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Lidig8r

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Posts posted by Lidig8r

  1. For the most part, the Cloak Room/Politics board has the reputation of being a joke, occupied mostly by people incapable of collaborative thought. Pretty much every thread breaks down to pedantic naming calling like children playing in a sand box who end up throwing mud pies at each other.

    However, this thread has had some very insightful posts, thoughts and exchanges of ideas. Yes, there have been some, not unexpected, name calling replacing intelligent discourse of the issues, but some good ideas from both sides of the aisle.

    Keep it up Gentlemen.

  2. Yes, he was mainly responsible for the upset win over BlowU in 2015.

    ChinVisor had pushed him out after 7 years after the 2014 season and he came directly to us as a wide receiver's coach.

    After Coach Potato saw that Shawn Watson was a cast extra for the Walking Dead after the Notre Dame debacle, Norvell was given play calling duties.

    As the BlowU game unfolded, you could tell that Norvell knew all of the BlowU defensive tendencies and adjusted the play calling accordingly.

  3. 19 hours ago, Go Pokes said:

    That's more of a book only thing though.  The TV show chooses to ignore certain book aspects and the whole "only Valaryians can ride a dragon" is obviously one of those things.  I can't recall any mention of it anywhere in the TV show.  

     

    Ok, now that I have read the article, I get it.  They kind of blew a big moment there.  Had they established these rules in the show, which could have been done with one 60 second conversation between Dany and Tyrion,  then whatever time they invest in Dany learns Jon is a Targ could have been used here.  They should have gone in order:

    1.  Sam tells Jon about his parents

    2.  Jon tells Dany about it and Dany questions it

    3.  Jon rides a dragon and she is convinced he is a Targ.  

    4. Dany, being awash with out of control ambition, goes "Mad King" on Jon by stabbing him in the chest as she is riding his sybian.

  4. Greetings fellow Bacchanalians and Oenophiles!

    We are located in North Dallas and have ready access to all three wine providers.

    A good friend is throwing 4 parties in the next 6 weeks. And so, I am wondering price wise, does anyone have experience comparing the prices for mostly middle of the road, "John Mackovic would not drink this stuff" wines.

    We will be buying by the case so the $10 - $12 per bottle price range is the target. (With some very good bottles stashed away for the true VIPs).

    Any thoughts are appreciated.

  5. 5 hours ago, Tired Horn said:

    I

    And I would agree that the only proper response at this point is... FUCK SHAKA!

    I am quite intrigued when that particular phrase is used in the pejorative sense.

  6. I used to do a ton of FDCPA defense work. Was admitted pro hac vice in over 20 federal courts outside of Texas to defend these types of cases.

    Just from your brief description, I see at least 3 to 4 FDCPA violations along with the attendant Texas Finance Code violations.

    Violation of the FDCPA is max statutory damages of $1000 plus mandatory attorney's fees.

    In negotiating the ambulance bill as part of the settlement, you emphasize it was never a legitimate bill to begin with so they don't hit you with a 1099 saying the amount you are not having to pay constitutes income.

  7. Perhaps the AAF should be talking with the NFL and NFLPA about implementing a rule allowing them to draft high school players.

    Players have to declare by December 1 of the senior year. If they declare for the AAF, they are then ineligible to play NCAA ball.

    Then, they would have to play a minimum of two years in the AAF.

    Something similar to baseball.

    That would have the potential to get the knuckleheads who can't even spell college and who have no interest in classwork, out of the university system and they would start to earn some $ from day one. Perhaps each AAF team would be required to have an "educational/life trainer" on staff and these high school players would be required to attend a life course ... i.e., learn how to balance a bank account, invest, etc.

  8. 22 hours ago, Lobo said:

    Always seemed bizarre to me that you preemptively take a flu shot or a wellness check or a colonoscopy and you get all kinds of coverage and reimbursements because you are actively preventing future, costly issues.  But you do the same think with your mental well-being and you get a middle finger from your insurance company.  What am I missing in terms of their hesitation?  I mean, the profits made on mental illness treatment down the road is nothing compared to the revenue on cancer, or blood disease, or end-of-life care.  What is their incentive for treating this like a pain in the ass?  Honest question.  

