sherri parker
| Sherri Parker Port Richey, FL, USA Post Op - BMI: 48.9 Surgery Type: RNY Member ID: parker979867456 Contact: Click here to send a Personal Message Surgeon: Barry Haicken, M.D. |
Click here for Sherri's surgery support page Click here for the 05/2004 Reunion Page Click here to print Sherri's cards (You can print your own cards, and if you're good at it, you can help print cards for your friends as well!) |
UNTIL MY RE-BIRTHDAY!
I am 42 and weigh 425 pounds. I basically grabbed a tiger by the tail and now I am running with it.
Back in May of 2002 I went to a lecture involving Wls. The Doctor was very nice and informative about the Laposcoptic Surgery.****Please note **** The lecture I went to was Dr.Dy in New Port Richey, Fl.
Knowing that my insurance would not cover wls reguardless. I gave the doctor a note telling him that I thought his lecture was very interesting. However I am one of the people that he talked about with insurance not covering wls.
I signed it and left my number on it. A few weeks later I got a call from his office(Dr. DY) asking for me to come in. I plainly stated that it would be a waste of time and money cause my insurance will not cover wls.
I was told that when it came to my health that there is no such thing as a waste.
The nurse then ask if I am sure about my insurance. I said you don't know Wal-Mart.
Their #1 thing is to deny the claim. It is alway's a fight to get them to pay for anything.
Also it clearly states in their handbook that any treatment obesity related is not covered including wls. Even if it makes another problem better.
So I made an appointment went in and was told of all of the thing's that I need to do.
I had gotton letter's from my PCP and my foot doctor. Both stated that it was medically necessary for me to have the WLS since my weight was uncontrollable.
Both mentioned what was wrong with me.
The surgeon submitted his letter along with mine.
The claim was turned down.
I wrote a letter of appeal and sent in copies of the letters. Again I was DENIED only to be remined that wls is not covered and I need to read the employee handbook on page 34.
Sent in second letter. Denied again. This time I was sent a copy of page 34 out of the employee handbook.
I called Wal-Mart Offices to speak with them about their decision. Again I was politly reminded that in the employee handbook on page 34 it clearly states that anything involving Obesity weight lose is not covered.
I asked why? I was told to look up the ERISA ACTof 1974. At this point I was like What is that.
Not really knowing what the Erisa act was. I contacted my State Rep. and Congresswoman. While at the sametime learning all I can about the ERISA ACT of 1974. Both took a look at the problem at hand.
The State Rep. contacted the Insurance Commissioner's Office. Only to be told the same thing that I knew all along.
From there they tried finding me a doctor that might help. What they did find was a Pulmonary doctor at USF that was trying to get a weight lose program going.*** Which fell through later.***
I went to see him. He ordered a sleep study. I now found out that I have Sleep apnea real bad. So I now go to bed with a CPAP machine at night.
Thinking that this would help me get the weight lose surgery I contacted Wal-Mart. Guess What. They would perfer to pay for the effects of obesity rather then help fix the problem. I was told that they would provide me with thing's that I might need to have a better quality of life. Meaning: CPAP, wheelchair, lift,nurse and whatever else is needed for a quality of life. I don't call this a quality of life. The only thing I need at this point in my life is the CPAP Machine.
Just to note they will cover an operation on my back for the chronic pain that my heavy hanging stomach causes along with removing the heel spurs that will only grow back. Because of my weight.
In closing I would like to say WAL-MART IS NOT OBESE FRIENDLY.
IF YOU OR ANYONE IN YOUR FAMILY NEED HELP WITH OBESITY. DON'T WASTE YOUR MONEY OR TIME WITH WAL-MART HEALTH INSURANCE. IT IS WORTHLESS WHEN IT COMES TO HELPING THE OBESE.
I HAVE DONE EVERYTHING POSSIBLE AND HAVE GOTTON NOWHERE. I AM A PRISONER OF THEIR HEALTH-CARE. BEWARE STAY AWAY FROM WAL-MART.
It is over I have nowhere else to turn.
You really don't know how helpless I feel.
Have a good life and best wishes on your adventure. Mine is the same FAT.
8/17/03
There is an old saying it's not over till the fat lady sing's. Well I am not singing. I am still fighting. I can't say much right now. But if there is a will there is a way.
I will not take NO for an answer. I will not roll over and die.
I have right's and so do you.
Wal-Mart say It is a life style choice. So is clogged artities.
But yet people with clogged artities can get help. Not me? I don't think so. Food is food. It all goes down the same way and comes out the same way. Just the effect is different. Sure lifestyle does play a role into this. We make choices everyday.
September 30, 2003
Wal-Mart Cost-Cutting Finds Big Target in Health Benefits
Restrictions, Tough Stance on Basic Claims
Keep Its Outlays Below the U.S. Average
By BERNARD WYSOCKI JR. and ANN ZIMMERMAN
Staff Reporters of THE WALL STREET JOURNAL
BENTONVILLE, Ark. -- Wal-Mart Stores Inc. is famous for cutting costs everywhere it can. Today a giant target for the world's biggest retailer is the health-care costs of its employees.
Wal-Mart makes new hourly workers wait six months to sign up for its benefits plan and doesn't cover retirees at all. Its deductibles range as high as $1,000, triple the norm. It refuses to pay for flu shots, eye exams, child vaccinations, chiropractic services and numerous other treatments allowed by many other companies. In many cases, it won't pay for treatment of pre-existing conditions in the first year of coverage.
The payoff: Last year, average spending on health benefits for each of the company's roughly 500,000 covered employees was $3,500, almost 40% less than the average for all U.S. corporations and 30% less than the rest of the wholesale/retail industry, according to estimates by Mercer Human Resource Consulting, a unit of Marsh & McLennan Cos.
As the nation's biggest private employer, with a U.S. payroll of 1.16 million, Wal-Mart could carry enormous influence with this approach at a time when all companies are struggling to contain the soaring cost of health care. In 2003, some 13% of U.S. employers trimmed health benefits, while 7% increased them, according to the Kaiser Family Foundation, a nonprofit research group in Menlo Park, Calif.
