OCLC (Online Computer Library Center), United Healthcare and ACN Debacle
This is my letter to everyone I have listed at the end and a few more.
_________________________________________________
March 18, 2008
United Healthcare
P.O. Box 30432
Salt Lake City, Utah 84130-0432
APPEAL LETTER
Dear Sirs
This is an appeal letter to reinstate my 24 visits a year of chiropractic visits. I have sent in several times since the denial by Joseph Carpino on December 10 2007 through my chiropractor stating the seriousness of my condition and the new MRI results. My Chiropractor has also sent in a complete and new evaluation of my condition.
I have heard nothing as in approval or denial of these requests and I feel that the ACN is ignoring these requests even with the new information of degeneration of my condition due to the neglect and wrong doing of OCLC, ACN, and United Healthcare.
I was also denied visits in 2005, 2006, and 2007 even with my medical doctor having written a prescription for me to have chiropractic treatments and letters stating that I have great improvements with chiropractic care.
Last year I paid out of pocket over a thousand dollars for my chiropractic treatments. This then created a hardship for getting medicines for myself and my fiancé which included high blood pressure medicine, diabetic medicine, colon medicine, migraine medicine, pain medicine among others. It also made it so I could not get new medicine my doctor wanted to put me on for the neuropathy and pain caused by the degenerative discs and scoliosis.
I also feel that United Healthcare and the ACN is in violation of contract since it has now been 4 months since I have heard any comment from United Healthcare or the ACN as to whether they are going to approve the 24 visits per year as per our contracts states I am suppose to have.
The last time I had any kind of a letter from the ACN concerning my chiropractic visits was December 10 2007. I have heard nothing since that time.
My last MRI on January 9 2008 showed that I have In the Thoracic
Degenerative Disc Disease at C5 with associated end plate osteophytosis. Mild midline to left paracentral posterior protrusion, mildly effacing the anterior epidural space. Minimal degenerative spondylosis involving the thoracic spine, right lower thoracic scoliosis mesuring 23 degrees, a thinning of the spinal cord.
In the Lumbar
L2-L3 Prominet disc space narrowing with anterior end plate osteophytosis, posterior joint arthrosis, right predominant with associated degenerative spondylolisthesis of L2, disc protrusion extending in to the L2-L3 neural foramen.
L3-L4 Decrease in disc signal intensity, degenerative posterior annular bulge, posterior joint arthrosis, left predominant with minimal neural foraminl stenosis.
L4-L5 Posterior joint arthrosis, left predominant minimal left L4-L5 neural foraminal stenosis.
L5-S1 Posterior joint arthrosis.
The left thoracolumbar scoliosis measuring 31 degrees.
In the Cervical Spine
C3-C4 decreased disc space height with left sided disc/osteophyte complex producing encroachment of the left anterior thecal sac and mild left foraminal encroachment.
C5-C6 dicreased disc space height with diminished signal intensity of the disc indicating disc desiccation/dehydration with broad based posterior disc protrusion type of disc herniation extending to the left with osteophyte. On measuring approximately 2.0-2.5mm producing encroachment of the anterior thecal sac and mild canal narrowing.
The Thoracic Spine and the Lumbar Spine has become worse since the MRI in 07. We believe this to be due to the wrongful doings, neglect, and denial of treatments by ACN, United Healthcare and OCLC for the last 2 years going into 3 now.
The ACN refuses to speak with the patient and refers me to United Healthcare. United Healthcare refers me to ACN.
The ACN states that my treatments are maintenance care. When did it become maintenance care to prevent spinal cord damage or to keep a person out of a wheel chair? If this is so then is not anything we do today in the way of health care considered maintenance? When will it become maintenance to take diabetes medicine, or high blood pressure medicine, have dialysis, or even open heart surgery?
I have not traveled since June 07 and am basically house bound except to go to doctor appointments and physical therapy.
I am now on Ativan, Percocet, and Cymbalta not only for the pain, but also for the depression caused by the worsening of the pain, the worry over financial matters, and the fact that I have not been able to have any kind of a normal life because of the denial of medical treatments which not only helps with the pain by taking pressure off the nerves but also makes it possible for me to function enough to be able to care of myself at this point. I have not been able to do any kind of work since last July.
Is the ACN Doing only what they want? On the ACN web site they have a statement about how everyone will have the best medical care they can through help with their experienced doctors and through education. The problem with this is the ACN will not talk with the patient as per United Healthcare rules. So how can the patient learn if they are not taught? In another part of their web site the CAN has a statement that they will survey their patients and doctors annually as to their over all experience with the ACN.I have never been sent a survey in the 3 years I have had dealings with them. Does the ACN only send these surveys out to a certain number of people? Where are the results of these surveys? Something the ACN does not seem to mention is they have a tier system for their doctors of chiropractic. A tier 1 is basically a doctor who does a limited amount of treatment on their patients, along with not having as much paper work to do and are not watched as closely. A tier 2 is a chiropractor who seems to have returning or chronic pain patients plus has a lot more paper work to do and for the most part the treatments are denied by the CAN, are watched much more closely, and most of their treatment requests are denied it seems. I have gone to two different chiropractors in the same office. One was a tier 1 the other a tier 2. Both gave the same treatment but the tier 1 doctor did not have any problems getting treatments approved. So to sum this up it seems the ACN is not looking at the patients and their health needs but at where the ACN has placed the doctor and the job the ACN think they should do to save the insurance company money.
