"get active" debate over Moore documentary

[marilyn michalak]

Count me in. The problem with class actions is that the attorneys get all the money. I'd love them to pay my Stenum bill!
Marilyn
Three level ADR
Stenum July'07

[marilyn michalak]

Erisa needs to go!If we are getting political about things, I'll go for a march on Washington (a crawl?) to bring attention to the fact that if you become permanently disabled and have purchased insurance through your employer, you are screwed. ERISA was meant to help the employee originally, but it (the only federal legislation on the books) was used for big corporations as a loophole to get out of paying . We Spineys are a target for a lot of things, because our problems are so expensive and problematic. I still think a crawl on Washington would be a good thing. The "million man that couldn't walk" march. We certainly deserve better. Even those of us who were well insured like me. All I have is social security, even though worker's compensation insurance was in place, and my long term disability was paid for twenty years! I have tapes given to me by my attorney that were spliced, altered, violating some law, reams and reams of tapes. Days on end, I would look out the window and the PI's cars were out there, waiting for me. Endlessly waiting to film and film, and that they did.
Then they send you to the creepy doctors who write ridiculous reports. Endless creepy doctors.
Wouldn't it have been cheaper to actually just pay what was owed?I really think it would.

Anybody else go through this BS?
Broke and Disabled Spiney
3 Level ADR Stenum July '07
Still have pain.

Originally posted by jeffdanto:
davidj8121 said it best - "If we want to get the attention of the health insurance industry lets all get together and file a $100 million dollar (or whatever the number may be ?? ) class action lawsuit against the insurance companies that are the cause of the problem. If a good firm thinks we have a case they will take it on a contingency basis ( no fee to us unless we win)."

Unfortunately, a lawsuit would just get thrown out. The reason this would happen is because of ERISA. To quote my paper that Texas-T posted above, here's an explanation of how ERISA does not allow individuals to file lawsuits against insurance agencies:

"Recent Supreme Court rulings have further interpreted ERISA to cover employer based health plans, for which the law was not intended to do. As a result of this interpretation, policy holders of employer based health plans can only sue their health plan for coverage in Federal court.

"ERISA's regulation of managed care organizations stems from its preemption clause (29 U.S.C., section 1144(a)) which states that "[ERISA] shall supersede any and all State laws insofar as they relate to any employee benefit plan." This clause has essentially "prevented states from regulating the activities of employee based health plans," which has provided health insurance agencies with more power to determine which procedures they cover while simultaneously holding them less accountable for their decisions.

"Two Supreme Court cases have further reduced the liability for managed care organizations. On June 21, 2004, the Supreme Court "effectively immunized managed-care organizations (MCOs) from liability for negligent decisions about the care of patients in private employer-sponsored health plans" in its ruling in the combined cases of Aetna Health v. Davila and CIGNA Healthcare of Texas Inc. v. Calad. Davila and Calad sued their managed care organizations under the Texas Health Care Liability Act, which is a state statute that holds managed care organizations liable for negligence "when they fail to exercise ordinary care in making decisions about whether treatment is medically necessary for a patient." Because CIGNA and Aetna are "ERISA plans", CIGNA and Aetna argued that ERISA preempted the Texas statute, and that the case must be resolved in Federal court under ERISA to recover insurance payments due for the two plaintiffs' procedures.

"The Supreme Court gave a unanimous decision that ERISA "provides the exclusive remedy for patients in ERISA plans when an MCO denies benefits – even if the denial is based on a decision that the disputed care is not medically necessary for the particular patient." Many fear that because of this decision, health insurance agencies will "have little incentive to make medically appropriate decisions if the only penalty for wrongful conduct is no more than what they should have paid for in the first place."

"According to Dr. Mike Magee, ERISA "has become the central pillar of defining the roles and responsibilities of the health insurance industry's managed care organizations. More specifically, it's used to define the extent of their liability for both health benefits and the fallout of decisions to extend, or not to extend, coverage for a wide array of health services."

