Avera Law Firm

The Avera Law Firm Blog is designed to update clients, vendors, and other interested persons regarding law firm news, personnel, legal issues, and legislative issues. The firm management welcomes posts and questions to the blog as an interactive means to provide information to the public.

Tuesday, October 13, 2009

Changing the Mind of the Health Insurance Company

On September 25, 2009, a sixty-three (63) year old happily married man, father of four and grandfather to thirteen grandchildren, and senior pastor at a church, was referred to Avera & Smith because he was suffering from stage IIB malignant melanoma of the left cheek which subsequently developed into metastatic disease to the left upper lobe of his lung and he needed help. When our client appeared in our office he had been given a very short period of time to live if he did not receive treatment for the metastatic disease. His only course of treatment, at this time, was Cyberknife radiosurgical management of the two lesions; however, his health insurance provider, Blue Cross Blue Shield was denying the coverage necessary to pay for this procedure.
His coverage was denied because Blue Cross Blue Shield’s doctors believed the procedure was investigational. The company made this finding even after being advised by our client’s treating oncologists that the procedure was not investigational and was his only viable option because the client had already undergone a partial left lobectomy in April 2009 which revealed a 2-cm metastatic deposit of malignant melanoma, and he subsequently developed additional pulmonary nodules, one in the right middle lobe and an additional nodule in the left upper lobe, for which he was treated with three (3) cycles of chemotherapy. This treatment was ineffective and during a follow up evaluation of his response to this therapy, it was found that the right middle lobe nodule had increased from 8mm to 12 mm and there was an increase in the left upper lobe nodule from 6mm to 12 mm.
The procedure was also denied after Blue Cross Blue Shield approved and provided coverage for the placement of a fiducial marker in his right lung for purpose of performing the Cyberknife treatment.
Tina Seifert of Avera & Smith became involved in this matter and was able to successfully and quickly convince Blue Cross Blue Shield to re-evaluate the denial of this coverage and finally succeeded in getting the company to approve and pay for our client’s treatment. We are very proud of quickly convincing BCBS that they were wrong.
Indeed, regardless of where you are in the healthcare debate, you should know that “bureaucratic” decisions are arbitrarily made everyday that affect the lives of hard working Americans. Whether made by a corporation or government, it’s wrong and should never be tolerated in our healthcare system.

posted by Mark Avera at 10/13/2009 10:55:00 AM | 0 comments

Tuesday, October 06, 2009

Wrong choice to Regulate Truck Safety?

ARLINGTON, VA (October 5, 2009) – Families of truck crash victims and a coalition of safety advocacy groups today sent a letter to the Senate Commerce Committee asking them to reject the nomination of Anne Ferro, currently the president of the Maryland Motor Truck Association. The letter comes on the heels of a New York Times editorial on September 23rd stating, “Ms. Ferro’s record, we believe, is disqualifying … Americans cannot afford conflicts of interest in the running of their truck safety agency.”
“Today, approximately 15 people will die in truck crashes. Yet this nominee is a trucking industry insider and lobbyist,” said Jennifer Tierney of North Carolina. “The New York Times got it right when they said she would regulate the very industry she has advocated for. This is the perfect example of the fox guarding the hen house.”
The letter, signed by thirteen safety groups and family members of truck crash victims, said “in addition to our initial serious misgivings about a trucking industry official leading the federal agency responsible for regulating the safety of the motor carrier industry, Ms. Ferro’s refusal to commit to the implementation of proven, effective safety policies and regulations, both during our meeting and in response to questions at the hearing, have led us to request your opposition to the nomination of Ms. Ferro as FMCSA Administrator.”
P.A.T.T. Founder Daphne Izer of Maine said, “Safety has been on the back burner for too many years, resulting in thousands upon thousands of needless deaths and injuries. I want safety put before profits. Even the Bush Administration wouldn’t have had the gall to make this move.”
“Ms. Ferro’s responses at the committee hearing and her current position as a trucking industry lobbyist have led us to oppose her nomination to head this critical safety agency,” said John Lannen, Executive Director of the Truck Safety Coalition.

posted by Mark Avera at 10/06/2009 11:26:00 AM | 0 comments