Help Me Hold UnitedHealthcare and TennCare Accountable

This is a Prior Authorization Request for Accessible Justice Submitted to You

Holding abusive private and state operated health plans accountable will be possible when you help people like me sue them. UnitedHealthcare Community Plan (UHCCP) is among the worst of the worst, but they’re part of a community of abusers with many accomplices. If you want the abuse to stop, then help me sue UHCCP and TennCare in federal court. I need your authorization to access that benefit.

I’ve done most of the work already, I just need attorneys to help me refile and litigate.

I need your help to find attorneys who will help me and those like me who are being abused, exploited, and injured by UnitedHealthcare and TennCare, and then sue them in federal court. 

I will need help funding this legal action. I am a disabled adult on SSI and can’t afford to fund litigation myself. Because I’m disabled I can’t work to earn the money to fund it. Because of SSI rules if I have more than $2000 in assets I get kicked off SSI and thereby kicked off of TennCare. The rules prevent me from even begging and receiving the money to fund a lawsuit or fund medical care. If I went for donations, I’d have to get enough money to pay for everything from living expenses, to all my medical needs, and the lawsuit. Something needs to be figured out. I’m stuck in a trap depriving me of health, dignity, and justice.

Tax payers have already paid for everything people like me should need, but those resources are being withheld, or illegally reappropriated by groups like UHC and TennCare so they can use them for their own benefit. I don’t like asking citizens to pay for things twice over, but I think you’re going to have to in order to put a stop to the blatant illegal activity that’s occurring.

I want you to help me make legal precedent by finally making it possible for disabled adults like me to access justice. Share my DefendTheDisabled Facebook page, my website, my articles, my lawsuit and my need to find attorneys to help refile and litigate it. Help me get the media attention that builds a platform people can gather around.

My Request Has Been Denied Many Times by Many People

Since 2020 I searched throughout Tennessee and could find no legal aid, no nonprofit, and no private attorneys willing to help disabled adult Medicaid recipients sue private or state operated health plans for service denials and the generalized abusive and exploitative misconduct that typifies Cigna and UHC health plans. From my extensive search I found no one in Tennessee even practices this area of law. Disabled adult medicaid beneficiaries have been abandoned to the abuse and exploitation of TennCare and its managed care organizations like UnitedHealthcare Community Plan. There is no safety net, just a steep cliff with a bunch of dead bodies:

(Image source: https://defendthedisabled.org/2020/01/31/the-illegal-activities-of-medicaid-programs-a-letter-to-the-social-security-administration/)

This year in June, I was injured and incapacitated again by the abuse of UHCCP-TennCare. The physical and mental trauma had hit a breaking point. My mind collapsed, with my physical health being pulled down with it. One day the issues with my jaws, head, neck, and nervous system were so bad I couldn’t walk properly. I attended my physical therapy appointment to manage the trigger points in my jaws, but my physical therapist understandably suggested it might not be safe to treat me today. Based upon how concerned he and others looked, and the suggestion made, I can only assume not only did my gait look as bad as it felt, but they could see the distress on my face. I was so tired of fighting, everyone and everything, the abuse, misconduct, the ignorance of doctors, my health and disabilities, the deterioration of my body and my mind, I didn’t have the energy to try to fight and convince my physical therapist to treat me. I just turned around and left, struggling to walk with my staggered limping gait, crying in despair (I almost never cry), and laid down on a bench outside, struggling to breath due to my respiratory issues. Wondering should I go to the ER even though every time in the past they either do nothing to really help, or try to involuntarily commit me to a psychiatric hospital that only subjects me to further abuse and discrimination? 

In my anguish and desperation the idea to call the office of my district’s elected representative came to mind. I explained my situation to Rep. Tom Leatherwood’s office. I begged and pleaded for intervention, for help, telling them how I was being tortured, and asking them to make my abusers stop. The office staff said they would relay my situation to Rep. Leatherwood, assuring me he was the Vice Chair of the Health Committee and the right person to be contacting. I was directed to await contact from Trey Jones, the legislative director at the Tennessee Department of Disability and Aging. I was assured Trey would help me. I got no call after a week or so and called back Rep. Leatherwood’s office to explain and ask what to do. I got more instructions, which I followed, encountered more problems, which I navigated, sending Trey the documents he requested from me, until finally, 84 days after my first call to Rep. At Leatherwood’s office, Trey and I finally had a discussion about my situation and what he could do. 

