Posts tagged ‘huster’

Affaire du coeur, Part 4

We were finally contacted by The Seattle-Times, which began knocking on a few doors themselves. They started rallying to our cause by rattling Regence’s cage, and working closely with the Insurance Commissioner’s office. I talked to Shelby Gilje at the Times, and went over what I had been doing.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2937714&date=19990108
and is reproduced here in whole without permission.

Friday, January 08, 1999
State Wants Insurers To Provide Details On Prescription Coverage
Shelby Gilje

Seattle Times Staff Reporter

The state is investigating a complaint from a consumer with a life-threatening illness who says her insurance carrier stopped paying for her drugs in mid-treatment with little notice.

Insurance Commissioner Deborah Senn did not disclose details of the complaint but cited it as an example of why consumers need more information on the prescription coverage their health plans provide.

Yesterday Senn filed proposed rules for health plans on what insurance carriers would be required to disclose up front to consumers. A public hearing on the proposal is set for Feb. 23. The rules could become effective in mid-March.

Senn is seeking comments from consumers and the insurance, health-care and pharmaceutical industries on about 10 recommended disclosures.

Among them, Senn has proposed that health-insurance carriers provide the following information to consumers:

— Whether the plan limits or excludes certain drugs that may be prescribed by a doctor, and whether substitutions will be encouraged for some drugs.

— When the plan can change the approved drug list or formulary.

— If a change occurs, whether the consumer will have to pay more or could be “grandfathered” to continue with a drug already in use.

— What phone number consumers can call to request a change in coverage or make an appeal.

— What consumers must pay to get a prescription filled.

— Whether their plan requires consumers to use specific pharmacies, and their locations, to pay the least out-of-pocket expenses.

— How many days of medication a consumer gets per co-payment.

Senn’s staff and industry representatives were involved in a year-long task force that studied consumers’ complaints about prescription and mental-health benefits.

Representatives of Premera Blue Cross and Regence Blue Shield were part of the task force and said it was a positive, collaborative approach.

But while Premera wants to support the disclosure recommendations, officials at the insurer said, they’re concerned about the cost of providing information on dozens of prescription plans and whether that detailed information might confuse consumers.

Regence already provides most of the information, said spokesman Chris Bruzzo.

“We are in strong agreement with the commissioner that more information, and direct, clear communications can go a long way to avoid confusion and mixed expectations,” Bruzzo said.

Regarding mental-health treatments, Senn’s proposal also would require insurance carriers to tell consumers what information about them would be disclosed to entities other than medical providers, how many mental-health visits the plan covers and how that coverage can be used.

For more information, see the insurance commissioner’s Web site at http://www.wa.gov/ins or call the agency at 800-562-6900.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

Still, it looked like no solution was close at hand, so I began working on Plan B. I had just read Through A Distant Mirror, about the 100 Year War which finally ended by a political marriage. It gave me an idea. If no one could come through for us, I would marry her to get her covered by my insurance policy, which was through an excellent company, with good coverage. I contacted the insurance company to see how soon they could cover a new spouse. They told me immediately.

I started talking to Tory about this plan. She thought it was a workable solution. We set a deadline to get the resolution solved, otherwise, Plan B it was. I contacted the Marriage License department and a local judge and set a date based on this backup plan. She would fly out on the deadline date, and we’d immediately get married, and I’d get her onto my insurance policy. Her only question was if her mom could come to the wedding.

Don’t forget, I was still faxing and mailing and calling everyone I could to resolve the situation without having to go through the backup plan.

Finally, 7 days from Plan B, Regence blinked. The pressure from the Insurance Commissioner’s office and The Seattle-Times, became intense, and they realized they were about to be dragged into the spotlight. Tory told me this on a Friday, I think. We were relieved that Regence finally capitulated, although they covered their ass by saying it was a “clerical error.”

