Woman, 71, fights back against Medicare – and wins!

Anita Chapman did it all by herself. The self-described Wise County girl from Texas took on one of the biggest challenges of her life. She fought Medicare over a $1,400 bill for an ambulance ride from her Haltom City home to the hospital.

Ever since her husband died a few years ago, it has been hard being on her own. “I’m an old gal from Paradise who got married at age 16,” says Chapman, 71. “As my daddy said, I went from doing what my daddy told me to do to doing what my husband told me to do. And I’ve never had to go through anything like this.”

On the night of March 2, 2008, Chapman couldn’t stand. Her doctor later described her symptoms as nausea, vomiting, a headache with severe weakness and spasms. A friend came by to help but couldn’t get her up. The friend called 911.

Paramedics took her out on a stretcher and gave her an IV solution for dehydration. She spent the night in the hospital.

A few days after coming home, she was notified that Medicare wouldn’t pay the $1,400 ambulance bill. She made a few calls and was told the bill was rejected because she didn’t need an ambulance. Unless she could prove otherwise, she had to pay the bill.

“It made me feel that I had to fight back and do something on my own,” she says.

So Chapman stepped into a bureaucratic maze of Medicare appeals, a multilevel system with strange terms such as redetermination specialist, adjudicator and administrative law judge. She worked long hours to complete Forms CMS-20027, CMS-20033 and CMS-20034B. She used a fax machine for the first time. In doing so, she set herself apart from most, Medicare specialists say.

“She’s one of the very few who continues to push Medicare,” says Pam Roach, the Medicare billing supervisor at MedStar Emergency Medical Services, which supplied the ride. “I know it’s hard for her, but a lot of the elderly don’t make the effort. They don’t have what it takes to fight the system like that.”

An advocate agrees with the sentiment. “Good for her, because there’s not a lot of help out there for these appeals,” says Judith Stein of the Center for Medicare Advocacy.

Chapman’s journey has lasted a year. It started with her request for a redetermination, which was denied by the federal Centers for Medicare & Medicaid Services.

The second appeal went to an outside company hired by the government. It denied the claim, explaining, “There was not an immediate threat to the patient’s life, limb or functioning of a body part, and the service does not meet the coverage requirements.”

After that, she received a warning: “IF PAYMENT IS NOT RECEIVED WITHIN 15 DAYS, YOUR ACCOUNT WILL BE REFERRED TO COLLECTION AGENCIES AND CREDIT BUREAUS.”

“Now that scared me,” she says. “Because I thought they were going to come to my door and take me to jail. I’ve never had a collection agency in my life. My husband paid every bill when we got it. We never bought anything on credit. The car, the house, everything we bought, we paid cash for.”

Of course, she appealed. An administrative law judge read a letter from Chapman’s doctor and another letter from Chapman’s friend that she was unable to get Chapman to stand. The judge also read the other side’s argument: The patient could have traveled “by any means other than ambulance service without endangering his or her health.” He never held a hearing.

The judge’s ruling arrived this month. When Chapman opened the letter, she first had to read through four pages of information about how to appeal. For sure, she thought she had lost again. Finally, on Page 5, she saw the words “FULLY FAVORABLE.” She read it again. And again. She won!

“You could have heard me shouting clear over Fort Worth,” she says, laughing. “If I hadn’t sent all that stuff in, I would have had to pay $1,400!”

The judge’s documents-only ruling shows the case never should have gone that far, Medicare advocate Stein says.

“Going from home to hospital in an ambulance should be covered in most circumstances,” she says.

There are two more steps.

Medicare can appeal to the Medicare Appeals Council by May 2. If Chapman loses that, she can ask for a judicial review in U.S. District Court.

So she waits. “Oh my gosh, are they going to make me do it again?”

“Come on,” MedStar’s Roach says. “Somebody have a heart.”

The Medicare site about appeals is www.cms.hhs.gov/orgmedffsappeals. An advocate’s site is www.medicareadvocacy.org.

A man fights for his right to have a garden

Mark D'Amico's garden before picture

Mark D’Amico doesn’t keep a conventional front lawn resembling the manicured look favored by his neighbors in Fort Worth’s Handley neighborhood. D’Amico created his own cottage garden.

