Category Archives: News

What happens when your insurer won’t pay?

04/29/13

It’s the fear every consumer has buying insurance. When it comes time to make a claim, your insurer will have some reason not to pay out.

The doomsday scenario isn’t just fantasy, it’s reality, say many people who fight insurance companies on a regular basis.

The issue was highlighted this week when a Saskatchewan judge awarded Luciano Branco $5-million, saying the actions of his insurance companies established “a pattern of abuse” — Justice Murray Acton noting he wanted to send a message to the industry.

The case could be a template for anyone paranoid about getting his or her claim cashed out.

The claimant in this case was a welder who was injured on the job. The judge noted the man, who suffered a permanent disability, was offered a “ridiculously low” settlement as the insurance companies dragged its feet for years on the claim.

While cases like this may not be the norm, Toronto lawyer Sivan Tumarkin has built a legal practice around getting insurance companies to pay up.

“I’m just getting more and more of these,” said Mr. Tumarkin, who used to work for insurance companies in a defense capacity. “I only started doing this because I had people coming to me who were having issues with insurance companies. You have a flooded home and they won’t cover. I have someone [who gets sick] in New York with travel insurance and they won’t cover.”

He says the insurance companies don’t out and out reject claims for no reason but their objections are in many cases for negligible reasons.

Mr. Tumarkin had an older couple as clients recently who put in a health claim for a fracture suffered by the wife while on vacation in the U.S. The claim was paid but the insurance company when back into their medical records and found out some of the information filled out in the application was incorrect and demanded $30,000 back.

The basis of many insurance claim rejections is something on a policy being filled out incorrectly, either on purpose or because of a misunderstanding.

You buy a life insurance policy and say you don’t smoke even though you have the occasional butt at a bar. One day you get killed in a car accident. If your insurer finds out about your occasional indulgence, there’s a good chance they’ll fight the claim.

“The law is you have to answer truthfully but it is ambiguous about the way you might answer the question as a lay person,” says Mr. Tumarkin. “They’ll look at absolutely everything they can to try and not cover you. I’m not saying in every case but a lot of them.”

He says insurance companies in property damage claims on car accidents will drag their feet on an investigation, knowing there is time limit to sue.

Out and out rejection of claims to meet some quota is probably more something you see in movies, says Mr. Tumarkin. “There is willful blindness on the part of adjusters,” he says. “There is never absolutely no reason they don’t pay. They’ll just use every excuse in the book.”

Pete Karageorgos, manager of consumer and industry relations with the Insurance Bureau of Canada which represents home and auto insurers, says there are no statistics on what percentage of claims get rejected.

But on the auto front, the industry has statistics that show in Ontario in 2010, the sector took in $9.4-billion in premiums and paid out $8.3-billion.

“It goes to show you the majority of money coming in goes right back out to pay claims,” said Mr. Karageorgos.

He adds insurance is a contract and any insurance adjuster will look at the conditions that could negate the agreement.

“Insurance companies are not just going to take your word for it,” said Mr. Karageorgos. “For any contract to be valid and effective, the conditions on both parties parts need to be satisfied.”

The issue for many people in hiring a lawyer is the up front cost. In the Saskatchewan case, the welder who sued his insurance companies had to be bailed out financial by family members.

One thing you can work out in some cases is an agreement whereby your legal bill is covered based on a contingency fee basis, your lawyer gets his bill paid from the winnings.

You can also consider taking your insurance company to Small Claims Court.

Another suggestion for consumers is buy insurance products from a broker, who is compensated by the insurance company but not employed by them. By using the broker, you have the added possibility of suing the broker if he or she gave you bad information when filling out your policy.

Some policies get reviewed by insurance companies before they are issued and people are rejected or assessed at a higher rate, such as in life insurance. But for low margin products like travel insurance, there is no investigation until a claim is submitted.

“You have the policy underwritten at the time of application not at the time of claim, so there is no surprises and it is completely on the up and up,” said certified financial planner Mark Halpern, of illnessprotection.com.

Sometimes he’ll get a client who wants to say he doesn’t smoke when he does occasionally and Mr. Halpern rejects that business because he doesn’t want to see the claim eventually dismissed.

In other cases, people make innocent mistakes about the type of medication or the maladies they have had in the past.

“It’s really important you keep a record of your medical history,” said Mr. Halpern.

He doesn’t dismiss the notion that insurance companies will reject claims for flimsy reasons and says a broker can be an important advocate on your behalf in that situation.

“If that doesn’t work, there is always [a lawyer],” said Mr. Halpern, noting in many cases the presence of lawyer leads to some type of settlement.

“The insurance don’t like to have bad press but they don’t want these things lingering if there is something [that could work against them]. In the worst case, you might get some settlement,” he says.

Alex Saltykov, founder of InsureEye Inc. which follows the industry, says there are no statistics to show what percentage of claims are paid out.

He says consumers really have to make sure they know what is covered and not because insurance policy are so complicated.

