The Real Life Stories Arnold Wouldn’t Hear

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An Injured Worker & Price Grouged Patient’s Message To The Gov

Gov. Schwarzenegger: Please come outside to talk to me.

Jodi Greggs, Sacramento, California

Five years ago, Jodi Greggs, then a 38-year-old, much-in-demand Licensed Vocational Nurse, went to provide a “standby assist” for a 200-pound patient from his bed to his wheelchair. In making the transition, the patient slipped, and grabbed Jodi’s shoulder for support. That move was the first step in a series that led to profound and irrevocable changes in Jodi’s physical and emotional health.

The state’s workers’ comp system has been an integral part of what Jodi and her family have gone through since that day. It has delivered some help, although not as much as it should, never punctually and rarely willingly: She has gone to court “so many times I’ve lost count” to get the system to provide services it should be delivering routinely.

Yet as bad as the workers comp delivery system is now, if Gov. Arnold Schwarzenegger has his way it will grow far worse, depriving Jodi and tens of thousands of other suffering Californians of relief. The new governor, who spends his time schmoozing at thousand-dollar-a-plate dinners with insurers instead of meeting with ordinary Californians who are in pain, has been cooking up plans that will take away much of the little they have and halt any progress toward making the system work better for the state’s needy.

The Governor’s proposals fill Jodi with both a growing despair and a desire to fight.

Jodi’s story began in San Jose on Nov. 15, 1998. A native of Orange County, Jodi spent 12 years in the San Francisco area, and had moved recently to Sacramento. A sought-after LVN, she was working two jobs and bringing in roughly $4,000 a month.

Like many such injuries, hers didn’t kick in right away, when her patient slipped and grabbed her. “There wasn’t much pain at first,” Jodi says. But there was at her next stop, where she began to hurt as she was changing a dressing. “I thought, oh my goodness.” But she didn’t make a big deal out of it. “I thought maybe I pulled a muscle.”

Jodi did the usual things: She iced her back. She went to Kaiser, whose doctor refused to take X-rays and told her to go home. She waited for her back to get better. Not long after, she tried a chiropractor, but “that didn’t work.” The pain intensified, and “I called in the insurance company at that point.”

The insurer stalled. Finally, 60 pain-filled days after the initial injury, it approved an MRI and an EMG. The former showed spinal stenosis and a ruptured disk. The latter proved nerve damage.

Jodi scheduled surgery, then discovered she was pregnant. She had thought she couldn’t have children, and regarded the baby as “a little miracle.” She postponed the operation, and went through the pregnancy agonizing with back pain.

The back surgery, undertaken after the baby was born, was unsuccessful. Subsequent physical therapy didn’t work either. Jodi, the mother of an infant and in great physical pain, was now 100 percent disabled. Unable to work, she found herself at the mercy of the worker’s comp system.

The most immediate impact was financial. “My financial situation is destroyed,” Jodi says. While workers comp is supposed to pay her at two-thirds of her salary, in fact she has gone from bringing home $4000 a month to bringing home less than $2,000. Her husband Walt, a web designer, has had to cut back his work in order to nurse his wife.

“We went from being somewhat affluent to being like being on welfare,” Jodi says. “We had a very nice lifestyle. Now, there is not one bill that we are not late on.”

Not far behind on the list of aggravations is the tendency of the insurers to “play games,” as Jodi puts it. Often this involves bean-counters making medical decisions.

For example, when Jodi got pregnant with her second child, she sought the insurer’s approval to see the pain management specialist who had guided her through her first pregnancy. It took two and a half months to get the OK, and she had to go to court. The specialist prescribed a Class C pain killer that would give Jodi relief while ensuring that her child was not born addicted to drugs. The court also gave the OK to an epidural steroid injection.

But that wasn’t the end of it. The insurance adjuster called both the pharmacy and the surgery center that was to administer the epidural and told them that they couldn’t give her the prescription and the shot, despite the court order, because Jodi was expecting a child. Jodi prevailed, but it was a needless delay, fueled in part, Jodi believes, by the adjuster’s personal animosity toward her.

The subtext was that this particular adjuster was somehow punishing Jodi for having a second child, or silently encouraging her to have an abortion. But Jodi’s religious faith precluded an abortion, and even if it didn’t, she says she felt her child, like the first, was a gift from God. “It was like God was sending me this message,” she says, her voice breaking, “giving me something to keep fighting for.”

There are countless other frustrations in the way the workers’ comp system is carried out, Jodi says. In her case, for example, they provide day care for one child but not the second. They balk at providing home health care aides, or day care. They make you fight and claw for everything.

There is another toll to be paid for being injured, almost as bad as the injury itself. That is the emotional pain for everyone involved. “This has torn my husband apart emotionally, ” Jodi says. “He’s got no life because he has to take care of me. This has been rough on my marriage.”

