spinergydude

Knowledge IS power. However, all the knowledge in the world is nothing whatsoever if no one can grasp it. So, then knowledge is wasted power.

In the blink of an eye.... Spinergy Dude awoke...

And now, somehow, someway non of my disabilities will stop me from sharing how the US Medical Insurance Industry tried to RAPE me of my right to know my rights to appeal, made errors they are aware of, and how....

Millions and millions of people in the US with ALL disabilities, not just the easy to tell ones like me... For you see for 25 years and even on and off after I was disabled in ways not visable... And, yet I was disabled my entire life, and no one ever knew...

Due to my diverse background, and a love to learn.... I would come to have the tools of knowledge to uncover or rather it presented its self to me....

Now if I missed one thing in my own fight for independence... Today right now... Instead of typing...

I would be on the floor in severe pain even more than I am constantly anyway, because my medical insurance decided it would force me into isolation...

In effect make me shamed of my self, feel worthless, lost like no hope, like I am not worthy of being human.... I would feel RAPED....

Because of something called business as usual... And, I am not anti insurance for profit... No. I am anti FRUAD by customers, and ANTI CRIMES committed by insurance companies who take advantage of an little know problem....

What was not counted on was I am one of about 2% of non professional laypeople who realize, understand, and can grasp the entire US Medical Health Care System all related laws, policy, ethics, and I can translate all of the double talk, techno babble into terms everyday people can relate to....

Only I can not write all that well, and even at that... Here in pain right now....

I continue.... Aetna my medical insurance company is not the only one to break laws, prevent people from knowing the right to appeal... But, in four days I was able to go toe to toe with the top level Medical Director, who is on the Baord of Directors.... And, he overturned my denial...

SpinerDude.LiveJournal.com where I am slowly going to do what I did to Aetna to the entire United States.... Become the formost expert in layperson speak on such boring, technical, medical , legal, and more that makes up our system we call the US Health Care System.... And, make it so it relates to YOU.

Because, in the blink of an eye.... Anyone can end up.... Disabled.
I speak for those who can not.

WHEC (NBC-10)
191 East Ave
Rochester, NY 14604
Re: Forced to live in my own excrement... And, my medical insurance company...
Dear WHEC (NBC-10):

Public Broadcasting Service (PBS)
1320 Braddock Pl
Alexandria, VA 22314
Re: Forced to live in my own excrement... And, my medical insurance company...

The New York Times
1627 I St NW, 7th Fl
Washington, DC 20006
Re: Forced to live in my own excrement... And, my medical insurance company...
Dear New York Times:

NBC News
30 Rockefeller Plz
New York, NY 10112
Re: Forced to live in my own excrement... And, my medical insurance company...
Dear NBC News:

Democrat & Chronicle
55 Exchange Blvd
Rochester, NY 14614
Re: Forced to live in my own excrement... And, my medical insurance company...
Dear Democrat & Chronicle:

It is time we all take ownership of this problem...


Forced to live in my own excrement... And, my medical insurance company...

What would begin as a fight for my own independence as a newly fully disabled person, would soon grow into a much more severe problem that until now, had no voice. I did live for just over two months where when I fell due to the severe chronic pain I live with I could not get back up or crawl to the toilet fast enough to avoid making a mess... If it was not for my becoming fully disabled I would had never discovered what I did as I did.

My issues aside, as I am not advocating for my needs now, and can not sit idle as more people pay the price. I was able to use my layperson skills and knowledge to inadvertently uncover an real ugly secret, that if not for my diverse background and pure determination to never give up, I would today be again living in my own waste.

I was able to find an error in my denied predetermination packet, I called the insurance company instantly as soon as I found it, I also had before I appealed them myself requested in three different formats my full complete rights to appeal as a customer/member. They flat out denied my access to that important information. They stated we would rather have the provider appeal and not you. I also got them to own and accept 100% ownership of the error they made, and had them contact the person who made it. I did this on the phone behind the scenes thinking this was a minor little oversight... A few days later I was told sorry we realized the error is ours, but we refuse to re-open the initial request now that we denied it. And, I also made the point of mentioned five or more times that they denied my right to information I had the right to know. They hardly acknowledged it when I mentioned that this was illegal.

I decided to review all of my information with a fine toothed combe and found a few overall miner issues in my case. However these issues proved also that at no time had the so called nurse that is on my initial denial letter ever actually read my information. As these issues are the kinds that raise medical red flags. They are not consistent throughout the entire packet of information, and so I left out key details to test my insurance companies legal honesty. The gloves came off, and I rolled the dice, and I had also collected medical evidence in the form of clinical studies, medical statements, and more showing my appeal letter was on its own 99.9% medically correct. As in I painted the picture of my need that clear before ever seeing this other information.