Trey told me he’d contact TennCare and Rep. Leatherwood and follow up with me later that day or by the end of the week. He didn’t do either. Six days after my call with Trey I got a call from a “health worker” from TennCare claiming Rep. Leatherwood’s office asked them to call me because I needed help finding a PCP. TennCare seems to have been led to believe I didn’t know how to look at their list of providers, or schedule an appointment. How my comments to Rep. Leatherwood’s office or Trey Jones could be construed into such an inaccurate gross oversimplification is baffling. Clearly, helping me had not been a priority.

Trey Jones and Rep. Leatherwood essentially punted me back to TennCare, with not a word from them as to why, let alone any assurance they or anyone else would oversee events to make sure the people at UHCCP and TennCare that have violated my rights for several years, who are actively abusing and exploiting me and other disabled adults, wouldn’t continue to do so. I sent Trey Jones an email asking why he didn’t follow up as he indicated he would. I wanted to know “what’s going on”, but got no response.

As an aside, every citizen in Tennessee who is made aware of a disabled adult being subjected to neglect, abuse, and exploitation is technically required by law to report that [T.C.A. § 71-6-103(b)]. I think it is inappropriate that Rep. Leatherwood and Trey Jones sent me back to the people abusing me in the manner that they did. Especially after I begged for their help in their official capacity to make TennCare and its MCO UnitedHealthcare stop abusing me. I spent 84 days trying to follow their instructions in order to get their help, after years of prior efforts.

As a result of being punted back to TennCare, I now have four people from various departments at UnitedHealthcare and TennCare who have contacted me asking me for information. As if, I hadn’t already sent their organizations several hundred pages of complaints, appeals, medical records, and an entire lawsuit. I told them they already have and have had all the information needed to understand how to help me. That they arrive asking me to explain things again as if I hadn’t, is further demonstration of their organization’s misconduct. It’s their job to manage and coordinate my care as a managed care medicaid program. I have nothing indicating to me that any of these four persons have the competency or the authority to actually get anything done. I’m only interacting with them because it’s part of the process of giving each party a chance, and then documenting their failures, and by proxy, the failure of those that punted me to them.

I’ve tried to get help from other elected officials as well. In 2020 I contacted Senator Paul Rose through his office, who in 2019 had handed out fliers in my neighborhood which boasted about how he was a friend to the disabled and elderly since he helped cosponsor the 2019 Tennessee Adult Protection Act (aka TN – SB1039)

[Image Source]

I spent some time investigating the Tennessee Adult Protection Act trying to figure out who was responsible for crafting it, and who could help me get it amended to better protect disabled adults and the elderly. I gleaned through the public records I could find, watched through hours of House hearings, hoping to find some type of detail to let me understand the reasoning behind the Tennessee Adult Protection Act, and the people behind the reasoning. I did not find either. I learned that the senators and representatives so proudly boasting their sponsorship weren’t involved much, or at all, in writing the laws, neither did they really read them once written, let alone understand them or the people that need the protection of these laws. I ended up sending an amendment proposal to Rep. Keisling and very briefly talking with him over the phone. I provided that same proposal to Trey Jones, which made sense given his position as legislative director at TN Dept of Disability and Aging. He didn’t make any mention of reading it to me. I’m a disabled adult who is being abused, has studied the laws extensively, and is trying to offer input to legislators. You would think my input would be valued and garner serious consideration and discussion. But, as far as I can tell no one has ever given my amendment proposal any serious consideration.

Long story short, in response to my plea for help with UHCCP-TennCare abuse, Sen. Paul Rose’s office called the police to my house for a welfare check claiming I threatened to kill myself if I didn’t get help. 

I explained to Sen. Rose’s office, this being transcribed from the call, “Why can’t I get help?” “…because there’s complete and total lawlessness within the medical insurance industry..” “the regulatory agencies that are tasked to enforce these laws aren’t doing their job…” “…people like myself find themselves completely undefended from gross rights violations…” “…an entire class of individuals that are supposed to be federally protected are instead being farmed like they’re livestock.” “…It’s like everybody knows and nobody does anything about it…” “…I have very unmet medical needs that endanger my life…I might very well die or kill myself prior to funding any type of resolution. So the idea that Sean Smith [me, the author] is going to somehow fix it is just kind of a misguided belief at this point. I need help. And if Paul Rose can’t do that, then fine, but he needs to be able to make that determination himself or somebody in his office does. And I need to be put in contact with somebody who will.”

