Endometriosis & Health Care Administration

“I did take revenge, I did get retribution, I won.”

When I post these comments on Facebook groups and articles about revenge and retribution for the fraud and abuse in  the US Health Care Industry, I am speaking from actual experience. I have literally lived inside Health Care my entire Adult Life, and I did take revenge. I have stood up for myself in my quest for treatment, and I have held those responsible for the fraud and abuse of my Health Care accountable.

I am critical of Women who play the Victim Card, because I fought, went to Court, did the work, while I was in debilitating pain brought on by a Sinus Cavity Implant caused by Thoracic (Pulmonary) Endometriosis.

My very first experience with any sort of Health Care was the United States Air Force. Prior to my enlistment, I had only seen Sports Physicians or OB/Gyn Doctors, and had always been under the care of my Father’s exceptional Health Insurance (Silicon Valley Employer Sponsored Health Insurance – White Privilege at it’s Peak!).

It took a very long time for me to realize that the Health Care Administration was what caused the most significant financial impact.  It’s not the Premiums, or Treatment Co-Payments that cause the financial burden, it’s the Process of obtaining Diagnosis, determining Treatment, and then keeping the Treatment Plan on track that costs the most to Patients. In this case Me.

In 2001, I took the first steps towards vindicating my experience at the hands of Health Care Administrators: I hired an Attorney. The basis of my Civil Suit against Prudential Health Insurance was Delayed Access to Health Care. The same journals which pinpointed symptoms, triggers, and provided baseline data which my Gynecological Oncologist used to save my Life, were used to prove my case of Blocked Access.

It took until late Fall 2003, and a trip to the 9th Circuit Court of Appeals, for the case to finally come to a close. I won on the basis of Contract Service Violations. The United States Legal System determined that under the Employee Retirement & Insurance Savings Act (ERISA), a Uterus, 2 Fallopian Tubes, 2 ovaries, a Sigmoid Colon, and an Appendix are worth about $3,000USD.

The chaos my Civil Suit caused had massive Collateral Damage. Over an 18 month period beginning in 2001 at the time I filed Suit:

  • Prudential Health Insurance merged with Aetna Health Insurance. The result was that I had to refile the Suit with Aetna.
  • Health Source Medical Group, the contracted Provider through Prudential Health Insurance, declared bankruptcy, and reemerged as Prospect Health Source Medical Group, and then finally closed in 2016. When Prudential merged with Aetna, all the Provider Contracts were re-negotiated, and apparently it didn’t go well for Dr. Lipper.
  • The Administration Employees within Prudential Health Insurance and Health Source Medical Group were laid off as their jobs were eliminated.

And we haven’t been to a Court Room yet.

In 2002 we lost the first round but had grounds for appeal.  My attorney and I had a symbiotic relationship: he worked pro bono taking the case as far as he could for the Experience and Case Type/Time, and I would split what ever we won 50/50.  We both agreed we should appeal, both for very different reasons.

I need to re-emphasize that this is all Administration. Not one practicing Physician in the Journey participated in the Delayed or Blocked Care. Every Physician on the journey was ham strung by the Administration Process and every one of them threatened with Financial Penalty for not delaying care.

Every problem with every Health Care Model comes down to a single source: Administration.

Non-Medical Staff, educated in Business, Communications, and Finance, with no medical training, working along side the most heavily educated, data-driven, Scientifically Savvy, Citizens in the United States. But wait, it gets better.

The United States has amazing & successful Teaching Hospitals, both Government run and Private Sector. Not only are these facilities overrun with Medical Scientists, Physicians, and Nurses, they are inundated with Medical Students. And they are managed by individuals who flunked Math. The ratio of Medical Minds to Non-Medical minds in these facilities is overwhelming, to where the petty antics of the uneducated interfere with the Medicine and actual Health Care.

Back to my Law Suit….