It's too soon to say whether Wal-Mart will pioneer a trend toward less-generous benefits. At the very least, other companies in the retailing industry, where margins are razor-thin, are watching Wal-Mart closely.
Soaring health costs "are absolutely an acute issue in the whole retail industry," says Blaine Bos, a principal at Mercer. "You've got to benchmark constantly what your competition is doing. And if you are in this industry, you certainly want to benchmark to Wal-Mart." Many companies are having employees pick up more of their health-care tab. Just recently, a top Wal-Mart rival, Minneapolis-based Target Corp., reduced health benefits for its part-time employees.
Wal-Mart says part of its philosophy is that the company should pay for catastrophic health expenses -- cancer treatments, organ transplants -- that could financially ruin an employee. It typically pays 100% of medical charges above $1,750 a year in out-of-pocket expenses; in addition to the deductible and premiums, employees pay 20% of medical costs up to $1,750. And Wal-Mart has no lifetime caps on coverage -- a benefit offered by just 42% of retailers and 47% of employers overall, according to Watson Wyatt Worldwide, a Washington-based consulting firm.
Tom Emerick, benefits vice president, says the company covers medical bills that exceed $100,000 each on at least 800 employees a year. A further 20,000 cases a year cost Wal-Mart more than $10,000 each. The company has paid for more than 300 organ transplants in the past five years, costing $1 million or more each.
Wal-Mart has been using a team of six people to scour every state for the lowest-cost networks of doctors and hospitals. In Colorado, for instance, Wal-Mart has contracted in the past two years with MMA, a Greenwood Village, Colo., managed-care provider that has a network of 7,000 doctors and 62 affiliated hospitals statewide. MMA calculates the cost of each medical procedure according to the market rates in 14 different regions in the state. Statewide rates tend to be higher.
Last week, Wal-Mart announced that it has ended its state contracts, such as that with MMA, in favor of a national contract with Blue Cross benefit plans to administer its health plan nationally. "The state-by-state analysis showed us we could save even more money by shifting to the Blues," says Mr. Emerick, referring to Blue Cross and Blue Shield.
Wal-Mart executives say shifting routine-care costs to employees keeps premiums down. The company has raised premiums 50% during the past two years, but an employee still can join the plan for $13 every two weeks, well below many employer-sponsored plans. That rate, however, comes with a high annual deductible of $1,000.
Wal-Mart offers other plans with higher premiums and deductibles as low as $350. About 90% of retailers and of U.S. employers overall have deductibles of $310 or less, according to Watson Wyatt. Wal-Mart employee premiums covered about one-third of the $3,500 spent per employee on health benefits last year, a share that experts at Segal Co., a benefits consultant, say is typical for large retailers.
The United Food and Commercial Workers union has made health benefits the centerpiece of its drive to unionize Wal-Mart's work force. One of the union's chief complaints is that Wal-Mart's plan discourages workers from signing up for coverage at all. The union cites, among other things, the company's six-month waiting period for new hourly employees, high deductibles, tight coverage restrictions and $50 charge every two weeks to cover spouses who could get insurance elsewhere.
About 60% of the roughly 800,000 employees eligible for coverage at Wal-Mart sign up, compared with 72% for the whole retailing industry, according to a 2003 survey by the Kaiser Family Foundation.
Company executives say they don't try to dissuade employees from taking coverage. Executives note that some retailers have even-longer waiting periods and don't offer health insurance to part-timers, who can join Wal-Mart's plan after two years on the job.
"When General Motors was the biggest company, it raised the bar on benefits and wages," says Al Zack, an official of the UFCW union in Washington. "Now Wal-Mart is the biggest, and it has lowered the bar."
"The problem is rising health-care costs," responds Jay Allen, Wal-Mart's senior vice president for public affairs. "We're grappling with it like everyone else."
Larry Allen (no relation to the Wal-Mart executive) and his wife, Jacque, were hired last year by a Las Vegas Wal-Mart as produce clerks and chose to forgo coverage, in part because they considered it too costly. They each earned about $8 an hour, so monthly health-care premiums of $200 would have eaten up more than 10% of their combined take-home pay.
Mr. Allen also was deterred by the plan's strict rules on pre-existing conditions. He previously had been treated for a liver disorder and high blood pressure, neither of which would be covered for at least a year under Wal-Mart's self-funded plan. Since the mid-1990s, these clauses have become less common in employer plans and remain in force for less than a third of new employees in self-funded plans, according to Kaiser. Such plans, common at most big employers, use corporate revenue and employee contributions to finance a menu of benefits.
Mr. Allen, 47, soon suffered a stroke and incurred $31,000 in medical bills. "I'm going to have to pay this debt, but I'm overwhelmed" by collection agencies, he says. This summer, he left Wal-Mart and took a job at the UFCW. He's now insured under a plan offered by the new employer of his wife, who left Wal-Mart last October.
Wal-Mart's benefits sometimes are a godsend. Two years ago, John and Tina Millwood's son, Simuel, was born with biliary artesia, a liver disease that required a transplant. Mr. Millwood, whose annual salary as a store assistant manager is $32,500, estimates that he has paid about $5,000 a year on health care since his son's birth. The child received $1.5 million of health care during his first year or so.
Seven months after Simuel was diagnosed and hours after he was placed on a transplant list, the Mayo Clinic told the Millwoods that a liver was available. Wal-Mart arranged for a private jet to fly the family from their East Texas home to Minnesota. Its health plan paid for the transplant, two months in the hospital, the parents' lodging during that time, several follow-up trips for additional operations and (for a year) a $1,000-a-month medicine bill that included costly antirejection drugs. Wal-Mart employees, through contributions to a special fund, also helped subsidize the family so Mr. Millwood could take two months off.
"For the rest of his life, Wal-Mart will pay his medical costs, because there's no lifetime maximum," says Mrs. Millwood, who quit her $22,000-a-year payroll-clerk job at a gas company to care for her son. The only thing Wal-Mart doesn't cover anymore is the current tab for his antirejection drug of $8,400 a year, so that's covered by Medicaid, the state and federally funded health program for the poor.