Mr. Saltykov found himself not completely covered for treatment he needed for physiotherapy because he had not read the terms of his insurance contract.

“You want it to be there in the worst moment of your life,” said Mr. Saltykov. “If you are not sure of what should be disclosed, you better disclose it even it makes your insurance go up. Otherwise you risk your company not paying.”

Breaking Branco

04/25/13

The article below obtained from the Northern Miner, April 24th, once again demonstrates the deceptive practices of insurance companies who collect premiums on the basis of false advertising and then fail to honor their obligations to the patient. When will our politicians take note and rectify these serious problems?

Luciano Branco’s long and soul-destroying battle with insurance firms AIG and Zurich has finally reached some satisfaction in the courts, with a Saskatoon judge awarding the injured Portuguese-Canadian welder $450,000 in aggravated damages and $4.5 million in punitive damages. It’s the largest award of its kind ever given by a Canadian court against insurance companies.
Branco, now 62, immigrated at age 24 to Canada, where he learned to weld and worked out West and up North. In 1994 he moved back to Portugal, and by 1997 was working at Cameco-subsidiary Cameco Gold’s (now Centerra Gold) huge Kumtor open-pit gold mine in Kyrgyzstan.
During a 12-hour shift on Dec. 25, 1999, he dropped a steel plate on his foot. He finished his shift, packed his foot in ice, and returned to Portugal at the end of his 28-day rotation to recuperate. Towards the end of his next rotation, he stepped on a piece of steel and reinjured his foot, and then sought medical treatment in Portugal, missing his next rotation.
He only reported his injury to the Kumtor operating company on his next rotation in June 2000, when he did not work at the camp. Kumtor continued to pay his base salary of $51,920 to the end of his contract in March 2001 (in fact, overpaying him $12,000 by mistake).
Anxious to get back to work, Branco had surgery on his foot in January 2001, but it was unsuccessful. Despite physiotherapy and rehabilitation treatments, Branco’s Portuguese doctor determined that he was permanently disabled and in chronic pain, a prognosis repeated many times in the following years by specialists in Canada.
American Home Assurance Co. (AIG) was advised of Branco’s work-related injury in mid-2000, which triggered the Saskatchewan Workers’ Compensation Board-equivalent claim handled under the AIG policy. His long-term disability benefits were covered by Zurich Insurance.
To make a long story short, AIG and Zurich refused to pay out the benefits owed to Branco, hoping the outrageously long delays, transcontinental complexities and non-stop legal bills would grind him down and force him to accept a much lower settlement.
In the recent judgment, Justice Murray Acton found that AIG and Zurich had acted in a “cruel and malicious” manner towards Branco for more than a decade, offering him “ridiculously low” settlements, including AIG initially offering him a cash settlement of just US$22,500. AIG didn’t make some of its payments owed to Branco until the day of the trial.
Zurich, for its part, internally approved Branco’s long-term disability payment in 2002, but never informed Branco, who didn’t receive his first funds from Zurich until 2009 and had turned down Zurich’s settlement offer of $62,900, minus $9,000 in legal costs in April 2003. “This court cannot imagine a more protracted and reprehensible behaviour than that of Zurich in blatantly refusing to pay what had been owed in monthly payments for almost eight years,” Acton writes in his decision. “The actions of AIG and Zurich establish a pattern of abuse of an individual suffering from financial and emotional vulnerability.” (The judge said that the mining company had treated Branco fairly, and only the insurance companies were liable for damages.)
The judge noted that prior to his injury, Branco was a “proud, athletic and hard-working individual” who was “warm, friendly and sensitive” and an “excellent employee” at Kumtor. After the injury and the withholding of benefits, however, he had become a “demoralized man full of sadness and loss of pleasure,” and an individual “full of anxiety and depression.”
The insurance companies, Acton writes, “virtually destroyed Branco’s life over the last 13 years,” causing his marriage to break down and financial burdens to be placed on his daughter and other family members, and his legal representation. The judge writes that the insurance companies tried to use Branco’s diminished life to “gain leverage” over him and force him to accept a low settlement.
“That Branco was able to continue to withstand this pressure for so many years from two different fronts is truly remarkable and almost superhuman, even though his resistance may have resulted in irreparable mental distress, which may last for the remainder of his lifetime,” Acton writes. “The question remains: how many individuals have been unable to withstand the financial and psychological pressure of these tactics?”
The insurance companies are expected to appeal the decision.

Reflections on Neurological Conditions

03/12/13

Many illnesses share common DNA roots. The five most common mental illnesses present in the following order:

1. Autism.
2. ADD.
3. Bipolar disease.
4. Schizophrenia.
5. Depression.

The latest research published in the journal Lancet indicates that all these diseases are the result of genetic variations, some of which have been extensively reviewed. i.e.:

• Chromosome 3
• Chromosome 10
• Calcium channels, which play a significant factor in controlling cell function
• Environmental influences

This synopsis of mental illnesses and the factors involved (many of which are unknown) are challenging, particularly with regard to effective therapies.