4-25-08 by Email I contact my insurance company, and on 4-30-08 they call me and the contact who I am speaking with is highly concerned about my level of satisfaction, and puts me on the spot to use my last appeal... I then stated my medical needs verbally, and they needed me to resend some medical documents I sent with my email... I restated the medical need, the lack of medical science knowledge, and offered for them to call anyone connected to my care... Ask them anything you need. I need not ever know. I called them on every issue, and imagine the surprise when they acted like a document I have in my hands was not in the data base they read not long before... And, when I provided the dates, times, and people and what was talked about, and also explained that should I decide to ask for ALL of my information in regards to this request case to be sent, if it does not match perfectly what I have in my hands right now, well I know my full rights as a customer, I understand the entire medical system, its rules, laws, and such and ERISA is nothing but a clever way to protect you.
Let me make this perfectly clear to you, that I proved my case 100% medically, and was not out seeking what else I discovered. I can not feel sure that you will change things so this does not happen again. As I mentioned this, my contact stated I read all of the pre-determination packet and can not locate that one page, but I found that your wheelchair fitter did not mention you owning a wheelchair, and she mentioned a few other issues, and stated I am a non clinical person, and I stated I am a mere layperson, yet we found all the issues with this, how can you expect me to take your companies word that a licensed, or fully accredited Dr, in a related field of my particular and unique set of medical conditions? I mean any medical personal would has caught these issues and resolved them, and when I called a little while back and asked your company to resolve these things as I was sure it was a little issue...

Well, I in the end they did nothing at all to change the way they do things, and nothing at all to help me not need to speak up for those who can not. You see my issue was just me, and now I know of a much bigger one, and I own it now... And, once you read this you will own it also... So if this sits idle and people suffer, and worse... I will hold all of you 100% just as accountable for this problem as I do not just my medical insurance company as working for Strong Memorial Hospital for seven years where I loved helping my patients and I advocated for them... And, only had a little peek at this even with my being partially disabled from 1995 to 09/07 when I become fully disabled...

I leave you thinking about a few things now: If I had missed a single little detail, I would be living in my own waste right now. My adult ADHD and all will not prevent me from speaking up now... I have contacted Senator Clinton, and others, and nothing yet...

But, who I speak for are the people with disabilities, and I will not be supercrip for you, I will not be super anything to prove my worth to any of you... I am asking that you of the press, and government prove your worth to me, and those I speak for now... I am tired of this abuse, and I will never give up, never... I am pure determination and gimpy or not I will be heard... Here is why...

How many people from the time medical insurance as we know it today have been denied if we took a look into the information submitted and the appeals, and other information if any.... Missed the same things I found? That means countless million of people suffered, lost the ability to remain sane ( was one of those due to adverse reactions to medicine I was on and closely watched, I fought that hell as well) how many people will be forced to go homeless? jobless? divorce? and how many will kill themselves thinking they have no other choice? How many died because the best medical access was denied all due to the insurance companies own errors?

Disability was something I never heard of growing up, oddly today I have never felt more able in all of my life, and yet... To look at me I can hardly do much with out severe pain... I have a billion dollar attitude, and that is why I am not disabled. Not enough to accept my wheelchair from the insurance company who was willing to let be suffer in forced isolation, then when I bring this all up to them, they do nothing at all to provide me any feeling they will stop it...

Well, kids have a voice, schools, even animals, yet we disabled are left to die in emergency situations where entire cities ignore us... We are made fun of, and lazy people block out access to parking, and buildings are not ADA compliant, and yet able bodied people complain the most about non issues really.

I dare anyone I sent this to to interview me... I dare you to give me a chance to be a voice for those who can not. I do not imagine you will though. Proof in hand or not, you will more than likely allow the medical insurance industry to go on doing what it has... Until one day you become disabled. I pray that none of you ever do, it is a horrid system if you lack the knowledge I want to share for free. I contacted PBS... I contacted the Melinda and Bill Gates people and others... So far it seems no one cares about the fact that roughly 98% of the working aged US population lacks the understanding of the system we all the US Health Care System and I know how to connect with them... I want to write books, be on PBS to record the information for future generations as it is timeless... And, it grows, and changes with times, and systems...