I communicated to them that I’m a disabled adult that is being abused by the illegal activities of private and state operated health plans and the variety of agencies who refuse to regulate either. That this abuse jeopardizes my health and safety. That I have spent years trying to survive this and get help. That despite my efforts I might be killed or kill myself due to my circumstances and the lack of assistance. I asked Sen. Rose’s office to help me get help. Help being requested so that, logically, I can get the care I need to remain alive and well and participate as a functional member of society. I asked them to help pursue the nation’s proper goals for people with disabilities [42 U.S.C. § 12101(7)].   Instead they chose to try to get me sent to an abusive psychiatric facility by calling the police to my house for a welfare check.

In 2017 after trying to get help for chronic jaw issues and chronic pain at Germantown Methodist ER I got dumped in a local psychiatric facility. When it became clear the ER was trying to commit me, I called my psychiatrist. I literally had my psychiatrist’s office manager on my cell phone’s speaker telling them they ‘didn’t have the authority to do this’ and instructing the ER physicians and staff and police to wait 15 minutes for my psychiatrist to get on the phone and talk with the doctors. I repeatedly expressed my concern to everyone there that the psychiatric facility could not meet my health and disability needs and would endanger my safety because of this. A male nurse at the ER claimed that the facility would meet my needs, even as I asked him how he knew that when the ER doctors had refused to help me with those needs, and got generic answers like, ‘because they are supposed to, it’s their job’. 

Rather than wait 15 minutes for my psychiatrist the ER staff conspired with the Germantown police who threatened to use violence against me if I didn’t go with the EMT’s immediately. I had been at the ER for at least over 4 hours, with many long periods of waiting, and they wouldn’t even wait another 15 minutes for my psychiatrist. At the threat of violence, I went with them, and they took away my cell phone. My psychiatrist actively tried to contact the ER doctors through their hospital’s main line, and later on tried to communicate with the doctors at the psychiatric facility I was transferred to. Both the doctors at the ER and psych facility refused to talk with my psychiatrist. Which means, those doctors all refused to gather any information on my medical history and disability needs from my treating physician. I wasn’t provided food I could eat, or any of the basic things I needed to manage pain, dysfunction, or get decent sleep. 

My experience taught me that that rather than care for me, the ER and psych facilities in Memphis will abuse and torture by neglecting my health and disability needs, and get paid by my private and state operated health plans for doing this. My psychiatrist later told me he believed my rights were violated. At that time, rights were an intangible thing I really didn’t understand, and so the importance of his comment didn’t register. It took another 2 years of additional rights violations and an insurance adjuster in a support group directing me to read the law before I finally understood. 

I explained to the police that Senator Paul Rose’s office called to my house that when I tell people about my situation and ask for help, especially the people at health plans or in the health plans provider network, they have often called the police for welfare checks rather than help me. Sometimes the police listen, as they did that day, and sometimes they don’t. 

I spoke again with Sen. Rose’s legislative assistant Autumn, trying to figure out how my call with them led to the police showing up later that same day. She, speaking on behalf of Sen. Rose’s office, repeatedly denied they had any involvement in the police being called to my house. I thought one of the people she sent emails to at TennCare may have called them to my house. I had to request records from the police department to get the truth. Autumn called the police and reported that I might kill myself if I don’t get help with a medical insurance problem. 

Note that no one reported to the police I’m a disabled adult being physically and psychologically abused [T.C.A. § 39-15-501(2);(11);12)] by TennCare and it’s contracted healthcare facilities refusing to comply with laws the legislator helped enact [T.C.A. § 71-6-101] and thereby suffering suicidal ideation as a result of that torture. They withhold those material facts, while at the same time refusing to try to stop that abuse, and I very much doubt they bothered to report it elsewhere when they’re refusing to report matters faithfully to the police.