Currently, there is an extensive amount of research being carried out in many leading clinical and research centres throughout the world and it would appear that genetic factors may be pre-eminent as the etiological causes responsible for these disease processes.

Laser Therapy is beginning to play a role in this therapeutic area, which of course is important, in order to achieve positive clinical outcomes. Some of the effects of Laser Therapy on neurological tissue include the following:

• Increase in ATP production raising energy levels within the cells
• Increased deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)
• Increased nitric oxide (NO) release
• Enhanced cytochrome c oxidase activity
• Modulation of reactive oxygen species (ROS)
• Modifications to intracellular organelle membrane activity
• Cytoprotective effects
• Down-regulation of pro-inflammatory mediators
• Increase in secretion of anti-inflammatory mediators
• Angiogenesis
• Neurogenesis and neuroplasticity facilitation

All of these physiological activities produce a neuromodulating or neuromedation type of effect, particularly on brain tissue.

This commentary is appropriate as at this time more effective therapies need to be developed to deal with these problems. At Meditech, we have had a long standing interest in these pathologies and recent discussions with several neuroscientists stimulate our efforts to accelerate the development of reliable therapeutic options.

As an increasing number of patients are treated, we gain experience, establish effective protocols and expect that our work in the treatment of these complex and problematic conditions will be particularly rewarding for patients.

THE JOYS OF GOVERNMENT HEALTHCARE

03/4/13

This article published in the Financial Post, Wednesday, February 27th, clearly demonstrates the absurdities resulting from government controlled healthcare. The degree of relevance may best be compared to the book, Animal Farm, penned by George Orwell many years ago.
Unfortunately in our current culture, rhetoric trumps reality, as recently demonstrated by the election of Barack Obama over Mitt Romney. The former is an orator, the latter a skilled proven businessman who is best equipped to run a company (i.e. the USA), balance the budget, and meet the needs of the people.
Evidence based results are no longer a factor in our society and some day we will rue the day this ceased to be the basis of all focus and reason.
Incidentally Laser Therapy, a technology that Meditech International has developed over the past 20 years, would probably take 3400 plus of those patients off the waiting list and improve the patient’s status so they would no longer require surgery or pharmaceuticals, and could resume a normal lifestyle.
The costs for this therapy would be approximately $1500-2000 per patient.
When will governments begin to devote some attention to the welfare of the people rather than the housing allowance of senators?
Fred Kahn, MD, FRCS(C)

WOMAN STILL WAITING FOR SURGERY AFTER 11 YEARS

Wendy Berringer’s feet are killing her. They hurt when she stands, when she walks and when she sits, which is what she was doing Tuesday, in her favourite rocking chair in her Halifax home, telling me about her bunions, a tiny broken bone in her left foot and her creaking left ankle, which cracks and groans and aches, causing her all manner of grief.

“I had my first appointment with my family doctor for my feet in 2002,” she says. “The original problem was my bunions. They rub in your shoes and you can’t walk properly. They are very sore. My family doctor made me an appointment to see a foot surgeon in Halifax to get the problem fixed.

“That was 11 years ago.”

In what seems like a parody of complaints over medicare waiting lists, Wendy Berringer is still, 11 years later, waiting for that appointment. Her would-be foot surgeon, an otherwise staunch defender of public healthcare, says there is nothing he can do about it, not when Ms. Berringer’s foot problem isn’t life and death — and not when his waiting list is 3,500 names long — and not when he is the only foot and ankle man in the entire province.

“I’ve been alone out here, really, for a long, long time,” says Dr. Mark Glazebrook from Halifax. “Dr. Andrea Veljkovic, in Kentville, is taking a job in Toronto.

“She was out here on a locum and we were hoping to extend her stay but the government said we didn’t have the money for her. Right now I have 3,500 people waiting to be seen by me in consultation. I have a private office where I see my referrals and the referrals are dated 2003 and 2004 now — and I have them chronologically up to 2013 — and I get close to 40 new referrals a week. And it’s for all of Nova Scotia.

“The province now acknowledges that there actually is a problem here, and they want to help us to get it sorted, so the Minister of Health has been fairly co-operative.

“But they still talk about resources and making decisions and, well, come on: maybe foot and ankle is not as important as cancer, and not as important as heart conditions, but a 10-year waiting list is way outside the norm in terms of what you should expect in public care, and if 10 years is the norm in public care than it is time to think of going private. People have the right to be seen for their problems.”

Dr. Glazebrook believes the public health care system is the “jewel in Canada’s crown,” and yet, he says, it is expensive to operate and if the government is more concerned with finding “efficiencies” than in hiring more doctors to tackle what is a Canada-wide wait time problem — that only additional manpower can truly fix — then we, as a country, are eye-to-eye with the proposition of actually having an honest conversation about private medicine.

David Wilson, a former paramedic, is Nova Scotia’s Health and Wellness Minister. He says the province’s NDP government has been “working hard” to ensure “that the province has a good complement of surgeons and specialists.”

