screen Shot 2017-10-11 at 5.07.10 PM.png

Grievance 7:  instead of promised return call, customer service survey

Attempted Customer Happiness surveys asking about each of these “customer service” experiences, by telephone and email.

To show that the corporation is not without a certain sardonic sense of humor, I had a solicitation call from an Empire representative, on 1/4/17, thanking me for my business and offering her assistance in renewing me with Empire so there would be no interruption of insurance for my health care.     

#3 The New York State of Health Marketplace

Errors are not easy to resolve at the New York State of Health (”NYSOH”). Answers to routine questions vary from representative to representative. There is a wait of several months to have even the most simple mathematical mistake by the NYSOH corrected, and one must go through a quasi-legal appeal process before NYSOH will correct its error.  Attached is a recent decision by a hearing officer that ordered NYSOH to correct an easily detectable mathematical error they had committed months earlier.   

Note that any employee of NYSOH could have used the online calculator on their website to instantly verify their error, generated automatically by their website (it is easy to instantly lose insurance coverage at NYSOH, hard to regain it), a mistake that took months to have corrected and resulted in the customer being forced to overpay by almost 100% until they did.

Compounding the aggravation of resolving problems with NYSOH is the policy of its director, Donna Frescatore. Representatives are specifically instructed not to divulge the director’s identity or any way of reaching her office. I have confirmed this policy many times, with many different NYSOH representatives.

#4 Common healthcare billing irregularities in New York State

The PPACA, whose primary drafter, Liz Fowler, went back to work in the health industry after her legislative work was done, apparently contains no provision that the cost of a medical service must be divulged to the patient before the medical service is performed.  

The doctor’s office or hospital cannot tell you the fee until the insurance company sends them a statement.  The insurance company cannot predict the fee until they get the provider’s bill.  The insurance company then eventually sends the patient an Explanation of Benefits, (“EOB”), detailing all charges, payments made and the patient’s responsibility for whatever part of the negotiated rate insurance has not paid.   It is like eating at a restaurant with no prices on the menu, and being sent a bill for the meal weeks later.  Except, of course, that it is not a meal at a restaurant, it is often a matter of life or death, or, at least, of health-related stress.

My kidney biopsy, for example, may cost the patient anywhere between zero and many thousands of dollars.  Simply no way to determine the cost prior to delivery of the service, under current law.  I had the procedure on May 26, I got the most recent EOB related to the procedure on September 28.  In the intervening four months, I got many bills from the hospital.

Though there is probably nothing your office can do about this particular practice, I offer it as an illustration of the scope of the challenges facing New York healthcare consumers.  I provide the following letter to the CEO of Healthfirst as a snapshot of the general billing madness under our current ‘regulatory’ scheme.   

Pat Wang
CEO  
Healthfirst
100 Church Street
New York, NY 10007

pwang@healthfirst.org

September 26, 2017

Dr. Ms. Wang:

I appreciate that you allow your reps to give out your contact information to customers who can’t otherwise resolve issues with your staff.   This encourages me to think that you might be helpful in resolving an aggravating billing situation that has been ongoing for months.    I applaud your willingness to be contacted, it shows integrity and is in stark contrast to the policy of Donna Frescatore, director of the “New York State of Health” (NYSOH) ordering her reps not to divulge her name to callers.

I request a corrected bill and an accounting showing my remaining credit toward premium payments.  The credit situation is described below.

During an August 25th call to Healthfirst to try to resolve the issue of incorrect bills being sent to me, my “case” was assigned an “escalation number” (347-79-923).  I was promised an accounting, showing payment history and current credit toward future premiums.   I received instead a notice, dated September 8 and signed by Christopher A. DiMarco, threatening me with cancellation of my health insurance for a claimed past due balance of $28.   

On September 19 I called Healthfirst and was assured that credit had been applied and my September premium paid in full.  I was also informed during that call that “finance” had included no notes on my account.   I could not be sent a simple receipt for payment or anything indicating my remaining credit.  I was assured by an extremely sympathetic rep that my account was paid through October, with credit remaining toward November’s premium.

Attached is the invoice I received on September 25.   It seeks payment of $482 for October (plus a past due amount), nonpayment of which will result in losing my health insurance (as I begin treatments for kidney disease and skin cancer).   It has been mailed to me in error.   I have a credit of several hundred dollars due to overpayments made as a result of NYSOH’s error.   NYSOH incorrectly denied my subsidy for 2017.   It took months, and a ruling by a hearing officer, before NYSOH was ordered to retroactively restore the subsidy, about fifty percent of the premium.  

