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Joe Riffe: Denied A Prosthetic By Metro Govt

February 16th, 2012 by jake · 19 Comments

That’s right – Metro Government denied Joe Riffe the prosthetic leg he needs.

My resolve has been tested today. I have to admit, I got the wind knocked out of me. It’s been quite awhile since I’ve let doubt creep in like it has today. I got a phone call from the company that I’m working with to get and fit my prosthetic. It seems Humana Insurance surprised them by not only denying my knee, but they denied everything. They denied the knee, the socket, the foot…everything that has to do with me walking. Humana is the only major insurance company left that does not provide a way to get the microprocessor controlled prosthetics, and their bullish actions have got me worried. They responded to my prosthesist that until they provide a request that includes a mechanical knee that is covered by Humana, they will continue to deny me. What does this mean for me you ask…it means my dream of being a paramedic stops here.

Click here to read the entire thing.

Our understanding is that Metro Government is self-funded (or something similar) and Humana merely covers what Metro Government says it wants to cover.

So, there you have it.

Greg Fischer and crew couldn’t give two flips.

Hiring a few friends at $100,000 a pop to “innovate”? Sure. That’s fine. Making sure someone who actually wants to serve the public gets to do so? Not so much.

But you – the reader – can actually put pressure on Greg Fischer to make this happen.

You know what to do.

Tags: Bad Behavior · Greg Fischer · Metro Government

19 responses so far ↓

  • 1 Bill // Feb 16, 2012 at 3:59 pm

    This is pure nonsense that this guy can’t get the help that he needs especially when it comes to Louisville Metro shirking their responsibilities as well as Humana. Thoroughly ridiculous on the part of Greg Fischer’s cronies and the people at Humana. These people are just as disgusting as the woman described in his blog ripping him while being in a store for being in a motorized chair and how he should get out of her way. These are the type of people that run this city and then in a two faced way talk about how COMPASSIONATE they are. If anything, instead of hiring their buddies, they should be finding a way to make sure this guy gets the help he needs to resume his life as normally as he can. Then again, these are same people and type of people that run LMAS and cover the asses of their buddies while mistreating animals. Im trying to read up on this more. However, these people running Metro government are more than willing to give hundreds of thousands to Cordish, giving about all kinds of other grants but can’t take care of one of their own. Truly a Possibility City

  • 2 Metrohack // Feb 16, 2012 at 4:00 pm

    No, employee health insurance is not self funded. What is self funded is other types of insurance like liability. Say if a LMPD officer runs over your ass, then the city’s self funded plan pays.

    They city pays around $525 a month for every employee with the employee picking up the remainder. Which is determined by what level, and who they want to include, spouse, family, etc. but the city amount does not change.

    So this is a case of Humana being assholes which is just another reason we need to go to a single payer system or Metacare for all!

  • 3 Metrohack // Feb 16, 2012 at 4:02 pm

    errr medicare

  • 4 jake // Feb 16, 2012 at 4:02 pm

    Please read before commenting, folks.

    And I quote:

    self-funded (or something similar)

    That said – Metro Government does have absolute final say over what will and will not be covered. HR and Greg Fischer have the ability to make it happen. They can approve it. They have been 100% absent.

    It’s not all on Humana.

  • 5 Gary Guss // Feb 16, 2012 at 4:05 pm

    In-Humana strikes again ! And you were worried about the Gummmints Death panels

  • 6 jake // Feb 16, 2012 at 4:09 pm

    Again, it’s not all on Humana.

  • 7 Gary Guss // Feb 16, 2012 at 8:43 pm

    It’s mostly what Humana covers like it says in the article…. “Humana is the only major insurance company left that does not provide a way to get the microprocessor controlled prosthetics, and their bullish actions have got me worried. They responded to my prosthesist that until they provide a request that includes a mechanical knee that is covered by Humana, they will continue to deny me”….
    This is how the policy is written, I guess the city bought the policy however

  • 8 jake // Feb 16, 2012 at 8:57 pm

    Unfortunately, he’s not completely spot-on with his claim that Humana is the only major insurance company left that doesn’t provide a way.

    There are plenty that do and plenty that don’t. And some that do even have policies that don’t cover them for various reasons.

    It’s not as black and white as it seems. And definitely isn’t all on Humana’s back.

  • 9 Brian // Feb 16, 2012 at 10:00 pm

    Metro is self funded for their medical insurance. Simply put, they pay Humana to administer the benefit and pay an administration fee to Humana. Then the actual claims are paid by Metro. Metro can override any decisions made. But they will be hesitant to do so due to possible perceived inconsistencies that could place them in a legal bind. None of these facts make what is occurring right or ethical as Metro should pay this claim despite any possible ramifications as it the right thing to do.

  • 10 Guuuurlpleasedon'tinsultheworkers // Feb 16, 2012 at 10:16 pm

    Fischy’s to busy hiring $100k cronies and staffing their offices. Checkout LouisvilleWorks.com to see the postings all while many agencies remain understaff and just like LMAS, EMS, Parks and MSD Fischy once again fails. All he has to do is call his millionaire buddies do the right thing.