At the same time, Wal-Mart refuses to budge on items covered by most employers. Four out of five employees in the U.S. covered by self-funded health plans get contraceptive-drug benefits. Wal-Mart employees don't. The policy triggered a lawsuit by a female customer-service manager in Georgia, which has turned into a class-action lawsuit in federal court in Atlanta.
The plaintiffs claim that Wal-Mart's policy discriminates against women, forcing them "to choose between paying their own out-of-pocket prescription costs or risking unintended pregnancy." Janine Pollack, one of the plaintiffs' lawyers, says Wal-Mart has 500,000 female employees of child-bearing age, although only a portion of them are covered by the company plan. Still, if Wal-Mart loses a class-action suit, the cost of paying for contraceptives would be "tens of millions of dollars per year," she says. Wal-Mart executives say they are worried that giving in on birth-control pills, which cost about $30 a month, could invite pressure to pay for everything from eyeglasses to Viagra.
Wal-Mart also refuses to cover obesity surgery, which effectively reduces the size of the stomach to suppress appetite. About 120,000 Americans are expected to undergo the increasingly popular surgery this year, up from 80,000 in 2002, according to Frost & Sullivan, a consulting firm.
Robert Dean, a Tampa, Fla., internist who treats about 200 Wal-Mart employees, says he has been in frequent futile battles to get Wal-Mart to approve this and other procedures. He says employer insurance plans have paid in 29 of the 30 cases where he has recommended the procedure. The exception: Sherri Parker, who is 42, stands 5-foot-6, weighs 425 pounds and is the wife of a Wal-Mart night supervisor.
Ms. Parker has sent numerous letters to Wal-Mart and to public officials, pleading for help in getting the company to pay for her surgery. In one August 2002 letter, to her Congressman, Ms. Parker wrote, "The problem has been with me all my life, and is not going away. I am just getting bigger and bigger." Recently, however, she concluded that her quest to get Wal-Mart to approve the procedure is hopeless.
Mr. Emerick, the benefits vice president, says Wal-Mart doesn't cover obesity surgery because there is no consensus among doctors and insurers that it's medically safe and effective. He estimates that between 2,000 and 3,000 employees or family members would apply for the procedure each year, at perhaps $40,000 apiece. And "there's a really high rate of complications" that can cost up to $500,000 a patient, he adds. The company also fears that, with Wal-Mart's annual turnover rate of about 50%, workers would join the company, undergo the surgery and leave.
In the past few years, Aetna Inc., Cigna Corp. and other insurers have begun covering the procedure in cases of morbidly obese patients who can document failed efforts to lose weight by other means. On the other hand, United HealthCare, another major insurer, recently dropped obesity surgery as a covered treatment in its standard plans. United HealthCare stopped covering the procedure because, a spokesman says, there isn't enough peer-reviewed medical literature in the U.S. that the surgery is safe and effective.
Wal-Mart also is aggressive in controlling medical costs related to on-the-job injuries. The company says these claims are a related and additional expense on top of the 18% increase in its health-care outlays last year, a rise in line with industry averages.
Mittie Funderburk, 52, says she injured her back in 2000 while moving photo-lab merchandise in the San Angelo, Texas, Wal-Mart. She didn't report the incident until two months later, when growing numbness in one of her legs immobilized her. Her doctor prescribed surgery, and a second doctor, selected by Wal-Mart, concurred. Nevertheless, Wal-Mart fought the claim for months, first alleging Mrs. Funderburk hadn't reported the accident in a timely fashion and then arguing she didn't need the surgery.
The company finally relented and she underwent surgery in April 2001, eight months after being injured, and returned to work that August. But by January, Mrs. Funderburk says, she was crippled with pain and went on medical leave. After several epidural pain blocks failed to work, two doctors advised more-extensive surgery.
Wal-Mart fought even harder, as the Texas State Workers' Compensation Commission and its Independent Review Board sided with Mrs. Funderburk three times. But Wal-Mart refused to give up. In May, it appealed the commission's final decision supporting the need for surgery to the state district court in Travis County. The case is still pending.
Last June, Wal-Mart terminated Mrs. Funderburk because she had been off work for more than a year. "My doctor wouldn't release me to go back to work until I got better, and he didn't think I would get better without the surgery," Mrs. Funderburk says. Wal-Mart declined to comment on this or any other specific case.
She applied to have the state of Texas pay for the surgery and underwent a spinal-fusion procedure in July that cost $30,000. If Wal-Mart doesn't pay, the state agreed to pay for the surgery and then pursue Wal-Mart for reimbursement.
Write to Bernard Wysocki Jr. at [email protected] and Ann Zimmerman at [email protected]
URL for this article:
http://online.wsj.com/article/0,,SB106452494523207000,00.html
The Basics
Does your boss want you dead?
'Dead peasants' insurance pays your employer a secret, tax-free windfall when you die. Insurers have sold millions of policies to companies such as Dow Chemical.
By Liz Pulliam Weston
Right now, your company could have a life insurance policy on you that you know nothing about. When you die -- perhaps years after you leave your employer -- the tax-free proceeds from this policy wouldn’t go to your family. The money would go to the company.
What’s more, the company might use this policy to pay for retirement benefits and other perks not for you or your fellow workers, but for your company’s top executives.
Sound outrageous? Such corporate-owned life insurance is also big business:
Companies pay a whopping $8 billion in premiums each year for such coverage, according to the American Council of Life Insurers, a trade group.
The policies make up more than 20% of the all the life insurance sold each year.
Companies expect to reap more than $9 billion in tax breaks from these policies over the next five years. The policies are treated as whole life policies. So, companies can borrow against the policies and write off the interest. And the death benefits are tax-free.
Hundreds of companies -- including Dow Chemical, Procter & Gamble, Wal-Mart, Walt Disney and Winn-Dixie -- have purchased this insurance on more than 6 million rank-and-file workers.
