From: Herbert Stein [mailto:firstname.lastname@example.org]
Sent: Friday, February 14, 2014 4:13 AM
To: Stephen J. Hemsley – CEO, United Healthcare; Chet Burrell, President & CEO CareFirst BlueCross BlueShield
Subject: “There are doctors, good doctors and better doctors.”
Dear Mr. Hemsley,
Now that I’ve explained how I go “Totally Bananas” every now and then and the fact I’ve been extremely busy these past nine or so days battling Joyce’s new health insurance company as it relates to her medications (another absurd and dysfunctional bureaucracy), it’s time I get back to my advocacy and battling the bureaucracy and lunacy at United Healthcare.
Along time ago I learned that when a physician hangs out his/her shingle to practice medicine it does not state whether they graduated first or last in their class. In addition, I also learned there are doctors, good doctors and better doctors. Please keep these points in mind which I shall come back to address shortly,
As part of my learning process I welcome feedback and discussion from both patients and physicians. I’ve just recently learned from a patient there is another distinguished health insurance executive who apparently gives a damn for the patient and is not blind-sided by questionable policy statements and questionable opinions from questionable physicians never having actually examined the patient.
Kudos to you Mr. Chet Burrell, President & CEO CareFirst BlueCross BlueShield and your people as I’ve learned from your private subscriber payer, formerly denied medical coverage, that your company has changed its position in respect to your subscriber. This patient just recently received approval for VNS replacement surgery from both her employer and CareFirst. This reasoned approach in this situation was to provide “continuity of care” while maintaining patient wellness is one of several reasoned factors and the rightful thing to do.
Bravo to you Mr. Burrell and your organization. Not too many of these large organizations (bureaucracies) truly care and think rationally what is both good for the patient and a long-term cost savings to the corporation.
I would like to extend my sincere appreciation to you, Mr. Burrell for doing the right thing. I’m sure the patients, physicians and government officials who receive my email distributions can also appreciate your positive and caring stance relating to these truly serious situations and ill patients.
Which now brings me back to you Mr. Hemsley and your organization at United Healthcare.
In my opinion your organization’s disingenuous and contrived response to your subscriber in denying both the patient’s initial request and first appeal as well as not comprehending the urgency letter of need as written by the patient’s highly qualified and distinguished psychiatric medical professional is truly obtuse and absurd on your company’s part. The fact that your Maureen S., Resolving Analyst was mindful in her letter of January 16, 2014 to cite (as I’ve quoted several places below) that all the supporting documents were referred to Medical Director, Amy Schneider, M.D. is most interesting and in some ways laughable, at least to me anyway. And which also brings me back to “doctors, good doctors and better doctors.”
“All of the supporting documentation was referred to a Medical Director, Amy Schneider, M.D.,
specializing in Neurology, not previously involved in this decision, for review.”
“We carefully reviewed the documentation submitted, our payment policies and the limitations,
exclusions and other terms of your Benefit Plan, including any applicable Riders, Amendments,
and Notices. We confirmed, however, that this service(s) is not eligible for payment as you
requested. You are responsible for all costs related to this service(s).
Amy Schneider, M.D., specializing in Neurology, reviewed your appeal. This decision was made
based on Vagus Nerve Stimulation 20J3TOI01 P. The determination is as follows:
This feeble letter and the opinions and statement contained therein reminds me of the former Senator and doctor, Dr. Bill Frist rendering his opinion in the Terri Schiavo case. What a sad and disgraceful commentary he exhibited and offered up.
An Internet search for Amy Schneider, M.D. yields a minimum of four (4) doctors with the same name, three (3) of whom appear to practice in Arizona so I’ll presume your company’s representative is referring to Amy G. Schneider, M.D. of Scottsdale, AZ. Please correct me should I be wrong? Of additional note of interest to me when searching for Dr. Amy G. Schneider is the very lack of information pertaining to the physician. Medical Director…of what? I could find no published studies and/or papers prepared by the doctor. So please explain to me exactly what are the outstanding qualifications of Dr. Schneider to have qualified her to review and offer up an opinion in this case? Upon further search I came upon the doctor listed at a mail route in AZ and P.O. Box in Minneapolis, MN. I called the doctor at the listed telephone number and I apparently caught her off-guard. I did introduce myself and stated my full name and the fact I am Mental Health Advocate/Activist and I just wanted to learn and better understand her Curriculum Vitae and other qualifications. Boy did she clam up ever so fast. I’m curious Mr. Hemsley if you or your staff had ever reviewed the Curriculum Vitae and qualifications and/or considered asking Drs. Charles Conway or Mark George or Harold Sackeim or John A. Rush or John O’Reardon or David Dunner or Scott Aaronson or Paul Goodnick but to name only a few highly qualified and noted psychiatric practitioners their thoughts and professional opinions regarding your subscriber and/or VNS Therapy for this unique patient population?