Also this past month I was asked by my doctor to do a survey at home as to how my condition is between treatments. This was asked for by the ACN person, Dr Carpino’s assistant, Dr Loopowits.
I have done that and it was sent in about 2 weeks ago and I still have not heard anything concerning this.
Sincerely
cc:
ACN
OCLC
ACA
Attorney General of Ohio
FTC
Ohio Department of Insurance
Labor Relations Board Foundation for Chiropractic Education and Research
CCGPP
Congress of Chiropractic State Association
Ohio State Chiropractic Association
10 TV News
WSYX TV6 News
Addendum to Letter
March 18, 2008
After I had written my letter and was printing out all the information to be considered I received a letter from ACN.
It states
“The submission of clinical forms/information by your provider was not considered complete as the following information was missing or not recorded properly. Your provider has been asked to correct and resubmit within 10days.
The diagnosis section does not contain a Primary diagnosis or the Primary diagnosis was not legible.”
It is attached
I know that Dr Keller has talked on the phone with the ACN and has discussed my case with them.
I just don’t know what more information they could need. As you can see I am being drowned in paper work because of their request of wanting at home reports.
Thank you for your time
Second Addendum
March 19 2008
I went to my chiropractor today and found out that the ACN has refused me once again until September 2008. That is 6 months.
That letter is attached.
Dr Keller talked with Joseph Carpino (administrator of my account). Dr Keller asked what could be done? Carpino told Dr. Keller to stop having me come in every week (of which I do not do), to stop having me make my appointments ahead of time (again I do not do you may ask anyone in the office), and to have me come up with a new symptom. I am afraid I cannot do this unless I do have a new system develop because I cannot lie.
Thank you
STENOSIS SYMPTOMS, DIAGNOSIS AND TREATMENT
Lumbar spinal stenosisThe term “stenosis” comes from Greek and means a “choking”. In lumbar spinal stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of pain, tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity. Spinal stenosis in the neck can be far more dangerous by compressing the spinal cord itself and possibly leading to major body weakness or even paralysis. This is virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine. In rare cases, lumbar spinal stenosis can go no further than to produce severe persistent disabling pain and even weakness in the legs. Most cases, however, have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting. This is called claudication which can also be caused by circulatory problems to the legs, as discussed later in this article.Practical point
Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with leg pain that significantly limits their activities, such as difficulty with walking.Spinal stenosis is related to degeneration in the spine and usually will become significant in the 5th decade of life and extend throughout every subsequent age group. Most patients first visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with significant activity limitations, such as leg pain and/or difficulty with walking.Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of spinal stenosis occur in the low back (lumbar spine), which is called lumbar spinal stenosis, and most will affect the sciatic nerve which runs along the back of the leg. When this happens, it is commonly called sciatica.
What is spinal stenosis?
The vertebral column in the spine and sacrum (at the bottom of the spine) is like a stack of blocks that serve to support the structures of the body. Each of these bony structures has additional bony attachments that serve to help stabilize the spine and to protect the spinal cord or nerves passing downward from the brain to organs, muscles and sensory structures of the body. Each vertebral body and its attachments and the disc between the adjacent vertebrae are known as a spinal segment. The entire length of the spinal column has a large central canal or passage through which the spinal cord descends, and holes to each side of the canal to allow emergence of spinal nerves at each level. The spinal cord stops at the upper part of the low back, and below that the tiny contained nerve rootlets descend loosely splayed out - like a horse’s tail – and are protectively enclosed in a long sack. All central nerve structures are protected further by membranes, with a tough outer membrane called the dura (tough) mater (mother).
Major types of stenosis include:
· Foraminal stenosis. As the nerve root is about to leave the canal through a side hole (lateral foramen), a bone spur (osteophyte) that has already developed from a degenerating disc can press on that nerve root. This type of stenosis is also called lateral spinal stenosis. This is by far the most common form of spinal stenosis. 72% of cases of foraminal stenosis occur at the lowest lumbar level, trapping the emerging nerve root (which comprises a major part of the sciatic nerve).·
Central stenosis. A choking of the central canal, called central spinal stenosis in the lumbar (low back) area can compress the sack containing the horse’s tail (cauda equina, or cauda equine) bundle of loose nerve filaments. Central spinal stenosis is more common at the second from the lowest lumbar spinal level and higher and is largely caused by a bulging of the disc margin plus a major overgrowth or redundancy of a ligament (ligamentum flavum) which is there to help protect the dura. This overgrowth is caused by segmental instability usually from a degenerating disc between adjacent vertebrae. The ligament arises from under the flat laminas of the vertebrae and the inside part of the facet joints (stabilizing joints located on each side at the back of the spine segments).
Far lateral stenosis. After the nerve has left the spinal canal it can also be compressed beyond the foramen byeither a bony spur protrusion or a bulging or herniated disc. When this happens, it is called far lateral stenosis.
These differences in anatomy may result in similar symptoms, which is why all forms of stenosis are typically referred to as simply ‘spinal stenosis’. However, if surgery is to be performed, the differences are very important in guiding the surgeon. That is, the bad spot(s) must be exactly known in advance to guide the approach for its proper treatment or removal.