These policies, nicknamed “dead janitors” or “dead peasants” insurance, soared in popularity after many states cleared the way for them in the 1980s. Congress recently tried to crack down on the practice, to the howls of the insurance industry -- which earlier this year managed to derail reforms.
The policies have generated lawsuits by survivors who got little or nothing when insured workers died. A couple of examples:
Jane St. John had two children and was pregnant with a third when her husband, a butcher at a Winn-Dixie store, was killed in an auto accident. When the Killeen, Texas, woman called the company to ask about insurance, she said she was told about a $17,500 policy to which she was entitled. St. John said Winn-Dixie told her nothing about the $102,000 the company collected from a corporate-owned policy on his life. She found out about it this summer, eight years after his death, from a lawyer who researched court records. The idea that the company would secretly insure lives, and then not share the benefits with the families, "is sick," she said. "That is creepy."
Mike Rice was a 48-year-old assistant manager when he died of a massive heart attack at the Wal-Mart store in Tilton, N.H. His widow, Vicki, became the lead plaintiff in a class-action lawsuit against the company after she discovered Wal-Mart collected $300,000 from a life insurance policy it owned on him. Vicki Rice believes job-related stress contributed to the heart attack and says it is “totally immoral” for Wal-Mart to profit from his death.
“In a lot of circumstances, the families don’t get anything,” said attorney Mike Myers of Houston’s McClanahan & Clearman, which represents survivors suing companies over corporate-owned policies. “The company tries its hardest to keep the policy a secret.”
Labor leaders and some lawmakers have denounced the policies as “unjust” and “repulsive.” The companies say profits from the policies can help offset the increased cost of employee benefits and enhance the businesses’ bottom lines.
Corporate-owned life insurance actually comes in two flavors:
Executive or “key person” policies that insure the lives of top executives. This coverage has been around for decades and has a clear business purpose, since losing the expertise, knowledge and contacts of top managers can be financially devastating for companies.
Broad-based or “janitors” policies that insure rank-and-file workers. Here the purpose is basically profit. The life insurance proceeds are tax-free. The policies have an investment component that allows companies to earn tax-deferred returns while the employee is still alive. And, of course, companies can take out tax-free loans on the policies. All these gains and income are used to fund operations, pay for executive compensation or boost other benefits.
No one knows how many corporate-owned policies are issued on executives versus rank-and-file workers. Wal-Mart alone had taken out about 350,000 such policies between 1993 and 1996. Nestle USA had policies on 18,000 workers in 2002, The Wall Street Journal reported. Enron had $500 million in policies on workers.
Sales of the policies came to a virtual standstill in September 2003, according to the insurer trade group ACLI, when the Senate Finance Committee approved legislation that would have taxed payouts made to companies if the employee had left more than a year earlier. That indicates that most policies aren’t being sold to protect companies financially against the loss of key current employees.
Strong insurance industry protests led the powerful committee to reconsider its action. Further work on the issue has been postponed until 2004, and indications are that the senators are “softening” on the idea of greatly restricting the policies, said Jack Dolan, ACLI spokesman.
Companies insist that janitors policies have a legitimate business function, but that’s an argument that’s been rejected -- forcefully and usually successfully -- by the Internal Revenue Service. In the mid-1990s, the tax agency began disallowing billions of dollars in interest payment deductions the companies had been taking on policy loans. The IRS maintains that the policies lack a bona fide business purpose and are basically nothing more than tax shelters.
The controversy helped convince Walt Disney and Wal-Mart, among others, to drop the policies. Winn-Dixie battled the IRS in court, but the supermarket chain recently lost its final round when the Supreme Court refused to review a lower court decision that backed the IRS.
So far, one company has prevailed against the IRS -- Dow Chemical, which took out the policies on more than 21,000 workers. A U.S. District Court in the Eastern District of Michigan ordered the IRS to return $22.2 million plus interest to the company. The IRS has appealed the ruling.
Survivors’ lawsuits, meanwhile, typically focus on two issues:
Whether the companies had an “insurable interest” in their employees’ lives.
Whether the companies were required to get the employees’ permission for the policies.
“Insurable interest” is usually a big deal for insurers. They want to make sure whoever is buying life insurance doesn’t have an incentive for bumping off the insured. Insurers usually require purchasers have a strong familial or emotional connection to the people being insured, or that they would suffer significant financial losses if the insured people died.
(It’s that latter standard that was loosened in the 1980s, making it easier for companies to buy policies for all their employees, not just key executives.)
Most states also have “advise and consent” laws that technically require companies to get workers’ permission before buying life insurance on them. But attorney Myers said many businesses circumvent these laws by purchasing the insurance in one of the states that doesn’t require notice or consent, including Delaware, Georgia, New Jersey, North Carolina, Pennsylvania and Vermont.
"Executives fly to Atlanta to meet with the insurance company and its brokers, sign some papers, get on their respective corporate jets and fly home,” Myers said.
Other companies offered their workers small policies -- typically $5,000 to $10,000 -- as an incentive to allow larger corporate-owned policies to be issued on the workers’ lives. The small policies can later be canceled, even if the company keeps up the premiums on the other insurance.
Anger about these practices likely will keep the heat on Congress to make some reforms. It’s possible that lawmakers will restrict severely companies’ ability to write the policies on rank-and-file workers. At the very least, companies probably will have to get workers’ consent before buying any new policies and clearly disclose that the coverage may extend past the time they leave the company, the ACLI’s Dolan said.
But he rejected the idea that corporate-owned life insurance was immoral or a company bet against its workers.
“It’s an important business planning tool,” Dolan said. “Companies are using it for extremely valid reasons.”
Liz Pulliam Weston's column appears every Monday and Thursday, exclusively on MSN Money. She also answers reader questions in the Your Money message board.
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November 1, 2004
States Are Battling Against Wal-Mart Over Health Care
By REED ABELSON
n the national debate over what to do about the growing number of working people with little or no health insurance, no other company may be taking more heat than the country's largest employer, Wal-Mart Stores.