How having one foot and ankle surgeon, with a 3,500 person backlog, qualifies as “good” is unclear. But, no matter, the politician says creating a parallel private system or offering health consumers a private option would pull money away from the public till and erode what the province already has, flawed though it may be.

“I think, and this has been a view of our party, and we have been very vocal about it, but I think we have to be very careful because the minute you [talk privatization] you open up the opportunity for profit to play a role and really siphon funds from a public system,” he said.
Dr. Glazebrook says hiring three additional foot and ankle specialists would cure his wait list woes. David Wilson says there is no money to hire them with. And so here we are, in a perfect pickle, with people like Wendy Berringer being told to grit their teeth and get in line.
“I know you have to wait your turn in Canada,” Ms. Berringer says. “I understand that. But sometimes the system doesn’t seem to work for the people that need it.

“I am kind of back to full circle, back to Dr. Glazebrook, and he has a 3,500-person waiting list. I have waited over 10 years to see him and I’m not getting any younger, you know.”

Timothy Caulfield

A Commentary on Electroshock Therapy

02/25/13

Historically, electroshock therapy has been utilized clinically for the better part of the past century. Aside from the trauma to the brain tissue, which may be irreversible, the benefit obtained, no matter how great, is only temporary. This in itself should mitigate against the application of this therapy. Needless to say, psychiatrists, psychotherapists, and others who deal with problematic patients, frequently become frustrated with a conservative approach and when stimulated by patients and/or relatives, may surrender to the temptation to change the therapeutic paradigm.

A preponderance of existing evidence indicates that utilization of ECT is controversial at best. From my personal perspective, I would certainly employ measures that are more conservative, such as psychotherapy, tranquilizers, etc. On the other hand, unquestionably there are occasions where ECT can be used as a court of last resort.

In the current medical climate, there is an overwhelming desire, if not need, to obtain “a quick fix” – ie. the so-called Instant Gratification Syndrome. This should definitely be replaced by less intrusive methods, requiring patience on the part of the therapist along with the client. More practitioners should give this matter considerable thought and reflection.

In our experience, in a small group of patients where ECT has been previously utilized, replacing this therapy with Laser Therapy has proven to be beneficial and obviates the need for more intrusive therapy. Studies in this area are continuing and indications to date are that wider adaptation of Laser Therapy is warranted.

Laser Therapy is used to widely irradiate the cervical spine, the brain, and of course the cerebrospinal fluid and its components. This creates a potent calming, or neuromediation effect, which is often dramatic from a therapeutic perspective.

For additional information contact Fernanda Saraga, Ph.D, Meditech International Inc., fernanda@bioflexlaser.com

GAMBLING COMMENTARY

02/11/13

It should be of interest to most citizens that legislation produced by governments is periodically reversed and all too frequently devoid of any perceptible reason. The purpose generally is to increase its revenues, thereby broadening its powers. Change is certainly an important component of our culture, for if we are to progress, occasionally we must move in a new direction. On the other hand, change should be implemented to positively impact the population’s needs and certainly not to create negative influences.

It was not too many years ago when gambling at almost any level, even card games privately conducted in the home, were considered to be criminal activities, particularly when an exchange of currency was involved. Citizens could be arrested at random, fined and even imprisoned, following due process of course. Now, governments around the globe are intensely pursuing efforts to popularize gambling under the guise of bringing wealth to the communities, but in actuality, simply to enhance “their coffers”. From criminal activity, it has been converted to an important “source of revenue” simply to provide governments with more clout.

All this has been done by the stroke of a pen, facilitated by lobbyists, and other nefarious influences. Does this make sense?

It is widely known that gaming at any level, especially when organized, nurtures criminal elements, initiates personal economic disaster and brings to bloom all the negative aspects of human activity, particularly those which can be considered to be criminal in nature. Prostitution, addiction to alcohol and drugs, theft and every known depravity follows in its wake, like a river surging through a broken dam. Moreover, in communities where it has been implemented, it almost immediately results in a form of “chronic depression” aside from the routine matters of degradation.

In recent decades, Indian reserves across North America, after approval by federal, state and provincial governments, have made casinos a staple on their lands. In no instance has it brought benefit to the population of those communities, except to the 2 or 3 band members who “manage the tribe’s funds”. The latter appear to spend it on fast cars, travel, alcohol and other addictions, followed by many months spent in rehab facilities. Only a modicum trickles into education, health care, better housing, matters where purportedly more support is to be provided.

Politicians, of course, will always state that this activity creates new jobs. And so it does. But are these productive and long-term jobs that create a positive impact on people’s lives? Definitely not. Gambling does nothing to improve the human condition and only serves to widen the hole of blackness and despair wherever casinos are located, be it major cities, resorts or reservations.