On Monday, as I was getting ready to leave for work, I got a call from Shelby. She told me to sit down, and proceeded to tell me what I had already known, that Regence had agreed to continue Tory’s coverage. She asked me how I felt about this finally happening and I told her I couldn’t be happier. I started checking my watch to see how much time I had left before I had to get to work. We chatted for a while, and then she asked me, “So what’s this about a Plan B.

I told her what my backup plan had been, and she must’ve been paying more attention than I thought.   This is the article as written by Shelby for the Times. They didn’t get everything quite right, but the important parts are there.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2937968&date=19990110
and is reproduced here in whole without permission.

Sunday, January 10, 1999
Health-Insurance Gaffe Nearly Fatal — Life-Dependent Drugs Not Covered, Woman Told
Shelby Gilje

Seattle Times Troubleshooter Columnist

Life looked bleak for Victoria Doyle, 41, a heart-transplant survivor, until just a few days ago. But now Doyle’s got insurance.

Just before Christmas, she was told that Regence BlueShield insurance no longer would pay for anti-rejection prescriptions because her policy has a $500-a-year cap on prescription drugs.

Because the drugs that keep her alive cost about $2,000 a month, the news was like a death sentence.

“I’m surprised I didn’t pass out right there in the hospital,” Doyle said.

Over the holidays, Doyle wrote a friend via e-mail that she felt as if she were “standing on a melting ice floe” because of the news that her drugs would not be covered.

On Thursday, Doyle got some good news from the state Insurance Commissioner’s Office. Don Sloma, a deputy commissioner, called Doyle and said Regence would cover her medication under the $200,000 lifetime-transplant benefits in her policy. Regence discovered a billing error, Sloma said.

Waltraut Lehmann, manager of regulatory affairs for Regence, said the carrier has only two other subscribers who are transplant patients, so “it’s a pretty unusual circumstance.” The confusion apparently arose over whether Doyle’s medication should be under the transplant-benefits category or the prescription-drugs category on the policy she bought in late 1996.

Representatives of Regence are working out details with Doyle’s doctors and pharmacists at the University of Washington, where she had the transplant July 4, 1991.

Doyle’s dilemma surfaced Thursday after state Insurance Commissioner Deborah Senn filed proposed rules requiring detailed, upfront disclosures on prescription coverage before consumers buy insurance policies. Senn will have a public hearing on the proposed rules Feb. 23 in Olympia.

“I’m glad for Victoria that we got this resolved, and I commend Regence for fixing it,” Senn said.

Among those Doyle told about her insurance problems was Jack Huster of Fort Wayne, Ind., whom she met through an online chat room about two years ago.

Huster, 35, a U.S. Postal Service data-entry worker, e-mailed the story of Doyle’s dilemma to Washington’s governor, the insurance commissioner, members of the congressional delegation, and local and national media.

“I wasn’t going to stand by and see her die,” Huster said.

Twelve years ago, Huster said, he spent New Year’s Eve with “somebody very special, and she was gone in three months because of a heart condition.” That was his wife, Kathy.

When he heard that Doyle was facing death if she couldn’t get her medication, he came up with a plan: If Doyle’s insurance wouldn’t pay for her drugs, he would marry her so his insurance would cover her.

Huster sent Doyle papers to apply for a marriage license and reserved a date with a judge for a wedding this month.

Doyle was touched by his proposal and caring. “It’s something wonderful from something terrible,” she said.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

Affaire du coeur, Part 3

 

I was working at the Remote Encoding Center, a postal facility, which involves keying the mail to codes to get it going where it needs to go. We were in the crush of time between Thanksgiving and Christmas. I’ve never worked in any postal facility as hard as I did during that time.

We worked the three to four weeks without a day off, 16 hours a day, 8 hours off. It felt like you had just fallen asleep and it was time to go do it again. It doesn’t sound like much, typing for 16 hours straight, but you try it everyday for three weeks, and see how you do. People were being led out of there in ambulances, passing out on their keyboards. My fingertips became painful. Tendonitis and carpel tunnel syndrome would get to the best of us. My tendonitis that I got during this time has never gone away. This was just a brutal period. Great money, great diet plan, but just grueling.

