Health

LEGAL AID FILES LAWSUIT AGAINST COUNTY OF ORANGE ON BEHALF OF HOMELESS INDIVIDUALS WITH DISABILITIES LIVING AT THE SANTA ANA RIVERBED

FOR IMMEDIATE RELEASE

LEGAL AID FILES LAWSUIT AGAINST COUNTY OF ORANGE ON BEHALF OF HOMELESS INDIVIDUALS WITH DISABILITIES LIVING AT THE SANTA ANA RIVERBED

On February 7, 2018, the Legal Aid Society of Orange County filed a lawsuit against the County of Orange for discriminatory actions taken against homeless individuals with disabilities who currently reside at the Santa Ana Riverbed. The lawsuit was filed on behalf of People’s Homeless Task Force, a homeless advocacy association, and seven homeless individuals who live at the Riverbed.

On January 22, 2018, the County began the process of evicting hundreds of people living at the Riverbed, the majority of whom experience mental or physical disabilities, or both. Although the County had previously committed to relocating every willing homeless person on the Riverbed to appropriate housing and services before requiring them to leave, the County buckled under mounting political pressure and began sweeping the Riverbed even though hundreds of people had not yet accessed the County’s services. The lawsuit alleges that the County’s program and its sudden eviction of Riverbed residents before the program was completed are discriminatory because its actions deny individuals living on the Riverbed access to the benefits of the County’s services by reason of their disabilities.

“My team and I were retained by desperate homeless residents living in substandard conditions with hopes of accessing the services and housing options promised by the County so that they could successfully exit the Riverbed encampments. Despite weeks of working with the County to seek reasonable solutions for our clients, it was clear that County services are so inadequate that they would only cause further harm to individuals with disabilities,” said Lili Graham, Director of Litigation at the Legal Aid Society of Orange County. “The County has identified the complex needs of the homeless in obtaining significant funds from the state and federal governments, yet much of that money has gone unspent. The County must take a hard look at the implementation of its program and work with knowledgeable professionals to create viable long-term solutions for chronically homeless individuals. A mass eviction of the County’s most vulnerable residents is not a solution.”

The lawsuit alleges that Orange County has nearly $700 million in unspent funds available to end homelessness, including $146 million for housing vouchers, $8 million for affordable housing, $67.5 million for mental health treatment and residential care, and nearly $227 million in CalWORKS funding. However, the County’s continued lack of willingness to implement long-term solutions to end homelessness has left these vast funding reserves largely untapped.

Plaintiffs are represented by Lili Graham, Sarah J. Gregory, and Michelle Kim Kotval, attorneys from the Legal Aid Society of Orange County.

Editorial contact: Lili Graham | 714.571.5282 | lgraham@legal-aid.com

About Legal Aid Society of Orange County

The Legal Aid Society of Orange County is a non-profit organization dedicated to providing free legal aid services to our community’s most vulnerable populations: veterans, the homeless, families, and low-income individuals. For over 58 years, LASOC has spread its services— advocacy, legal counseling, community education, and legal representation—throughout Orange County and southeast Los Angeles to bring equal access to justice for all.

New Workshop: Limited Conservatorship en Español

LASOC/CLS would like to announce that our Limited Conservatorship Workshop will now be offering it’s first workshop specifically for Spanish-speaking litigants. The first Spanish Workshop will be held on Monday, February 6th at 12:00pm in the Santa Ana Court in Room A-100. The workshop will explain what a Limited Conservatorship is, the process for obtaining a Limited Conservatorship, common problems and a review of the forms needed to obtain a limited conservatorship.

We will likely hold this workshop in Spanish at least one more time during the year. Therefore, this is a rare opportunity. If you would like to attend our Limited Conservatorship Workshop in English, it is the first Monday of every month at the Santa Ana Court in Room A-100, with the exception of holidays.

Fighting Goliath: A mother’s battle with big insurance

Fighting Goliath: A mother’s battle with big insurance

fighting-goliath

What would you do if your child was sick with a life threatening disorder? What if after years of research, treatment, and doctors’ visits, there seemed to be no cure? What if, by a miracle, a doctor on the other side of the country said he would operate on your son and greatly improve his quality of life? What if your insurance company denied coverage for the medical transportation needed to take your son to see this doctor?

This is the grim situation Lily* faced with her 22-year-old son, Jonathon,* who suffers from Ehlers-Danlos Syndrome (EDS), a rare disorder with symptoms that include episodes of temporary paralysis and dystonia (severe involuntary muscle contractures). These episodes deprive Jonathon of the ability to move his muscles, including the muscles responsible for breathing.

Read how Lily, with the help of the Legal Aid Society of Orange County, overcame her battle with her insurance company to get her son the lifesaving procedure he needed:

Fighting big insurance feels like a modern day ‘David versus Goliath’ and our battle involved boots on the ground and prayers in the air. My 22-year-old son, Jonathon, struggles with numerous health problems, the most significant being Ehlers Danlos Syndrome. EDS is a rare genetic disorder where his body produces defective collagen.

