| Know Your Rights Handbook |  |
Want to be your own advocate? Learn how by ordering the Know Your Rights Handbook today.
Learn about health and disability insurance, Social Security disability, employment discrimination, family and medical leave, school-based accommodations, resource location, and much more.
Click here for more information.
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Look What I Just Found!
Our good friend Cindy Holtzman turned us on to CureABill. If you have a medical bill that you don't understand or think is wrong, submit it to them. They are gathering a group of experts at medical billing, like Cindy Holtzman, who will review the bill for you FOR FREE!!! Any bill, big or small, can be reviewed at your request. Just follow the easy instructions on the site.
And it's a two-fer this month, since I also found (or, to be exact, they found me) the Invisible Disabilities Association. They help people to cope with invisible chronic illnesses. Where we do the legal and insurance work, they provide support and community. Check them out.
Wait!!! A three-fer. Unprecedented. But I am SO moved by these two young people. So please go here and watch their videos and see everything that's wrong with our health care system all in one place. So sad -- but these two are so brave and so in love. They touched me, and I suspect they will touch you, too.
Jennifer
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What I'm Reading
I confess that, at the moment, I'm reading summer junk -- a Patricia Cornwell mystery, to be exact.
But there's a book I'm looking forward to that I'd like to tell you about. Our friend Jon Reiner wrote a great article about his struggle with Crohn's disease called the Man Who Couldn't Eat. It was really amazingly candid and moving.
Well, Jon's book of the same name is coming out in September and you can pre-order it at Amazon.com here. The publisher has also created a website with a video in which Jon talks about his experience, which you can check out here.
Jennifer
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Get Your Guts In Gear
Advocacy for Patients is a beneficiary of Get Your Guts in Gear's 2010 Rides, and hopes to be a beneficiary of the 2011 Rides, as well. 2011 Ride dates are June 10-12 (New York); August 5-7 (Northwest); and September 16-18 (Midwest). To learn more about Get Your Guts in Gear, see their website for details or call 866-9IGOTGUTS (866-944-6848).
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| Advocacy for Patients on the Move!
September 18, 2011: CCFA Manhattan
October 2011 (date TBD) CCFA Miami
November 6, 2011: CCFA Long Island.
Can we do a webinar for your organization? Contact Jennifer and we'll be happy to accommodate your request.!
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It's Too Hard to Be Sick in America
Our book, It's Too Hard to Be Sick In America, is available FREE for your reading pleasure on our website. In it, we tell the stories of some of the patients with whom we've worked in order to show policymakers what chronic illness really looks like. Go have a read -- and the next time you talk to someone who clearly doesn't "get it," give them a copy of It's Too Hard to be Sick in America.
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Advocacy for Patients with Chronic Illness
We provide FREE information, advice and advocacy services to patients with chronic illnesses in areas including health and disability insurance, Social Security disability, employment discrimination, Family & Medical Leave Act, school-based discrimination, and resource location.
Need help?
Call (860) 674-1370
or email us.
Advocacy for Patients Needs Your Help!
To keep providing these services for FREE, we need your help.
WE DO NOT SOLICIT DONATIONS OUTSIDE OF THE FOLLOWING STATES:
CT, MA, WA, MN, CA, IL, NY, TX, VT, MT, ID, WY, NV, SD, NE, IA, IN.
Advocacy for Patients is committed to using its funds to support the work we do on behalf of patients. Accordingly, due to the cost of registering to solicit donations in other states, we do not solicit donations outside of the states listed above. Nevertheless, generous donors from many states make unsolicited donations for which we are very grateful.
THANK YOU!
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Rights vs. Jobs
We've been getting a lot of calls lately from people who feel that their employers are not abiding by their obligations under the Americans with Disabilities Act (ADA) and Family and Medical Leave Act (FMLA). They call ready for a fight. Most of the time, our job is to talk them down.
What? A group of lawyer/advocates talking people down when they want to assert their rights? You read it correctly. Not in every case, of course, but we try to help people keep their jobs. And sometimes that means strategizing around a boss that doesn't always play by the rules rather than involving a lawyer and starting a war.
The FMLA is pretty straightforward. If your employer has 50 or more employees and you have been employed there for at least 12 months, you're entitled to up to 12 unpaid weeks of leave in a 12 month period. The employer gets to decide what the 12 month period will be -- calendar year, fiscal year, or a rolling 12 month period -- but they have to tell you that. FMLA time can be taken intermittently, even an hour at a time. So if you have doctor appointments or Remicade infusions, you can use the FMLA for any time you miss due to illness.
