Blue Cross California; the next Cigna?

Here it goes again, another insurance company playing doctor. This is the story of San Diegan Scott Eveland; student, son, star football player. Scott suffered a severe brain injury during a football game on September 14 of last year.
He's been receiving care at Palomar Medical Center. Recovery has been slow from what doctors described as a "catastrophic brain injury." He was in a coma for a month. However, he has been slowly regaining his ability to speak and move.

Recently, Blue Cross of California decided to discontinue paying for his care at Palomar. Why? He is slowly recovering and making progress. It's a pity he's not up and running around as quickly as Blue Cross wishes.

When Michael Moore's movie 'Sicko' debuted, Blue Cross VP Barclay Fitzpatrick sent out a memo expressing concern of their "brand" being included with other companies such as Kaiser Permanente ("thrive") and Cigna. Fitzpatrick said,
"You would have to be dead to be unaffected by Moore's movie, he is an effective storyteller."
After seeing this movie, his primary concern is the reputation of their brand name. He notes the following were included in the movie:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad treatment of members. * BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection. * BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature. * BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding
inaccuracies in applications to enable post-treatment payment denials."

He goes on to express this concern, "The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as Moore's efforts in the movie and surrounding PR activity are seen by more of
the community...If popular, the movie will have a negative impact on our image in this community."

Oh, really, Fitz! Ya don't say! But here, you have a young man recovering from serious brain trauma, and his recuperation is taking too long for your liking, so you want to send him home, or to a nursing home.
Dr. Keyvan Esmaeili, director of the Acute Rehabilitation Unit, said Eveland has been showing a "very nice, slow, gradual improvement." Esmaeili said that in the past week, Eveland has been able to string together short sentences for the first time.
He also notes that Scott receives three hours of therapy daily, which certainly would not continue in a nursing home.

"Also, with us he will continue to receive medication management on a daily basis, physician intervention and nursing care on a daily basis," Esmaeili said. "In the long run, we think he will be better off staying in a place like ours, where we think
he will get about 50 percent better than he would at a nursing home."

The family has appealed the decision to remove Scott from Palomar's Acute Rehabilitation Unit.
Eveland will remain at Palomar until the appeal process has been completed.

Here is a letter written by Scott's mother, Diane Luth.

Dear Blue Cross,
I understand that you have denied my son, Scott Eveland continued care in acute rehabilitation at Palomar Hospital. I am troubled by your decision and would like you to take a look at my son's day to day life through the eyes of his mom.
In the past 4 weeks Scotty has shown leaps and bounds progress. I think it would be detrimental if not tragic to my son if you didn't at least allow him 4 additional weeks to show his continued progress at Palomar acute rehabilitation.
Scott has made a marked change since the doctor prescribed the drug Ambien. It has made Scott more alert, coordinated and able to communicate verbally.
Just this last weekend Scott was able to tell us his first and last name. He told us who his younger brother was and his older brothers.
We asked him what position he played in football. He responded by saying middle line backer. We asked him what his favorite brand of clothing was. He answered "Polo".
He was able to tell us the color blue and red when asked. I held up my hand and showed him 5 fingers. I asked him to tell me how many. He said 5. I changed hands and asked again. He said 5.
I found his nurse and asked him to watch. Again I asked Soott how many fingers I was holding up. He said 2. He was correct.
His friend from school visited him yesterday. She asked him if he remembered going to the Prom last year with her. He nodded yes. She asked him where he got his Tuxedo. He said "Men's Wearhouse".
The week before I saw him talking to himself. I asked what he was saying. I realized as he was staring at the wall he was reading one of the many posters in his room. He said, "Get well Scotty". I said to him, "you can read that can't you? "He nodded his head "yes".
Today the Physical Therapist told Scott that if he needed to go to the bathroom to go. She told him that he was going to be put into the Light Gate walking apparatus. So go if he needed to. He said yes.
After he went he was able to communicate that he had a bowel movement. Scott assisted his Aunt and myself when we went to change him. He lifted up his hip to help get his shorts off.
He is moving his legs more freely and holding them up in a bent position for 15 to 20 minutes at a time. He is initiating steps with both his right and left leg when put in the walking apparatus. In the morning he helps with his toothbrush in brushing his teeth.
He also makes movements with his electric razor in the appropriate fashion to shave himself. He uses a straw to sip liquids. He has been eating from a spoon and swallowing after each bite.
He is making progress and in my opinion it has been huge in the last month. How will one more month not benefit everyone involved?
If Scott shows additional improvement let him continue his recovery. If he doesn't then we revisit the decision to move him.
In closing, I wish to make one final point: Scotty has always been very smart and hard working. Throughout his life he has received various awards for academic achievement, and other accomplishments. He has received football awards every year throughout high school (including this year) for exemplary performance & commitment to excellence; as well, his academic curriculum has been weighted with AP classes his entire high school career. He has had a passion for politics, was a strong debater and was voted "Most Likely to Become President" by his senior classmates.
I have come to learn that there is still much that is unknown about brain injuries. I also understand that the first year following such an insult is the "window of opportunity" for making progress toward recovery; after that, one can expect little improvement.
I know that Scotty's recent progress has amazed and exceeded the expectations of several of his doctors, nurses and therapists. I also know that he has only just begun to scratch the surface of what he can and will accomplish if given the resources.
I often wonder what Scotty's contribution to the world would have been had this not happened, but I am not discouraged for I know that his impact is yet to come.
Scotty has been destined for greatness his entire life, and I submit that this fact is as true today as it was before September 14, 2007.
Diane Luth
Scott's mother

While politicians are promising health insurance for all, this underscores the fact that the bottom line is not health care, it is protecting the brand name and the bottom line. This isn't health "care," it's a travesty. Scott Eveland is showing marked improvement.
His doctors agree that staying at Palomar will improve his chances of recovery.

So, what's the deal? Does Blue Cross want to perpetrate the next horror story about Big Health Insurance companies?
Blue Cross' motto is "Life. Live it well."
Scott's trying. He's a winner. But Blue Cross California apparently thinks this motto is meaningless. It's the bottom line, stupid!

Cigna turned around too late, after a nurse's rally outside their offices in Glendale California.
All Scott has is fifty high school students and friends, who held a rally yesterday outside Palomar Medical Center.
Please, let us add our voices to that of these kids.

In November 2006, Brian Sassi was named President and CEO of Blue Cross California. I think he needs to hear from us that this kind of
negligent greed is not the direction he should be moving in.

Blue Cross of California        
21555 Oxnard St.                      
Woodland Hills CA 91367

Blue Cross California is pretty cagey on their websites. For some reason, there's no contact information. Unless you want to buy their insurance, of course. It'd be cool if someone with more know-how could post relevant contact information so we can stop this now! Scott needs therapy. He is still benefiting from treatment and this needs to continue.

I am sure you all feel the same sense of anger and disgust as I do by this decision. This is a young man's life and future being played with! Blue Cross California has to be made to realize that their bottom line is as important to us as Scott's life is to them.