Tuesday, May 15, 2012

Mayor Mary wins a round against Blue Cross

The Clarion-Ledger reported Madison Mayor Mary Hawkins-Butler and her husband Jim Butler won a victory against Blue Cross/Blue Shield before a federal arbitration panel recently:

"An administrative appeal officer recently awarded coverage to Butler for cognitive rehabilitation therapy, calling it "medically necessary" after his insurer, Blue Cross & Blue Shield of Mississippi, originally denied his claim last year. The family went through layers of appeals through the course of a year before receiving this final verdict in late April.

"We completely agree this opens the door for 800,000" stroke victims in the U.S., said Susan H. Connors, president and CEO of the Brain Injury Association of America. "Even though this is one person in one state and one insurance company, the one plus one plus one equals many."

Butler suffered life-threatening ailments, a cerebral hemorrhage followed days later by two strokes in October 2010. His doctors later recommended cognitive rehabilitation - essentially physical therapy for the mind - to help his brain catch up to his physical improvements....

Medicare and Medicaid have no national policy for brain-trauma rehabilitation, Connors said, while private insurers' coverage varies considerably.

Blue Cross maintains its denial in Butler's case was based on current medical literature in regard to specific health issues and procedures.

"Medicine is an evolutionary field and we recognize that the agency conducting the independent review of this case has reached a different conclusion as pertains to cognitive rehabilitation. We will abide by this decision and continue to review the medical literature in the future," said John Sewell, Blue Cross director of corporate communications...

"The mayor and Jim learned that there is a very, very limited window of time after a stroke to have this therapy applied," their attorney Trae Sims said. "From a cognitive rehabilitation standpoint, if you miss the window, you don't get it back.

"Fortunately for the Butlers, they had the ability to get him help, but what happens to others who don't," Sims said.

The family's insurance policy is like most Blue Cross policies in that it had the same exception for cognitive rehabilitation, Sims said. "If you suffer a traumatic brain injury by blunt force trauma, as a result of a fall or car accident, they cover it. For any other, like a stroke or aneurysm, they don't.

"It's like Blue Cross is saying 'we'll pay for cognitive rehab therapy but you've got to be injured in the right way.' Talk to any neurosurgeon who treats these patients and they'll tell you as far as rehabbing an individual - from a car wreck to a stroke - the therapy is basically the same..."

Before undergoing therapy, Butler needed round-the-clock care. "It was obvious he was not the same person," Hawkins Butler said.

Now after therapy, Butler, who worked as a homebuilder, is more of the person he was before, she said. "He's driving. He can't work but he has his dignity back, and he has a quality of life
...." Article

Timber Ridge is the same place that treated Stuart Irby. I remember seeing him in public before he spent several months at that facility. His speech, motions, and gait were much improved when he returned. Made a believe out of me. Several physical therapists and doctors have told me the key to such therapy in most cases is within the first few months after the stroke or injury. Unfortunately, most people can't afford such therapy if the insurance company won't cover it.


Anonymous said...

BCBS is and has been the carrier for the quaint city, it is rated on utilization (premium vs claims)
Will the renewal be justified and extremely large or will they decide not to insure said quaint city?

Anonymous said...

BCBS is not customer friendly, nor do they care. I have heard BCBS described as the land of misfit toys.

Anderson said...

BCBS vs. Mary Hawkins ... oy.

Makes me feel like Truman felt about Nazis vs. Soviets.

Anonymous said...

Oh no, will BCBS ever be the same? I guess she will meet with the top executives she probably doesn't like the color of blue, just for eyeshadow. Many people have fought BCBS and won but I have never seen it in the news. But they are not opening up an Antique store or running for reelection next year against the bag boy at Kroger. All I know is there needs to be change throughout the COUNTRY!!!!!! And it is best we start here at home!

Alley said...

Good for them! BCBS is scum and they don't care about the people they insure. All they care about is how good Carol Pigott looks.

Shadowfax said...

The 'I hate Mary' asshole crowd has emerged from the sewer.

Anonymous said...

BCBS has instituted draconian practices toward it's insured to control costs. They limit the type of drugs covered, demand generics in patients who are controlled on brands, make medical offices jump through hoops to evaluate patients with lab test, scans, and procedures. God forbid you need special services, a bypass, stent, a branded cholesterol drug, or some kind of intervention. Don't even mention a preexisting condition, you are on your own for a whole year. It reminds me of the old adage,"Why does a dog lick is balls??? Cause he can."

