Ms. Evelyn Johnson
HIPP Representative
Department of Health Services
Premium Payment Unit
P.O. Box 1287
Sacramento, CA 95812-1287
Dear Ms. Johnson:
In the process of filling out your form and getting documents together, at the last minute I realized that I didn't have the HMO's EOB.
Actually, there are two overlapping HMOs, each providing virtually nothing.
The overlap was cause by the second HMO's, CareAmerica, refusal to accept
my wife's treatment (as preexisting) at the time the first HMO, Maxicare,
told all providers that she was no longer covered because they are discontinuing
doing business in the State of California. During this time, my wife
was gnashing out her front lower incisors because of her distress, treatment
for which was withheld because Maxicare claimed it to be a dental matter.
Because of this their response, the Department of Corporation placed Maxicare
in a moratorium.
From March 1997 through April 1998, my wife was without neurologist
or treatment for her condition, so if they claim benefits, they are lying.
They were also trying to show food expenses with my C.O.D. food
supplier, though I was paying for all food. This is the FiberSource
my wife gets through her G-tube. My supplier accidentally tipped
me off about this, and in order to avoid a State investigation, they are
currently paying for all food which they had claimed to have paid.
This was Maxicare.
CareAmerica has provided one fifteen minute office visit to see
her PCP. He was awful. She has had one home visit by the new
PCP, some documents filled out by him, but virtually nothing else.
Her wheelchair and bed are now eighteen months overdue and counting.
Both HMOs are involved in this.
I pay for all chucks, diapers, nursing and supplies, though both
HMOs are supposed to provide a variety of specialists in our home every
week for at least 120 visits per calendar year.
If you still need EOBs, I should go over them with you.
I am not sure what you mean in saying "An EOB letter is available upon
request from the HIPP....which are not available from PHPs/HMOs."
As you know, the Governor at any time may request a full accounting of
any HMO, including, going into their books. He has bully pulpit over
them by law. He is empowered to do so. I am sure, anything
you might need from them, he can get. It would be very interesting
to learn what both HMOs have claimed in my wife's care and something to
which all State agencies should be alerted. It might just be the
tip of an iceberg concerning fictitious accounting methods in order to
demonstrate to the State the inordinate costs in providing health care
to all citizens
Yours in Trust,
_____________________________
Joel E. Webb - Patient Advocate
910-B 20th Street,
Santa Monica, CA 90403
(310) 829-0767 (home nurse) (310) 828-2292
(office)
copies to:
Senator Tom Hayden
23rd District
10951 W. Pico Blvd., Ste 202
Los Angeles, CA 90064
Representative Sheila James Kuehl
41st District
16130 Ventura Blvd., Ste 230
Encino, CA 91436
Governor Pete Wilson
300 S. Spring Street,
South Tower, Ste. 16701
Los Angeles, CA 90013