 

Collagen is the body’s natural “glue;” it holds everything together and provides tensile strength. It’s found everywhere in the body: tissues, tendons, ligaments, bones, and internal organs. Jonathon’s collagen is like an old brittle rubber band you find in the junk drawer at home. You stretch it out to use it, and it just stays stretched out and won’t hold anything together.

 

The last three years have been the most terrifying in our lives. Ignoring the fact that my son dislocates significant bones (shoulder, hips, fingers, ribs etc.) daily, he was also having life threatening neurological attacks. In just one month he had 47 full body paralysis events and nine dystonia attacks (every muscle in the body contracts). He passed out 13 times, and stopped breathing four times!

 

After years of research, I found a neurologist in New York that gave us our first glimpse of hope. He had us perform traction on Jonathon’s head (I would just lift it perfectly straight up) and every one of these attacks stopped. When I would let go and they would resume. The problem was cranial cervical instability: his spine and head were way too loose. Corrective surgery was set for July 2016 and began with all the insurance approvals. At the end of May, the insurance approved the surgery and we began looking for air transportation.

 

Flying Jonathon to New York from California was going to be tricky. Whenever Jonathon is in paralysis, none of his muscles are working and he flops around like a rag doll. On a flight to Washington to train his medical alert dog, Jonathon was paralyzed for takeoff. I assumed strapping him to the seat and putting on a neck brace would be safe, but I was wrong. The force of takeoff flattened the top of his spine, the second curve reversed and pushed all of his ribs out and open (like shucking an oyster), and both of his hips dislocated.

 

We couldn’t chance that happening again. The next take off could permanently paralyze or kill him. Additionally, Jonathon would periodically stop breathing, and at home we had a ventilator that plugs into the wall; however, there would be no ventilator on a commercial flight.

 

In early June, the insurance company denied our request for medical air transport, as it was ‘not medically necessary.’ I called the neurosurgeon and he informed the insurance company of the necessity of medical air transport. Still, it was denied.

 

I wrote an impassioned plea stating all the medical reasons this type of air transport was a necessity. I then called the insurance company and requested an expedited appeal. Expediting it was the only chance I had at getting the insurance to review the documents prior to surgery, otherwise, the insurance had 30 days to review the file, putting the review two days past the date of surgery.

 

I had to wait two long days to see if my expedited appeal would be approved. Insanely, I was confident they would expedite the appeal; after all, the insurance company had approved the surgery so they knew the date I needed it by. Surely they would calculate this information into their factors. Two days later I found out how wrong I was. The insurance determined that reviewing it on a standard review time would not pose ‘a serious threat to his health.’

 

Really!? Try staying up all night making sure your child is breathing. Try not panicking when you are putting on the respirator before he passes out. I asked if there was an appeal to the appeal. No. Was there a supervisor I could talk to? I was told I could complain to the California Department of Managed Healthcare (CDMHC). By now I was in full blown panic. It could take days just to find the right person. I was trying to go from fighting a healthcare giant to getting help from an even bigger impersonal giant.

 

On my first call to the CDMHC, the very first person I spoke to listened compassionately and led me to the Legal Aid Society of Orange County (LASOC). I had no alternatives, but I was worried about the cost. Our family is inundated in medical bills; I have taken Jonathon everywhere I could to get the medical help he desperately needed. I called LASOC and was put in touch with Andrew, our lawyer.

 

Because of the urgency of the situation he cleared time to see us almost immediately. I was afraid to bring up the cost so I waited for him to tell us. I was utterly shocked to find out that his assistance came without charge, zero, zilch! We told him our story and our request was simple: all I wanted was for the insurance to expedite our appeal and look at the request I sent.

 

Andrew went beyond my request; he contacted Jonathon’s medical doctors and physical therapy office and requested all the pertinent records. He filed an application for Independent Medical Review with the Department of Managed Health Care, and in 24 hours submitted Jonathon’s records and an argument for expedited review and approval of the air ambulance.

 

Within a week we heard back from the plan. Not only did we get the expedited appeal, but we also we got the full approval for the flight. More than that, the Manager of Appeals and the Case Manager were on the phone at the same time telling me this. Wow, did the doors fly open in a big way. They also told me Jonathon could have his own Case Manager if we wanted it. I tried two years ago to get one and I was told they didn’t do that anymore! Heck yes, sign us up! Andrew was the first person I called (apologies to my husband) and he was as excited as we were but he asked me if I had that in writing. Oops. No, I hadn’t thought of getting that, so he set right to work getting all of the paperwork and making sure we got what the insurance had promised.

 

My son had his 11.5 hour surgery in New York with his brilliant neurosurgeon and he is now three weeks free of paralysis, three weeks free of dystonia attacks, and he hasn’t stopped breathing once!

