M4A Now: The Myth of Privatized Healthcare (Doc)
Donation protected
GOALS FOR THIS DOCUMENTARY PROJECT:
1) Ensure Zaki gets the care he needs from his medical teams
2) Hold those who have broken laws to account, with evidence
3) Call attention to the greater need for Medicare For All, by highlighting Zaki's story, and other relevant stories.
ADDITIONAL INFORMATION AND RELEVANT DOCUMENTATION ABOUT THIS PRODUCTION TO FOLLOW SOON.
+++++++++++++++++
Below is a statement from Zaki's mother, Nicole, on her experience with navigating the healthcare system in her fight for her son's care.
An April 2020 poll revealed that 69% of the US supports Medicare for all.
And as much good as it does, GoFundMe is not a substitute for quality, universal health care.
The goal of this GoFundMe is not to support Zaki’s treatments. The goal is to make a documentary to investigate how and why the private healthcare system is not working for any American, regardless of where you are on the political spectrum.
My son, Zaki, was born with Noonan syndrome, and I've spent the past four years fighting to keep him alive. Zaki required a heart transplant, which he received 8/7/17. My son survived a 19 minute code blue August 17th, 2017 and a 23 minute code on August 30th, 2017. 10 days after transplant. The transplant team was at a loss, and I ended up diagnosing my son with Lymphangiectasia.
A peer review study spanning five hospitals revealed that he is the only child to ever survive congenital Lymphangiectasia. He has two thoracic ducts both with flow and his central lymphatic system flows completely backwards, a completely novel condition never before seen.
My son has 14 specialty needs, but he could be anyone’s son. THIS IS OUR FIGHT. The US has a population of 338 million people. If 2 million people donate $1 we can FORCE politicians to answer for ill gotten gains derived from the for profit healthcare system which kills children.
I humbly ask you, to donate to make this documentary and understand this fight is for ALL of us. My child represents your mother, brother, sisters, children, nephews, nieces, grandparents.
If you cannot pitch in directly, and know of skilled volunteers passionate about Medicare for all, #M4A - volunteering is welcomed too. One hand cannot clap alone. People from all over the world came together to save my son's life. Legally, insurance companies are required to cover my son's needs. In order for me to fight for everyone to finally have care in the US & the EU to maintain their single payer healthcare, I need the help of all of you. 250k lives have been lost due to covid alone, how many people would have sought treatment had M4A existed? Lives could have been spared.
Supporting Materials:
I live in the state of FL, but this is about all of America. My insurance company, Centene Corporation, operates out of 38 states and expands into the UK where they're fighting to retain their NHS. I have whistleblowers ready to come forward who can corroborate the stories of fraud that shackles providers from administering care. I also have recorded phone conversations, as is legally my right in this situation. Further, written documents from AHCA reveal that orders are not being properly filled, or are passed off to unqualified people, which is against several federal and state laws (see below).
+++++++++
This isn't MY fight, this fight is OUR fight as a country.
It's not just sick children, it's seniors. It's millions on disability. Over 40% of people in the United States have pre-existing conditions. As we will show, outright neglect can cost taxpayers more money in the long run than proper treatment and preventative care.
Here is a story: After my son received his heart transplant, the hospital was ordered by the insurance company to send my son home to die on July 16th - 21st, 2018. My son’s SpO2 levels at the time were not consistent with legal parameters, and so it would seem that he was not legally discharged.
I stayed awake six days to keep my son alive.
But this is not about the wonderful doctors, nurses, and caseworkers at the hospitals. These people are doing the best they can in impossible situations. Their hands are tied by insurance, and patients pay the ultimate price. Doctors and specialists should be free to treat as they feel is best. But they cannot because the insurance companies will not let them.
Recently, the DOJ decided to fine PROVIDERS (hospitals and doctors) $3.2 BILLION dollars but they never go after the HMO(s). Every HMO stock traded on Wall St represents a life lost including sick kids leaving families devastated for profit. Under section 20.55 it is left up to the 'discretion' of AHCA whether or not to fine an HMO for fraud if you receive care under Medicaid/Medicare.
When you call in to lodge a complaint? You speak to individuals who know NOTHING about basic anatomy and physiology. How can they effectively do their jobs? They can't.
