Friday, January 8, 2010

Survivor: Don't Trust Health Insurance Companies

Just before the U.S. Senate panel voted to send the healthcare reform bill to the Senate floor for debate and a vote, the health insurance lobby released a report directly attacking the healthcare reform proposals moving through Congress. The PriceWaterhouseCoopers report claimed that reforming healthcare would result in higher insurance premiums and raise consumer healthcare costs.

Linda McCoy has a word in mind to describe that report, but being a woman of decorum and respect, that chosen expletive would never cross her lips.

"It is an understatement to say that the insurance industry cannot be trusted," said McCoy, mother of Darien Smith, a partially-recovered quadriplegic who was paralyzed from the mouth down after a series of accidents working in a warehouse. Darien's story of recovery spans more than ten years, and is chronicled in the book McCoy and Smith co-authored, I Heard A Voice Say "Never Throw In The Towel!"

"From the very start, the company and the insurance companies did everything they could to prevent paying Darien's medical expenses," she said. "First, the doctors, who recognized how much trouble it would take to keep Darien alive tried to get me to sign a Do Not Resuscitate contract - which I would not sign. Then, the insurance companies kept putting us off because the doctors kept telling them Darien was going to die. Even attorneys wouldn't take my case, because they'd interview the doctors, who told them Darien was going to die. It was almost as if everyone was trying to railroad him into the grave so they could save money."

At the fulcrum of it was Darien, who through eye-blinks communicated in alphabetical code to his mother the words, "I want to live. I will walk again."

She pledged never to give up on him, and took on the hard work of fighting the insurance companies and the doctors, who all seemed determined to create circumstances that would end up in Darien's death, according to McCoy.

"When he was in the hospital, Darien would 'code' three or four times a day, meaning he would go into arrest or aspirate into his tube or some other life-threatening situation," she said. "They were getting tired of all of the cost and attention necessary to keep Darien alive, and eventually, they tried to move him into a nursing home (I told them 'Over my dead body!'). Again, they were trying to save money, without any concern for the drop-off in care to Darien."

As the years wore on, Darien eventually came home, and each year, there would be more progress. After losing nearly 60 pounds after the accident, Darien started putting weight back on, a little at a time. He began to speak again, spurred on by singing therapy his mother would perform with him. All the while, the insurance companies would tinker with his care-giving team. At one point, they reduced the salaries of the nurses from the going rate of $25 down to $10 per hour, hoping they would quit. Another time, they outright fired the nurses, McCoy said.

After 8 years, she finally found an attorney, Ted Leopold, who would take their case, and they sued the insurance companies - USA Inc., National Union Fire Insurance Company of Pittsburgh, GAB Robins, North America, Inc. and Sedgwick CMS, Inc. - for all the hassles. The timeline of McCoy's claimed offenses was nearly 20 pages long. Just before trial, all three companies settled with McCoy, promising to provide for Darien's needs for the rest of his life. Darien cannot breathe or walk under his own power, but can move and speak again, something doctors never thought would happen.

"Now marks a new chapter in our lives," McCoy said. "We still have one more big hurdle, and that's getting Darien out of that wheel chair. If it should not happen, no one will be able to look back and say we didn't give it all we got. But we'll never forget the struggle to make the insurance companies accountable to their promise, accountable for their actions and finally accountable to their obligations under the law. No matter how people feel about healthcare reform, they should be adamant about one thing - the insurance companies must be held accountable for the life and death decisions they make with their balance sheets."


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