Anonymous said...

"Makes me feel like Truman felt about Nazis vs. Soviets."

Or Alabama vs. LSU"

Sorry KF ;-)

Dillon Allen said...

@Shadowfax Why do you characterize as an "asshole" rising from the sewer anyone that has anything negative to say about a LONG-term mayor who certainly utilizes shady, if not outright illegal tactics (they're only "legal" until you can prove she used them)? Not-so-subtle intimidation, outright threats, and refusal to fulfill public duties based on the mayor's personal whim or her (for lack of a better term) cronies is rampant. Our quaint city is run not so dissimilarly from a mafia family. Those of us with family members who have been subjected to her don't have that favorable of an opinion of her dictatorial style of governance. Surely I feel sympathy for her family's personal struggle against BCBS, but that doesn't change the fact that she's a public official and is, therefore subject to public scrutiny. It's no secret that there are a lot of people who don't like her. Why would their reaction to an issue that is on the fence be such a surprise? Even the Butlers' lawyer is quoted as saying the policy didn't cover a TBI due to stroke etc. I don't know enough details about the case to speak intelligently, but it COULD appear that she is simply taking the tack that is not that uncommon - she deserves special dispensation.

Nuff2Say said...

ok, everyone on here is pretty much bashing BCBS. With some of what they do ticks us off there is something they did for my family. My father was admitted to a local hospital for a possible stroke... long story short... the Dr's found a brain tumor, operated and removed what they could, and he went through recovery. With the expense of the cancer meds, surgery, rehab, etc BCBS of MS stepped in and took care of ALL his claims. My father and mother did not have to worry about anything. My family did NOT ask for this, nor are we "in need" of help but are not well off. When you start bashing them, there are some angels there.

Anonymous said...

Nuff2Say - I'm glad things went well for your family, but they were jsut doing what you paid premiums for, and what they were contractually ogligated to do. They're not "angels" because they did what they were legally required to do.

They have obstructed necessary medical care for dozens of my patients. They refuse to explain why, and refuse to allow me to speak to a PHYSICIAN as to why they won't cover a medically necessary test or treatment that is the standard of care in the 49 states that have better health outcomes and rankings than this one.

Anonymous said...

This looks like Mary grandstanding again. BCBS of MS has denied and granted many claims throughout the years and appeals have been heard and won, but never notorized in the paper like the Queen B. I agree the Mary haters are coming out in droves and will be there for the bag boy. It is time for a change in Madison. She and her muscle need to go. John Bell would be a breath of fresh air for Madison and feel he would make some necessary changes in some of the city's agencies.

Shadowfax said...

The thread now morphs to a campaign stop for Johnny B. Since it has, a statement from the opposition seems fair here. What Madison needs is NOT a 'breath of fresh air'. Madison has plenty of fresh air. We have all seen how Crosby operates as a county supervisor. I suggest we don't want that in Madison, The City. Maybe the haters are Johnnies Come Lately to the city. Hawkins literally built the place with tenacity and protective armour positioned to benefit the town, not herself. Had it not been for her hard-ass approach to the job and her (overly) protective attitude, we could look like Pearl or Brandon or Clinton, all lovely little places, yet absent of sensible zoning and plastered with tacky crap everywhere.

To the gentleman who claims to have been done wrong, stating he has certain knowledge of illegal activity, put up or shut up.

Anonymous said...

Looks like Heath Hall the public relations guy for madison county is at work on this site--

Anonymous said...

I call bullshit, if this were the case the stars have lined up very mysteriously.
There are enough gray areas in their contracts to deny a percentage of most claims.
Either count your blessings are tell us you work on Lakeland drive.

Anonymous said...

Why is it that everything with Shadowfox is negative and always has to bring up others... Does this make you the big man? King fox and queen Mary please yah deserve each other......

Anonymous said...

Hey, at least I got my "Healthy U"

Shadowfax said...

@ another Madison-hater @ 6:54:My post was particularly positive. Madison-Positive, Mayor-Positive. What's negative about portraying this town as it is, an enviable respite from the rest of the metro?
I didn't 'bring up' anybody. The people I mentioned (Crosby and Hawkins) had already been mentioned. If my challenge to the poster who claimed 'illegal activity' is 'bringing up others', so be it.

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.

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Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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