He was so serious about the 150 different plants and flowers in his garden that he registered it as a “Certified Wildlife Habitat” with the National Wildlife Federation.

“It saves on water,” the artist says. “It’s big, bright and colorful. Flowers and hummingbirds and butterflies just swarm it — or used to.”

After a neighbor complained, D’Amico got into a scrape with Fort Worth’s code compliance department. He received a violation notice in 2006.

D’Amico says he told code compliance officer Robert Chambers that his plants and flowers were hard-to-find examples of exotic varieties. He had purchased seeds and traded for them for a decade to assemble the collection.

Several of the species are extinct in the wild, D’Amico says he told the code officer. Cultivating them and spreading the seeds helps keep the species alive.

The code officer said he understood and asked D’Amico to send him a list of all the plants, D’Amico says. Because he never heard from anyone in the city again, D’Amico says he believed the matter was settled.

But one day while he was home, D’Amico says he heard heavy equipment outside.

“I came out into the front yard and everything was gone,” he says.

“Not just mowed. They scraped it to the bare dirt with a big riding lawnmower. I was horrified.”

D’Amico’s home is not part of a neighborhood association where deed restrictions can enforce a neatly mowed lawn. Fort Worth code only states that grass and weeds cannot grow taller than 12 inches. No mention is made of shrubs and flowers.

“We called and sent letters and e-mail to both the mayor’s office and the city councilman who represents Mark’s neighborhood,” says Tom D’Amico, Mark’s father and the listed property owner. “Both offices ignored our calls, letters and e-mail. That’s pretty sad.”

Mark D’Amico says, “They can destroy anyone’s garden at any time for any reason, and there’s nothing anyone can do about it.”

Or is there?

Father and son answered that question step by step. First, they filed an $8,000 claim against the city. But that was rejected because the city said it had immunity when it came to actions of its employees, Tom D’Amico says.

They next filed a small-claims court lawsuit for $4,500. In a hearing, Mark D’Amico testified that he had no idea the city would destroy his cottage garden because neither Chambers nor anyone else informed him that the garden was in jeopardy.

In turn, a city lawyer argued that Chambers was carrying out his duty as a city employee and was immune from any legal vulnerability.

The justice of the peace decided in favor of the city, based on the city’s invocation of the doctrine of governmental immunity.

Father and son appealed to Tarrant County Court. Once again, the city pleaded its case for government immunity, court papers show. But in that courtroom, it didn’t work.

Tarrant County Court at Law No. 2 Judge Jennifer Rymell ordered both sides into mediation.

I left a message for Chambers at work, but he didn’t return the call.

He now works as a field operations supervisor in the water department.

A city spokeswoman said that because the case is in court, the city cannot comment.

Mediation was held last week, but no settlement was reached.

Meanwhile, another hearing is scheduled in Rymell’s court Monday because the city is contesting that court’s right to hear the case.

Tom D’Amico offers this advice to avid flower gardeners and collectors:

Anyone targeted by code compliance should “aggressively act and defend your rights as a property owner.”

He says, “Document all contacts [e-mails, notes, letters] with code enforcement and send any correspondence to them by certified mail requiring signature confirmation.

“Don’t be afraid to question their authority and take them to court if you feel your rights were violated. We cannot let governments automatically invoke governmental immunity and assert domain. They need to be held accountable.”

Final note: Mark D’Amico is growing back the garden.

Behind the scenes at a troubled Texas electric company

How rare to see what goes on behind the scenes at a Texas electric company.

Watchdog Nation Staff is pleased to see that a smart blogger recognized this fact: On the behind-the-scenes nastiness, as alleged in a lawsuit, involving troubled Amigo Energy, the blogger notes that “the Star Telegram was the only media source” to report this.

Because the live link to Lieber’s column won’t last forever, here is what the founder of Watchdog Nation had to report:

There was the chief executive officer of Merrill Lynch who bought the $35,000 toilet for his office. Then we learned about the peanut butter company CEO who the Food and Drug Administration says knowingly shipped products tainted with salmonella.