As a result of NYSOH’s error, I was required to pay Healthfirst the full premium from February through June.  When I got a bill for July, I called Healthfirst and learned that a credit had been applied for my overpayment.  After payment of July’s premium the rep calculated my remaining credit at $876.

Since then it has been a health insurance headache every month.  In another context, it would be tempting to characterize the attached invoice demanding payment for a premium I have already paid as an attempt at fraud.  I am sure it was sent to me in error.    Please have somebody update my account and send me an accurate statement of my payments and remaining credit.

(invoice attached here)

Thanks,

 

A short time later, after a call from one of Ms. Wang’s assistants, I got a corrected bill that demanded payment of -$183 on or before October 1.

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A Little History

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                                                                                                              (photo credit)

As we learn, words matter very much.   What we call something frames the conversation and removes certain aspects completely from the discussion. Most of us recognize that there is a more truthful description of an actual incident and a less truthful one.  Those who would manipulate public opinion seize the selected description that serves them best.   We can see this daily in the asinine pronouncements of President Pantload and the often convoluted defense of these remarks by his loyalists.   It is an old ploy: call the thing something else and we are no longer talking about the thing that concerns you the most.

Look at the thirty-four words on this marker about an event that took place on April 13, 1873, Easter Sunday that year.  A beautiful example of this.

Context:  this incident took place less than a decade after the end of the Civil War, a war that grew out of a peculiar form of commerce, institutionalized racism and a region’s military defense of chattel slavery based on that racism and commerce.   It is an American war that continues to rage, as a glance around today will confirm.  

The side that lost America’s bloodiest war was forced by the winners to ratify constitutional amendments that would give full citizenship to a race that had until a few years earlier been mostly enslaved.   The former Confederate states were not happy about being forced to do this, but they were compelled to sign so they could get Federal funds to restore the destroyed infrastructure of the South.

After the election of 1872 local whites were enraged that former slaves were again attempting to vote and, worse, were intent on trying to enforce the results of an election their candidate had won.   An armed garrison of blacks guarded the courthouse at the county seat of Grant Parish, to ensure that their candidate was sworn into office.  Local whites, heavily armed, most on horseback, with at least one cannon, besieged the former slaves guarding the voting box.   After the surviving outnumbered blacks surrendered they were taken prisoner.   Dozens of these unarmed prisoners were summarily executed by the mob over the next few hours.

Riot or massacre?  You decide.

Note that three white men were killed.   In a riot.  Then 150 blacks were killed, probably while running amok.  “You know how those people are…” is presumed here, I can almost hear the demur, lowered voice, almost apologetic.  

The passive voice “were slain” is another great touch.  You know, shit happens in a riot.  It is so much more tasteful than “were butchered” or “shot point blank by members of a mob who also tortured many before killing them”.

Then the historical marker concludes, like an incompetent president doubling down, with the punchline, of sorts.

“This event on April 13, 1873 marked the end of carpetbag misrule in the South.”

It is amazing in its bluntness and accuracy, to cite only two ways it is amazing.  Once local mobs could kill blacks with impunity there was no way the former slaves could hope to enjoy the rights of citizenship.   It was probably the Supreme Court decision on the case a few years later, freeing all the white perpetrators/victims of the riot, that marked the end of so-called carpetbag rule, and the compromise that settled the 1876 presidential election, and removed federal troops, that led to the end of enforcement of the new federal laws in the South, the return of “home rule”, but that is a trifle. 

The carpetbaggers were unscrupulous northerners who came down to plunder the helpless south after the war.  There were a bunch of them, no doubt, and some enriched themselves in the manner of ticks gorging on the blood of a noble animal too weakened to resist.  But the “carpetbag misrule” on that plaque refers to the efforts of the Federal government to enforce the constitutional amendments preventing slavery, extending full citizenship and the vote to former slaves.   This “misrule”, enforced with troops and often called “bayonet rule”, included making the former Confederacy do everything it had gone to long and bloody war to prevent:  treat its blacks as equal citizens.  “Misrule” because it is so unfair for the victor of a war to impose its will on those who lost, no matter who fired the first shots.

