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HealthChoice Disability Program

Oklahoma State & Education Employees Group Insurance

Mary of Tulsa (10/03/03):
I am a 43-year-old female and I was diagnosed with Ankylosing Spondylitis in 1994. I became a full-time employee for the State of Oklahoma/Office of Juvenile Affairs 6/5/95. I had no choice in paying for disability insurance, it was a requirement.

Finally, I had worked and struggled with severe pain from head to toe as long as I could. In August of 2001 my right knee, elbow, hips and back had become so painful with stiffness, inflammation and swelling, I could no longer manage a job. I could not properly groom myself for my position, nor could I safely drive the distance I had to drive back and fourth. First, I could not turn my back and neck in the morning to safely see to change lanes, or get on the highways necessary to get to work.

My right knee was so swollen and stiff I had to pull my leg from the gas to the brake with my right hand. Imagine driving 60 miles per day with your precious daughter in the car, wondering if today would be the day I would make a mistake and kill us both or someone else.

After being treated by an orthopedic specialist, MRI's, physical therapy which made my knee worse, etc. etc., The orthopedic specialist told me it was time to file for disability. I told him I had disability insurance through the state, he said file a claim. When I went to speak with my primary physician after the specialist's diagnosis, he stateD that I had reached the end of the line. I could no longer perform my duties, and it was nearLY impossible to stay awake at work with the amounts of medication I was taking. I was always ill because I caught everything everyone else had due to having an autoimmune disease. I also have no tissue left on both sides of my jaw joints, making it very hard coping with headaches that made me want to put a gun to my head.

My physician and specialist diagnosed me as permanently disabled. I followed all the rules, jumped through all the hoops as well as my doctors. I was turned down not once but twice. I was evaluated by a "nurse" who was not an RN, and I was turned down by the Oklahoma State and Education Employee Group Insurance Board. Not one doctor sits on this board, I never spoke to a doctor, I never saw one of their doctors. I was lied to, and payed these thieves monthly without a say in the matter. They stole my money while giving me and thousands of other workers for the State of Oklahoma a false sense of security.

I wrote my Governer, and to my suprise I got a response. They stated my concerns would be addressed, that he felt sure they would be attentive and forthright in considering my concerns, and that he was to be apprised of their correspondence with me. I never heard a word for three months. I then turned them in to the State of Oklahoma for Insurance Fraud, writing the Insurance Commissioners Office. I received an answer stating they felt real sure Healthchoice would be contacting me soon. Again, I heard nothing.

I called the Insurance Commissioners office, I spoke to a concerned young lady. She said they were all state employees as well, and they were all moved by my letter. They were worried this might happen to them one day. She called them every day until they sent me a response. The response was to file a grievance, and the packet to do it with. Again more hoops. But this young lady stated they have made me their mission. Jump through this last hoop and we will help you all we can.

I wouldn't have to jump through hoops if insurance companies were honest. They hide behind the fact that there are only three lawyers in Tulsa, Oklahoma that handle disabilty insurance cases. Diability insurance provided by an employer goes to federal court, not state. It takes a minimum of one and 1/2 years to two years to settle. These three lawyers can't afford the manpower to take any more cases, and they are financially strapped because of the time it takes to settle a case.

Insurance companies are thieves of the worst kind; they take your money without batting an eye. Then when you are in dire straits you are SOL. I have been financially ruined, my house is being forclosed on; I only have 6 months left on a 15-year loan. I finally made it to a wheelchair this last July and was bed-ridden for a month. I now take two injections of Enbrel a week, it costs $1100 per month.

Yes I have a disease, a rare and painful, debilitating disease. I did not ask for this disease, and would not wish it on my worst enemy if I had one. Every single day, I have to look my husband and daughter in the eyes, knowing that we are losing everything. The guilt I feel is even more painful and debilitating then my disease.

What has happened to America? Have we the people become victims of common thievery committed by our own financial institutions? The only system we have to fight these common thugs has been corrupted by the common thugs we are forced to fight. Therefore it is a lose lose situation from the git-go. America the Beautiful has become America the Ugly!

A lot of buck-passing is evident here. In fact, there is no insurance company involved. The program that supposedly protects Mary and 170,000 other Oklahomans is self-funded by the state (see press release below). This is not unusual but it makes it pretty hypocritical for the state to shed crocodile tears about how it's trying to help. The governor could solve Mary's problem with a 15-word memo if he wanted to.

Unfortunately, it is very difficult to sue public bodies and litigation may not be the answer for Mary. Normally, a disabled person can receive subsistence coverage from Social Security but public employees are often not included in the Social Security program, which would seem to be the case here. Mary should, at the very least, apply for Medicaid coverage, which would help with her medical and prescription expenses.

Oklahoma State & Education Employees Group Insurance Board
News Release - 8/15/03
Contact: Hilary Johnston (405) 717-8868

State Insurance Board Adopts Rates for 2004
The Oklahoma State and Education Employees Group Insurance Board (OSEEGIB) adopted premium rates for its HealthChoice health, dental, life, and disability insurance programs for 2004. The Board took action at its August 15th meeting, and the new premiums will be effective January 1, 2004.

The adopted 2004 health plan premiums represent an overall increase of 8.58% above current rates. Following the Board's 10 a.m. meeting, Board Chairman Richard Womack said, "Although the increase is significant, several of our neighboring states are facing increases that range from 15% to 17%, and while those rates are not yet available, we believe the HMO participants will adopt increases ranging from 14% to 25%. We understand, and are very sympathetic to the hardships that any increase may cause our members, and the Board has done its best to keep the increases as small as possible."

The HealthChoice Basic Plan has been designed to provide 100% coverage for the first $500 of eligible health care, competitive premiums, and a financial safety net in the event of catastrophic illness. ...

A slight increase was adopted for the HealthChoice Life Plan and premiums for the HealthChoice Disability Plan will increase from $4.10 to $6.28 per employee, per month. ...

All 2004 rates were calculated by the Board's actuary, The Segal Company, based upon actual HealthChoice claims experience data.

OSEEGIB provides self-funded health, dental, life and disability insurance for approximately 170,000 governmental and education employees, retirees and dependents.

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