Michigan Disability Resistance

Renea Robinson isn’t sure how her children got poisoned.

Perhaps the paint in her Detroit house is to blame for elevated lead levels in the blood of three of her four children, ages 5, 6 and 8. Or the galvanized steel water pipes, which have since been replaced?

Or what about the kids’ school?

After the Flint water crisis, many schools in Michigan began testing their water for lead. And in 2016, Sampson-Webber Leadership Academy — the prekindergarten-8th grade school Robinson’s kids attend — was among 19 Detroit schools that had elevated levels of lead and/or copper after testing.

Lead is neurotoxin that can irreversibly damage brain and nervous system development, and it’s particularly harmful to young children. Robinson said recent tests showed three of her children’s blood slightly higher than the federal “level of concern,” and her oldest son suffers headaches, which is among the symptoms of lead exposure.

“I play it safe,” said Robinson, whose children’s school has since tested far below federal “action level” for lead in drinking water.

Consumers must first attempt to resolve disputes regarding a denial, reduction, or termination of a health care service directly with their health plan/entity through the internal grievance process of the health plan/entity. If you have completed the internal grievance process and a resolution cannot be reached through the internal grievance process, our department may review your dispute under the external review process to determine if your dispute was handled correctly under the terms of your coverage and related laws.

For more information regarding FAX or mail-in submissions please visit DIFS How to File a Complaint to download the Request for External Review form (FIS 0018).

DIFS can assist in resolving disputes under the external review process for many health insurers. However, we do not conduct external reviews for the following insurances: Non-governmental self-funded health plans, Medicare or Medicare Supplement, Worker’s Compensation, Auto, and federal employee benefit programs including military, and/or liability insurance, etc. See http://www.legislature.mi.gov/(S(sdsms1moblxcjw1lucgtaqhd))/documents/mcl/pdf/mcl-550-1905.pdf for the complete listing.

*At this time our system does not allow for the online submission of the following types of complaints: Business-to-Business, Provider Clean Claims, and Proof of Claim Against a Mortgage Company Bond.

Request For Review Eligibility

DIFS will assist in an external review if ALL the following apply:

• You have exhausted the health carrier's internal grievance process. (unless waived because the health carrier did not complete their review within the required time).
• The request is within 127 days of receipt of a final adverse determination.
• The patient was covered on the date of service.
• The health care service appears to be a covered benefit.

Today’s episode is about invisible disabilities with Tiffany Peterson and Linda Williams. Tiffany and Linda share their lived experiences as women with invisible disabilities, the misconceptions about invisible disabilities, and the need for language and symbols about disability that we can all identify with such as iridescent amoebas giving side-eye (listen to find out more).

Transcript

Unable to walk or talk, barely able to see or hear, 5-year-old Maddie Holt of Everett, Wash., waits in her wheelchair for a ride to the hospital.

The 27-pound girl is dressed in polka-dot pants and a flowered shirt for the trip, plus a red headband with a sparkly bow, two wispy blond ponytails poking out on top of her head.

Her parents can't drive her. They both have disabling vision problems; and, besides, they can't afford a car. When Maddie was born in 2012 with the rare and usually fatal genetic condition called Zellweger syndrome, Meagan and Brandon Holt, then in their early 20s, were plunged into a world of overwhelming need — and profound poverty.

"We lost everything when Maddie got sick," says Meagan Holt, now 27.

Multiple times each month, Maddie sees a team of specialists at Seattle Children's Hospital who treat her for the condition that has left her nearly blind and deaf, with frequent seizures and life-threatening liver problems.

The only way Maddie can make the trip, which is more than an hour each way, is through a service provided by Medicaid, the nation's health insurance program started more than 50 years ago as a safety net for the poor.

Designed for Medicaid's most fragile

Called non-emergency medical transportation, or NEMT, the benefit is as old as Medicaid itself. It requires the transport of certain people to and from medical services like mental health counseling sessions, substance abuse treatment, dialysis, physical therapy, adult day care and, in Maddie's case, visits to specialists.

However, citing runaway costs and a focus on patients taking responsibility for their health, Republicans have vowed to roll back the benefits, cut federal funding and give states more power to eliminate services they consider unaffordable.

More than 1 in 5 Americans — about 74 million people — now rely on Medicaid to pay for their health care. That includes nearly 104 million NEMT trips each year at a cost of nearly $3 billion, according to a 2013 estimate, the most recent.

Proponents of limiting NEMT say the strategy will cut escalating costs and more closely mirror private insurance benefits, which typically don't include transportation.

Health care costs are "a hungry tapeworm on the American economy," Berkshire Hathaway Chairman and CEO Warren Buffett says, and now his firm is teaming up with Amazon and JPMorgan Chase to create a new company with the goal of providing high-quality health care for their U.S. employees at a lower cost.

The new company will be "free from profit-making incentives and constraints" as it tries to find ways to cut costs and boost satisfaction with the health care plan for employees of Amazon, Berkshire Hathaway and JPMorgan Chase. The trio unveiled their new venture in a news release.

"The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost," the companies said.

The enterprise unites three of the largest and most envied companies in their respective sectors — from retail to banking, and including Berkshire's wide portfolio of companies such as Geico and Fruit of the Loom. And in Buffett, Amazon's Jeff Bezos and JPMorgan's Jamie Dimon, the companies also have veteran leaders who have shown an ability to solve vexing business problems.

According to recent annual reports, taken together the three companies employ more than 950,000 people worldwide.

The three CEOs say they're aware of the enormous challenges they face.