Hospitals are faced with the constant threat of being thrown out-of-network from the HMO for not discontinuing services they know their patients need. The patients are often left with the impression doctors don't care. False. They do, but their hands are tied. Hospital staff are victimized by this system just as much as patients.
*What does being thrown out of network mean?*
It means that hospitals will be deprived of patients managed by group insurance (insurance obtained from work), Medicaid, Medicare and Affordable care act plans.
The HMO(s) have made so much money, they've started buying up pharmacies. For example, Aetna acquired CVS. Blue Cross, forces patients to only get medications from Walgreens. The US has the ILLUSION of choice. But companies like Centene and Acria are part of encroaching monopolies.
My son's current transplant hospital washed their hands of my son 2/15/19 - the reason? "It's not you, it's the insurance company".
Here are some facts with respect to my son’s treatments:
-Centene corporation (known as 'Sunshine' or Ambetter in FL) demands letters of medical necessity, which is a nightmare for any provider.
-Oct - Jan - monthly, Centene ECC dept demanded 400+ pages of Rx(s) -
-Under CMS guidelines, as a provider, you write an RX with 2 words, medically necessary.
-Under these for profit HMO(s) since Rick Scott they basically want a book for each RX.
-I rose to the challenge and helped his practitioners write my son's letters of medical necessity.
-The insurance company resorted to fraud, again, with impunity from AHCA.
-7/8/19 - in real time, AHCA permitted fraud in front of her face & proclaimed her hands were tied.
-The transplant team told me in March 2019 - "We do not have the resources to keep up with your demands" when speaking to the insurance company.
-Centene corporation forced the transplant team to contact Children's Hospital of Philadelphia and told them they would take responsibility over my son's diet management. They never did.
-From Feb. 15, 2019 - the hospital dumped my son onto a PCP who has written two letters rightfully stating he is not qualified to manage a heart transplant child.
-This PCP is forced to go through his manager to write for Rx(s) which he is not qualified to use my initial ones which the hospital copied and pasted.
-March 2020 - Head of transplant team told AHCA, the insurance company + their legal team their medical belief is my son should go to Children's Hospital Of Philadelphia quarterly.
-Since I was cut off from dealing with CHOPS' lymphatic diet team, my son's kidneys have been taking a hit. Dr. Yuav Dori is a lymphatics M.D., biomedical engineer, lymphatics doctor all in one. He and his staff are the only ones globally with the knowledge & capabilities to treat my son.
-The insurance company's response was not to deny treatment, but deny him medical transportation, despite legislation(s) stating it's legally required.
They know what they're doing is illegal but they also know the hospital made their recommendation. If my son perishes, the hospital is protected via Torte laws & the insurance company can continue to harm children for profit.
There have been thousands - millions - of lives lost. How many more will we lose to these indecent practices?
To date, my son cannot walk because AHCA allowed the insurance company to discontinue his Physical Therapy. He was never given speech therapy, which is legally his right to have.
Instead, the insurance insisted that the Private Duty Nursing agency change my son's plan of care (which I wrote myself because their Director of Nursing wasn't qualified to write it).
Despite the deposition citing the legislation(s) and signed letters of medical necessity they still ruled against me.
Legally, every disabled child under the age of 21 has a right to 200 diapers per month and four packs of wipes. I am watching parents all over the country suffer in agony, unable to afford to care for their children but unaware of the existing laws and the level of intimidation doctors face via HMO medical directors.
Dr. Dori from the Children’s Hospital in Philadelphia is the only M.D. who can help my son. The damage to my son's kidneys has been left unchecked, and he essentially has no transplant team willing to take responsibility for him since 2/15/19. Children with conditions even less complex than my son are in and out of the hospital frequently due to lack of services and medical supplies.
++++++++++++
Having a child in Intensive Care costs taxpayers $50k a day. Some hospitals are using these to create profits, which drains funds from the public non-profit sector, hinders innovations, and funnels money into politics, in order to preserve the status quo.
Tax payers see little return for their money, and the children who do survive aren't permitted to thrive.
The industries affected:
Hospital transplant programs: US news ranks transplant programs by survival rates. It's an unfair system when some states have more effective leadership.