    Up until 2008, mental health did not have to be covered at all.

    Their incentive is that it is a financially sound business decision to treat it like this. The majority of your claims for denial are going to come under group health plans. This means ERISA is the controlling statutory law. That means, no jury trials. It also means that you have to show that a decision to deny payment for treatment is "arbitrary and capricious." There are also fewer attorneys who have expertise in ERISA litigation.

    Insurers can project the estimated costs of care for a type of treatment. They then project the life expectancy of those making claims. The can project the estimated legal costs to defend lawsuits and include an amount representing the probable amount they would have to pay for adverse judgments. And, it comes down to a business decision.

    This despite the fact that with eating disorders, let's say, the ratio is 1:4. That is, aggressive treatment in accordance with generally recognized standards of care at the manifestation of the disease (1). is much more likely to result in a favorable outcome, and (2). If claims continue to be denied, the insurer is looking at spending 4 times the amount it would pay at the start of treatment.

    But, when you factor in that 1 person dies every 62 minutes from an eating disorder, they gamble that the 1:4 ratio favors them.

  9. 8 hours ago, TwiceHorn said:

    How likely is it to stand up on appeal?

    Did they consent to magistrate jurisdiction or is it just a recommendation at this point/

    Both parties consented to Magistrate jurisdiction. So, there is no appeal to the Article III judge.

    The ruling is very meticulous. The trial occurred over 10 separate days in late October of 2017. This judge took over 15 months before the decision came out. Once the remedies portion of the trial is concluded, it would go to that "conservative bastion" of the 9th Circuit Court of Appeals. In other words, that appellate court is not going to overturn it.

    As for the remedies, in addition to the new guidelines and oversight, I would not be surprised to see the plaintiffs' attorneys ask the court to set up a common fund from which the previously denied claims, if approved by the moderator for enforcement of those claims, could be paid. They may simply ask the court to order that UBH/Optum fund the plan in an amount equal to one day of their net revenue ... or $696 Million.

    It's going to be interesting.

  10. 7 hours ago, Mach 1 said:

    So how would this help someone recently denied coverage from a different carrier, say Cigna?

    I have a relative recently denied coverage for a 30 day rehab stint for alcohol.  Also treated for depression, anxiety.

    Based on the ACA can they not deny coverage?  Or does it depend on how the policy is written and then we'd have to threaten to sue based on the UBH decision?

    I would first find a treatment center and get them to start to start the process of obtaining preauthorization. When this is denied, you instruct the case manager to demand a peer-to-peer review with the "independent" doctor the insurance company is using. You also have a right to the identity of this doctor. You find out the state that doctor is licensed in.

    The issue that most treatment providers and insureds face is that they focus on the insured first. You need to attack their guidelines first. Get a copy of the policy. You will see that Cigna's guidelines probably do not comply with the generally accepted standards of care.

    Then the issue becomes is the peer review doctor making recommended treatment decisions based upon guidelines that do not comply with the standard of care.

    For the most part, the ACA is worthless and will not provide the remedies you need.

    It is complex yes. But it is doable. And.. in talking with the attorney for the plaintiffs in UBH, his firm has been retained to go after Cigna now as well ... and BCBS.

    You have not heard about the Wit case in the news yet because the remedies part of the case has not been resolved. When that decision is rendered, that is when it becomes hot news.

  11. For those suffering from mental health issues, undoubtedly you have also run across insurance issues. Your insurance provider does not approve treatment. Your insurance provider reduces the level of care prematurely. Does not approve certain treatment. And you are kept in the cycle of despair.

    Some may question, but what about mental health parity? Wasn't the Mental Health Parity law passed in 2008? And what about the Affordable Care Act?

    Yes, they exist. But, in essence what they did was to tell insurance companies, you are now in a football game. You are on one side. Families, patients and doctors are on the other side. Sometimes they play at your home field. Sometimes you play at their field. Ok, go.

    With this, parity laws allowed insurance companies to decide the rules for the football game, not have to tell other side what those rules were, they got to appoint their own referees and replay officials, and they got to be the commissioner of the league.