Obviously you, your company nor Dr. Schneider noted any more recent documents and articles or took any time to read a recent finding of Dr. Charles Conway and an opinion by Dr. William Bunney which differs from Dr. Schneider’s opinions.
In reviewing your subscribers appeal and that of his/her psychiatric physicians how is it that your doctor’s opinion did not take into account in her recitation about drugs the very fact that this therapy is not a drug so why in the world does she fill the document discussing drugs? In fact it is a newer neuro-modulation therapy so your company’s lengthy diatribe about medication is simply not applicable in this situation. You too have made the very same mistake that is part of the initial controversy relating to this treatment. VNS Therapy is not a drug but a medical device. In hindsight we all can agree the studies should properly have been designed to allow for a minimum of one year study. Instead it was inappropriately based upon a protocol of a 12-week-drug-protocol. This fiasco should be a text book case study for what not to do and I am quite sure Medtronic and St. Jude took this into consideration when designing their DBS studies. So with that fact in mind it does not preclude that the therapy is either unsafe or ineffective as was faultily reasoned by Dr. Schneider. The fact is those patients who wish to continue with the therapy, i.e. your patient subscriber, has responded and obtained efficacy continuously for several years contrary to the gibberish presented and the very reason CMS has finally come to understand the benefits being derived by this implanted group of patients. The very exact same therapy you approve and pay for in epilepsy patients are also being utilized by a number depression patients and they too are benefiting. For the epilepsy patient you illogically reason it is both safe and efficacious and not so for the depression patient? Give me a break! Is that not stupidity or something close to it?
I’ll also point out to you and Dr. Schneider that 100% of the VNS depression patients wanting to continue with this therapy are both responders and obtaining long-term efficacy. Should you want to discuss statistics, this response rate and long-term efficacy is unheard of when treating this unique group of severely depressed patients. I guess this fact may also have been overlooked by both you and Dr. Schneider.
Your company pays for cross over medications approved for epilepsy that were never adequately double-blind studied for depression patients. You pay for ECT and yet there has never been any large double-blinded study approved by the FDA. Add to the fact that after many years ECT was finally acknowledged to have potential serious side-effects of cognition and memory impairment and was officially recognized in a study by Dr. Harold Sackeim.
Your recent policy decision of February 1, 2014 in my opinion is a “Swiss Cheese Policy”. One truly full of holes contrived to fill your companies political and financial objectives. The facts and realities are that some of the worst of the worst depression patients who have suffered in agony and anguish for decades after having tried all the available conventional therapies, like my spouse, and who have had numerous yearly hospitalizations have finally responded, benefited and have obtained long-term efficacy from VNS Therapy despite your irrational protestations. These individuals and their more knowledgeable attending physicians know the therapy works for their implanted patients unlike your Dr. Schneider with her Dr. Bill Frist type political and medical agenda and opinions made from afar.
I was also reminded by another of your private subscriber payers denied coverage for a VNS replacement several years ago, only at that time the opinion was written and submitted by Eugene B. Lofton M.D., Regional Medical Director. Dr. Lofton’s specialty being Internal Medicine. It seems you have propensity to hire physicians (sort of like ghost writers) whose opinions affecting people’s lives come with questionable expertise and/or credentials.
I’d make a suggestion should you ever have need for brain surgery; don’t accept the writings of a hired proctologist for his/her health care opinion.
There comes a time in one’s life that one has to be guided by one’s conscience to do what is right and just. Mr. Hemsley your time is now. You have the power and the authority like Chet Burrell to maintain the “Continuity of care” and wellness for your subscriber. Like your fellow CEO, Chet Burrell, you too can do what is right. Only do it now! There is no need for this patient to agonize, suffer and worse yet when we know there is a treatment, proven in her case history, that will alleviate her illness and set the patient on a road to recovery for you and/or your company to obstinately stand in the way of him/her achieving wellness.
Joyce and Herbert Stein
1008 Trailmore Lane
Weston, FL 33326-2816
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