The fucking issue is still being bitterly fought.  The racism behind it is deeply baked into our society.   Calling it by another name?   Just more of the same.

Bravo, by the way, to the creators of that historical marker.  Making America great again.

Edited letter to the A.G.

Dear Mr. Attorney General:

I am appealing to you for assistance, on behalf of many thousands of New Yorkers caught in a sometimes life-threatening situation regarding their healthcare.  As described more fully below, citizens of our state have no government agency that intervenes in cases where patients are mistreated by the corporations we buy health insurance from.   This is true even in cases of apparent fraud.  

I urge you to propose legislation to correct this grave oversight.  The need for state regulation of health insurance grows ever more acute in light of the current federal administration’s determination to gut all regulation.

I’ve followed your career and admire the principled and proactive steps your office has taken against the powerful perpetrators of various frauds.  Leaving politics aside, as one must in a letter like this, it is gratifying to see someone in office holding powerful entities responsible for their bad acts.  Your office is well-suited to fix what I believe is a healthcare emergency affecting the lives of countless New Yorkers who purchase private health insurance, particularly older citizens and those living just above the “poverty line.”

As frustrating as my healthcare-related ordeals have been, a 61 year-old currently trying to get treatment for kidney disease and skin cancer, I have the benefits of fluency in English, computer literacy, legal skills.  It is hard to imagine the life-shortening stress that is inflicted on the elderly and other vulnerable New Yorkers unable to get so much as a hearing for often unappealable denials of health care.

It has been a challenge to put the many healthcare-related issues I’ve been forced to navigate into a streamlined letter.  I’ve attempted to keep this letter short and dispassionate.  To that end I provide some of the devilish details in a series of attachments.  I have confirmed many times that my experience as a consumer who buys health insurance on the New York State of Health Marketplace (“NYSOH”) is representative of the experiences of countless others.  

Attachment # 1 is a detailed description of the “consumer help” cul du sac that desperate NYS residents can spend a few hours in, looking in vain for help with health insurance-related troubles.  Anyone in your office can retrace the useless steps.  Creating a healthcare ombudsman position would be a good first step here.    

Corporate “persons” are without conscience and motivated only by a zeal for profit.  When left unregulated, it is no surprise such “persons” act as they see fit.  In the case of health insurance companies, they are free, for example, to repeatedly refer patients to “in-network” doctors who are not actually in-network.  They are also relatively unrestrained when refusing to provide services, under a variety of corporate rationales, in spite of what the Patient Protection and Affordable Care Act (“PPACA”) may have to say about it.   There is no penalty for these common business practices and they are well aware of it.  Regulations to address these things, with an enforcement arm, would be a good start.  (see #2)

Those mandated by the PPACA to purchase health insurance from the New York State of Health Marketplace may find themselves with a host of new problems during the short holiday season window for purchasing insurance. A consumer advocate or ombudsperson on site at NYSOH would greatly aid in resolving problems, including simple mathematical errors, that presently can only be addressed by a lengthy appeals process.  (See  #3)

Billing irregularities, including improper bills, which are to be expected in a law as complicated as the PPACA, are probably the most common form of immediate stress most of us are regularly subjected to.   The rep at your office’s consumer help desk offered help with billing problems, problems I suspect are legion.   I offer a short overview of the larger problem and one recent snapshot as #4.

Thank you for your time.  I am available to amplify anything written here and to testify anywhere you may require.

Yours sincerely,

 

From attachment 4:  

The PPACA, whose primary drafter, Liz Fowler, went back to work in the health industry after her legislative work was done, apparently contains no provision that the cost of a medical service must be divulged to the patient before the medical service is performed.  

The doctor’s office or hospital cannot tell you the fee until the insurance company sends them a statement.  The insurance company cannot predict the fee until they get the provider’s bill.  The insurance company then eventually sends the patient an Explanation of Benefits, (“EOB”), detailing all charges, payments made and the patient’s responsibility for whatever part of the negotiated rate insurance has not paid.

My kidney biopsy, for example, may cost the patient anywhere between zero and many thousands of dollars.  Simply no way to determine the cost prior to delivery of the service, under current law.  I had the procedure on May 26, I got the most recent EOB related to the procedure on September 28.  In the intervening four months, I got many bills from the hospital.