(Resources:
Cornell Law School. U.S. Code Collection http://www4.law.cornell.edu/uscode/html/uscode29/usc_se...0001144----000-.html

Cornell Law School. U.S. Code Collection http://www4.law.cornell.edu/uscode/html/uscode29/usc_se...01003----000-.html#a

National Conference of State Legislatures. "Maryland's Fair Share Health Care Fund Act Overturned in ERISA Challenge" (1/29/2007) http://www.ncsl.org/programs/health/fairsharenews.htm

Hellinger, Fred J, Ph.D. and Gary J Young, Ph.D., "Health Plan Liability and ERISA: The Expanding Scope of State Legislation." February, 2005. American Journal of Public Health. http://www.pubmedcentral.nih.gov/art...?artid=1449155

Mariner, Wendy K. "The Supreme Court's Limitation of Managed-Care Liability." 2004. New England Journal of Medicine

Magee, Mike. "The Laws that Protect Managed Care" Health Politics.Org. http://www.healthpolitics.org/progra...t.asp?p=erisa)

It's quite unfortunate that this has yet to be amended. While trying to get the attention of the public through Oprah and Michael Moore may or may not be the best idea, my advice is to write your congressmen and women, and your state's senators. Explain to them the frustrations and pain you all have had to endure. Mention ERISA. Cite Texas-T's World News Tonight video to show that this is debilitating. Call your local news. There have been stories done in Florida, California, D.C., and I think Boston on local news stations about patients with back pain who have been denied coverage for ADR.

There's a lot of work to be done, but there are also many quality resources to get in touch with to help make a difference. Let's not limit ourselves to Michael Moore and Oprah.

[marilyn michalak]

Originally posted by marilyn michalak:
<BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by marilyn michalak:
I am sure that both sides agree that we need insurance reform NOW!! If you want to understand the seedy underpinnings of insurance businesses (ALL OF THEM), please read "Insult to Injury" by Ray Bouhrris. It documents just how they routinely get out of their contracts with us, the consumer. A MUST READ !!! Let's by all means use Oprah and Michael Moore to help us out!!!
Marilyn
bottom three ADR Stenum '07
Still struggling with pain

</div></BLOCKQUOTE>


The wonderful thing about Democracies are that they are always being re-worked. Our power is only in numbers. If we choose to work toward a common goal, which would be insurance company reform. I should be getting a few payments here, but as things are, I'll never see them.
And do I need money!!! OY!

[marilyn michalak]

If Oprah is interested, she is pure gold. She is a real power broker in this country, and whether you like Michael Moore or not, he is too. Our individual complaints could become one voice, asking for justice, insurance reform, and the American Way!(Maybe it's time to get a cape on, haha) I call for a walk on Washington (crawl, wheel, lay down, whatever) It's our time!!I just spent eight years in bed being tortured by the insurance companies, then went to Stenum and paid out of pocket. I have to deal with Worker's Compensation as my insurer and they play all kind of tricks to get out of paying for health care of any kind. I legally cannot use my other insurances, so I go without health care, pay for it myself, or bargain with the doctors. Let's get off our sore behinds and do something about this!!
Marilyn
three level ADR Stenum July'07
Still struggling

Originally posted by LBP:
wow, I'm a little offended and it sure is easy to say all this when you're on the other side I guess. This is too important of an issue for us to fight each other over our politics.

I happen to like his prior docs and yes I'm a liberal democrat and so are many litigators... but I understand not everyone agress with his politics. But any press is good press...I don't care where it comes from if it puts the heat on the Insurance Industry.

Please don't judge this Moore project until you see it. The best thing about Moore is that he opens up controversial diagalogue. Nothing wrong with that.

Oprah does TONS of things to help people. Do you actually watch her shows? And this seems to be the year of medical issues. Something I welcome! Especially with her support of Barak as a presidential candidate.

I am pretty sure if there was a class action to be made...it would be a whole lot easier with national attention from Oprah because all the news stations would follow.

If an attorney takes this case...it will not be out of the goodness of his/her heart and bankroll..he/she will expect a huge fee, and even on contigency you still have to pay for costs to fight the good fight, up front...experts are VERY expensive...depositions are expensive, investigators are expensive...this stuff is not on contingency. Any attorney taking a case like this will be seeking a lot of media attn...and would welcome attention from the Oprah show and Moore. Plus what are the real damages for an attorney to make money on a case unless the laws change. Given the status of the Supreme Court and recent rulings re ERISA it's an uphill battle and we need all the ammunition we can get.

Putting the heat on an election year could be perfect timing.

