Patrick J. Geraghty, CEO of Blue Cross and Blue Shield of Florida (Florida Blue)

From: Herbert Stein [mailto:fabrik@bellsouth.net]
Sent: Saturday, February 28, 2015 3:18 PM
To: Chet Burrell, President & CEO CareFirst BlueCross BlueShield
Subject: Battling Florida Blue...

To Joyce’s fellow patients et al,

I need your help.  If anyone out there reading this message knows the direct email address for Patrick J. Geraghty, CEO of Blue Cross and Blue Shield of Florida (Florida Blue) I would gratefully appreciate your assistance by sending me the address.

I am trying to advocate for a fellow VNS Depression patient being denied coverage for the replacement of his/her prosthesis as a private pay subscriber.

Mr. Chet Burrell, President & CEO CareFirst BlueCross BlueShield,

I would appreciate if you could give me Mr. Geraghty’s direct email address.  I am aware and thank you for the assistance you previously gave to one of your VNS Depression patients by paying for her replacement and based upon what she had told me you did so stating, “continuity of care”.  At the time I did not fully understand the significance of the term as I now know it establishes a medical precedence and practice which Medicare/Medicaid and the private insurance carriers should have been adhering to.  I would also ask, if possible, if you would contact your fellow CEO and apprise him of the patient that his company has been denying medical coverage.  If necessary I’m sure the patient would supply you with personal information so that Mr. Geraghty would see to the expediting of this case.  Just let me know.

It is truly shameful and anxiety ridden that these implanted patients with a medical device and I have to shamefully fight tooth and nail with our last once of strength for that which already exists in medical doctrine and practice buried somewhere in the vestiges of HHS and no one knowledgeable enough throughout these bureaucracies to come forth to rightfully help these patients and rectify the situation by stating, “continuity of care”.

Shameful, shameful, shameful on all you bureaucrats who sit back, spout platitudes, collect your checks and really make no effort to reach out and truly help with a few exceptions, that’s unfortunately the way I see things based upon my lengthy advocacy for these patients.

Shame on you all for not comprehending what it is like to help keep someone alive!

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

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Still battling Florida Blue…

From: (redacted)
Sent: Saturday, February 28, 2015 9:58 AM
To: Herbert Stein
Subject: RE: DECISION THAT THE NCD RECORD IS COMPLETE AND ADEQUATE TO SUPPORT THE VALIDITY OF NCD 160.18(C), VAGUS NERVE STIMULATION

Hi Herbert.
Got your call and the email updates. Thank you.
I take it from the document, this decision is not overturning the 2013 to cover battery replacement but rather rejects the argument that the previous decision to stop coverage of new implants was not based on full record of evidence. Is this your thoughts?
I am working with a case manager at Cyberonics and I am awaiting a predetermination of benefits. I expect it will be denied. I have starting collecting all my medical records. Also I have started a draft of a personal statement.
My next step will be to find the direct contact info of Florida Blues CEO.
I will keep you up yo date if how this transpires.
Again thank you for your continued support to all if us.
Sincerely
(Redacted)
Sent from my Windows Phone

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From: Herbert Stein [Redacted]
Sent: Saturday, February 28, 2015 12:57 PM
To: (Redacted)
Subject: RE: DECISION THAT THE NCD RECORD IS COMPLETE AND ADEQUATE TO SUPPORT THE VALIDITY OF NCD 160.18(C), VAGUS NERVE STIMULATION

(Redacted),

My understanding of this recent appeal decision is that they are upholding the May 4, 2007 decision to not pay for any implants or care of new patients on or after that date.

While denying insurance coverage to new patients it goes on further to state for the first time in this recent appeal decision, in writing, the care and replacement of the device rightfully for Medicare/Medicaid patients implanted prior to May 4, 2007 under the doctrine or law of “continuity of care”.  I further interpret this decision to mean that the private health insurers, who normally follow CMS’s lead, should also follow the “continuity of care” doctrine as quoted below:

(1) “continuity of care” standards that are “widely accepted within the medical community (i.e., a physician should not discontinue treatment that is effective for a patient)”; (2) “well-accepted medical standards of care that acknowledge that it is unsafe for beneficiaries to have an implanted medical device that is not properly calibrated, monitored, or is otherwise non-functional”; and (3) “CMS policy statements wherein CMS has recognized that continuing Medicare coverage for beneficiaries who received Medicare-covered durable medical equipment (DME) before it was non-covered ‘helps avoid disrupting the continuity of care for the beneficiaries . . . .’” Id. ¶¶ 40-42 (quoting 78 Fed. Reg. 40,836, 40,877 (July 8, 2013)).

Not being a legal authority I can only express my opinion based upon my readings but were I in your position I certainly would emphasize and strongly hang my hat on the above information and decisions to encourage, enforce and coerce your insurance carrier to relent and do the right thing.

If you’re able to obtain an email address for Florida Blue CEO I’ll jump immediately on advocating for your cause.

I’m here and available to encourage and support your efforts.

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

---------------------------------------------------------------

NOTICE OF CONFIDENTIALITY / Disclaimer

---------------------------------------------------------------

Disclaimer: This E-Mail is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521 and is legally privileged. The information contained in this E-Mail is intended only for use of the individual or entity named above. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you receive this E-Mail in error, please notify the sender immediately at the email address and/or phone number above and delete the information from your computer. Please do not copy or use it for any purpose nor disclose its contents to any other person.

CONFIDENTIALITY NOTICE: This e-mail message including attachments, if any, is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail, destroy all copies of the original message, and do not disseminate it further. If you are the intended recipient but do not wish to receive communications through this medium, please advise the sender immediately.