Archive for October 2023
Katie Beckett TN to the Rescue!
“Would Your Wife Really Go to the News?”
Before we finally qualified for services from the state of TN, a “nurse caseworker” from “Cigna” would contact me concerning ME’s care, or lack there of. Often.
Every time I turned around, our doctors’ orders were being denied by our “insurance company”.
On one particular call, (that I took out of the house since my husband was on calls, working from home due to Covid), I was so sad. The “nurse caseworker” informed me ME was again denied care.
I began to cry. I was devastated each time they informed me.
I begged for help. Begged her to tell me what I could do to get the help. She clearly stated that there was nothing I could do. (Again, not true, she was obligated to tell me the appeal process. Instead she said to me, “I’d save that appeal process for the treatment she needs” Again, coercing me to give up. Definitely against good faith laws.)
I started bawling. I said to her through tears, “Please ask someone. Please, I’m begging.”
I then added, “We don’t qualify for services. My husband’s income is past the threshold. The state of TN does not have Katie Beckett, and our insurance keeps denying her care.”
I then said, “Oh my God, this is news worthy!”
She agreed it was heartbreaking, and said she’d do what she could to advocate for us.
We hung up.
I waited to go inside until I collected myself, so my husband wouldn’t worry. I wiped my tears, and straightened myself up. It was not more than a few moments. But I knew I needed to take a moment.
I walked into our house.
Just as I walked through the door my husband’s work phone rang.
He had it on speaker, so I remained quiet so as not to be disruptive to his call. I began to walk to another room, when I overheard this…
“John, this is N*** C***.”
John said, “Hey N***, what’s up?”
N*** said, “Hey, Cigna just hung up the phone with your wife. They said she said she’d call the news about your daughter’s care. Would your wife really go to the news?”
John looked at me, as if to ask me if this was true.
I was in complete shock.
He said, “Don’t worry. I’m sure she won’t.”
N*** said her thank you. As if to say, we appreciate you for keeping her under control.
I knew my place. I knew what I was just told to do.
John hung up the phone.
That was 2019. It was right after we nearly lost ME in November of 2019, and her recovery was going to take up to a year. Recovery that I would have to do nearly all alone, due to denial of care. (Our “insurance” approved I believe it was 20 minutes of OT, once a week.) For a child recovering from near death, with a disorder that was not addressed fully, this was horrific.
That was the first day of the end of our marriage…
That was the first day that systemic denials nearly destroyed our family.
And absolutely caused ME pain and suffering.
Along with pain and suffering on me.
Little did I know what was to come.
This would be our smallest battle.
We were just too naive to know it.
Grover, today I celebrate you!!!!!!
We made it baby!
34 years and going strong!
Happy anniversary to my forever boyfriend!
Love won!
Who Is Ultimately Responsible?
One Year Ago Today…. Whistle Blower Status Declared…
As most know… October is emotional for us.
Many people witnessed our horrific journey first hand, but I’d like to recap for those who did not. As well as for those who did, but want clarity.
Anniversary’s, good or bad, have a way of prompting a lot of emotions.
Today’s the one year anniversary my husband declared whistle blower status.
Also today, one year ago…
MaryEllen was dying.
She had a significant routine of dangerous drops in blood oxygen levels to her brain,
along with her heart rate dropping. Night and day, her monitor went off. Even on oxygen her oxygen was dropping.
Katie Beckett approved MaryEllen’s treatment in September.
The IVIG center told us they would take her case, pending the approval of her primary insurance.
My husband’s company is self insured, and they denied it.
We waited for weeks for their reply to our doctor’s appeal! Many many weeks.
We also offered to pay out of pocket, but that was not an option. We begged actually.
The answer from the IVIG provider was always no.
This is to protect the consumer from going bankrupt from medical care, and to get the primary insurance health care benefit plan to do the right thing.
Unfortunately for us, that did not happen, and MaryEllen continued to decline even though our doctor did all of the correct steps for off label approval. As many know, a 120 page document was withheld from the process.
Now we had no hope, and NO ACCESS to her health care.
Make no mistake about it, our primary insurance denial, absolutely cut off access to her care.
Now mind you,
in September
the SVP of HR heard about our plight, and reached out to John. He explained to John that IP is self insured and he’s “the final decision maker.”
He then told John he’s “running a $500MM business and this isn’t expensive compared to other treatments.”
We had hope
Not long after that, the SVP of HR told John that this treatment isn’t FDA approved, and he wasn’t approving it, and is not doing a favor for John.
The comment about the favor cut deep.
Anyone who knows John knows he would never ask for a favor.
Also, remember,
ME’s doctor had immediately sent in the 120 page document for the off label process.
The exact information that was sent to Blue Care TN, her secondary insurance, that guided them to approve it immediately after the first denial.
Now John and I had no options.