The latest? The CEO at a Texas electricity provider who is accused of ignoring state regulators and trying to overcharge customers to save the company.

And who makes these allegations? None other than the company’s previous CEO, who says he was fired when he tried to blow the whistle.

Javier Vega, the former CEO and founder of Amigo Energy of Houston, filed a wrongful-termination lawsuit against Amigo’s current owner, Fulcrum Power, in Harris County district court in November.

His lawsuit is more than an employment dispute.

It says, “The case also involves the greed and corruption of certain individuals and legal entities that led to blatant and knowingly illegal efforts to collect improper rates from Texas retail electricity consumers.”

In a brief interview, Amigo’s current CEO said the allegations are false.

“We vehemently deny all of Mr. Vega’s claims,” Gerardo “G.P.” Manalac told me. “We intend to let the litigation go its course.”

He added: “Amigo, like any other retail electric provider, had a very difficult year. But we turned the corner on that and are back on track.”

He said his company is cooperating with an investigation by the Texas Public Utility Commission into allegations of overcharging.

The lawsuit offers a peek at the turmoil behind the scenes at Amigo last year, when hundreds of customers complained that they were overcharged. Many said the company refused to answer their complaints and sent a collection agency after them, sometimes within days of the first bill’s arrival.

The PUC reprimanded the company for violating state rules, but it has yet to levy fines or other penalties.

According to Vega’s lawsuit, the problems stemmed from his decision in 2007 to sell his company to Fulcrum Power of Houston, which was a wholesale electricity provider for Amigo. Vega stayed on as CEO.

The first year went smoothly, the lawsuit says. But last June, Manalac, Fulcrum’s co-founder, took day-to-day operations away from Vega, who kept the CEO title in name only.

Manalac, though, did not buy electricity at lower prices for future use to hedge against price jumps, the lawsuit contends, something that Vega handled when he ran the company. Vega claims that he repeatedly warned Manalac to stop selling fixed-rate contracts to customers because the company hadn’t bought enough electricity at lower prices to make a profit. If prices jumped, he warned, the company could find itself in severe trouble.

Prices did jump, and the company lost $15 million by “gross mismanagement in a mere five months” last year, Vega contends in the suit.

To make up for the loss, the suit says, the company turned to “aggressive price increase methods” aimed at former customers of National Power, which closed in May. Amigo bought National Power’s variable-rate customers, who suddenly found themselves paying higher prices with a new provider.

According to state rules, an electricity provider may not raise rates by more than 10 percent in one month unless a customer is properly notified. Rates for former National Power customers in Dallas went up to 16 cents per kilowatt-hour, and Houston-area customers were stunned to see their rates jump to 20 cents. That increase was handled with proper notification, the suit alleges.

A few weeks later, Amigo again raised the rates for former National Power customers, this time as high as the 24- to 25-cent range. There was no proper notice, and the increase was more than the allowed 10 percent, according to the suit.

Customers were also wrongly billed at the higher rate for a period before the rate took effect, the suit charges. When some customers received several months’ worth of bills at once, they were stunned by the higher rates and called to complain. But they couldn’t reach anyone at Amigo. More than 700 customers complained to the PUC, which launched an investigation. In September, the PUC ordered the company to “rerate” hundreds of customers – lower their bills to the proper amount.

The PUC also cited Amigo for numerous violations – not sending bills to customers, refusing to offer payment arrangements to shellshocked customers, not giving proper notice before an increase and not responding to customer complaints.

The suit contends that Fulcrum cut Amigo’s customer service staff, leaving angry customers with phone waits “in excess of one hour for tens of thousands of Amigo Energy customers.” There was also a backlog of 10,000 unanswered customer e-mails.

PUC staffers were coming down hard on Amigo because of the many complaints. One PUC official, the lawsuit says, asked an Amigo executive whether the company wanted “to continue to be in this business.”

Manalac insisted on a get-tough strategy aimed at customers who owed money, even if the charges were incorrect, the suit says.

He ordered that collection letters be sent to customers only days after their first bills arrived. And he refused the PUC’s directive that Amigo go back and rerate the bills, court papers say.