*PDN (private duty nursing agencies) - they're often forced to send LPN(s), home health aids for an RN only RX - just to operate in the green.
*Speech - Rick Scott cut Eastern Seals program in favor of privatized healthcare leaving thousands of disabled children without speech.
*Occupational therapists
*Physical therapists
*Respiratory therapists
*DME - Durable medical equipment service company's.
The laws that have been violated:
Federal laws:
-Americans with disabilities act sec 2, 5, and 7
-The Medicaid Act - sections 5&7
-CFR440.70
Laws used
-Smith Vs Benson
-42 CFR 441.15
State laws:
409.905 (Mandatory Medicaid coverage for disabled children blow the age of 21).
See: AHCA Model Contract Attachment II, Exhibit II-‐A, at 5 regarding procedures managed care plans should follow and stating:
Authorization of any medically necessary service to enrollees under the age of twenty-‐one (21) years when the service is not listed in the service-‐specific Florida Medicaid Coverage and Limitations Handbook, Florida Medicaid Coverage Policy, or the associated Florida Medicaid fee schedule, or is not a covered service of the plan; or the amount, frequency, or duration of the service exceeds the limitations specified in the service-‐specific handbook or the corresponding fee schedule. The Managed Care Plan shall also include following language verbatim in its enrollee handbooks: [Insert Managed Care Plan name] must provide all medically necessary services for its members who are under age 21. This is the law. This is true even if [Insert Managed Care Plan name] does not cover a service or the service has a limit. As long as your child’s services are medically necessary, services have:
-No dollar limits; or
-No time limits, like hourly or daily limits. <-- this law is good until Feb 23rd, 2023 link attached. AHCA has received below letters of medical necessity and the syringe order(s) were honored.
-DOJ complaint: 35585-BGG
A special thank you to :
Noonan Foundation
Boston Children's Hospital, and Dr. Amy E Roberts
UF Shands
Joe Dimagio
Wellington Regional
Nicklaus Children's
Dr. Bruce Gelb
Dr. Max Itkin
Dr. Yuav Dori
Thank you for saving my son's life, Children's Hospital Of Philadelphia.
Hopefully Zaki will see you soon.
1) Ensure Zaki gets the care he needs from his medical teams
2) Hold those who have broken laws to account, with evidence
3) Call attention to the greater need for Medicare For All, by highlighting Zaki's story, and other relevant stories.
ADDITIONAL INFORMATION AND RELEVANT DOCUMENTATION ABOUT THIS PRODUCTION TO FOLLOW SOON.
+++++++++++++++++
Below is a statement from Zaki's mother, Nicole, on her experience with navigating the healthcare system in her fight for her son's care.
An April 2020 poll revealed that 69% of the US supports Medicare for all.
And as much good as it does, GoFundMe is not a substitute for quality, universal health care.
The goal of this GoFundMe is not to support Zaki’s treatments. The goal is to make a documentary to investigate how and why the private healthcare system is not working for any American, regardless of where you are on the political spectrum.
My son, Zaki, was born with Noonan syndrome, and I've spent the past four years fighting to keep him alive. Zaki required a heart transplant, which he received 8/7/17. My son survived a 19 minute code blue August 17th, 2017 and a 23 minute code on August 30th, 2017. 10 days after transplant. The transplant team was at a loss, and I ended up diagnosing my son with Lymphangiectasia.
A peer review study spanning five hospitals revealed that he is the only child to ever survive congenital Lymphangiectasia. He has two thoracic ducts both with flow and his central lymphatic system flows completely backwards, a completely novel condition never before seen.
My son has 14 specialty needs, but he could be anyone’s son. THIS IS OUR FIGHT. The US has a population of 338 million people. If 2 million people donate $1 we can FORCE politicians to answer for ill gotten gains derived from the for profit healthcare system which kills children.
I humbly ask you, to donate to make this documentary and understand this fight is for ALL of us. My child represents your mother, brother, sisters, children, nephews, nieces, grandparents.
If you cannot pitch in directly, and know of skilled volunteers passionate about Medicare for all, #M4A - volunteering is welcomed too. One hand cannot clap alone. People from all over the world came together to save my son's life. Legally, insurance companies are required to cover my son's needs. In order for me to fight for everyone to finally have care in the US & the EU to maintain their single payer healthcare, I need the help of all of you. 250k lives have been lost due to covid alone, how many people would have sought treatment had M4A existed? Lives could have been spared.
