I shared in my  last post that I will be introducing to my readers the much unknown facts about the Self Funded Benefit Plans that fall under consortiums, associations, and MEWA’s. 

Again, I will delve in more about what I’ve learned about these entities, but here’s another back story. 

As more and more people at IP find out what has happened to us, they then open up to us. 

When they share their journey, we hear one continuous theme…..

The never ending fight. 

A fight that’s beyond anything I hear in disability circles or any other circles for that matter. 

A fight that Memphis providers have told us often is unique to IP. 

So many employees have come to me to share their story concerning their fight for care. (See Note number 1) 

I’ve listened closely as they've opened their hearts concerning some of their most private journeys. 

I try to help guide them through next steps, whether it be the appeal process, or advising them to not discuss directly with HR or Cigna, but instead to put everything in writing.  Or often times simply showing them a copy of our real plan, not the Cigna “example”, so they can make more informed decisions going forward. 

I’ve been brought to tears so many times listening to what others have endured as they’ve pushed through what it takes to get what they, or a loved one, has needed. Care that is in the plan mind you. This is important as we go forward. 

(If it is not in the plan, that is a whole other battle. One that is completely different than denying care that is in the plan.)

Which makes denials that are in the plan all the more egregious. If it is in the plan, it should be dealt with swiftly, professionally, and in good faith. 

(Yes, ME’s treatment was in the plan.) 

We’ve heard stories of people on life saving drugs who  all of a sudden were informed of a denial of their much needed care. 

We’ve listened to stories of employees who shared they were trying to get information, and they are passed from Acreedo, to Cigna, to Express Scripts, waiting on hold, with no end in site, all of this while many are in a moment of desperation. Our experience as well. 

Employees share they spend an incredible amount of time on health insurance issues. We have found this to be unique to IP. Other employees of other companies report that their plan is followed in good faith, and it’s a smooth and simple process. 

It is not only time consuming to endure this process, but also exhausting, and sadly, during some people’s scariest moments. Being able to trust your health care benefit plan is of utmost importance during these very scary times. 

I understand this well. Each time we nearly lost ME, I was too exhausted to understand the system. Too exhausted to do anything but rely on doctors to tell me what we could or could not do. No part of me knew it wasn’t really the doctors making decisions. I was too exhausted to learn this, and counted on good faith laws to protect us. 

I began to  learn more and more what the providers and doctors were doing behind the scenes to fight for ME’s care. This included multiple calls by the provider, and a staff of employees, to justify treatment that has already been justified.  Phone call after phone call by their staff, hours waiting on a line with no one was answering them… 

In spite of the fact that the off label process had already been submitted. 

The Department of Labor and TennCare employees were teaching me all the way through what IP was doing, and what IP was failing to do, to follow their plan. The plan they created. The plan they are obligated in good faith to follow. 

Not only was this frightening to us, as we watched ME decline again, it was truly a waste of so many good people's time and money. This is an absolute incredible burden on the medical community. Especially in the greater Memphis medical community. 

Providers here have informed us over and over again that they either; would not take a case from IP, or they would share with us the well known facts of what they had persevered through for years with IP's Self Funded "Benefit" Plan. 

You know it is bad when your reputation proceeds you. 

Doctors here are pushing an initiative to improve the pre-authorization process that sucks up resources, time and money by the provider. Many providers opened up to us that IP leads the way for this struggle they go through. 

This is neither neighborly to the Medical Community, nor is it ethical. And it most certainly creates an undo amount of stress on employees, their family members, and providers.  

This recurring theme has been at times overwhelming to listen to. Though each time I am drawn in by the care and the compassion of those who tell me their story. 

I often wonder what the SVP of HR and the VP of Global rewards strategy is? 

Surely it’s not to improve the employee experience for IP employees. 

Is their strategy to make it so painful and difficult to get care that people give up, to lower cost? Please tell me this is not so. (I gave up often for this reason. Care that we so desperately needed.)