And the children, one of whom is now 4 and the other 5 months? “I’ve got a very active four-year-old whose mother can’t take her to the park, or go down the slides with her, or even get down and play on the floor. She has to take care of me. And she has to know that Mommy’s sick.”

Although they show love and support, it’s devastating and “very depressing” to know that you’re putting your loved ones through that.

Workers comp, if it were administered right, could ease some of the burden by providing such things as day care and home health aides, and in countless other ways. Instead the new governor is working on takeaways.

His proposal seeks to deprive patients of the right to choose their doctor. Schwarzenegger also wants to deny workers comp care to anyone who does not have an X-ray to verify the injury. But what if, as in Jodi’s case, the doctor won’t take an X-Ray? That is a huge escape tunnel for insurers.
If the governor’s new bill had been in effect five years ago, “I would have received no benefits,” Jodi says.

Jodi would like to see reforms in workers comp and they are not the so-called “reforms” that Schwarzenegger seeks. Jodi would like to see the benefit raised, with no cap so that nobody has to suffer loss of income. She also says the system ought to look at its clients in the context of what the client needs to keep the family intact. That would include more home care and ay care, not less as the governor is proposing.

And finally Jodi would like to see accountability: to see insurers answer to someone so they can be called on the carpet for abuses. She tried to change adjusters, for example, but was told she couldn’t. “I want it to be fair.”

Jodi pledges to fight now to hold on to the good things that insurers provide and to fight against givebacks. It isn’t easy because she is still in constant pain, often unable to get out of bed because back spasms cripple her when she tries. “I have my good days and I have my bad days,” she says. She is trying to make the most of it.

Gov. Schwarzenegger: Please come outside to talk to me.

Jon Marcus, San Francisco, California

Jon Marcus, an executive recruiter, has been insuring himself for several years through Blue Shield. But endless rounds of rate hikes have his head spinning.

“I realize as I see health care costs rising, that we are all reliant on the health insurance system to afford any kind of health care need.”

Marcus has been driven to sign on for catastrophic health insurance, the least expensive. Catastrophic coverage, however, is generally useful only in dire situations.

How have insurers stuck it to Marcus and others who, like him, are self-insured? The daggers are too many to enumerate. But here are some of them:

In the past three years, his rates went up: first, 14 percent, then 30 percent and finally 20 percent. In 2004, Blue Shield has told Marcus to expect another double-digit increase. Marcus once had a zero deductible; now it is $750. He had 20 chiropractic visits covered at a discount; now his insurer covers only 12. Blue Shield used to cover the lab work for his annual physical; “not any more.” His co-pay has gone from $35 a visit to 30 percent of whatever the visit costs. Taking everything into account, he says his health care costs have increased 300 percent over the last three years.

The result: “I am asking doctors ahead of time what it’s going to cost.” Like others swirling in the vortex of out-of-control medical costs, Marcus is making health decisions not on the basis of health, but on the basis of expense.

His situation is further exacerbated by the fact that he has a pre-existing condition, which insurers will not cover. “Denying people insurance for pre-existing conditions is a common practice in the health insurance industry,” Marcus says.” He has a friend, a contract worker, who cannot get coverage for himself, his wife or his kids because he has the pre-existing condition of high cholesterol, which is treatable with medication. Another is in the same boat, with his family, because he has sleep apnea.

It annoys Marcus that health care providers do not ask those who work for a company the kinds of detailed health questions they ask the self-employed. “People who work at CISCO, for example, are just as healthy (or unhealthy) as anyone else,” Marcus says. But “if you apply for health insurance through a job there are no questions.”

Asked if he has suffered emotionally because of all this, Marcus grows impatient. “What do you think?” he asks. Is he dissatisfied? “It’s not a matter of dissatisfaction; it’s a matter of being screwed. They’ve got you. What are you going to do?”

Greed rules the marketplace, he says, and “the politicians have sold out to these companies. What happened to the capitalist system?”

There is no rational relationship between the rise in health care costs and the rest of the economy, he notes. While health care has risen 30 percent, the consumer price index has risen only three percent.

Things are getting worse, Marcus says. “With more people losing their jobs, and more people doing contract work, more people can’t get health insurance. Roughly 6.5 million people in California (about 17 percent) don’t have health insurance.”

Insurers, Marcus says, have “abused the system.” They have “too much power, outrageous rights, they can deny you coverage for almost any reason, they can raise rates for any reason, and they can even find reasons to drop you.”

“I want to see health care prices, and the industry, regulated,” Marcus says. “The government should totally take control. Let’s face it, if you don’t have your health you don’t have much else. Why should we allow a system to govern our health care that places profit far above our health care? This insurance system has to change.”

Consumer Watchdog
Consumer Watchdog
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