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If I could run a program, mine would dive into the realm of the US Haelth Care System. Now, not like any other program has tried do do before either. In true PBS fashion my effort would be a ever adaptive, always current educational information forum designed entirely around the average person's understanding, or rather lack of understanding all that is really going on with the health care system.

I can use my own life as the key example of how it is actually possible for someone with no degree(s), formal college, or anything considered as extra vocational training, to understand, and grasp the US Health Care System on all levels, from all sides, and how you as the person with provate medical insurance to Government provided insurance... Can work with the current system as broken as it is, and actually get better coverage, better levels of service, all done in far less time, with less overall energy, frystration and suffering than anyone had ever imagined.

Using me, and this is recently also.

1995 Partially Disabled... I apply for and am denied SSD in the late 1990's. At age 25 in 1995, I had no freaking clue. But, I did have as I still do to this day one thing that the health care system was not ready for... Determination, and the will to never, and I mean NEVER give up.

Going from a retail sales background and manual labor, after the state of NY unemployment office staff suggested many times for my wife and I to divorce in order for me to get benefits from the state... I decided then, I will not commit fraud, even at the suggestion of a state employee. My wife made something like $14.00 a month to much and so I was to not recieve any assistance from the state of NY. No job retraining as I requested, and nothing else... No, I would not be able to have that benefit, or any others.

So, the struggle begain... For the first 2 years plus, I taught myself how to use every office program on my Mac SE 30, and when we got even back then 2 old Power Mac PC's I kept up my retraining. And, two days after I requested to be allowed back to work I was a medical records auditor for a local home health aid company for the summer...

And, that would be the start of my Medical Office Industry career, where unknown to me my past job diversity combined with my new skill set, would educate me in ways no college could ever. How could I know this? Well, I worked at Stanford University during rush in the book store a couple of years, and worked as store manager of a retail store, and many other jobs, I would work at the book store of R.I.T., and soon where I would end up at Strong Memorial Hospital, University of Rochester as a secretary.

I would know my rights as a customer and how customers are taken advantage of by many companies banking on a good 98% of the public fully unaware of the rights they have. I would then start to read, and study medicine in regards to my medical condition. Not formally, but using the same books, the clinical documents that also teach future Drs. I became proactive in my health needs.

I would also learn much about locating resources to help when no one else could or would help... For instance, when I required a cane, and wheelchair for longer walks, I first asked my treating Dr at the time. He explained that he did not want me at age 25 becoming dependent on these items... OK, but, what about me wanting to go to events, festivals, and remain out of the house for a longer time than I can now? You are way to young to need these things... You to young to have been injured this way... So I asked... When would you suggest is the best time to become injured? What age? I mean to me, the pain, the injury do not seem to care on bit about my age... So, if I am to young, what age is best for this? He could not answer... Well, the fact is NO age is.

I located the needed wheelchair and cane, and never once hid these from him, or any of my providers. When asked why I have them, I told them flat out... I need them to make the walk from the car out in the parking garage, to your office several hundred yards away, when I can barely make 100 feet on a good day... How can you reasonably expect me to make an even greater dustance without assistance? I only use the wheelchair for situations where the distance is over the over the 100 feet or the distance I can walk before I collapse.

At no time in the on and off again use of these items had I ever been asked or considered to not need them... And, oddly enough I donated the items when I thought my condition was resolved. And, to my providers surprise I would not come to depend on any item for assistance, more than I would depend on my own common sense.

2005 I sent my appeal to SSD, and in 2/08 in less than 20 minutes I was granted full disability by the Administrative Law Judge, and he had been the same person in the late 1990's who would deny me. And, even then I thought he was a great person, as he saw I was partially disabled, he also took his time to explain how SSD is not for that kind of person... OK, I was greatful he explained it to me, so I could understand it.

In 9/07 I would try the last, and only treatment left that was non surgical in nature in order to resolve my condtion... That was SJ Joint Dysfunction my left SIJ. The treatment Radio Frequency Ablation, and it made me much worse... So bad as to where I am reminded of it every day to this day. The risk was very slim, I mean tiny that it could leave anyone worse. I knew the procedure, and trusted the Dr. The Dr. was a proper Dr. actively on the Medical Boards, and was practiced in this area of specialty... I have had so many treatments before, some offered short term resolution, and others made it worse, then it would calm back down...

Through all of my adventures in all realms of the medical health system... I would learn the innermost working, I would also learn to advocate for my patients when they had issues with insurance, and of course when you call from the providers office, one as large as Strong Hospital insurance companies tend to listen, and allow the needed medical service to be covered. That included brand new, so called untested, or unproven medical options... I mean access to the very best levels of the medical system, covered by insurance.

That was totally different when I called from home, and started the process of my own medical needs... 12/07 The Predetermination packet was sent in... 30 days about later the intitial denial came back.

Now, the part that makes my idea interesting to PBS... Is what I do next in order to get the full and complete attention of one of the largest, and most difficult to get an approval out of insurance giants of the US.... And, how in four days I got fully approved...