Manalac sent an e-mail, papers say, urging bill collectors to “to pester these people” to pay. In another e-mail, he wrote, “Allow them no negotiation the first or second round (and then we can go from there).”

Vega talked about quitting, but before he could, the suit says, Fulcrum executives told him he was fired for spreading harmful information about the company.

Vega’s lawyer did not return phone calls. Fulcrum’s lawyer declined to comment.

It may not be a good time for some chief executives, but it can be an even worse time for customers.

Sounds of gunfire stir woman’s sad memory

Although her street is called Paradise Court, Marion Blackburn was a nervous wreck. New neighbors built a shooting range on the other side of her property line in unincorporated Johnson County. Their shooting was loud, and she feared a stray bullet would ricochet toward her house. Even in gun-loving Texas, Blackburn could be forgiven for her worries. Twenty-six years ago, her oldest son was killed in a shooting accident nearby. She knows what it’s like to lose a loved one to a stray bullet.

In recent weeks, Blackburn called and wrote letters to about a dozen federal, state and county elected officials, anybody she thought could help. But she neglected to make the one contact that mattered most.

She started with a call to the Johnson County sheriff. Deputies came by and looked at the boundary lines and the shooting range. They pronounced it legal.

“Can’t be,” Blackburn remembers thinking. But it’s true. Texas laws are lenient, compared with city rules, when it comes to shooting in unincorporated areas of a county.

A person can use a gun in unincorporated areas, in most cases, as long as a bullet doesn’t cross a property line or the shooter isn’t behaving in an irresponsible manner. It’s a Texas tradition, for sure.

The shooting range is built with logs and tin and has a dirt berm behind it. Sheriff’s deputies pronounced it solid, Blackburn recalled. The shooters’ position is less than 30 yards from the home.

It’s against the law to shoot across someone’s property line, but these neighbors shot along their own side of the fence.

Lt. Tim Jones, a spokesman for the Johnson County Sheriff’s Department, says that deputies tell shooters to stop when they violate laws, and that some are charged with disorderly conduct.

The bottom line is responsibility, says Alice Tripp, legislative director for the Texas State Rifle Association.

“No matter where you are, you’re responsible and accountable under the law for the discharge of a firearm or bow and arrow, just like you are with your car,” she said.

“If you damage someone’s property or injure someone, it doesn’t matter where you are. Nobody could say that you could shoot into someone’s house and that would be OK.”

Still, from Blackburn’s perspective, that’s almost what happened to her 19-year-old son, Glenn, in 1983.

Glenn died from a gunshot wound to the back of his head — from a rifle. The three friends with him later told investigators they were outside when it happened. At first, it was ruled a suicide.

During a grand jury inquiry, the friends admitted they had lied about the circumstances. Glenn had died when one of the boys accidentally pulled the trigger, according to Blackburn’s recollection.

No charges were ever filed.

“There are too many things that can happen with weapons that are unexpected,” she said.

After few elected officials bothered to reply to her letter-writing campaign, Blackburn contacted The Watchdog.

I reviewed state law and found one exception. County commissioners can enact a shooting ban in unincorporated areas in platted subdivisions where properties are 10 acres or less.

Blackburn’s neighborhood is legally called Paradise Estates. She lives on Lot 70.

When I told her, Blackburn talked about circulating a petition among her neighbors.

Before doing that, though, I asked her why she never tried to talk to the neighbor with the shooting range. She said she felt intimidated.

So I left her home, went around the block and knocked on the neighbor’s door.

Roland Buie greeted me. I told him why I was there.

Buie is a minister who moved into the neighborhood to start a church. His pastoral manner quickly emerged when I told him about Blackburn and her family history. He shoots with his two sons for enjoyment, he said, but he wanted to help her.

“As a pastor, I deal with people’s problems all the time,” he said.

“I don’t want to make her feel uncomfortable in her own home. We’ll quit shooting out there. Tell her I apologize. I really didn’t mean to upset her in any way.”

I asked if she could come over. He quickly said yes, and in a few minutes, I introduced neighbor to neighbor.

They each apologized to the other. “Really, I guess I should have walked over here, huh?” she said.