 

Now my son has a chance to go back to college. He has actually gone out without me without all the rescue equipment we used to carry around. Andrew still checks up on us; we are waiting for the insurance to cover the bill for that medical flight, and they promised if I used the company they approved we wouldn’t have out of pocket expenses. You can bet Andrew will hold them to that. Take that Goliath!

 

Since 1958, LASOC has provided legal aid services to our communities most vulnerable populations. Please consider supporting our organization through a donation so we may continue to help families like Lily and Jonathon.

 

donate-now-button

 

*Names have been changed to protect identity

LASOC saves mother from over $35,000 in medical bills

LASOC saves mother from over $35,000 in medical bills

iStock_000021393950_XXXLarge_smaller

Jessica* recently gave birth to a beautiful, healthy baby; her and her husband’s second child. However, when Jessica attempted to pay the health care costs associated with her pregnancy, she encountered some technical difficulties on her health care provider’s end. “We had been contacting [the insurance plan] for two weeks trying to make a payment,” explains Jessica. “They kept telling us they were having technical difficulties with their computer network.”

Unable to pay her bills online or over the phone, Jessica’s only option was to mail a check, which she hoped would make it to her provider before the end of her grace period. But when Jessica called her health care provider to confirm if they had received her check, she was informed they had not received payment yet; therefore, her policy would be cancelled.

“I had been going through post-partum,” reveals Jessica. “The stress of that alone is enough without having to also face your insurance company now denying coverage due to a deadline for payment within less than 24 hours.”

Without healthcare coverage, Jessica and her family were left with over $35,000 in medical costs, mostly from her stay at the hospital where her baby was delivered. “Just the hospital stay alone was $15,000,” affirms Jessica. With a household monthly income of only $4,000, it would be impossible to pay these bills.

A referral by Covered California led Jessica to the Legal Aid Society of Orange County’s (LASOC) Health Consumer Action Center (HCAC), a specialized program dedicated to helping low-income clients access the health care system in Orange County.

On Jessica’s behalf, HCAC filed a grievance with her former health care provider. When her grievance was denied, HCAC filed a complaint with the Department of Managed Health Care (DMHC) highlighting Jessica’s continuous contact with her former health care provider as well as her numerous attempts to pay her bills.

“Jessica went through a tough time trying to handle this issue while also taking care of her newborn,” says LASOC Attorney, Angela Leong. “She definitely needed a health advocate to go through all the grievance and appeals procedure to finally get that $35,000 bill out of her life.”

Within just a few weeks, DMHC granted Jessica her reinstatement request, allowing Jessica and her family to regain coverage. HCAC played an integral role in advocating for Jessica and her family’s right to health care access, and with their help, Jessica can now rest easy knowing her family is covered.

“Angela was very helpful, understanding, and comforting, which was a relief,” says Jessica. “It was nice to talk to someone who was willing to listen and help, whereas my health care provider was just closing the door.”

To hear more success stories like Jessica’s, subscribe to our newsletter here.

 

*Name has been changed to protect identity.

Health Consumer Action Center victories

Through extensive advocacy, the Health Unit resolved the following medical billing issues. These cases are representative of many medical billing disputes cases HCAC has resolved.

An Orange County consumer tried to resolve a hospital bill incurred in May, 2012.  Consumer had no health coverage at the time of service. She paid the bill in the amount of $1182 that was due to the hospital but she continued to receive billing statements with an unpaid balance (over $8000) and eventually her account was sent to collection. She disputed the bills for many years since 2012 without any success and finally reached out to HCAC. HCAC intervened, disputed the bill on behalf of consumer, and escalated the matter to the executive management of the hospital.  Through extensive advocacy, the hospital agreed to discharge the outstanding balance, pulled the account from collection and sent a written confirmation of zero balance.

An Orange County consumer with Orange County safety-net program requested assistance with a medical debt that was related to an emergency physician’s charges, which he was unaware until he pulled his credit report.  The emergency visits was made during the time when he had coverage through the County’s safety-net program. Consumer had presented his insurance card to the emergency hospital at the time of service.  Sometime after,  he had changed his address and had not received any bills.  When he found out the debt, he disputed with the collection agency and provided proof of health coverage at that time of service and a notice stating that the emergency physician’s bill was uncovered because the provider failed to timely file the claim. HCAC disputed with the collection, whose position was that the hospital had no responsibility to volunteer patient’s insurance information with the physicians. HCAC escalated the issue with the emergency hospital’s executive level staff, who stated that the contracted physicians had a shared system containing patients’ insurance information and investigated the claim. HCAC confirmed with the emergency physician that the account was pulled from the collection.  The collection also sent a confirmation letter that the account was cancelled.  Consumer later checked that the debt was removed from his credit report. Through HCAC advocacy the consumer’s debt was resolved.