Though there is probably nothing your office can do about this particular practice, I offer it as an illustration of the scope of the challenges facing New York healthcare consumers.  I provide the following (obviously minus preamble, dear reader)  as a snapshot of the general billing madness under our current regulatory scheme.   I compare it to eating at a restaurant with no prices on the menu, and being sent a bill for the meal weeks later.  Except, of course, that it is not a meal at a restaurant, it is often a matter of life or death.

 

An excellent historical analysis

An organization, seeking to foster a real conversation about our history of violent racism, lynching in particular, had the funding (from Google) to shoot me a compelling video ad on youtube that led me to explore their website. From their report:

When the era of racial terror and widespread lynching ended in the mid-twentieth century, it left behind a nation and an American South fundamentally altered by decades of systematic community-based violence against black Americans. The effects of the lynching era echoed through the latter half of the twentieth century. African Americans continued to face violent intimidation when they transgressed social boundaries or asserted their civil rights, and the criminal justice system continued to target people of color and victimize African Americans. These legacies have yet to be confronted.

The organization is called The Equal Justice Initiative.  Their project is of crucial importance, in a country being made great again by people who deny our ongoing bloody history, and climate disruption, our 2500% higher rate of mass killing by gun than any other nation and many other horrors that are denied at our peril.   The website is very well done.  The historical section I read is clearly and beautifully written.  

When I was in law school, twenty years ago, a case called U.S. v. Cruikshank was mentioned in a one sentence footnote in the casebook for Constitutional Law.   As I began researching what happened to enforcement of the amendments intended to outlaw slavery, guarantee full citizenship to former slaves and give black men the right to vote, I stumbled on more details about the little known case.   After reading the lower court decisions, and the Supreme Court’s final word, I came to understand that Cruikshank, as much as the aptly named Slaughterhouse cases (which gave a miserly reading of the rights of federal citizenship that would be our law for almost a century), was actually the death knell for the new rights of citizenship for black people in America.

When an organized, torch carrying crowd marched and chanted recently in Charlottesville, Virginia, protesting the proposed removal of a monument to the slaveholders’ armed rebellion against the U.S.A., the stink of an undiscussed history hung over that procession.  There was the occasional shot of a screaming chap wearing a swastika, a chant about Jews, delivered by the marchers without love or irony, and also those carrying and wearing the symbols of those who enslaved and terrorized blacks.  There was a near century, after the Civil War, of often public lynching that extended to twenty states, walking with these angry white men.

Most people, on many sides, many sides, have a revulsion for the symbols of racist regimes of the past, however little they might actually know about these notorious regimes.  These symbols stand for a time when violent hatred ruled the day.  That’s kind of the point of bringing these potent symbols to a rally.  They are used to rub people’s faces in an easily recognizable worst case scenario for a minority, when the violent racists of the day ruled and the government smiled on the murderers.  

Cruikshank was one of the leaders of a mob of angry whites, defeated Confederates, who swarmed into Colfax Louisiana on Easter Sunday 1873. They came heavily armed, on horseback, with at least one cannon.  The whites were there to see that Negros did not get the final word on the vote, that no Negro take power over any white. They attacked the black Civil War veterans who were guarding the courthouse, defending the county seat of newly renamed Grant Parish after a bitterly contested election won, on black votes, by Republican advocates of black rights.    

It was a slaughter, pure and simple.  As many as fifty black men were killed hours after surrendering.   The whites, who had overwhelming numbers, killed every black they came across, left their corpses rotting on the field on the day Jesus was resurrected and rose up to heaven.  The failed federal prosecution of the perpetrators of what Eric Foner called the worst instance of racial violence of the Reconstruction era   would, more than a century later, become a one sentence footnote in the Constitutional Law casebook. [1]

The federal prosecution over Cruikshank and his comrades was ruled unconstitutional by The Supreme Court.  It said, amid pages of legal analysis that drily took the indictments apart point by point, that the Constitution protected former slaves only from government action– not from the actions of a private mob.   It left enforcement of such crimes up to each individual state to deal with as they saw fit.   The case quietly closed down all federal prosecution of outfits like the Ku Klux Klan.  

The decision was a stinking piece of legalistic cavil, like other racially driven decisions over the years, but you can’t appeal that decision anywhere, of course, even if the Court is demonstrably sympathetic to the former enemies of the U.S.   The ruling in Cruikshank led to all the defendants walking, triumphant as that iconic grinning Southern sheriff with his Red Man chewing tobacco pouch almost a century later, into a long period of unrestrained, often deadly, brutality against former slaves.