Is it due to incompetence? This is the best they can do? They’ve not laid out a plan for smooth best practices? 

Is it possible that such a large consortium of companies have too much power? Do we need to push for legislation for oversight of large consortiums?  Or does that already exist in the books, and it needs to be applied? 

Is it causing ripple effects in the organization that are damaging to the trust of employees? 

From those who share with me, here is my takeaway: 

1. Employees' health, and their family members, under the benefits plan, suffer greatly without timely care. 

Mary Ellen’s pain and suffering is something I can never explain in words. I struggled with this especially because I heard my whole adult life about the IP Way, and I trusted that. 

Does this fit with the words leaders routinely say that employees are our most important asset?

It was incredibly heartbreaking to realize the company that my family and I loved so much had withheld a most needed 120 page document. 

I begged, and begged,  and begged for the document to go through the full review process, that Dr. Hoy (See note number 1) so swiftly put through. While my sweet ME literally became sicker by the day. 

How could this be? By the people I had come to trust as family.

Surely they would follow the off label process and their plan for a sweet little girl who did nothing but be born into this system. Who had already fought to live for so many years. 

Surely they would follow the off label process for anyone. 

Surely they follow their plan to a T. 

Though our experience says otherwise. 

2. Other companies do well with managing their self insurance programs.

I hear it all the time in my disability circles. 

Their company follows the plan and processes that are part of the industry, and their child gets care that is needed, swiftly, and easily. 

When families contacted me during this process,  they were shocked that we were enduring this incredible trauma. Having to choose between the company we loved our whole life, and our daughter’s tragic disorder and care to save her life… is a position no one wants to be put in. 

We ask… what would you do? 

Thankfully, due to our fight… 

She is now thriving, and doing amazingly beautiful! Just like Dr. Hoy was certain she would do! 

As federal and state agents walked me through this process, and guided me as to what to say and to whom, they would also share their shock over what we were going through with John’s company. 

It was as if everyone in the industry knew exactly what was happening. 

The only individuals who did not know that all in the industry were telling us, and knew this,  were the people who were denying ME her much needed care. 

Reminiscent of the childhood classic, The Emporer's New Clothes. (Often referred to as The Emperor Has No Clothes)

They shared with me that companies they deal with are going above and beyond with health care to attract and retain employees in this tight labor market. That when the companies are reminded what they need to do to follow ERISA they adjust quickly to ensure they are in compliance. 

This was not our experience. 

3. Recently, we’ve had some local doctors share that they are not accepting new IP patients because IP is so difficult to deal with. One of own providers didn’t want the case because we were covered by IP. They have the right to refuse based on concern they won’t be paid. This provider said they had a history of fighting for payment from this benefit plan, and they did not have the resources to continue to fight them. 

It’s been reported to me, and continues to be reported to me, (all the way to this past Friday), the hours their employees have to invest in from chasing down the payment . This is incredibly burdensome and costly. And truly not neighborly. 

Is the ripple affect that this is limiting the access to the best providers Memphis has to offer? In our experience, the answer is yes. 

This extensive unnecessary paperwork takes time away from them doing what they went to school to do, which is treat their patients. 

Essentially the SVP of HR's execution of the IP self insurance program is limiting access to great doctors for their employees. Pitting  doctors against their patients, potentially for cost savings incentives. 

4. And this one really hits me…. 

What are they thinking regarding getting the best out of their team? 

Unquestionably, if an employee, or their loved one has an health issue, that will trump any work issue every day. 

You’d think the SVP of HR and VP of Global Rewards would want to make health care easy and keep employees focused on the mission of IP. 

Not to mention, people get extremely emotional and stressed working through these health care issues. 

Could these create more health issues?

They 100% do. 

Our family alone can share what the stress of this battle for ME’s life did to us. 

This whole thing just doesn’t make good business sense to me. Also is this moral and ethical behavior from one of the country’s largest public companies?

I’ve so many questions. 

Which always lead to this one… 

….once again, 

why?