Clearly, gambling as a solution to economic problems created by the greed, stupidity and fraudulent practices conducted and sanctioned by governments and the financial sector, create problems significantly more extensive than those it pretends to relieve. All citizens should stringently oppose these measures in the interest of long-term public welfare. It is imperative that voters express total opposition to this intrusion, which has always been contrary to the public interest. The so-called benefits that it delivers, primarily to governments, lobbyists and a select few managers, simply impose another oppression on the populace. Once entrenched, legalized gambling, like a bad disease, will never disappear and this negative impact will expand exponentially.

The Filipiuk Comment

12/12/12

With the US election results now behind us, the markets are squarely focused on the “fiscal cliff” threatening the country. If Congress and the President don’t come to terms before the end of the year, the economy will be hit with tax increases and spending cuts that could lop 3.6% off the GDP. This would put the US economy into a full-blown recession. Many are hopeful that a compromise will be reached, but one must remember that, even if there is a deal done, the US government still must grapple with the reality of a gaping annual budget deficit that is unsustainable. Up until now, the US economy has been kept above recession levels owing to a trillion-dollar annual increase in government spending. Much of this extra money is being provided by the US banking system and the Federal Reserve. The Fed is printing money, and buying government bonds and mortgages to fund this deficit. It has also cut interest rates to zero so that the financing of this debt hurts as little as possible. Recently, the Fed extended its “Quantitative Easing” program indefinitely, claiming that it was to help the unemployment rate. In reality, it is likely that it is just allowing the government more time to get its house in order: i.e. to kick the can down the road. Ever since Obama’s re-election, the stock market has been going down, partly as a result of the slowing global economy but also of the uncertainty surrounding the future government policy. Even if the “fiscal cliff” is avoided, the US economy won’t he helped much, as it still faces gargantuan deficits and spending cuts to come.

I recently came across a fascinating video created by Paul Grignon, entitled “Money as Debt”. The 47 minute film explains in very simple terms the history of the modern banking system, how it has deteriorated, and how it can possibly be fixed. It is a truism that, in order to succeed in any realm of life, whether it is sports, business, or investing, it is essential to know the rules of the game. This video demonstrates how the banking game is structured and is very thought-provoking. For example, the fact is that we live in a debt based money system, in which money is created through the issuance of debt. Since there is an interest charge on debt, more money must be created year after year to service the debt (or money) that has already been created. Eventually this compounding goes exponential and is unsustainable. We are potentially at that point right now. The fact that a system that functions this way was ever allowed to become the mechanism for how our world creates the money for its economy is mind boggling. I think that many people still find the concept of money’s being printed out of thin air to be surreal. It is an unconscionable privilege bestowed on a few, and its consequences can be devastating. Most of us have to earn our money through work, yet commercial banks and central banks can print it at will. I really encourage clients and others to watch this video and form their own opinion.

THE STATE OF THE FINANCIAL WORLD

11/5/12

– and how it affects us

The world’s financial systems, as a result of the greed and corruption of Wall Street facilitated by their political cronies, unofficially have been out of control for several decades. The reason for confirmation of these events is that over the past 3 to 4 years, official interest rates in the Western industrialized nations have lingered at near zero levels. This is unprecedented in history and signals a massive disintegration of systemic failure. Quantitative easing and subterraneous inflation fuel both the confusion and conflagration. The end result, barring a miracle, is that these measures will not save the financial markets, our life savings, our pensions or the planet.

To keep the game going, the US Federal Reserve continues to resort to monetary inflation but that process is erosive in the extreme. At the corporate level, including small business, higher costs and shrinking profits compound the problems. Looming over all this is the increasing cost of imposed healthcare systems, which may be called the ‘Insurance Tarp’.

To further muddy the waters, we have the US election, which fields two candidates or parties that are literally making up the facts as required. Neither Obama nor Romney has a definite vision and the US currently has more problems than solutions. One may safely hypothesize that the upcoming election will change nothing − no matter who wins. Despite this I would favor Romney for the potential of real change.

The solutions: return healthcare to the client-provider level, erasing the costly administrative intermediary complex. Similarly, governments must solve the problems they create by radically reducing the number of politicians, political parties and bureaucracies.

Finally, solutions for individual self-preservation: do not purchase any paper – no matter who writes it, sells it or delivers it. Purchase solid income producing properties and acreage that has potential for future development. For immediate needs, purchase precious metals, diamonds, etc. for direct holding. The prognosis – critical at best!

Insurer’s New Role: Managing Treatment

08/27/12

U.S.-Style Approach
Company seeks alternatives to expensive drugs

I was somewhat surprised to read the enclosed article authored by Tom Blackwell in the National Post on Thursday, July 26th, 2012. The subject certainly caught my attention. The reason? For as long as I can remember, insurance companies have always interfered in healthcare – from deciding which treatment in their opinion is best, which drugs are most appropriate and whether they should pay for treatment at all. My position has always been that people pay for insurance coverage and the insurance company should therefore pay for the treatment. Simple enough, but in an increasingly complex world, nothing is simple anymore. More significantly, the insurance industry and its minions are in essence dictating medical practice, which they are not qualified to do and the influence they exert may indeed be highly detrimental to the patient’s health status.