It was somewhere around the beginning of December I think, that I got a goodbye letter from Tory. Regence BlueShield, her insurance company, had locked her coverage out at $500 per year. Her heart meds alone ran a cool $2,000 a month. Without those meds, her heart would go into rejection. It was pretty much a death sentence. She had accepted it, the coverage for her heart meds ending at the end of January.

Now, see, I get rather upset when someone tries to kill a friend of mine. I lost one person to heart disease by an act of God, I sure as hell wasn’t going to lose someone else to a bureaucracy. Despite the stress of work, I started a one-man war against Regence from 1,500 miles away.

I emailed and faxed the Insurance Commissioner, the state General Attorney’s office, the media, the Governor’s Office. I called in chips from government contacts. I called, I wrote. If I had been in Seattle, I would’ve started kicking down doors.

Only one little problem. Most of these places shut down during the month of December, not to open again until after the 1st of January. I got no responses from anyone. Towards the end of December, despite finally getting some breathing space from work, we both began to panic. Tory could literally count her pills before they ran out. It’s mind-boggling that someone could count their days left in the world by the pills that they have left.

In the midst of this, with my focus just on Tory, my relationship ended with my girlfriend. It was cruel on my part, but that’s what happened. Things were changing too fast for me.

It was the beginning of January, and Tory and I were just starting to get nibbles from some of the people I had contacted. The most disturbing was one news network that implied that it would be a great story if it all ended in tragedy. The most heartening was from the Insurance Commissioners office, but even they admitted they could only work so fast. Time was running out for Tory, and there seemed like there was nothing I could do about it.

Affaire du coeur, Part 2

In 1997, I was struggling with depression. I started to run a depression chat room on AOL. It was therapeutic helping other people. It helps to make you forget about your own condition.

I had been prescribed various meds, but they made me sick, so I discontinued them. Instead, I got trashed every night on rum and cokes, and would go online.

Part of my gig was a talent for making others laugh, drawing them into conversation, making them forget how they felt for a few hours. I did, however, continue to provide support when someone asked for it, either in the room or via IM.

I’d get IM’d a lot, and preferred to keep my focus on the chat room, so I’d hit IM’s with my one question cultural literacy test to scare them away. No one had ever answered it right, but the question was “Who was Sweeney Todd?” Finally, Tory answered, “the Demon Barber of Fleet Street.” Holy cow! I had never had anyone answer that question right. Okay and now it seems like every smartass knows it.

I started corresponding with Tory after that. I was thinking about a move to Portland Oregon, and she lived in Seattle, so I was hoping she could help me plan out the move, and tell me what to expect.

I say here now, in all honesty, that I never had the intent of getting romantically involved with her. She was intellectual, funny, and just a warm friend. She and I were both in relationships at the time.

In one of our conversations, she told me she had a heart transplant, and expected me to freak out. After Kathy, I was pretty immune to being startled by anyone’s cardiac condition. I told her that it didn’t bother me, but I was intrigued and asked her what it was like.

It’s not always like what you see on TV and movies. The transplanted person isn’t necessarily capable of doing handstands or backflips. Tory had limited mobility due to her oxygen intake, and was somewhat weaker than you and I, despite having the transplant back in 1991. She put it in a way I could understand. When you and I go up a flight of stairs, just thinking about it, our brains start sending chemical signals to the heart to begin pumping a little harder in preparation for it. For her, her brain was sending signals to an alien organ, and her heart wouldn’t start catching up until she was near the top of the stairs, and the heart figured it was under load. She’d be exhausted once reaching the top of the stairs.

She is a fascinating person. Not a person to pity. She’s survived so long with a transplant, that she’s an inspiration to other transplant patients. Most don’t survive as long, developing kidney or liver problems, resulting in another transplant if there’s a donor match, more than likely with or without the secondary transplant, dying. Much, much later, I was in a room of transplant patients who were all fascinated by her longevity.