Here is a historical marker, put up by the state of Louisiana in 1950, photographed by Billy Hathorn (photo credit here). 

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At the end of the twentieth century only an enterprising law student with an overriding interest in history could find out anything more about the case, about the then largely unknown Colfax massacre, about any of this shit.  As we march along in the twenty-first century, this is the kind of history we need to be learning from together. This website is an excellent tool for learning.

As the director of the Equal Justice Initiative writes:  

We cannot heal the deep wounds inflicted during the era of racial terrorism until we tell the truth about it.

True dat, as my father would say.

 

[1]  how’s this for a footnote?  

Opposition among white Democrats to suffrage for blacks resulted in 1,081 political murders from April to November 1868. Almost all of the victims were black, and some of the whites who were killed were Republicans.

source

Burying the lede

The eagle eyed (or more accurately eagle eared) Sekhnet had a good comment on the letter to the A.G.   I need a more dramatic, attention grabbing opening sentence.   One must not bury the lede.   Can’t make a sale without a good pitch, and a good windup is essential to ze nasty break on zat strikeout pitch.

The present draft begins with this bland statement (note passive voice use, it’s not like it was written by me, he said):

I am writing to give you an on-the-ground view of the stressful health care situation for hundreds of thousands of us in New York State.

Admittedly, not much there to grab you.

My more fiery, overwrought first draft, months back, opened:

I am writing to alert you to a massive consumer protection failure in New York State, regarding denials of purchased health care, and to urge your office to investigate this unchecked fraud.

There might be something there… but not enough.

I am writing to alert you to the scope of the healthcare crisis for tens of thousands of New Yorkers…  

Sekhnet dictates (with some on the fly revisions):

I am appealing to you for assistance on behalf of many thousands of New Yorkers placed in an untenable position regarding their healthcare.   

This also needs to get worked in early on, I suppose:

As frustrating as my medical insurance ordeals have been, I have the benefits of fluency in English, computer literacy, legal skills.  I cannot imagine the life-shortening stress that is inflicted on the elderly and other vulnerable New Yorkers unable to get so much as a hearing for often unappealable denials of health care.

On the other hand, since this is the holiest day of my great-grandfather’s religion, and a fasting day, at that,  I’d better wrap this up and get ready to bring these fruits I’ve been slicing and the other things we’ve been preparing up to our gathering to break the fast.   Once it gets dark.  That first drink of orange juice never tastes better.

 

 

Dear Mistuh A.G.

For reasons too tedious to detail here, I will use this platform to compose the beginning of a draft to New York State’s activist attorney general urging him to take action.   This AG is the guy who successfully sued President Winner over his fraudulent university.   In NYS the AG also proposes and advocates for legislation, as it turns out.   I have a plan.  Relatively short, streamlined cover letter with several attachments laying out the infernal particulars.   Blah blah (see #1)  blah blah blah (#2) etc.

Dear Mr. Attorney General,

I am writing to give you an on-the-ground view of the stressful health care situation for hundreds of thousands of us in New York State.  As described more fully below, citizens of our state have no government agency that intervenes in cases where patients are mistreated by the corporations we buy health insurance from.   This is true even in cases of apparent fraud.  

I urge you to propose legislation to correct this grave oversight. The need for state regulation of health insurance is even more acute in light of the current federal administration’s determination to gut all regulation.

I’ve followed your career and admire the principled and proactive steps your office has taken against the powerful perpetrators of various frauds.  Leaving politics aside, as one must in a letter like this, it is gratifying to see someone in office holding powerful entities responsible for their bad acts.  Your office is well-suited to fix what I believe is a health care emergency affecting the lives of countless New Yorkers, particularly older citizens and those living just above the “poverty line.”

It has been difficult to put the many healthcare-related issues I’ve been forced to navigate into a streamlined letter.  I am certain that my experience as a consumer who buys health insurance on the New York State of Health Marketplace is representative of the experiences of countless others.  I have confirmed this many times over the last few years.  

As frustrating as my ordeals have been, I have the benefits of fluency in English, computer literacy, legal skills.  I cannot imagine the life-shortening stress that is inflicted on the elderly and other vulnerable New Yorkers unable to get so much as a hearing for often unappealable denials of their health care.  I’ve attempted to keep this letter short and to include the devilish details in a series of attachments.