“I can’t even begin to know how it feels to lose a child,” he said.

He told her he intended to dismantle the shooting range. They talked about neighbors they both knew and their families.

When I left, they were becoming friends, neighbors.

Tell everyone you know about Dell’s legal action

Jacquelyn Wright usually gives advice and solves problems for others. But when it came to her Dell computer, the Tarrant County Precinct 4 justice of the peace struck out.

“I want Dell to either honor their warranty or refund what I paid for the warranty,” the judge told The Watchdog about her PC, which lost power.

A Dell phone technician wanted her to open the computer and fiddle with the insides, but she didn’t feel qualified. She was afraid that if she made a mistake, her warranty would be voided.

Sorry, Dell informed her, the warranty only applies after you have done what the phone tech asks you to do.

The Watchdog contacted Dell. The company didn’t respond for several weeks, so I relayed the problem again.

Dell later reported that it had tried to resolve her problem “several times.” A spokesman added, “Dell, however, is willing to reimburse the cost of her power supply.”

That was news to Wright, who told me she had received “no reply from Dell whatsoever” after The Watchdog intervened. The judge, who presides over a small-claims court, added: “They lied. No phone calls. No e-mails. No letters. None. Nada.”

This is not the only example I’ve found showing a disconnect between what Dell says and what its customers say.

Now customers such as Wright have a way to receive compensation for their problems from Dell and its subsidiary, Dell Financial Services.

Last month, Dell agreed to settle a case joined by 47 state attorneys general. Dell will reimburse eligible customers for past business practices. The company also agreed to change some of its practices and procedures involving warranty service, interest charges, marketing, rebates and other customer service issues.

If you did business with Dell between April 1, 2005, and April 12, 2009, you have until April 13 to file a claim with the Texas attorney general’s office for a piece of the $162,000 Dell has set aside for reimbursements.

Dell admits no wrongdoing. “The issues represented only a very small percentage of the tens of millions of Dell customer transactions in the states during the 4-year period,” spokesman David Frink said in statement. “Dell’s goal is to provide the best customer service experience possible.”

Tell that to Gene Morgan, who went to the Dell Web site to find out what kind of memory stick his mother-in-law’s laptop needed. He copied the part number and then purchased it from another company. But the wrong part was listed. The laptop crashed and died.

He complained to Dell about the inaccuracy. He tried for weeks to get the company to acknowledge its mistake. The incorrect part is still listed on the site, he says.

Here’s the disconnect: The Dell spokesman says that a staffer contacted Morgan and explained the situation and that Morgan was “good to go.”

“He told our rep he was calling you that day to let you know his questions had been answered to his satisfaction,” Frink said. “He told our rep that he was then leaving on a two-week trip.”

Says Morgan, “I have not been out of town.” He added: “I never got any response from Dell at all. As for the laptop, we had to buy a new one. It was not a Dell. We would not do business with them after the treatment we got.”

Joseph Johnson of Keller was victimized once by an identity thief and then, he says, a second time by Dell Financial Services, which refused to help him clear up fraud on an account.

The thief opened a Dell account using Johnson’s name, and the transactions were hurting his credit score. Johnson tried for months to get Dell’s help, but no one would return his calls, he says.

After The Watchdog intervened, Johnson said, a Dell staffer called and “told me she was aware that you knew and preferred to keep this out of the papers.”

The account was closed. Dell contacted the credit bureaus. Total time of problem resolution: four months.

Ronald Goldman of Fort Worth did somewhat better. When his computer froze, he knew it was under warranty. But when he sought help, he couldn’t understand the phone techs because of their accent, and he says they couldn’t understand him. He asked to speak to someone in Round Rock, home of Dell headquarters. He says he was told he had to pay $149 for a North American tech.

Bottom line: “She answered many questions. I am on my way to resolve my problems.”

All Dell customers who feel they were wronged by the company should take advantage of the settlement and file a claim. But hurry, the deadline is in 52 days.

Filing a claim Learn about the Dell settlement at www.TexasAttorneyGeneral.gov or call 800-252-8011.