But... Alone I can only reach a few thousand people a month... SpinergyDude.LiveHournal.com my blog... I ask for no hand outs, I ask for no money. I give my time free on a volunteer basis... As I can do it... It takes everything I have to even type, and here I am... Not getting angry... I am DOING SOMETHING ABOUT MY, no let's make this now that you read this OUR PROBLEM.. I can not write worth beans to educated people... But, the top level medical Director if my medical insurance no longer just sees me as disabled. As it was he one of the Board of Directors that found out the school of hard knocks school me well.

I am the Proactive Patient & Advocate for the disabled. This covers babies, toddlers, children, teens, young adults, middle aged adults, and the elderly... So does anyone want to help me, help myself, as I help those who can not? Then I dare you to: DO SOMETHING. :)

SpinergyDude

I started this in support of the United Spinal Association, and the publication they produce called: Action

The community is run by me, for disabled people to learn about Action, and the United Spinal Association, as well as have a alternative place to meet, and share informtion that is not on myspace.

Please join up show support, and if your a company or in the position to help spread the word please do. We are looking for companies who do not mind a possible donation or to support the needed help section I started, as sometimes money is not the only issue we disabled people face. It sometimes is for more simple things that we can not do alone, or afford ontop of our normal bills... But, would go a long ways to helping those who need the help. It is not a want, or wish list.

I hope to be able to open up communications for medical professionals to be able to offer INFOMRATIONAL help and insight, that the members will review with there medical Dr(s) in real life. We do not try to diagnos, and, only can provide our best educated guess, that people need to see a medical person about.

I want to be an extension of the Action publication, and be a informative cummity. Able bodied or not, a member of the United Spinal Association or not no matter, as long as you want to be active and help, and share what you may know, you are welcome.

http://community.livejournal.com/action_mag_live/

See you soon...

February 19, 2008
Investigators Target Health Insurers Over Practices

Lisa Girion of the Los Angeles Times discussed investigations in Los Angeles and New York into health insurance companies' policies on canceling coverage and pricing. Both investigations mark rare examples of involvement by law enforcement officials in the regulation of the health insurance industry.
"Health Insurers Become a Popular Target" (Brand, "Day to Day," NPR, 2/15).


Readers are invited to send feedback to: chl@chcf.org
http://www.californiahealthline.org/articles/2008/2/19/Investigators-Target-Health-Insurers-Over-Practices.aspx?topicID=38
Article located at the link above.

Today untold millions of people in the US go about life with out ever once thinking about what if my life changed suddenly? What would I do? And, yet everyday people affected by a life changing event...

Well, I am not going to whine about the broken health care system in the US, all to often people with great ideas can not make them work. For any number of reasons, from big business to special interest groups... Everyone has something to say about every aspect if it means a change from what is used now. And, I agree what is used now is broken, but not so much that we can not also learn where, how and what needs to be done to make it work as it was designed to work, without ever once changing a single thing. Other, than what we know.

Medical Insurance Industry (MII) - Has things set up the way they do now to make it a long process for members to trudge through. Laws like ERISA designed to confuse, and hide the fact that it is more protection for the insurance industry, than it is for you or I. And, the MII knows every possible loophole to take the most advantage of us.

The funny thing, is that this is the case in all other aspects of our lives as well. And, what is taken advantage of is the lack of understanding, the knowledge we have rights in areas we mostly never even knew about. For the most part a good 98% or more of the general public are even aware of these. Now, what are the chances that a layperson could slowly over time from the school of hard-knocks learn and actually grasp these separate yet intertwined chunks of knowledge?

Well when I was 25 years old, life would change for me, and I would need to fight, and teach myself many things in order to be able to keep on going... No one else would offer, and even the employees of the NY State Unemployment office strongly suggested my wife and I divorce and still life in the same home... So I could get vocational job retraining, some food stamps, and other help as needed... Not for me.

And, life would lead me through all of these areas that no single college could ever hope to cover... And, before you knew it, I was where I am today...

Where is that? Well not being forced into feeling shamed into isolation due to being fully disabled. Let, me tell you now.

And, what was broken to million of others, and can not be changed or fixed... The fact that the insurance company Aetna attempted to abuse the fact it assumed I lacked the same level or more knowledge than it had about the entire health care system...

Let's just say that 12/07 my pre-determination packet was denied, my rights to know information, also denied, and my personal appeal denied... That was it, time to employ my ideas, and methods....
On 4-25-08 Contact Aetna, and by 4-30-08 I was approved proper Durable Medical Equipment... As prescribed.

And, now Am am seeking the means to expand and share this knowledge...

Wheelman normally, but here SpinergyDude...