One of the things I was surprised that did not come up during the Trials, was my Military Service. I should have been living inside the Veterans Administration all this time, but due to Administrators making grave, and harmful, errors in my Military Records, I landed in Private Sector Health Care with Employer Sponsored Health Insurance.  Maybe because by 2000 the Clinton Era pre-existing condition rules were in effect, and I had managed to remain Employer Insured and therefore protected. But I was initially diagnosed by the US Air Force in 1988, so it really surprised me that it didn’t come up.

Right around the time the Pulmonary Endometriosis symptoms appeared in 2003, my attorney informed me of our Appeal Hearing, we are headed to 9th Circuit and I arrange to take the day off from work to stay by the phone. We won. It was crazy the emotions, but I won. My nose is bleeding every 20 days on Cycle, the Endometriosis has spread, but I won.

The next phase was the Settlement negotiations and I was receiving $1,500. My attorney called to tell me the parameters of the Settlement and emailed me the Contract. I was dumbfounded.  Aetna Legal had included a Non-Disclosure Contract covering all aspects of the case. I could not believe what I was reading, I was furious.  I called my attorney and I told him I would not sign away my right to Speak about what happened to me for a measly $1,500. It wasn’t even rent money!

I signed all the Documents except the Non-Disclosure and actually wrote on the Contract that my signature would cost $1million in addition to the insulting $1,500. My attorney freaked out. I told him to walk away from it, I was not going to be insulted by this ridiculous Non-Disclosure.

In the end, the Settlement was finalized without the Document, which is why I am able to blog and write and speak of my experience at will.

February 2004, just 6 months after the Settlement Payment, I was dumped from Health Insurance the day I was wheeled into OR Recovery at Little Company of Mary Hospital in San Pedro. I did not have Health Insurance again until 2007 when I was a Full Time Employee in Las Vegas, NV.

Now back to that part of the Story where the Veterans Administration made “grave & harmful errors” to my Personal Records.

As a direct result of being dumped from Health Insurance, my Mother harassed me into filing another Claim with the VA for benefits. This would be my fourth attempt at locating my Medical Records, but my first at the Long Beach VA. All other attempts had been made through the Los Angeles VA. I really did not have it in me for that fight. I went anyway, and as I had predicted was told the same information I had been told in 1991, 1994, and 1999: the only records available were performance evaluations and a DD214. I had no way of proving I was diagnosed at Shaw Air Force Base Hospital in 1988, or that I had undergone significant Treatment for the disease in 1989.

Over the years I have been accused of many things, but there are several that repeat over and over again: that I am a Trans. You would think this is just cruel social gossip, but when you pair the gossip with 20 years of Mail addressed to Mr Hopke, one has to wonder, right? Of course this is just paranoia.

In 2004, I did not know that my Personal Records indicated I was Male. Again, the grave and harmful error made by Veterans Administration Non-Medical Employees rears it’s ugly head.

Eleven years later, 2015, after 25 years of rejection based on lost Records, I receive the Award Letter and access to eBenefits with login credentials, and discover my social security number is assigned to a Male within the Veterans Administration Database. And then it all makes sense: claims to the VA for Endometriosis are automatically rejected based on the Gender on File.

A grave error, wrong Gender, caused so much Harm, and cut me off from Medicine & Health Care that could have changed the course of my Life. A Health Care Administrator, non Medically Trained Employee, placed the wrong letter in the Gender box sometime between February 1990 and June 1991, and changed the course of my Life.

The ripple effect, or Collateral Damage, caused by that single grave error, was catastrophic to some people, not including me. I forced a Merger of Health Insurance companies. I caused the bankruptcy of a Medical Group. I caused the Termination of several Health Care Industry Employees. It took 12 years from the time the error was made within the Veterans Administration, until the blast radius was felt in the Private Sector.

The United States really does have the best Medicine, the best educated Physicians, and the most experienced Nurses. Every Health Care Facility in the United States is staffed with the best and brightest minds our Universities can produce. Physicians across the nation bring an arsenal of knowledge to every hospital, every medical office, and they employ the best and most experienced Nurses.  Our Medicine and our Physicians are not the Issue.

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