I tried to explain to Sen. Rose’s office in the followup phone call, “Make no mistake [UHCCP-TennCare misconduct] affects the entire State and it’s not going away unless somebody does something about it and to expect the person who’s already incapacitated to somehow find the attorney that doesn’t seem to exist, get the funds to be able to fund the legal case for years, and survive through all of that while their life is already in peril is just kind of…beyond absurd.”

Autumn told me that she would make sure Sen. Rose was made aware of my situation, but that his office couldn’t do anything to help me. I asked if they could send me a letter saying that, so that the next time someone tells me they can’t do anything and I should contact my elected representative, I can show them the letter. Autumn said they can’t send me such a letter. I noted to myself at the time, that they’re sitting on the sidelines, basically doing nothing that will really help, and I can’t even get them to assist with something as simple as a letter saying they can’t help me, so I can use that letter to try to get other people to help me. So, with no letter, and no help, all I’ve got to work with is sharing this.

I’m still pretty much alone in my advocacy efforts and pursuit of litigation. I tried to get help from all these appointed officials at TennCare and other agencies, nonprofit organizations, legal aid societies, law firms, healthcare facilities, representatives, senators, legislative assistants and directors, almost all doing a hard pass on combating the extensive fraud and corruption perpetrated by UnitedHealthcare and TennCare that results in depriving disabled adults of their civil and constitutional rights. I don’t know if people need convincing that I’m telling the truth, or convincing that they can actually do something about this, or just don’t care about what’s happening.

I drafted a complaint about Sen. Paul Rose, and I think it worth a quick read. The ending deserves a highlight:

 “I am tired of being at the receiving end of illegal activity and having no defense but to cry out and scream for help while being assaulted. If there [is] any party in all of this that is a danger to themself and others, it is persons who stand by and do nothing as our health system operates in [a] manner which undermines our Nation’s Foundations; it’s people, their health; Their Constitutional Well-Being”.

I did not file the complaint, or publish it until now. Partly out of fear of reprisal, and because I shy away from complaining, and figure it’s better to keep trying to find people to work with than to attack people who won’t work with me. The biggest reason though is that from 2020-2023 the abuse I was subjected to put my life in danger, led to multiple serious injuries, and incapacitated me. I kept trying to get help throughout 2020-2023, encountering complacency, misconduct, and discrimination, and only occasionally finding something, and someone, which was helpful. 

It wasn’t until October of 2023 that I managed to regain enough function and motivation to resume pursuit of legal action and complaints. I still fear reprisal and harm from those I now call out. I’m disabled, and there’s no meaningful consequences to the people who abuse me, be they health insurers, their in-network doctors and facilities, police officers, or elected officials who go door-to-door representing themselves as an ally to the disabled.

I’m stuck in an endless cycle of abuse and exploitation, which transpires with what seems the express permission and at times support of my district’s elected representatives, agencies across the state, a large portion of the medical community, and what seems almost the entire legal community. These people have had chance after chance to help fix this mess. 

To get accountability people like me will need Litigation and Advocacy, and I want to believe there’s people out there who will help that happen. Talk about my story. Pester attorneys and law firms. Make calls to representatives and senators. Demand aid be provided to me and those like me. Demand better laws that get drafted and protections that get implemented with the involvement of people like me who know firsthand how things are broken and where they need fixing. Don’t wait on academics, officials, or the large nonprofit organizations to figure out what needs to happen, because they’re not here; I AM, and they’ve abandoned me to this position that I defend. I’m trying to hold this line that they have deserted. 

I demand the rehabilitative care that I am statutorily entitled to as a disabled adult Medicaid recipient, but am being deprived of by the illegal activities of UnitedHealthcare, TennCare, and their inadequate provider network. I want you to demand it with me. I want you to help me hold UnitedHealthcare and TennCare accountable. I want to sue them in federal court until it’s them who is afraid and intimidated by even the threat of litigation by their Medicaid beneficiaries.

Help me enforce the laws that protect disabled adults and Medicaid beneficiaries. This abusive machine isn’t going to stop without litigation and systemic changes, and neither of those is going to happen without you and me and this. 

So turn off those movies and games about fake heroes with fake deeds for fake problems and help me here and now do what’s right, the right way, before it’s too late. Eventually they will finally succeed in abusing me to death.