Her father was an FBI agent, and her mother was really nice. I remember a phone call that she had to end because her mother had made oatmeal for her and she had to go eat it. Who was I to argue with her mom?

She came from a cultured background, growing up around the world as their father moved from place to place.

And she cracked me up. During the transplant, she got to choose the music they’d play in the operating room. She chose Wagner’s Death and Funeral March. I have a grim sense of humor, but it’s tough for me to top that.

Eventually there came an opportunity to meet her in Chicago in 1998 for a weekend. We’d meet in a public spot, Border’s Bookstore café, in case one of us was an axe murderer. I’m still not sure about her. There are a few rusty axes in the garage. Naw, just a coincidence.

Anyway, I remember walking into the café and spotting her, and the first thing that came to mind was, “I am way out of my league.” I’m a street kid who grew up to be something of a blue collar guy. She was just the opposite. Well educated, sophisticated, and beautiful. That sort of thing puts a lot of pressure on a guy. I couldn’t decide to run for my life, or just stroll up and start chatting. I chose the latter, despite my misgivings.

We had a great weekend, cruising favorite museums, restaurants, the best parts of Chicago. Hey, I’d visit Chicago, and go to Carey Street, among other dives. If you know Carey Street in Chicago, you know what I mean. But I also love the Museum of Science and Industry. We both love Colleen Moore’s Fairy Castle.. See it and you’ll know what I mean. I also like the Shedd Aquarium, Brookfield Zoo, and a bunch of other great places to visit.

Well, after that, like I said, I knew I was way out of my league even if I harbored any romantic fantasies, but we were great, close friends. We went back to our separate lives but we continued to correspond online. I mean, how many streghe belle do you get to meet in a lifetime?

Affaire du coeur, Part 1

Someone read a newspaper article about the day I got married in January of 2000. That person only knew what was written; not the events leading up to it, or the articles that proceeded it. I’ve thought about this story for a long time, and maybe it’s time to tell all of it.

It was 1987. Kathy had a congenital heart defect. It had hospitalized her a number of times. Finally, they decided to do a diagnostic surgery. Nowadays they’d do a biopsy of the heart by running a long needle with snippers on the end of it up the groin artery, to the heart, and take a snip of the heart for diagnosis. Back then, they didn’t have this procedure, so to evaluate the heart, they’d have to open Kathy’s chest.

The procedure was to be done in Texas. Kathy stayed at her mom’s the night before. She called me, and to be honest, I don’t know what we chatted about, but it turned to the surgery, and she told me she was scared. I flippantly told her that she’d be fine, and I’d buy her a beer when she got back. The most painful thing I remember about that conversation was that I didn’t tell her that I loved her. Just that I’d buy her a fucking beer when she got back.

 

The day of the procedure, March 22nd, 1987, I was sitting in my kitchen tinkering with a new computer. My phone rang.

I knew what it was before I even picked up the phone. It plays back in slow-motion even to this day. I stood up and walked to the phone, and picked up the receiver. It was Kathy’s mom. She told me that Kathy hadn’t survived the surgery.

 

I’m understating it, when I say I was devastated. I dropped the receiver, started to shake, and sat on the floor. I don’t remember when I stopped weeping.

 

A black hole in time passes, and I’m a pallbearer at her funeral. I tried to be strong, but still wept.

 

They tell you that with time, the hurt goes away. It never really goes away, just turns into a dull throb of pain. On her birthday, on the day that she died.

 

I never said “I love you” at the end of that phone call. Every year since, I have a rose placed in a beer bottle at her gravesite. It’s been decades, and I still turn into a mess on March 22nd.

 

There was nothing in my power to stop it from happening. I’ve had a long time to think about it. I can say I’m sorry, I can say a lot of things, but I’ll never forget what I didn’t say.

 

A few years ago, I had a dream about her. I don’t remember much of the dream, but I remembered the color of her eyes, her laugh, every part of her face that I had touched.

 

You never forget.