In order to qualify for FMLA time, you have to have a "serious health condition." That means you need a medical "certification" for FMLA. You do NOT have to disclose your medical records; you need a doctor to certify that you have a chronic serious health condition that continues over an extended period of time, requires repeated visits to a health care provider, and may involve periods of incapacity. (FMLA also can be taken for an acute illness, but I'm focusing here on chronic illness.) Your employer may have a form they use for FMLA, so you should ask your human resources department if they have a form or if your request for FMLA leave and your doctor's certification (a brief note) can just be submitted in any format. According to law, there is no special form. Many employers require the doctor to say how many hours a week of FMLA they anticipate and they limit the employee accordingly. There is nothing in the FMLA regulations that anticipates that you will be limited to a certain number of hours of FMLA per week, although your employer is entitled to a doctor's note for each absence.
The ADA is a bit more complicated. As you know, the ADA prohibits discrimination and requires employers to make reasonable accommodations. What constitutes a reasonable accommodation differs from case to case. If you are the only person who answers phones then it may not be reasonable to ask your employer to have someone cover phones for you; if you are one of 25 people who answer phones, then asking for someone to cover for you is more reasonable.
To obtain the protections of the ADA, you have to be (a) a qualified individual; (b) with a disability. The disability part is pretty straightforward. A person is disabled if s/he is substantially impaired in a major life activity. Major life activities are things like seeing, hearing, walking, concentrating, thinking, but also bodily functions like digestion, bowel, immune system. The list is not exhaustive.
The more difficult piece is being a "qualified individual." To meet that test, you must be able to perform the essential functions of your job with or without accommodations. So if you work on a computer and you have rheumatoid arthritis and need ergonomic equipment, as long as you could perform the essential function of computer work with that accommodation -- with the ergonomic equipment -- you meet the requirement. But if attendance is an essential function of the job, as it is in most cases, and if you have trouble making it to work every day, you may not be a "qualified individual" even if the reason you can't get to work is your disability.
Most of the people who call us about job-related problems are having problems making it to work every day. The FMLA is your protection against being fired. If you work for a small employer -- fewer than 50 employees (unless your state has an FMLA that pertains to smaller employers, which some do) -- or if you have not been there for 12 months, you may not have the benefits of the FMLA, in which case you can be fired for bad attendance if attendance is an essential function of your job. Even if you have FMLA protection, if you miss more than 12 weeks in a 12 month period, you can be fired for bad attendance.
Even when you are a qualified individual with a disability, you should try your best to resolve matters without getting a lawyer involved, at least up front. So the first thing we will do if you call us is to try to coach you on what to do and what to say. If you request accommodations and establish that you are disabled, the employer is supposed to enter into an "interactive process" with you to try to figure out what accommodations will address your disability without unduly burdening your employer. So there will be a negotiation, some back and forth, in which you explain their needs, they evaluate your request, and then you trade ideas for how those needs might be met. If you feel you have already done your best, we will get involved, but you should keep in mind that employers don't like hearing from lawyers. Even if we resolve your case for you, we can't promise that your employer will be happy.
There are employers out there who know that employment discrimination cases are very hard for employees to win, and they would rather be taken to court than accommodate you. Employers only have to prove that accommodating you would constitute an undue burden in order for you to lose. So, to use the telephone example above again, if you're the only person who answers phones and you need, as an accommodation, to have someone cover phones for you when you go on bathroom breaks, for example, the employer may claim that's an undue burden -- and both the state human rights agency or Equal Employment Opportunity Commission (EEOC) and a court may (depending on all the circumstances) agree.
Some employers are prepared to take that risk, and when they see you have brought a lawyer into the picture, you may be fired. It's wrong. Indeed, it's illegal for an employer to retaliate against you for exercising your rights. But it happens.
And if you've already been fired by the time you get to us, it may be that the best thing we can do for you is to try to negotiate a severance agreement.
While it's important to stick up for yourself and to seek accommodations if you need them in order to keep your job, it's also important for you to try as best you can to preserve the relationship with your employer. It does you no good to win the battle -- obtain accommodations -- and lose the war, your job. We have seen employers negotiate accommodations, act like all is resolved, and then pass people with accommodations up for promotions and raises, or even fire the employee a year later. If they've waited a year to take adverse action against you, it will be hard to prove it's retaliation. Knowing it in your heart isn't enough.
So the best thing to do is to know your rights, use us as a sounding board, let us help you with strategy and in preparing for a meeting with your employer. Not only will you probably get the same or better results as we would get, but your employer will feel like it was less confrontational, and may even respect you more for the way you handled the situation. No doubt you will have more respect for yourself, as well, when you realize that you really can advocate for yourself if only you have some knowledge and direction.
When worst comes to worst, though, we are here to jump in. Although we do not litigate, we are effective at writing letters and negotiating resolutions to problems. We will help you as best we can. But a good result in a case like this is not just a resolution to a problem; it's also keeping your job. Jennifer |
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Appeals
The federal departments of Health and Human Services, Labor and Treasury have issued additional regulations on health insurance appeals, and they are disappointing, but not as much so as I had feared they would be. The issues that can be raised in external appeals if you live in a state that has no external appeal law (Mississippi, Nebraska, Alabama) or if you are a nonfederal government employee are narrower now, limited to issues involving the exercise of medical judgment and rescissions (retroactive cancellations of policies). In addition, notices do not have to be translated into many different languages. Most translations are only to Spanish; Tagalog, Navajo and Chinese are required in only 6 counties in the United States. You ,ay have only 60 days to file an external appeal rather than 120 depending on what state you're in. All of the information you need will not be included in denial notices; you will have to ask for that information, assuming you know to ask. If you would like a detailed summary of the rules, you can find my summary here.