Supporting Materials:
I live in the state of FL, but this is about all of America. My insurance company, Centene Corporation, operates out of 38 states and expands into the UK where they're fighting to retain their NHS. I have whistleblowers ready to come forward who can corroborate the stories of fraud that shackles providers from administering care. I also have recorded phone conversations, as is legally my right in this situation. Further, written documents from AHCA reveal that orders are not being properly filled, or are passed off to unqualified people, which is against several federal and state laws (see below).
+++++++++
This isn't MY fight, this fight is OUR fight as a country.
It's not just sick children, it's seniors. It's millions on disability. Over 40% of people in the United States have pre-existing conditions. As we will show, outright neglect can cost taxpayers more money in the long run than proper treatment and preventative care.
Here is a story: After my son received his heart transplant, the hospital was ordered by the insurance company to send my son home to die on July 16th - 21st, 2018. My son’s SpO2 levels at the time were not consistent with legal parameters, and so it would seem that he was not legally discharged.
I stayed awake six days to keep my son alive.
But this is not about the wonderful doctors, nurses, and caseworkers at the hospitals. These people are doing the best they can in impossible situations. Their hands are tied by insurance, and patients pay the ultimate price. Doctors and specialists should be free to treat as they feel is best. But they cannot because the insurance companies will not let them.
Recently, the DOJ decided to fine PROVIDERS (hospitals and doctors) $3.2 BILLION dollars but they never go after the HMO(s). Every HMO stock traded on Wall St represents a life lost including sick kids leaving families devastated for profit. Under section 20.55 it is left up to the 'discretion' of AHCA whether or not to fine an HMO for fraud if you receive care under Medicaid/Medicare.
When you call in to lodge a complaint? You speak to individuals who know NOTHING about basic anatomy and physiology. How can they effectively do their jobs? They can't.
Hospitals are faced with the constant threat of being thrown out-of-network from the HMO for not discontinuing services they know their patients need. The patients are often left with the impression doctors don't care. False. They do, but their hands are tied. Hospital staff are victimized by this system just as much as patients.
*What does being thrown out of network mean?*
It means that hospitals will be deprived of patients managed by group insurance (insurance obtained from work), Medicaid, Medicare and Affordable care act plans.
The HMO(s) have made so much money, they've started buying up pharmacies. For example, Aetna acquired CVS. Blue Cross, forces patients to only get medications from Walgreens. The US has the ILLUSION of choice. But companies like Centene and Acria are part of encroaching monopolies.
My son's current transplant hospital washed their hands of my son 2/15/19 - the reason? "It's not you, it's the insurance company".
Here are some facts with respect to my son’s treatments:
-Centene corporation (known as 'Sunshine' or Ambetter in FL) demands letters of medical necessity, which is a nightmare for any provider.
-Oct - Jan - monthly, Centene ECC dept demanded 400+ pages of Rx(s) -
-Under CMS guidelines, as a provider, you write an RX with 2 words, medically necessary.
-Under these for profit HMO(s) since Rick Scott they basically want a book for each RX.
-I rose to the challenge and helped his practitioners write my son's letters of medical necessity.
-The insurance company resorted to fraud, again, with impunity from AHCA.
-7/8/19 - in real time, AHCA permitted fraud in front of her face & proclaimed her hands were tied.
-The transplant team told me in March 2019 - "We do not have the resources to keep up with your demands" when speaking to the insurance company.
-Centene corporation forced the transplant team to contact Children's Hospital of Philadelphia and told them they would take responsibility over my son's diet management. They never did.
-From Feb. 15, 2019 - the hospital dumped my son onto a PCP who has written two letters rightfully stating he is not qualified to manage a heart transplant child.
-This PCP is forced to go through his manager to write for Rx(s) which he is not qualified to use my initial ones which the hospital copied and pasted.
-March 2020 - Head of transplant team told AHCA, the insurance company + their legal team their medical belief is my son should go to Children's Hospital Of Philadelphia quarterly.
