Is $10.46 a Living Wage by Elyssa D. Durant, Ed.M.

As a former resident of the state of Tennessee registered in the 5th Congressional Disrict of Tennessee, I am a recipient of TennCare, and a member of the Daniels Class.

I am urging you to take immediate action. PLEASE sign the economic recovery package before it is too late.

As someone who has lived and voted in the state of Tennessee since 1996, I have witnessed several shifts in policy, both on the local and federal levels.

Governor Bredesen is currently “holding off in spending” until he learns what federal aid will become available to the residents of Tennessee.

Even under of the best of economic circumstances, the state has often been reluctant to release state monies until they are in physical receipt of all federal matching dollars. This delays program implementation and compromises the integrity of the research design.

Consistency is a critical component of effective program development and design. If we hold back state funds until the feds work put the details of this enormous, comprehensive package, our current programs will suffer as a result.

We cannot wait for a determination regarding federal funding before we to determine our state’s budget while the programs throw already are suffering financially.

When I was twenty-two years old I developed a medical condition, and it quickly became obvious to me that it would be a lifelong struggle to cope and adapt to having physical disability.

I purchased three independent policies, and was still covered under a terminal liability clause under a major medical ERISA (federal) plan.

As someone who also needed to turn to federal funds and intervention in a crisis, I know that if or when help does arrive, it usually too late.

That did not work. Let me assure you that when it comes to withholding critical items like food, housing, social services, it adds up exponentially. Withholding medical care simply because of procedure and bureaucratic red tape, is shameful and cruel.

The money is there, but it seems there should be a certain level of oversight and accountability if we expect it to be used effectively without delay and without excessive administrative delay and costs.

We need to have some level of accountability to ensure the timely and proper disbursement of funds. In my experience, there is little recourse for person’s individuals who are caught up in the complicated payment arrangements, complicated language, and the systematic, procedural delay when it comes to the processing and payment of claims.

Let me personally assure you, there is a very real human cost here as well… and unless there is immediate intervention, much more than just money will be lost.

Please sign the bill before any more jobs, homes, and future are ruined by because help did not fast enough. Please release the funds, because we are running out of time.

At 36 my spinal cord is damaged from years of delayed, sub-standard medical treatment as I attempted to navigate a system that simply does not work. I owe the federal government $179,982.00 in student loans.

When I am able to work, I make $10.46/hour as a substitute teacher in MNPS. That job comes with no security and no benefits.

I have an advanced master’s degree from an Ivy League Institution. I am nine credits shy of a Ph.D. in public policy.

Despite having maintained a 3.83 grade point average while earning my masters, and just over 3.2 during the three years I was enrolled full time in a doctoral program.

Despite havimg comparable coverage, the insurance company refused to give me COBRA and would not cover my pre-existing condition even through both Columbia and Vanderbilt Universities used the same underwriter for student medical insurance: Chickering US HealthScare.

I had no break in coverage, and even purchased a private HMO (Oxford) plan that cost several hundred dollars each month just so I could prevent becoming uninsurable before my 25th birthday.

Wrong.

Not only did I continue to pay for all three policies, I also had to pay for treatment and STILL wound up on TennCare and Medicaid.

Despite doing all the “right” things, I was still unable to transfer benefits from one graduate school to the next.

I am telling you this because it demonstrates the disconnect between policy development, implementation, and the need for regulation.

When left to their own devices, insurance companies will nogt and have not done the right thing.

They consitently deny legitimate claims, and complicate the appeals process to make it som difficult that even healthy people find it difficult to keep up with.

Despite considerabe efforts for intervention, each and every agency I contacted was unable to intervene and enforce public law.

They clearly identified the problem in a letter I received that sats, “While I sympathize with your dilemma, the Insurance Department does not have the authority to override the terms of this contract.”

Executives and attorneys employed by the insurance department companies, HMOs, and utilization review are fully aware of this fact, and recognize thazt although they are breaking the terms of the contract, the liklihood for any real intervention is marginal at best.

The only reourse for a person who has been mistreated (both legally, professionally, and ethically) by large insurers is in the judicial system.

Because of complicated legal maneuvering and the complicated lavbyrinth that s insurance law, there are stipulations in federal law, such as COBRA and ERISA that prevent the states regualtory authority (of which there is none) from taking action.

This is true of Medicaid (TennCare) populations as we’ll l. Historically, Medicaid recipients were protected by a federal law, but the state of Tennessee filed for a federal waiver thaqt now protects them from honoring the basic stipulations that were set forth in the Medicaid Act of 1965.