Still, this is all better than it was before health reform, when some states and self-funded plans didn't have to have any external appeals, and the rules were different from state to state.
But this is not the final word, either. So there's still time to contact your members of Congress and ask them to ask the agencies to beef up these rules. If you've ever been denied coverage of something by your insurer, then you know how important these rules can be. So please call or write your members of Congress today and ask them to ask the agencies to reinstate the broad rules they initially issued last July.
To find your Senators, go here. To find your Representative, go here.
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Kaiser Needs YOU!!!
The Kaiser Family Foundation puts out really critical publications on health care from which all of us benefit greatly. Right now, they are working on putting together some stories of people who don't have insurance and what the struggle has been like for them. They want to interview you for about 15 minutes, record the interview, get a photo of you, and then post the photo online with a clip of the interview and a short summary of your experience.
If you are or have been uninsured and needed care, PLEASE do help. Kaiser is one of the most important sources of information about the effects of health policy decisions on ordinary Americans. I know that a lot of you have really compelling, sad, sometimes uplifting stories to share. If you're willing, you may email Jessica a JessicaS@kff.org, or if you would prefer to go through me, you are welcome to do so.
Kaiser helps keep me informed, which means, in turn, they help keep you informed, which means we should try to help them if we can. So please do. J
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The Chronicity Project
This is the space in our newsletter where we talk about health care policy affecting the chronically ill.
Here's an update on what's happening in the legislative arenas:
Federal
Sadly, I don't even have to change anything here. The GOP still won't raise the debt ceiling without massive cuts to the deficit. The Dems say the failure to raise the debt ceiling would cause us to default on our obligations, which could destabilize an already fragile world economy. The GOP refuses to talk about raising taxes, even on the richest Americans, even by eliminating tax breaks for oil companies. The Dems say they agree that the deficit has to be cut, but revenue enhancements like ending breaks for big oil should be part of the plan. And Medicare continues to rest at the center of it all, with the GOP proposing to gut it and instead provide people with insurance vouchers to buy their own insurance (which will cost more than the vouchers, especially if you consider deductibles, copays and coinsurance), and the Dems determined to, in President Obama's words, try to fix it with a "scalpel rather than a machete."
Contact your members of Congress and tell them what you think. To find your Representative, go here; to find your Senator, go here.
Connecticut The legislative session is over. As you know, Connecticut became the first state in the nation to have required paid sick days -- up to 40 hours per year for those in the service industries with 50 or more employees. We've met with the State about the insurance Exchange, as have insurance industry insiders, agents and brokers, and representatives of large and small business. The Office of Policy and Management is posting the results of all of the stakeholder meetings they've had here. You can read all the views there. In other positive news, although full-blown SustiNet with a full public option will not happen right now, the legislature passed a bill creating an Office of Health Reform and Innovation, and to study possibilities, including a public option that those of us who support SustiNet really want. As part of this huge piece of legislation, they also passed the pooling proposal that will allow municipalities and nonprofits to participate in the state employee insurance plan. And the SustiNet Cabinet will study the possibility of a public option down the road. Also, Connecticut has initiated the Connecticut Insurance Premium Assistance Program which helps AIDS patients pay their insurance premiums. Contact the Department of Social Services for more information. Connecticut also passed a bill that would allow the Attorney General or Healthcare Advocate to request a hearing (called a symposium) whenever a health or long-term care insurer raises rates more than 10 percent. However the Governor vetoed it, thereby depriving us of the best chance we had to control health insurance premiums. Connecticut also passed a bill prohibiting "step therapy" -- policies by insurers that require consumers to try less expensive meds before they can have what their doctor prescribed. There's a lot more that has been passed as part of the budget -- more than we can summarize here. But at least we have a budget, and the damage wasn't as bad as many of us feared. As always, it's always good to contact your State Senator or Representative and tell them how you feel about things. Your State
Most states are just about finished with their legislative sessions this year, as well. Laws outlawing "specialty tiers" for the most expensive drugs are still live in CA and NE. If you live in those states and you want to be able to afford your meds, contact your state legislators. In the meantime, keep up the fight. First, be aware. Read your local newspapers. Find the website for your state legislature. Read. Write your state legislators about things that concern you. One tool we like is the Kaiser Health News, to which you can subscribe for free. But don't just read: ACT. Go to hearings and testify. Tell your story. Put a real face on the healthcare crisis. |
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Jennifer C. Jaff, Esq.  Executive Director
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