The company, despite its popularity with consumers, has grown accustomed to being accused of crushing Main Street merchants with its sprawling stores and low prices and of driving down wages for workers across the retail industry. And more than a million former and current female Wal-Mart employees are part of a sex discrimination lawsuit that the company is fighting.
Now, Wal-Mart finds itself under attack for what critics see as its miserly approach to employee health care, which they say is forcing too many of its workers and their families into state insurance programs or making them rely on charity care by hospitals.
Wal-Mart vigorously defends its health care policies, saying it offers affordable coverage for all employees.
The company says it has no way of knowing how many of its employees, whom it calls associates, or their families are insured under state programs. The larger issue of whether companies can and should absorb the soaring cost of health care is a national issue, said Susan Chambers, the executive vice president who oversees benefits at Wal-Mart. "You can't solve it for the 1.2 million associates if you can't solve it for the country.''
A survey by Georgia officials found that more than 10,000 children of Wal-Mart employees were in the state's health program for children at an annual cost of nearly $10 million to taxpayers. A North Carolina hospital found that 31 percent of 1,900 patients who described themselves as Wal-Mart employees were on Medicaid, while an additional 16 percent had no insurance at all.
And backers of a measure that will be on California's ballot tomorrow, which would force big employers like Wal-Mart to either provide affordable health insurance to their workers or pay into a state insurance pool, say Wal-Mart employees without company insurance are costing California's state health care programs an estimated $32 million a year.
Meanwhile, in Washington State, where the insurance commissioner is pushing the legislature to adopt a law similar to the one on the California ballot, companies that struggle to compete with Wal-Mart while insuring most of their own workers have become openly critical.
"Socially, we're engaged in a race to the bottom," said Craig Cole, the chief executive of Brown & Cole Stores, a supermarket chain that employs about 2,000 workers in Washington and adjoining states and pays for insurance coverage for about 95 percent of its employees. "Do we want to allow competition based on exploitation of the work force?" he asked.
Wal-Mart, which disputes the California figures and says it cannot verify the Georgia and North Carolina data, says its employees are largely insured. It cites internal surveys indicating that 90 percent of its employees have insurance - many through means other than Wal-Mart's coverage because they are senior citizens on Medicare, students covered by their parents' policies or employees with second jobs or working spouses.
"We are doing everything we can to take care of our associates and not shift costs," Ms. Chambers said.
The company has gone on its own offensive, saying last week that it was spending $500,000 to defeat the California measure, Proposition 72. The measure is opposed by many other businesses, particularly restaurants and retailers, and by Gov. Arnold Schwarzenegger, who asserts that it would impede the state's economic recovery and lead to a loss of jobs.
Wal-Mart has also been running a television ad nationally that features a Wal-Mart worker whose company health insurance covered his toddler son's treatments for life-threatening liver disease. "Without Wal-Mart,'' the father says, "I don't know that he would have made it."
But critics say the reality for too many Wal-Mart workers and their families is no insurance - either because they are unable to meet the company's eligibility requirements or because they cannot afford monthly premiums as high as $264 a month for family coverage on an $8-an-hour cashier's wage. Wal-Mart says its employees make $10 an hour on average.
Countering Wal-Mart's television ad, a California group supporting Proposition 72 has begun publicizing the case of a former Wal-Mart employee, Marco Guillen, who says he twice missed the company's annual enrollment deadline for health insurance. The first time, he said, was because he was confused about his eligibility. The second time, he said, was because he was in a coma after being in a car accident. His medical bills were about $1 million, he said, and were paid by the state's Medi-Cal version of Medicaid.
Wal-Mart declined to discuss the specifics of the case, saying that doing so would violate Mr. Guillen's rights under the federal laws governing patient privacy.
The company says it spent about $1.3 billion of its $256 billion in revenue last year on employee health care to insure about 537,000 people, or about 45 percent of its work force. Wal-Mart says that 23 percent of its employees are not eligible for coverage, but that it covers 58 percent of those who are.
That compares with an insured rate of 96 percent of eligible full-time or part-time employees of Costco Wholesale, the discount retailer that is Wal-Mart's closest competitor nationwide. Costco employees - most of whom are not represented by a union - become eligible for health insurance after three months working full time, or six months part time.
At Wal-Mart, which has no union employees, many who work full time must wait six months to become eligible. Part-time workers are not eligible for at least two years. Because of turnover, some employees never work long enough to become eligible.
If there is any place where Wal-Mart's labor costs find support, it is Wall Street, where Costco has taken a drubbing from analysts who say its labor costs are too high. Costco's pretax profit margin is only 2.7 percent of revenue, less than half Wal-Mart's margin of 5.5 percent.
Wal-Mart now asks employees to pay 33 percent of the company's cost of providing insurance, but says it plans to reduce that to 30 percent. So far, Costco has resisted pressure to increase employees' share of health care premiums beyond a planned target of 8 percent in 2007, reasoning that too many of their workers would be forced to drop coverage.
"From the very beginning of time, the founders here felt you have to pay a living wage and provide benefits," said Richard Galanti, the chief financial officer of Costco, which is based in Issaquah, Wash.
Wal-Mart finds itself up against a national tradition of providing health insurance to workers that took root during World War II, when wages were frozen and many companies offered health benefits in lieu of higher pay. After the war, unions at many big manufacturers also demanded generous benefits, and workers of all stripes throughout corporate America came to expect health insurance as a right of employment.
But in recent years, as global competition has become more intense, as organized labor has lost some of its clout and as medical costs have spiraled upward, employers have become increasingly unwilling to shoulder the cost of coverage. In 1987, only a quarter of the people working for large companies did not have insurance. By 2001, that figure had increased to about a third, according to a recent study by the Commonwealth Fund, a New York nonprofit group dedicated to health care research. Industry experts assume the percentage of working uninsured has continued to grow.
Other data indicate that of the 45 million people without health insurance in this country, nearly 70 percent are working full time or are the dependents of full-time workers.