The Daniels Class is latest casulaty of such maneuvering and reulted from a decision to vacate protections for SSI recipients in receiving Medicaid in the state of Tennessee.

As many as 150,000 TennCare beneficiaries are at risk of losing their health care coverage. Thisis ih addition to the 270,000 that lost their coverage in 2005.

How can we possibly support Goivernor Phil Bredesen for a cabinet position in the new Obama administration?

He is not a champion of civil protections, he is a product and a reflection of the corrupt, for profit health care system that has not worked for Tennessee and will not work for America.

Now that Tennessee will be receiving additional funding fromnt eh federal government, it is the best ointerest of our state and our coountry to protect the public from falling victim of the health care industry.

We should not sacrifice the Daniels Class or any other protected class– or any resident of our state to be subjected to the subjective guidelines that determine eligibility and disabiity.

With more and more people losing their jobs, it goes without saying that many will be left without employer sponsored health insurance for themselves and their families.

COBRA is prohibitievely expensive and since TennCare is now closed, many people will be forced to go without coverage.

For those who manage to keep their TennCare or other form of health care coverage, they will have to pay more due to adverse selection and the simple fact that they will disproportionately carry the fuinancial burden of the growing number of uininsured.

This is not a value judgment; it is just business.

The business model has no place in the health care system.

The only way for iunsurance companies to profit is by (1) denying payrnt for services or (2) shifting the cost of the debtonto the individual consumers by raising premiums.

What this ultimately amounts to is a larhe number of uninsured or uninsured individuals who annot afford to pay the insurance premiums or the outrageous cost of medical care int his country.

Hospital such as Vanderbilt continue to stay afloat because they do not negotiate cost of care when it comes to providing care.

You can schedule an appointment only after insurance or credit history has been verified by the billing department, and if your lucky the insurance company might actually pay the claim.

In the event that they either reject the initial claim (not uncommon) for any number of reasons, and the payment or appeals process takes longer than 90 days (depending on the rules of the treatment facility and the billing department) you will be sued.

You will be contacted by a collectiomn agency, and you will have held repsonsible for the payment.

Even if the appeal does go through, you will then have to request reinmbursement by proving to them that there was a duplication of benefits.

This requires a the teduios task of contacting someone in utilization review to review your claim, and foward all EOBs (Explanaition of Benefits) so you can prove that their was an overpayment or duplicate payment.

How much time do you have???

Now lets say for a moment that you did not lapse on your policy, maintained conmparable and continuous coverage even if you did lose your job.

Or, inteaad perhaps you employers are managed to waut out the time waiting mandatory before you could enroll and then receive benefits.

Say you are super responsible citizen, and decide to even purchase a plan that offers interim, temporary coverage in the event that something just might happen during those 90 days before the new policy kicks in, or maybe if you have COBRA coverage with an 18 month extension.

You think your covered? Nope.

In the event that either of the other two policies (COBRA or your new policy with your new employer) they will send the bill to you. Chances are that you will appeal, and appeal, and appeal, and you may even win.

But it will probably take about 18 months and you will probably get so frustrated (or sick) that may, in fact, just wind up paying the fucking bill.

They know this.

They know that we, as a people, tend to be rather complacent and lack the fortitude, patience and comittment to follow through all the eay to the end. You have aappealed and a final judgment is made.

Great!

Now good luck getting the money back.

Alternatively, in the event that one or both policies just happen to approve the claim right away.

The excessive cost of medical care, allowing from the s simply the only way insurance companies can continue to profit is by it is one we already know how insurance, majority of people will most people will be left without of the and dseek to limit access to health care.

I have not been granted any leniency by extending the amount or time permitted to complete my degree– or allow me to transfer the credits towards another program at the same institution, and ultimately left me financially devastated and emotionally bankrupt.

Throughout the three year process of filing medical appeal after the next, I acquired over 1/4 million dollars in debt due the student loans I needed to pay for my unreimbursed medical expenses.

My life will never be the same.

My heart will never be the same.

And now once again, I face losing my healthcare that I fought so hard to get?

Where is the safety net?

Where is the American Dream I so diligently chased after ?

What was the point of investing so much in a future that I can never enjoy?

How can the you justify spending so money much on an education that will never be utilized?

I understand the how I just don’t understand why.

Maybe one of these days Vanderbilt University and the Department of Education will realize it might be cheaper to hire me that harass me.

I need a real paying job, but with the skyrocketing unemployment rate, it looks as though I will have a lot of competition.

Please do something and do it quick. I would not wish this experience on my worst nightmare.

Sincerely yours,

Elyssa D. Durant

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