In essence, the article states that now Canadian insurance companies are following the footsteps of what is common practice for private insurers in the U.S. but virtually unheard of in this country. In my experience, practicing medicine for over forty years, this is a completely false assertion, as the nefarious practice of denying coverage has been prevalent in this country in numerous forms, from the time insurance companies have been in existence.

In addition, the article, as is so common in Canada, “bashes” the U.S. for its practices, which are deemed to be ‘mercenary’, rather than compassionate. For a period extending over twenty years, I practiced medicine in the U.S. and found conditions there, from a comparative perspective, to be generally more liberal and never experienced the interference that exists in Canada at this time. Needless to say, this situation has changed in all countries around the world with the rising costs of providing “quality?” medical care and delivery systems under the aegis of governments, insurance companies and other gatekeepers who strive to manage healthcare, unfortunately all too often to the detriment of the standard of quality once expected. Administrative costs go up, at the expense of funds available to actually deliver therapy to patients – a circumlocular and erosive practice.

But, back to Insurance. In too many instances, the insured have faithfully paid premiums for a period of several months to over thirty years, often without deriving any benefit from this so-called ‘protection’. Nevertheless, at the first hint that the insured may require some assistance, no matter how legitimate, the initial response of the representative of the insurance carrier is an almost reflex NO. The insurance salesman who has sold the policy to the client disappears after he has received his generous commission, which often continues for the life of the policy. Armed with policies covering home insurance, life insurance, disability insurance etc., the salesman ostensibly sells you whatever he can, in order to “protect” you against the many things that may at some point, strike one down. When the time of payback occurs, no matter how minute, the sales agent has long departed from the scene.

Several years ago, a mid-level bank executive, who happened to be my account manager, had purchased a $100,000 dollar policy from the bank for which he worked – no questions asked, in the event of a heart attack, stroke or other catastrophic episode. Over a 2 week period, this individual checked in and out of a hospital while sustaining two separate, severe coronary infarctions. It is truly amazing that he survived and so much for the intelligence level of bankers. Still, the $100,000 coverage, which was to be provided without question, was denied. The reason – ‘the enzyme’ profile of the hospital records did not coincide with the standard adopted by the insurance carrier. I think we all get the point. The insured was forced to hire an attorney who settled for $70,000, from which he deducted over $20,000 for his participation in this debacle. So much for advertising, integrity etc.

Historically, insurance companies love to collect premiums and hate to give up a nickel of their ill-gotten wealth at any time – particularly in the past decade, with the billions lost in the housing bubble, poorly structured investments and laboring under the bloated, undeserved salaries of senior management. Just like governments, increasing the tax base while literally putting small business out of existence, insurance carriers have followed a similar trend. Not a pretty picture – except for those who get the big salaries for making bad decisions and under-serving their clients.

In my personal medical practice, up to 80% of patients present with an initial complaint about the problems they have with the insurance companies – not the description of their illness but rather the hurdles they face in paying for healthcare.

Every day, I see a number of patients who have been denied coverage for treatment that should have been instituted immediately after the illness occurred or certainly in a more timely manner and may only be approved after a long wait time and not infrequently requiring legal recourse on behalf of the insured. This obstructive behavior pattern benefits no one. At all times, insurance companies have on retainer legions of specialists, medical assessors and other “hired thugs” to carry out the ritual of denial, on their behalf. Several weeks ago, I saw a patient whose insurance company spent over $20,000 on multiple assessments and in the end, was denied coverage for the treatment of a medical condition. With Laser Therapy, this patient’s problem was cured over 3 weeks at a cost of less than $1,000. By now, I hope that everyone is beginning to understand the problem.

Why does this state of affairs exist? The root problem is the combination of corporate behavior patterns and economics – invariably, a bad mix! The human factor may involve the lobbyist, representing the insurance company, collaborating with the political powers that are the incumbents of today or possibly those of tomorrow. By contributing to the campaigns of all political parties and candidates, regardless of stripe, the companies are virtually approved and immunized for whatever skullduggery they plan, which invariably is to their economic advantage. Insurance companies are all about making money and that is their primary objective. They do not care about the individual or their problems; indeed the latter are considered an impediment at best.

Politicians are devoted to campaigning, getting elected and staying elected. The alliances with big business carefully developed over decades, are clearly designed to the carrier’s advantage, coupled with the politician’s need to maintain their individual power base. The patient is generally forgotten. The coverage, sold to him by the super salesman, with unlimited clauses for denial hidden in the fine print, often is not worth the paper on which it is printed. The insurance company and their sales representatives make money; the politician stays in power and the patient ‘whistles in the wind’. Salesmen don’t really care what happens once they have made a sale and along with all the other players, are complicit in victimizing the patient, ie. the individual who has had an accident or has become afflicted with an illness, who in a time of need finds the support that he religiously paid for over many years – unavailable. In my mind, this is just another one of the scourges so prevalent in health care today.