Wal-Mart's rise to become the nation's biggest employer and largest retailer also speaks to a larger shift in the economy in the last generation, as a growing proportion of jobs shifted to service industries. Wal-Mart has succeeded because tens of millions of shoppers around the country flock to its stores for its sharply discounted prices. That business model, which is being widely imitated, depends on low-cost labor.
But government officials in various states, as well as some other employers, say Wal-Mart should nevertheless share more of the financial burden of its workers' health care.
"The Wal-Mart executives chose to remove the responsibility from themselves," said Mike Kreidler, the insurance commissioner for Washington State, who is pushing for a law requiring employers to provide insurance coverage either directly or indirectly.
Although Wal-Mart officials flatly deny it, some Wal-Mart employees say they are encouraged to turn to public health care assistance. When Wal-Mart hired Samantha Caizza, a single mother of three, as a cashier at its Chehalis, Wash., store last November, she says she was told by a personnel manager "to get ahold of the state" for coverage for her children.
Unlike many Wal-Mart workers, Ms. Caizza was willing to talk to a reporter about her experience because she was fired in June - for reasons she said had to do with union organizing activities. Wal-Mart said it could not comment on her case.
The company hands out instructions to its employees to help them to apply to social service agencies, which Wal-Mart says is simply part of the service they provide employees who need to have their income verified for any number of reasons.
Many employees say they simply cannot afford the health plans being offered. Ms. Caizza, for example, worked about 32 hours a week, making $8 an hour. Full-time employees make about $1,200 a month on those wages, meaning the $133 to $264 they are asked to pay for family coverage may not be within their reach. And even the cheapest plans come with a hefty out-of-pocket price for employees, where they may be on the hook for as much as $13,000 in medical costs for their families.
"While I was working there, I couldn't afford it for my children," said Beverly Winston, another former employee, who says she turned to state-subsidized coverage for her children while working at Wal-Mart in Renton, Wash., in the late 1990's. Ms. Winston is among the group of women around the nation now suing the company for sex discrimination.
"We work very hard for that to be affordable," said Ms. Chambers, the Wal-Mart executive, who said she thought the prices for the least expensive plans were "a very reasonable opening-price point.''
With the number of uninsured people in Washington climbing - now slightly more than a half-million people, or 9.4 percent of the population by one estimate - the state is grappling with the rising costs of caring for them. "The problem is getting much worse," said Mr. Kreidler, who says the cost of caring for the uninsured in Washington now approaches $400 million a year.
Asking the hospitals to keep paying the rising cost of the uninsured is not a solution, Mr. Kreidler said.
But Wal-Mart says it is not reasonable to ask companies like it to solve the problems of the uninsured and the escalating cost of medical care. It needs to be "part of a national debate," Ms. Chambers said.
There is hope. As I have stated earlier it is not over with till the fat lady sing's. Well I am not singing.
Back in May of 2003 I was feeling down.
I called the governor's office and told them about me.
They referred me to Vocational Rehab.
I called them and set up an appointment. I had to take a test as to what type of skills I have. Then they ask you what you want / need in order to get back to work.
They are helping me on getting the WLS.
I have been through all of the testing completeing my last one on 11/19/03.
I now have my last follow up appointment. Next I will have to hand carry all test results to my surgeon. Then he will review the results and decide if he will do the operation or not.
If it is a go I will get to meet him for the first time.
So for now I am waiting.
12/18/2003
Well I didn't get to hand carry the results due to a lot of factors. However they recieved everything via mail & fax.
12/28/03
Called the doctors office just to get a idea when I can expect an appointment. Was told that they did not get an Ekg and it was up to me to get everything done.
I was like I gave all of the scripts to the doctor's I can't help if they did not follow the directions. Good thing I called.
So I called my PCP to see if I can get one done there.
Yes! I lucked out.
So I went in for an ekg.
Now back to the waiting game. I am so done with waiting. I want to get the Wls and get on with my life. I so badly want it back.
1/06/2004 WAITING!!!!!!!!! Come on pick up the phone and call........
1/8/04
I must be dreaming.....the phone is ringing...I answered it. There was this voice that asked to speak to me and I said "speaking". She then said "Hi this is Pat from Dr. Haicken's office,I am calling you to set up an appointment to meet the doctor". I then said in a sleepy voice "Who is this again?" She repeated herself. Then she asked me if Jan 15 @ 12:30 would be ok for me. I replied "Sure". She then said we will see you Jan 15 have a good day. I hung up the phone and went back to sleep. Later on that day I told my husband I had a weird dream. He asked what it was. I said the doctor's office called today while I was asleep. Some lady named Pat. Said the Dr. will see me Jan 15 @ 12:30. He checked the caller Id and handed the phone to me. OMG!!! They really did called. Amazing what you can remember after taking nyquil for a head cold & sore throat. So it is finally getting closer.
Later on that day I had to call Vocational Rehab to let them know about the appointment. I spoke with my counslor's superviser. She said that now everything is down hill and assured me that the state will surely approve this. Since they have paid for all of my testing so far ($8,000.00). I hope this is so it has been a long battle for me. Now I pray that when I do get the WLS I make it.
1/15/04 I saw the doctor. When I first got there I was weighed in and had my picture taken. I was also given some papers to sign. From there I watched a movie about the surgery. It was very well done.
I met him....... Dr. Haicken. He is a very nice doctor and is very concern about the people he operates on. He is also very open about everything.
Well next he took a look at my stomache and pulled out his purple marker. I have been lined. Yes, I have a purple line going down my stomache to see where he will open me up at and how long it will be.
Hummmmmm not so bad. Not real long either. So Now I can say I have be "Lined". So now I am back to waiting. Not for the surgeon but for Vocational Rehab to approve me. It can take as short as 3 days and as long as 2 weeks. Maybe longer. I hope the approval will be soon.
2/12/04 Still no word from Vocational Rehab. At this point I am getting ready for a battle. Cause for me No news is not good news.
3/5/2004
It's over so Thank You for reading my page. The towel is thrown in. I am tired so tired.