Besides, how on earth would Oprah "take a cut" of ADR surgery? That's just insane.

[ZorroSF]

Originally posted by davidj8121:
Hello ALL,

I hear what your all saying and I agree with most of it but if you really want to be taken seriously the last thing I BELIEVE the ADR community should do is assoicate ourselves with Micheal Moore. The guy is an absolute idiot and an extremist that has never done anything for anyone but himself. Everything he says or documents is less than half the truth.

David J.

You have shown us no proof that he's an idiot and no proof that he tells half truths. If anything I think you've revealed something about yourself. It's too bad you want to sit off on the sidelines for this one.

[Harrison]

This topic is getting a bit inflammatory and in danger of becoming divisive. Just to overshare, this is why I hinted earlier about not broaching the Moore issue earlier -- his work is provocative and usually elicits a very visceral/digital/opinionated response!

That being said, I like the quote it’s “better to light a candle than curse the darkness.” We as a community have started an informal, but very personal appeal that I would like to share with “the media.” Our message is not in danger of being quelled by the Oprah gatekeepers! I will work hard to get this story -- our story -- to other media outlets, especially our congressman in D.C. And I can now say that I was in their offices, speaking with them and their legislative assistants!

It may not change the woefully dysfunctional insurance issue (with ALL new procedures, not just ADR), but we do have the chance to educate influencers in the media, government and the rest of society. That is, we will tell them our grueling stories of suffering while under the duress of unmanaged care.

Now that I’ve come this far, I believe that anyone like Moore who can move people to act in a constructive path towards positive change is a very welcome force in our complex society.

Thanks to all contributed their stories, I have about nine so far. Let’s get back to work.

[LBP]

I cant believe we only have 9 stories submitted??? I sent private messages to over 100 people to ask them to read this post????

[marilyn michalak]

I do not agree with your classification of Michael Moore as an idiot. Neither Oprah. We should keep in mind that we have an objective, and they are advocates. No matter what you think of them, they can help us get our message out there. We want medical care paid for, we want disability payments owed to us, we want justice when it comes to trials (including workers' compensation) . What do you guys and gals think of converging on Washington DC? We want action, let's go for it. I am going to challenge Oprah to have her cameras follow me through a "normal" day. I just got my physical therapy denied by Work Comp. I cant walk so I went to Costco and rode around in one of those little carts. A man had to help me with a giant cake that I got for Fathers' Day. Kind people are everywhere (everywhere but working for insurance companies). Spend a day with me and see how great it is to get injured at work. I was called a "Malingerer" despite diagnostics that proved otherwise. We who lose our lives (and lifestyles) to dangerous workplaces deserve respect( and money owed by insurance companies, health care, etc.) If we want our message out there, lets get our sorry behinds out there and tell people what its' like to have a serious health problem in this country. It sucks!!!
marilyn
3 level ADR Stenum July'07
Still hurting

Originally posted by ZorroSF:
<BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by davidj8121:
Hello ALL,

I hear what your all saying and I agree with most of it but if you really want to be taken seriously the last thing I BELIEVE the ADR community should do is assoicate ourselves with Micheal Moore. The guy is an absolute idiot and an extremist that has never done anything for anyone but himself. Everything he says or documents is less than half the truth.

David J.

You have shown us no proof that he's an idiot and no proof that he tells half truths. If anything I think you've revealed something about yourself. It's too bad you want to sit off on the sidelines for this one. </div></BLOCKQUOTE>

[Harrison]

Marilyn, good points all around! LBP, thanks for all your hard work…wow…100 private messages is impressive. For what it’s worth, people in the marketing/PR world would be very happy with a 9% return…not to mention the financial world.

It’s not over yet. My original request was asking folks to submit letters to me until tomorrow, but I’ve figured out a few ways to make this easier for me, you and the media. More in the next 48 hours.

Thanks all for expressing your concern. IT MATTERS!

[Bailey]

Count me in! I'm not sure exactly what we are looking for, but I'll be happy to share one of the success stories. Harrison, please IM your private email address and I'll be happy to share my story. Please let me know what you are looking for. I am crazy passionate about ADR and what's I've been through and what's it done for me. My friends are tired of hearing about it! Give me a platform and I'll share. I just want a day or so to collect my thoughts... Let me know how to help!

Craig