-Since I was cut off from dealing with CHOPS' lymphatic diet team, my son's kidneys have been taking a hit. Dr. Yuav Dori is a lymphatics M.D., biomedical engineer, lymphatics doctor all in one. He and his staff are the only ones globally with the knowledge & capabilities to treat my son.
-The insurance company's response was not to deny treatment, but deny him medical transportation, despite legislation(s) stating it's legally required.
They know what they're doing is illegal but they also know the hospital made their recommendation. If my son perishes, the hospital is protected via Torte laws & the insurance company can continue to harm children for profit.
There have been thousands - millions - of lives lost. How many more will we lose to these indecent practices?
To date, my son cannot walk because AHCA allowed the insurance company to discontinue his Physical Therapy. He was never given speech therapy, which is legally his right to have.
Instead, the insurance insisted that the Private Duty Nursing agency change my son's plan of care (which I wrote myself because their Director of Nursing wasn't qualified to write it).
Despite the deposition citing the legislation(s) and signed letters of medical necessity they still ruled against me.
Legally, every disabled child under the age of 21 has a right to 200 diapers per month and four packs of wipes. I am watching parents all over the country suffer in agony, unable to afford to care for their children but unaware of the existing laws and the level of intimidation doctors face via HMO medical directors.
Dr. Dori from the Children’s Hospital in Philadelphia is the only M.D. who can help my son. The damage to my son's kidneys has been left unchecked, and he essentially has no transplant team willing to take responsibility for him since 2/15/19. Children with conditions even less complex than my son are in and out of the hospital frequently due to lack of services and medical supplies.
++++++++++++
Having a child in Intensive Care costs taxpayers $50k a day. Some hospitals are using these to create profits, which drains funds from the public non-profit sector, hinders innovations, and funnels money into politics, in order to preserve the status quo.
Tax payers see little return for their money, and the children who do survive aren't permitted to thrive.
The industries affected:
Hospital transplant programs: US news ranks transplant programs by survival rates. It's an unfair system when some states have more effective leadership.
*PDN (private duty nursing agencies) - they're often forced to send LPN(s), home health aids for an RN only RX - just to operate in the green.
*Speech - Rick Scott cut Eastern Seals program in favor of privatized healthcare leaving thousands of disabled children without speech.
*Occupational therapists
*Physical therapists
*Respiratory therapists
*DME - Durable medical equipment service company's.
The laws that have been violated:
Federal laws:
-Americans with disabilities act sec 2, 5, and 7
-The Medicaid Act - sections 5&7
-CFR440.70
Laws used
-Smith Vs Benson
-42 CFR 441.15
State laws:
409.905 (Mandatory Medicaid coverage for disabled children blow the age of 21).
See: AHCA Model Contract Attachment II, Exhibit II-‐A, at 5 regarding procedures managed care plans should follow and stating:
Authorization of any medically necessary service to enrollees under the age of twenty-‐one (21) years when the service is not listed in the service-‐specific Florida Medicaid Coverage and Limitations Handbook, Florida Medicaid Coverage Policy, or the associated Florida Medicaid fee schedule, or is not a covered service of the plan; or the amount, frequency, or duration of the service exceeds the limitations specified in the service-‐specific handbook or the corresponding fee schedule. The Managed Care Plan shall also include following language verbatim in its enrollee handbooks: [Insert Managed Care Plan name] must provide all medically necessary services for its members who are under age 21. This is the law. This is true even if [Insert Managed Care Plan name] does not cover a service or the service has a limit. As long as your child’s services are medically necessary, services have:
-No dollar limits; or
-No time limits, like hourly or daily limits. <-- this law is good until Feb 23rd, 2023 link attached. AHCA has received below letters of medical necessity and the syringe order(s) were honored.
-DOJ complaint: 35585-BGG
A special thank you to :
Noonan Foundation
Boston Children's Hospital, and Dr. Amy E Roberts
UF Shands
Joe Dimagio
Wellington Regional
Nicklaus Children's
Dr. Bruce Gelb
Dr. Max Itkin
Dr. Yuav Dori
Thank you for saving my son's life, Children's Hospital Of Philadelphia.
Hopefully Zaki will see you soon.
Fundraising team (2)
Nicole Richardson-Bessadok
Organizer
West Palm Beach, FL
Dana Rovang
Team member