Everybody that has had the WLS you are so lucky.
3/8/2004
Maybe I threw in the towel too soon.
Spoke with Voc Rehab today if I can get Wal-Mart to write a letter stating that they have no plans to cover the surgery then they (Voc Rehab)will cover the surgery.
So now it is time to deal with the devil (Wal-Mart).
I dealt with the devil and got my letter. Now they are going to audit my claims history to make sure I have not used my insurance to pay for any of the needed testing for the WLS. I am also flagged so they will look at any claims twice as hard. That is fine with me. Gee what a nice company Wal-Mart is.
4/08/04
Had consult for my filter. It lasted all of 20 minutes. The purpose of the filter is to catch any blood clots that might break free (in legs) and travel to your lungs. Having a fatel effect.
4/09/04
Appointment to have my filter put in. Wow let me tell you some experience. You feel like in the end you have been hit by a truck.
They enter through your juggler vein. Travel on down to the "Y" where both veins meet from your legs. They place the filter there. It has a 99.5% success rate.
The filter stays in place forever.
While I was at the hosp., in recovery they wanted to know a date so I had to call Dr. Haicken's office for the date. That was like pulling teeth to get a date. I was reminded that they would call me.
I explained that the Hosp., was asking for a date and requested I give them one before I leave. The young girl was not really nice about it.
But I do have a date: MAY 7, 2004.
I can't say at this point that I am excited over my date yet. I guess because I have faught so hard to get to this point.
Nobody should have to go through the hoops that we have to go through to get a life saving surgery.
Needless to say a person is well trained by the time you get to the table. "Sit, wait, beg,write,cry,go here, go there,diet,be here, be there,Oh Approval LOL,nasty remarks".
4/22/04
Wow! it is hard to believe that I am getting closer to my date. Don't ever give up. Keep on trying. Who would ever thought that I would be this far. A date.
I would like to Thank all of my new friends that I have met over the internet for their ear and shoulder. God only knows I used both a lot.
My pre-op appointment is April 27 @ 9:30. So I guess that means I am getting closer.
This has been a long hard battle. But yet another battle is about to begain soon. For my job is not over.
4/27/04
Well the day is here. I get to go in for my pre-op appointment. Hopefully all will be a go. When I got there I didn't know what to expect. I thought I would have gotten to see the doctor just before surgery.
No, I didn't I saw his nurse. I was somewhat disappointed. I thought it would be him going over the details. However it is alomost over with.
So she listened to my chest & heart, checked my feet (I was a little swellen / that time of the month will do it to ya.),And asked if I had any questions. I asked for scripts since I am going through Voc. Rehab. They seem to script you to death. I had to explain that my insurance WILL NOT PAY FOR 1 THING BECAUSE THEY DO NOT APPROVE OF THIS IN ANYWAY. Plus I have to make sure anybody that is used is a vendor of Voc. Rehab. Otherwise I will be responsible for whatever is due. Believe me there is NO MONEY to be had here.
I got some scripts but I am not going to say my viewpoints. Is it more believeable to me yes & no. I had to fight so hard to get here and still fight to get a date. Fight is just a word for lack of having another word to express myself.
So time is now ticking away.
You can't hope that in the back of your mind that you made the right choice. I feel like I did. But as we all know we alway's have reserves about anything like this.
5/6/2004
OMG!!!!! 1 more day. I am Not ready in No way. As I told people I was going to wait till the last minute. I had faught so hard for this that it seems like a dream. Now I only pray that all will go well.
For the past couple of days I have had lot's of emotions. Which is normal.
Here it is 12:30a.m. I am still up. In a few more hours my dad will be flying in and my very dear friend Becky. Becky had the surgery in Aug 2003 and is doing well.
She has plans of staying with me the whole time. God love her. She is like a sister to me.
Becky I love you very much and I want to say "THANK YOU". You have been there for me when my own blood relatives haven't. I love ya.
It is hard to find a friend like her.
Next thing I want the Whole World to know is I have the best angel in whole wide world.
Michelle Masri of Texas. I remember the day when we met in the Chatroom. You have been nothing but wonderfull to me. I want to thank you for the support you have given me and the owl food. :) I loved the stories that we shared and Maher saying "Surgery on order for you". He is something else.
You have been wonderfull and I love ya too like a sister. It is strange how thing's happen.
Next I can't forget Suzy & April. The 3 of us was fighting for approval. April had hers first,next Suzy, then me. There were times I thought gee, I helped people get approved and I can't even help myself. Thing's happen for a reason.
Next the last supper.
We went to Ruby Tuesday. The waitress asked if I had been approved yet I said "It has been a long time since I had been in". Yes, I am going Friday May 7 to have the surgery.
She hugged me and said "Let me give you a dessert on me". So I said "ok". I had my last scoop of ice cream with strawberries on it.
There are so many people that have read about my battle and have supported me. As a tear comes to my eye. Words can't express the emotions that I feel and the Thanks I would like to express.
My day is finally here. Now I am a believer.
Don't ever give up. God only knows there were times when I was ready to give in. But I felt like how dare they tell me "NO". Who in the Hell do they think they are? I refused to rollover and die.
for those that would like to know I will be in Morton Plant in Clearwater (727)462-7000.
May 7,2004
Well the day arrived. Wow still seemed like a dream to me. I was to arrived at the Hosp at 7:15 a.m. Which I did. I had all types of support with me. My husband, children,dad,and a dear friend from back home. They were allowed to see me off and wish me well as I was being prepped. My surgery was to be at 9:15. I kissed all and was wheeled away at 9:00. However I went into surgery @ 10:25 a.m. I saw people there that I had met and am helping to get the surgery.
Wow. The Hosp Admin was suited up and went in with me to observed the operation. She was wanting to learn about it. She came over to me and said "Sherri today is the day that you had been waiting for". I will be here for you. Next the doctor arrived and said "Well today is it". "Let's go"!
All went well. As I was coming too I was asked where did I hurt.