MaryEllen was dying, and this denial did not only deny her care, but denied her ACCESS to care.
This denial would be the difference between life and death.
I contacted a lawyer. Through tears I told him our story.
He advised us to have John declare whistleblower status and file with HIPPA, ERISA, GINA and ADA.
The weekend of October 15th of last year was horrific. Numerous close calls with MaryEllen, lack of sleep due to her monitor going off all night, by day calling every politician, and advocate we could think of, to beg for help.
Two desperate parents, who were trying to help their other children understand it all as well.
Terror running through all of our bodies.
On this day, October 17th, 2022, John was brave enough to finally declare whistleblower status, and file with ERISA, HIPPA, ADA and GINA.
Now for the heartwarming part of the story. I continued to reach out to politicians, and thanks to one politician’s staff member, in 4 days, on October 21, 2022 the decision to deny her care was overturned.
The politician who went into action was Representative Kevin Vaughan’s office.
His staff member reached out to the TN Justice Center.
The TN Justice Center called me immediately after Representative Vaughan’s office reached out to them.
On the October 21st, the TN Justice Center called me a second time.
This time it was to tell me that they took ME’s case to court, and the judge sided with MaryEllen, and the state of TN would pay for the treatment, and go after IP in what’s called a “pay and chase”.
This is a day we will never forget.
Thank you tax payers and state employees in TN.
November 2, 2022, MaryEllen received her first treatment, and the healing began.
The state paid for the treatment till February 2023 then it was a transferred to IP, according to our our (Cigna) account.
Today, on this one year anniversary of John’s declaration of whistleblower status, a huge and scary day, we celebrate our sweet ME and how beautifully she is doing!
We still haven’t determined how to stop this from happening to someone else, but we will continue to advocate and work with politicians like Representative Kevin Vaughan, to create legislation so this can never happen again to another person.
We’ll dig deeper into more what happened in the upcoming weeks.
There is a lot here to unpack that we think you’ll find helpful to know.
IP continues to deny any wrong doing or to investigate other cases John has told them about. It’s amazing the power self insurance companies gives to one person.
One advocate told us “this is the most egregious abuse of self insurance they had ever seen”
Today, people in the community, friends, and John’s colleagues have said to him and me, “If it was my child, I would have done the same exact thing.”
It’s heartbreaking and difficult, daily, to have to declare whistle blower status. But we’d do it all over again.
The love, support and comments have helped us see the good, and continue to be the good. Thank you for all who have reached out to us. You hold us up!
What Does It Mean To Claim Whistle Blower Status?
It takes a lot of courage to share what you know is happening in the company you work for, that is, maybe, doing something that is perhaps unethical.
When you do that retribution may follow.
Hopefully that’s not the case and instead of retribution a company acknowledges the wrong doing, and fixes the problem.
Unfortunately that’s not always the case.
Which is why Whistle Blower Status exists.
Did you know there are laws against retribution to an employee for reporting wrong doing?
My husband claimed whistle blower status over a year ago when he realized ME was not getting care that was included in his company plan. Care that would save her life. Care that the state of TN approved.
It’s a horrific decision to make between saving your child’s life, and saving your job that helps you continue to live the life you’ve been living.
John was terrified to claim Whistle Blower status a year ago.
But he did it to save ME’s life.
Thankfully there are laws to protect Whistle Blowers.
Let’s look at what these laws look like.
Here is the law in the state of TN:
https://www.findlaw.com/state/tennessee-law/tennessee-whistleblower-laws.html
Employees should not be punished for doing what is right.
Thankfully we have many witnesses who will gladly testify that ME was wrongly denied care.
Since my husband reported this as a Whistle Blower he should have protection from retribution for reporting what he heard and saw.
We will ultimately see if being a Whistle Blower destroys you, or if becoming a Whistle Blower creates the change that is needed by telling what you saw or heard.
Our situation will either encourage people to tell what they see, or discourage people from reporting wrong doing.
I hope it encourages people to report wrong doing…
Time will tell…
I’ll report here.
The Lessons We Learned While Saving Our Daughter’s Life
The journey that unfolded as we fought to save ME’s life was one we never expected. We were just your average family, raising kids, working hard, and trying to bring good to the world where we could. Nothing out of the ordinary.
Nothing out of the ordinary until, we were caught in the middle of bureaucratic red tape trying to get ME much needed care to save her life. What we witnessed during this process was horrifying and traumatic.
Thankfully, we had people guiding us. They helped us understand what we needed to do to cut through this bureaucratic red tape, that society had placed ME squarely in the middle of.
As we approach the healing part of this journey, we want to help others going through what we experienced. Our hope is to educate while we tell our story.
Follow along here as we teach, guide, and one day soon announce our book we are writing. We hope these efforts will help in our continued healing, while we help others.