Now, in order to relieve themselves of the stigma of enforcing the denial, insurance carriers plan to hire so-called legitimate “new companies” to carry out the hatchet job on their behalf, under the adage that this is impartial and protects the patient. This can hardly be construed as an event designed for the patient’s benefit. It simply removes the stigma of saying “no” from the insurance company. In essence, to protect the carrier’s economic position, a new “hired gun” will now perform the negative aspect of their premeditated actions. This measure is simply good PR and an easier way of saying no.

This entire scenario is neither new and definitely not American, even though Canadians have been conditioned to criticize the U.S. as a place where “everything is so much worse”. This is another falsehood propagated by politicians to make us feel better about being Canadian – a presumption that is entirely without justification. Both the U.S. and Canada are great countries with immense resources and many positive attributes, but the delivery of insurance policies as opposed to the delivery of quality healthcare and preserving the patient’s best interests, are definitely not part of that programme.

How can this inequity be corrected? Obviously the burden should fall on the shoulders of politicians. But do they act? Yes, but unfortunately only in the interest of the insurance carrier – the big hungry beast that feeds them in so many ways.

How can this be changed? First of all, by no longer condoning the falsehoods put forward by the PR and sales pitch of the insurance conglomerates. Second, by ensuring the protection of the rights of those who have been victimized by purchasing policies designed primarily to increase the carrier’s bottom line. Only then will justice be served.

One must think back to the days of pre-World War I, an era when governments in Canada, the U.S. and other countries were still the servants of the people. Today, the reverse condition prevails. Profit is the name of the game. Governments are preoccupied with taxes, interfering in business and imposing unrealistic regulatory practices; the list is endless and destructive, not only in this but many other situations.

Revolution? Perhaps, but this is always messy as we see currently by the heads flying around the world; most notably, Hussein, Gaddafi and soon to be Assad. Governments must get back to the basics of governing, rather than interfering in business, with inappropriate spending and a total disregard of our constitutional rights. They should operate for the benefit of the people, which is what they are paid to do. This mandate must be reinstated and enforced.

Health insurer’s U.S.-style plan seeks to ‘manage’ members’ drug costs

Under a type of plan that is virtually unheard of in this country, Great-West Life will try to determine if appropriate lower-cost medicines are available in place of big-ticket specialty drugs

A major Canadian insurance company is getting actively involved in the medical treatment of drug-plan members prescribed hugely expensive new medicines, playing the kind of direct role in basic health care that is common for U.S. private insurers, but virtually unheard of in this country.

Under a “case management” system already implemented at hundreds of workplace drug plans, Great-West Life’s representatives will try to determine if appropriate lower-cost medicines are available in place of big-ticket specialty drugs, work with the patient and doctor to “understand different treatment options” and assess the effectiveness of the drug therapy.

The program also requires clients prescribed specialty drugs to use pharmacies that Great-West designates, raising a red flag with at least one regulator.

“Is that an appropriate type of care, where some third party is telling you where you should go? asked Don Rowe, secretary-registrar of the Newfoundland-Labrador Pharmacy Board. “I have concerns about big businesses cutting deals with one another to be the exclusive, sole provider.”

Some analysts, however, say such measures are becoming a necessity as drug plans financed by employers, workers and unions grapple with a new wave of medicines that target small clusters of patients — but can cost as much as $500,000 a year.

“If somebody else is footing the bill … there’s going to be a lot more scrutiny for these claims,” said Michael Sullivan, whose company Cubic Health advises employers and other private drug-plan sponsors. “It [the GWL plan] could usher in a new generation of more American-style managed-care in Canada.”

He stressed, though, that the development is “brand-new” and it remains to be seen how extensively or effectively Great-West will manage cases. Such insurers process claims, but do not underwrite the cost.

Close to 2,000 private drug plans are now operating with the new system, and most of the 30,000 or so other plans administered by the Winnipeg-based company will likely join them by the middle of next year, said Brad Fedorchuk, the insurer’s vice president of marketing.
The prescriber is still responsible for the appropriate treatment, but it just needs to be demonstrated to us that is also the most cost effective

He touted the idea as a way to let plans afford the cost of new, potentially life-saving drugs that otherwise might be too dear for them to cover — and often are not funded at all by government programs. Case managers would simply ensure all options are considered before a drug is administered, said Mr. Fedorchuk.

“Doctors may not be aware of the cost differences between various treatments,” he said. “At the end of the day, the prescriber is still responsible for the appropriate treatment, but it just needs to be demonstrated to us that is also the most cost effective.”

Prescription drugs have long been one of the biggest and fastest growing costs in health care, accounting for about $26-billion annually. The sector’s growth slowed to a halt in the last two to three years, as many blockbuster drugs lost their patent protection, ushering in cheaper generic copies.

