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Everything posted by Lidig8r
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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.
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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.
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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.
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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
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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?"
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Interesting choice of wording. Very graphic. Don't they have the sovereign immunity doctrine in Floriduh?
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What new UT gear are you looking to buy this year?
Lidig8r replied to GhostOfTomJoad's topic in Football
Come on! That's only two lap dances. -
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.
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That's Coach Potato standard right there.
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Especially when it is sitting on my face.
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Oregon State? That's a big ass, funky lookin' beaver on the sleeve.
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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.
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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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This is a pretty good list of 54 DBs (with some listed who should not be on there) https://247sports.com/college/texas/Article/Rod-Babers-ranks-the-top-DBs-in-Texas-Longhorns-history-179744/
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Our president needs to focus on academic issues and increasing the international reputation of the University of Texas as a global leader in research and education. The president of aggy needs to focus on improving relationships with barnyard animals and lobbying representatives in Austin to lessen the criminal sanctions for lascivious acts perpetrated against creatures with four legs.
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Oh, I definitely check in on this thread on a semi-regular basis. I was open about my struggles on the Shag before here and can give updates. One of the things I have told others who have opened up to me with their struggles and who routinely say, "I know my issues cannot compare to yours, but ..." is that you cannot compare levels of grief. Grief is as individual as the person suffering. I reading Another's soul-baring post, I was caught up in the newness and raw power of it. I felt that it needed room and space to be reviewed, not diminished in any way and have the collective help one can get from this thread be directed toward him. My issue was just the usual roller coaster of emotions that comes into our lives. I know that the permanence that is the reality of the death of a loved one is a concept that is so incredibly difficult to grasp. It grips you in different ways, at different times. I hope that Another continues on a good path with his eyes, heart and soul open... embrace those kids every chance you get. And be the Storm.
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To get things back on topic... just thank God Coach Potato is gone and is now USF's problem. No take backs of course. The rotting stench he left on our proud program is just about completely dissipated. Much like the second ex-Mrs. Lid. Onward and upward Gentlemen.
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Were we overmatched? Listening to the pundits on ESPN with a multi-billion dollar contract with the SEC ... yes. They athletically scared the bejesus out of you? Again, ESPN hype and playing only one OOC team with a pulse will do that. We do have a good coach. And good coaching resulted in the win against a team perceived to be superior to ours. The game was nowhere near as close as the score. Their weaknesses were identified and attacked. It is nice to have a coaching staff capable of that instead of a coaching staff still trying to learn to spell ... weakness. In the unlikely event that Potato is still with USF with they come marching in to Austin in 2020, the beat down will be absolutely epic.
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Gentlemen ... Gentlemen ... a little respect. The vaunted 2018 edition of Alabama football just joined a very unique and exclusive club. In fact, that club only has two other members ... The 2003 edition of the Oklahoma Sooners and the USC Condoms of 2005. That club? The greatest college football team in the history of God not to win the national championship. HERE'S TO THE LOSERS! HUZZAH!
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Move that ou - Washington State Rose Bowl down a number of notches. Washington State was nothing special at all and only got the Rose Bowl bid because the Orange took USC. Game did not even sell out. Oh.. and as a not so interesting aside.. two of the three co-Grand Marshals of the Rose Parade that year were .... Bill Cosby and ... Fred Rogers, from Mr. Roger's Neighborhood. I bet they could have had some interesting conversations. Further proof that ou's bowl record is in part built on luck and less than stellar opponents. Their only national championship in THIRTY-THREE (33) years came against an underwhelming Florida State team in Stoops 2nd year. Their BCS wins include over an over-rated Washington State team and an unranked UConn team.
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This is nothing less than a formal declaration of war upon the University of Texas. "Nations and princes endowed with some pride are not generally willing to wage war without a previous declaration, for they wish by an open attack to render victory more honourable and glorious." Gentlemen... war has been declared!
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That's what the little guys say.
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It's what Stephen F. did to himself when he saw that Sam Houston entered the race to become the first President of Texas.
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