    The silence coming from Metro Council is deafening. Hey Jim King, you have enough lettuce in left pocket to personally fund a what this gentleman deserves. It’s bad enough to have a horrible Mayor, its even worse to have a do nothing council that just as gutless and cowardly.

    Start a fund, I’ll write a check and this community will also step up when our leaders won’t. Fischer is earning enough points on his asshole card to earn a free trip to hell, first-class of course! Fischer you are a schmuck, a dumb-ass, and self-inflicted moron. Too bad we can’t put aspirin between our legs to get rid of you. What a fucking joke and we the people are not laughing you sorry sack of shit. Do us a favor and go back to living in your daddy’s shadow. All you have to do is pick-up the damn phone and I’m sure one of your many hack staffers will dial the number. I hope Jacob uses his national influence and let national folks know that you are a moron and to self-absorb to help someone in your community. Turning your back on First-Responder that wants to return to work and save more lives!!

    Mr. Riffe, thank-you for your service, your determination and on behalf of a grateful community we are sorry that the leaders we elected have let someone of your stature down. Should you ever get a prosthetic; please put a hook on it and shove it the mayor’s sorry ass and every asshole in the local media for ignoring this awful mess.

  • 11 Cavemouse // Feb 16, 2012 at 10:47 pm

    FYI – there is a donation button on Joe’s blog. Some of us are giving what we can every payday with our “OT Bloated” paychecks. We are not allowed to donate our sick time or vacation time to Joe, so we try to help as much as we can. All of the local media has been told of Joe’s situation, but only Jake and WAVE took up the challenge. This has been picked up by EMS bloggers nationwide and one is tweeting to Humana almost hourly demanding they help Joe. The national EMS community is going to band together for Joe. Please read his blog and give if you can. He is struggling to pay for his insurance and daily expenses because he has used all his vacation and sick time and no longer has a paycheck.

  • 12 Brian // Feb 17, 2012 at 6:24 am

    Cave mouse, I will eagerly donate. Good stuff. But you may want to communicate to the EMS bloggers to Tweet Metro and not Humana. Humana is not guilty on this particular one (hard to believe and indeed rare). But they are simply a TPA (third party administrator) that pays claims with Metro dollars as decided by Metro. Kudos to Jake and Wave for bringing this to light.

  • 13 jake // Feb 17, 2012 at 7:55 am

    No one deserves kudos for anything.

    This is just the right thing to do.

  • 14 T // Feb 17, 2012 at 8:54 am

    Has he tried sending a letter to Grievance & Appeals department @ Humana. I have sent more letters than I care to think about over the years and have fought them tooth and nail on multiple things. In almost all cases, they ended up paying the bill. We even had a lawyer threaten to sue them once over a bill and they ended up paying it, although they acted like they were doing us a favor. I realize that exception clauses might not be in his favor but it is worth a try if he hasn’t gone that route yet. I hate dealing with Humana.

    Oh, in response to another posters comment, the city often gets out of other, non-health insurance related issues by claiming and being granted sovereign immunity. Getting into an accident with a city employee doesn’t mean you are going to get a payout.

  • 15 Earl // Feb 17, 2012 at 9:57 am

    Brian-
    Metro’s health insurance IS NOT self-insured.
    Metro’s LIABILITY insurance is of the self-insured variety.
    Humana is the insurer, plain and simple.
    They offer three plans, and all the options are negotiated by LM HR. So- Humana insures the employees under terms and policies negotiated by LM HR.
    It’s a fairly easy thing to look up. LM pays Humana thousands of dollars per year, per employee for that coverage. Some of that money comes directly from the city, and some of it comes in the form of paycheck deductions.
    In your way, the money coming from the paycheck deductions would have to go to a health savings account. It does not.

  • 16 Metrohack // Feb 17, 2012 at 10:04 am

    Ty Earl, same thing I said in the 2nd post, just not as well as you.

  • 17 Slug // Feb 17, 2012 at 10:09 am

    WRONG Earl (unless metro has changed it in the last 5 – 6 years). metro’s medical plans are self-funded with stop-loss coverage for really big claims. fully insured plans for employee groups as large as metro are nuts. administration fees are paid to insurance company to administer the written PLAN that defines what is covered and what is not. however, metro can override just about anything.
    Brian is right on.

  • 18 Brian // Feb 17, 2012 at 10:38 am

    Earl, I know I am correct on Metro being self funded in this particular instance (not looking to argue…..just happen to know for sure). Typically larger organizations are self funded as the administration is lower on self funded groups. Or put another way, the profit margins of an insurer are lower on self funded groups compared to fully insured groups (as the insurer has no risk as they do not pay the claims). That is why Metro has the final say on whether this claim can be paid or not (since it is their money). So the pressure needs to be placed on Metro to do what is right.

  • 19 Earl // Feb 17, 2012 at 10:58 pm

    A second look proves you are correct. Humana administers the employee health insurance, while LAGIT apparently administers the rest.
    Apparently they also have it set up to where it makes money for LM government into the seven figure range, as of 2009-2010.
    That wouldn’t be an issue if Abramson wasn’t continuing to hold press conferences every year, saying the insurance premiums were rising and the employees’ paycheck deductions were going to have to cover them.

    You learn something new every day…

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