That downward trend is expected to be short-lived, though. Coming on the market are “biologics” and other, extremely expensive, specialty drugs for relatively small groups of patients with cancer, auto-immune diseases and less-common conditions. Remicade, for Crohn’s and rheumatoid arthritis, costs up to $50,000 annually per patient; Soliris, at $500,000 per sufferer of a rare blood-disorder, has been dubbed the world’s most expensive medicine.

Private drug plans, provided to many Canadians through their employer, cover about 36% of the cost of prescriptions, but are expected to absorb the bulk of the specialty-drug burden, since their clients tend to be younger and often need the medicines their whole lives.

While specialty products — nick-named “niche busters” — are prescribed now to less than 1% of plan members, they account for 17% of costs — a number projected to keep climbing, said Mr. Sullivan.

“This notion of these expensive biologic drugs is perceived by entire countries as being a major policy challenge,” said Steve Morgan, a pharmaceutical-policy expert at the University of British Columbia.
This whole proposition seems to be a very concerning step on a dark path toward the American model

Restricting how the drugs are covered is a reasonable response, said Aidan Hollis, a University of Calgary health economist. “Some doctors prescribe very expensive drugs when there are equivalent, lower-priced drugs available.”

Yet the GWL program is already creating a stir in the pharmacy world, with its requirements that some patients get their specialty drug from a designated store. Mr. Fedorchuk said Great-West Life has made agreements with certain pharmacies to win better prices, try to avoid wastage of the costly drugs and more efficiently serve patients.

That reasoning did not hold much sway, however, with a Newfoundland woman who was recently told by GWL she would have to start using a pharmacy in Ontario instead of her local druggist for a specialty arthritis drug. Partly out of concern about how the temperature-sensitive substance would be handled, she fought the move and for now has managed to stay with the local business, said her Newfoundland pharmacist, who asked not to be named.

“The fact they’re restricting the patient’s right to choose is a huge issue,” he charged. “This whole proposition seems to be a very concerning step on a dark path toward the American model.”

THE SHOE IS ON THE WRONG FOOT

08/3/12

Today, shoes are available in a bewildering number of styles from the 6 inch stiletto heel to the shoe sock. The offerings are eclectic, to say the least. In my extensive medical practice, in which I see approximately fifty new patients each week, many present with problems originating from improper footwear, therefore incurring pathologies such as Plantar Fasciitis, Achilles Tendonitis, Bunions, Hammer Toes and most significantly of all – secondary problems of the spine, the result of biomechanical imbalances.

To advise you with regard to selecting proper footwear, I wish to provide some guidelines to be heeded, whenever you buy your next pair of shoes. Most people, as we all know, have more than a sufficient number of styles and patterns in their closets, however economics permitting are always adding to these reserves. Whereas fashion and the environment may be taken into account, do not let these factors dictate your choice.

Personally, I am aware how much the soft spike in golf shoes, as opposed to those made of steel, predominant as recently as 10 years ago, have preserved the careers of not only many golf professionals, but also the average amateur. With the use of soft spikes, the trauma to the feet is comparatively minimal and one can easily walk 36 holes without discomfort. In the era when the metal spike was still in vogue and as much as I like the game, I often prayed for the season to end. By late November, my feet were killing me and I welcomed the conferred winter respite.

Now on to the selection process – First of all, make certain that you are dealing with someone who understands how to fit a shoe properly, never mind the sales pitch. Once that has been accomplished, allowing for adequate but not excessive width and length, walk around the store for an appropriate period of time, to determine if the fit appears to be satisfactory. These are simple, but often disregarded rules. Next, I generally arrange with the store manager that I will wear them at home for a short period of time and request permission to return them, if the fit is uncomfortable. If that is acceptable to management, one can feel safe and proceed to complete the purchase.

Tips – Today, many people walk a great deal at work, pursue sporting activities or even walk several miles daily in their own home. A soft sole is therefore paramount. Whereas these types of shoes may not be suitable for social occasions, including some offices, they will preserve the health of the feet and avoid back problems.

In situations where running shoes are not permitted in the workplace, obtain black comfortable shoes with a soft sole and a good arch support. In my experience, these are best found in shoes manufactured by New Balance, Asics and a number of other companies. The two mentioned above are personal favorites as they are sufficiently wide, although I have worn others in the past, also with a significant level of comfort. Sometimes, even a good manufacturer, for whatever reason, makes products that are less satisfactory than previous versions. On occasion, Nike has been found to be guilty of this transgression. This is knowledge that I have gained from both personal experience and the observation of patients and for obvious reasons have developed a special interest in this area.

On the other hand, I fail to understand why manufacturers keep changing the models other than for competitive reasons. For instance, New Balance put out a model 6 years ago, but only for a short period of time. With much effort, I was able to purchase 2 pairs of this type (now both worn out). That said, I would still love to have them bring the old model out of the vault. For my needs, it was ‘the absolute perfect shoe’ and hopefully, they may take note of these comments and recreate this particular model.

The advice provided should be helpful to those purchasing new shoes. Most important, make sure that ‘the shoe fits’ and do not rush into a purchase.