    That my be changing. On March 5, 2019, a US Magistrate Judge issued a 106 page ruling in a case involving United Behavioral Healthcare/Optum. This ruling eviscerated UBH and held that UBH insurance guidelines do not comply with the applicable standards of care, were deceptive since they were first run by the finance department in order to keep benefit expenses down. The UBH expert witnesses were deemed not credible. And UBH was found to have violated its duty of good faith to its insureds. 

    The remedies stage is happening now. I have spoken with the plaintiffs' attorneys on a number of occasions. I set up a meeting with one of the attorneys and some of the most influential people in the eating disorder industry at a recent international conference held in NYC. The plaintiffs' attorneys will probably be asking the court to appoint an independent panel to implement guidelines which do comply with the generally accepted standards of care, to appoint an overseer to enforce those guidelines, the class members whose claims were denied can reassert their claims and the UBH guidelines will be thrown out.

    They will also be asking for a pool of funds to be established so that class members can make claim for certain damages. Now, UBH/Optum make a net revenue of about $29 million ... PER HOUR! And yes, you read that correctly. So, you can imagine how large that pool could be.

    The game is changing. And the rules of the game are now going to be decided differently.

    Here are two articles I have written about the decision:

    UBH/Optum Decision

    Using the Optum/UBH Decision Now

    • Like 5
  12. 21 minutes ago, Tex Long said:

    Prolly a bit of both - bigger bucks and a coach on a hot seat. If you save the HC's ass, plus rep for you and a better OC job next; if you don't but it's on the D, you could be next in line of HC. Win-win for Bell.

    And Bell has the luxury of knowing he can run any offense, he can call any play, he can recruit anyone he wants and Coach Potato will stand there, looking around going, "which way did they go? which way did they go?"

  13. 29 minutes ago, PilotsError said:

     

    • Police fingered Patel while searching for driver's license photos of men with the same name in Martin County. They said his "license photo matched the look of a man seen on video the police had shot at the spa."

    Interesting choice of wording. Very graphic.

    Don't they have the sovereign immunity doctrine in Floriduh?

    • Like 1
  14. 15 hours ago, utee94 said:

    I don't care a lick about Renault, but I'm all for a successful Ricciardo.

     

    And looking at the Renault video.... "We're No. 4! We're No. 4!" Oh, and on the video, let's put a clip of our car crashing from last year and getting smoked down a straightway by our competitors.

    Fucking French.  The aggy of F1.

  15. 3 minutes ago, HtownHorn said:

    If Elko leaves, then it would be what 4 assistants to leave in 13 months or less year at Jimbo aggy?

    DL coach lasted a week

    OL coach lasted a year

    TE coach lasted less than a year

    DC lasted a year

    That's Coach Potato standard right there.

  16. 1 minute ago, 'stache said:

    We’ll have pretty sweet throwbacks this year, probably another too for the last season in the current stadium. These are 1959 championship throwbacks.

    b1a1600d5b9dbe177c5d3d0b1cbe8394.jpg

    e7faf0093c0e79c1cf1f2ca6c77ed1bc.jpg

    Oregon State?  That's a big ass, funky lookin' beaver on the sleeve.

     

  17. This thread has been cathartic.

    It's no secret that many surlyians (surlyites?) have been ripping Mack on here on a more than frequent basis.  And yet, Charlie NumbNuts seemed to slide without even the slightest bit of angst.

    That obviously is not the case, or simply needed a forum to vent the pent up piss and vinegar at Charlie Numbnuts.

    For what he did here at Texas... Fuck him and Feed him Fishheads.

  18. This thread stands in marked contrast to the thread started about the culture under Herman.

    Herman's job coming in was so monumental. He had to clean out the stench left by Strong. A stench of losing. A stench of failure. A stench of incompetence.

    We had gotten away from our history. We had gotten away from being Texas. Just as the baseball team doesn't dog pile for winning sub-regionals, or regionals, the Texas football team doesn't carry around their head coach on their shoulders after winning a regular season game.

    We aren't back yet. 

    But at least the road is before us and there is clarity of vision.

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