I said my Chest. I remember I kept repeating it. They called in a Cardiologist to check me out. All was well. From There I went to ICU just to be observed. I had the best care ever. Whenever I woke up the nurse would give me me ice chips to suck on. OH YUMMMMMMM.... Once I was able to walk the next day I went walking everywhere in ICU. I was doing so well they gave me the great boot that (Saturday) night. Was moved after 9:00p.m. So off to a new room. Was it the wild ride that you hear so much about? No, it was a smooth gentle ride. Up on the sixth floor I go. Getting all cozy and settle in here comes the lab people. More blood. At this point I felt like I had none. But they managed to find a drop.
May 9,2004 Sunday
My best friend Becky came up and spent the night with me having a watchful eye.
I had done a little too much that day and that night they gave me some extra pain reliever. Let me tell you it knocked me on my butt. Sometime in the middle of the night they came in for blood and vitals. I didn't even know it.
May 10,2004 Monday
6:00 a.m. Then it happened. OMG!!!!! did you hear it? It was loud. Very loud. I heard this loud growl. I whispered to Becky. "Becky, Becky wake up". She was of course half out it. Saying "What's wrong honey"? I then said "Shhhhh did you hear that"? raising up out of bed she looked at me puzzled and said "Hear what"? I said " How can you sleep with that noise?' There is something in this room and it is not friendly". Puzzled as she looked at me asked "What are you talking about"? Confused I am like What do you mean What am I talking about? There was this noise and it was a loud Growl. All of a sudden it Growled again. Laughing at me Becky told me that it was my stomach and it sounded like it was hungry. No, way I thought. My stomach doesn't growl. Let a lone like that. It did it again but louder. My thought for the moment was "what have I done"? Becky called for the nurse telling her I needed something to eat. It growled over and over again until it had gotten something to eat. WOW!!!! What did Dr. Haicken do to me?
It sounded like a wild tiger was in my room. The nurse arrive with some chicken broth. Yummmmm Yummmmmm it was sooooo good. No more growls. So we were able to go back asleep a little while longer. The nurses made their rounds and all so far was going well. Dr. Haicken cmae in and looked at my incission. Told me I was out of there. I am doing "GREAT". So I got the great boot. But this time it was to go home.
We called my hubby to come and get us. The funny thing was he knew I was going home on monday. LOL. I kept saying "No Way".
I want to say my Husband has been the most supportive husband ever. I love him so much. My poor son cried everytime he had to say good bye to mommy. He has such a tender little heart. My daughter was brave and held together well. She is so sweet.
Becky is like a sister to me and I love her. She came down to be with me during this time. Thank you.
My dad was there for the first time in my life. When I needed him the most. Dad, I love You and by you being there meant so much to me. Now time to end the tears. Sniffle Sniffle.
MAY 17, 2004
Today I went to the doctor's office. They removed every other staple. I lost 11 pounds.
May 24,2004
FREEDOM!!!! They removed my bars. Thank God. Oh those things hurt. They rub into you. Wow FREEDOM......
June 01, 2004
Rest of the stitches came out. So far I am doing great. Having a hard time with Puree. Chris seems to think I have a stricture. As soon as I eat something it seems to rest in my chest then comes back up.
So waiting to have an upper G.I. done. The hold up at this point is Vocational Rehab.
Today is a mile stone for me. For the first time in 8 years I am able to put on my wedding band. I can't believe it.
Channel 10 news came out today to talk with me about Wal-Mart Health Insurance and ho I had to go to the state for help with WLS.
Should air next week. Sorry it wasn't aired. Turned down because it was another fat story.
July 20,2004
Need to exercise...I went today to join Shapes. Wow I can't wait. Hit the gym again.
Aug 9,2004
Hurt my leg today. Ouch..Of all thing's you would think that a fittness center would have a proper ladder in the deep-end of the pool. Went to get out of the pool in the deep-end and the second runner broke. Well down I went scraping my leg real bad. Man the pain.
The runner's are made of plastic with NO support and when I was getting out it broke. Found out it has happened 3 or 4 times before.
Went to the Hospital and am now on crutches for 2-3 weeks. not so happy.....
Aug 22,2004
I am as of today in a 22/24W from a 6x. I can't say how much I weigh cause I am still off of the scale. However I am losing in inches...
Sept. 8,2004
I went to see my PCP today. OMG!!! I am on the scale for the first time in 13 years. Yes!!!! I weighed in at 342. Good bye 400's. Now I need to get to 200's. I thought I would never see any weight under 400. Here I am under 400. I feel great and have NO regrets on getting the surgery. I am getting my life back. I now say "Bring on the scales". No more fear of the scales. The scales is now my new friend.
I can truly say that the surgery is working for me. The happiness I feel for once in my life is great. I can now see the numbers and not guess. I have another tool on my side. The Scales.
People don't realize on how Obesity makes you a prisoner of a condition. With the knowledge of treatment it is ashame that insurance companies deny us the right for coverage to be treated. It kills me on how the government turns their back on us "The Obese". We are not second class citizens. We are human just like everybody else. I fought hard and long for the surgery and I got it. You must believe that it is possible. Because it is.
Now look at me. I am sitting here and saying "WOW I am 342". We all long to be thin. But most of all accepted and healthier.
Nov. 2,2004
Well here it is election day. I hope that Kerry wins. The surgery changes your life in so many ways. Doors open up and people look at you differently.
My lose I feel haven't been that great in the amount of time it has been. But I need to remember that everybody is different. As of this date I weigh 327. Yes!!!! But it is not coming off that fast. I want it gone today.....
You know what else is amazing I am under educated to work for the Hospital or my surgeon's office. But yet they refer people to me to help get advise about Vocational Rehab. I don't mind....But I am in need of a job....Go figure...I have enough brains to get the surgery and help others get it but yet not enough education to be hired doing that. Well my Associates Degree isn't worth much....I guess.
I am a person that had to fight tooth and claw for the surgery. Self pay was NOT an option. So therefore it did NOT come to me easy. I can't get a job helping others or going around talking about the surgery , the problems that you may
01/25/201