4/25/08 I contact the insurance company in a way I know will get attention of the people I need to take notice.
On 4-30-08 I am now going point by point over everything I found, and was able to explain fully so as to leave no doubt that I have a real medical need. As well as pointed out all of the issues that could in fact affect millions, and more....

If I missed anything at all in my health needs, I would still be to this day over medicated, and in a mental instatution... I also would not have been able to go head to head with the top most level Medical Director of one of the largest medical insurance companies in the world... And, with the clinical medical documentation I have to support me alone, proved I deserve the coverage.

The other issues, are well... Let's just say that should I ever decide to uhm write a book... Or, if given the shot to share my experience and knowledge some other way... Will shock the, and amaze lay people as well as medical professionals alike...

And, with the information I would provide, it would not matter how broken the medical health system is, or how wrong it seems... With these tools... Tools that once you have, will always be able to adjust to the new or different systems as they are introduced... Tools, that my insurance company never imagined someone like me could possible know. Tools that will not allow fraud to happen, as I did medically prove my case first, and the other issues just turned out to be a bad business model, and not so ethical or legal practices that I called the company out on. Alone, they would not, could not ethically, or legally made the company approve my request. I knew that, I also read ERISA not just Section 502(a) but almost all of it... That is the most messed up, goofy thing I have ever seen... And, I could only laugh at it. In the end, it is tripple talk, designed to mask the fact that it protects the insurance company more than the customer/member, and if you prove that you had been singled out, and made an example of, even with proof of error on the insurance company's side, you can only ask for what was denied, and nothing else. Even if the insurance company abused the system... Well, let's just say I was being abused, they made errors, my providers made some oversights and the mess was missed... And, if I did not catch it... I would be to this day denied, and still appealing... To just point out the errors they made, and issues missed... Not even getting to the medical proof... And ERISA kicks in after all internal appeals have been used... That can be over six months to nearly a year later... Where I could have been forced into isolation for a good seven ot more months...

Forced isolation does not affect just disabled, newly disabled people, children, but, also the elderly... One day if we are lucky we will live to be elderly... What happens when Medicare leaves you in the cracks... A limbo like I was...

My knowledge is just for private, but ALL insurance... No only medical, but ALL insurance... All situations where we as people depend on a company for a service, and or a product...

It is amazing all the hidden rights, that a good 98% of the general public is not even aware of... And, it is not just medical insurance companies that prey on people who do not know these rights...

The program name would be: Broken
The subject: How to make it work as it is, and as it changes.
The Market: The General Public
Age limit: 5 years to 205 years...
Intersting: Oh, yeah.
Actual hard core proof: Of course.
Is my knowledge worht knowing: Only if you're a customer, patient, disabled, seeking help or resources... If your human, and live in the US, or anyplace... This can be adapted to help you.

College could not, is not, will not ever offer more than what real life offers... Granted I do not have a fancy degree to be a Dr... Or other professional... I went to the school of hard knocks, and came out a Professional Proactive Patient & Advocate...

My goal is a win/win for all sides. That means, I also will cover the methods to improve the broken system at a profit to the medical insurance industry, and to show how this method could provide the best for all sides...

So, if you ask me... I think a show about what can we do, can be done, and just how to make things work as they are, and may change to... When it comes to the US Health care system... And in layperson speak... A real educational experience to be had by all... And, the information I would present would be timeless as well, so that 10 years later when most people will have forgotten all about this... Replay it, and poof all over again your educating the next generation of people... And, repeat as needed... Commen sense does not get old, it just gets forgotten... PBS os here to help us remember it...

Wheelman.WordPress.Com where I retyped the approval letter I got from Aetna.
What was approved for SIJD that is not medically treatable with todays current medical science: A Wheelchair system, that meets my needs.

Imagine now, how many people have missed error, not known rights, and got denied? Maybe someone you know, or knew may have been in this same spot... For the time private health insurance has been in place... How many people have suffered, been forced into silince and isolation, and how many went insane and lost it, how many lost there homes (Like I am soon), how many people got divorcced because the spouse could not support two people ill family members, and work many jobs (like my wife does now), how many people killed themselved feeling that was the only option left, how many people never got medical treatments, medicine, and tests that could have saved them? How many children do we need to see die from this? How, many elderly people will Medicare force into isolation until they just die?

I speak up not for me anymore... I have decided to become the voice that ROARED this is WRONG! And, I can not stand by and allow people to suffer... So, I will do what I need to in order to share my knowledge... I do not care if I get paid for it or not. However, I would like to move out of the cold, and damb humid area I live in... As, I can produce clinical studies that show people in severe chronic pain... Do a ton better in a constanly steady climate where it is warmer year round...

I speak in layperson, I can go point by point with the best of the best Medical Directors, with humor, with the ability to keep people wanting more... Like I always want...

I never give up. I mean never!

Join me on this adventure...
It's airing on PBS sometime soon. :) (well I hope at least)

Or I will just write a book... O,o Maybe Reading Rainbow will highlight it... :P