The attorney general’s Web site has Frequently Asked Questions and a claims form.

Dell customers who did business with Dell Financial Services or Dell between April 1, 2005, and April 12, 2009, are eligible.

Self-regulation of online spying by the spies? Oh, please!

Have you heard of online behavioral advertising?

That’s Web sites tracking your online activities, including your searches, and delivering advertising to you based on your interests. For now, the practice is unregulated by the federal government, and companies are supposed to regulate themselves.

But the government and privacy experts are scrutinizing this growing practice in light of privacy concerns. They say they worry most about use of sensitive information regarding finance, children’s privacy, health and Social Security numbers.

A Federal Trade Commission report says a company engaged in the practice must provide “clear and prominent notice” to consumers that it tracks Web habits to match related advertising. The report says such alerts are often posted in lengthy and difficult-to-understand notices.

Companies need to create effective disclosure statements separate from privacy policies, the report says. It also says companies should let consumers opt out of behavioral advertising.

Dear AT&T, With Love from The Watchdog

Dear AT&T:

I have a question for you: Why do so many people complain to me about your customer service? Repeatedly, they tell me about customer service reps who drop the ball. Lately, I’m hearing a lot of grumbling about your U-verse television service.

See, I have this job that allows me to monitor in an unscientific way which companies are on top of their game. When I keep hearing from readers about one particular company, I know things aren’t right.

Lately, I’m hearing about you.

When you rolled out your U-verse television service in Dallas-Fort Worth 16 months ago, were you prepared to handle your customers and all their ensuing troubles?

Your spokeswoman told me about the “phenomenal customer growth” that brought you 100,000 new U-verse customers in the region. She didn’t agree that there are major problems and said you diligently train your staff of 300,000 to provide great service to everyone.

You do have a call center dedicated to U-verse troubleshooting, and your promised two-hour installation window for a technician visit is commendable – when it works.

“Overall,” spokeswoman Sarah Andreani told me, “we really have gotten a positive response from U-verse customers.”

Granted, J.D. Power and Associates named you the best TV provider in customer satisfaction for our region. So good for you. But the folks who contacted The Watchdog apparently didn’t vote.

I’m talking about customers like Shaun and Kim Hamblin, who ordered U-verse but waited three times for installers who never showed. And when one finally arrived, he accidentally cut their DSL line and they lost Internet service for days.

There’s Cheryl Vieau, fighting a $225 disconnect fee without much success for weeks. “I have been on the phone, mostly on hold, for hours,” she said.

Thomas Parker, fretting for a year about U-verse, said he is giving up: “I have no more patience for this. I haven’t complained in over a month because what’s the point?”

James Burke said six technicians visited his home, but none could fix his poor TV service. “No one seems to care about my problem,” he said.

Seth Viertel has tried for months – “I am at my wits’ end” – to get payments restored to his checking account that were originally credited to the wrong customer account. “AT&T’s customer service is anything but,” he said.

Rebates and rewards? Another sticky wicket. Charles Dempsey couldn’t get his promised $50 gift card from you for signing up for your long-distance plan.

Donald Martin is waiting for his referral reward, too. Someone on your end punched in a wrong number. “It seems there are so many little things that can disqualify one for a reward, and AT&T doesn’t even let you know if they are not going to honor them,” he said.

Complaints about your land-line and cellular service are rarer, but hey, you’re the phone company. That’s what you did for a century before you suddenly spread your wings into TV and computers.

Before you celebrate, though, I’d better mention Morgan Bilbo. He’s still ticked at you because he continues to receive bills for calls he says he didn’t make. “I am very upset and losing sleep over it,” he said.

AT&T, maybe I’m being too rough, but maybe not. Listen to Joyce Polson, who began her letter to me about her U-verse/Internet package this way: “The worst day of my life was the day my husband switched us to this messed up service.”

All these customers contacted me because they couldn’t get anywhere with you. I passed them on to Andreani, your spokeswoman, and she took over from there.

But AT&T, I really don’t want to be your middleman.

As Andreani said, one unhappy customer is one too many.

“We are continuing to improve, but you know what, we have a lot of work to do,” she said.

Amen.