I am therefore attaching a detailed description of the “consumer help” cul du sac that desperate NYS residents can spend a few hours in, looking in vain for help with health insurance-related troubles.  Anyone in your office can retrace the useless steps.  Creating a healthcare ombudsman position would be a good first step here.  (see # 1).  

Corporate “persons” are without conscience and motivated only by a zeal for profit.  When left unregulated, it is no surprise these “persons” act as they see fit.  In the case of health insurance companies, they are free, for example, to repeatedly refer patients to “in network” doctors who are not in network. They are also relatively unrestrained when refusing to provide services, in spite of what the Patient Protection and Affordable Care Act (“PPACA”) may have to say about it.   There is no penalty for these common business practices and they are well aware of it.  Regulations to address these things, with an enforcement arm, would be a good start.  (see #2)

Those mandated by the PPACA to purchase health insurance from the New York State of Health Marketplace may find themselves with a host of new problems during the short holiday season window for purchasing insurance.  A consumer advocate or ombudsperson would greatly aid in resolving problems and errors that presently can only be addressed by a lengthy appeals process.  See  #3

Billing irregularities, including improper bills, which are to be expected in a law as complicated as the PPACA, are probably the most common form of immediate stress most of us are regularly placed under.   The rep at your office’s consumer help desk offered help with billing problems, which I suspect are legion.   I offer a short overview of the larger problem and one recent snapshot as #4.

Thank you for your time.  I am available to amplify anything written here and to testify anywhere you may require.

Yours sincerely,

 

Death by American Healthcare (part 4 of 22,000,000)

Let us stipulate that the wealthiest citizens of this nation, as a polity, are not greatly concerned with the illness or death of masses of Americans who did not have the good sense to be born into the right social circumstances.   We have a privatized health care system here that would be a cause of great national shame, in a nation where shame for such things was still possible.   We are, as a nation, shameless fucks.   A glance at any of President Fuckface’s recent tweets will confirm this, whatever mix of disgust and shame we may also personally feel as a result.  

Here is a letter I was compelled to write today:

Pat Wang
CEO  Healthfirst
100 Church Street
New York, NY 10007

pwang@healthfirst.org

Dr. Ms. Wang:

I appreciate that you allow your reps to give out your contact information to customers who can’t otherwise resolve issues with your staff.   This encourages me to think that you might be helpful in resolving an aggravating billing situation that has been ongoing for months.    I applaud your willingness to be contacted, it shows integrity and is in stark contrast to the policy of Donna Frescatore, director of the “New York State of Health” (NYSOH) ordering her reps not to divulge her name to callers.

I request a corrected bill and an accounting showing my remaining credit toward premium payments.  The credit situation is described below.

During an August 25th call to Healthfirst to try to resolve the issue of incorrect bills being sent to me, my “case” was assigned an “escalation number” (347-79-923).  I was promised an accounting, showing payment history and current credit toward future premiums.   I received instead a notice, dated September 8 and signed by Christopher A. DiMarco, threatening me with cancellation of my insurance for a claimed past due balance of $28. On September 19 I called Healthfirst and was assured that credit had paid my September premium.  

I was also informed during that call that “finance” had included no notes on my account.   I could not be sent a simple receipt for payment or anything indicating my remaining credit.  I was assured by an extremely sympathetic rep that my account was paid through October, with credit remaining toward November’s premium.

Attached is the invoice I received on September 25.   It states that I must pay $482, on pain of losing my health insurance (as I begin treatments for kidney disease and skin cancer).   It has been mailed to me in error.   I have a credit of several hundred dollars due to overpayments made as a result of NYSOH’s error.   NYSOH incorrectly denied my subsidy for 2017.   It took months, and a ruling by a hearing officer, before NYSOH was ordered to restore the subsidy, about fifty percent of the premium.  

As a result of NYSOH’s error, I was required to pay Healthfirst the full premium from February through June.  When I got a bill for July I called Healthfirst and learned that a credit had been applied for my overpayment.  After payment of July’s premium the rep calculated my remaining credit at $876.

Since then it has been a health insurance headache every month.  In another context, it would be tempting to characterize the attached invoice demanding a large payment for a premium I have already paid as an attempt at fraud.  I am sure it was sent to me in error.    Please have somebody update my account and send me an accurate statement of my payments and remaining credit.

Thanks,