Reliable Review Services and the Shady Doctors They Hire

Reliable Review Services and the Shady Doctors They Hire

I remember when Anne, a representative at Lincoln Financial Group first told me that my disability claim was up for review. She explained that after 24 months of receiving long-term disability benefits, things were changing. I was leaving the “own occupation” period and entering the “any occupation” period.

Or, put another way, instead of proving I could no longer work as a technical writer, I had to prove that I couldn’t work at all. Funny they don’t put that on the brochures, but I figured, Whatever. This changes nothing. I’m not any more abled in 2019 than I was in 2017. Let them do their review. No big deal.

Anne assured me the any-occupation review process would be conducted by an independent medical team. I swear she called it a “team” though I can’t prove it, because she said it in a phone call. (If I had one do-over to spend on this insurance stuff, I’d refuse any and all phone communication and insist they put every last word in writing.)

In reality the “independent” review was conducted by one dude: Brian L. Samuels MD, and he worked for a company called Professional Disability Associates (PDA). Brian’s report was an insult to medical practitioners everywhere. An utter failure to provide an objective, fact-based summary of my abilities. So I looked him up, discovered he didn’t seem to be doing much in the way of clinical work anymore—and that he was paid more than $29,000 from pharmaceutical companies in 2016 alone—and concluded he was probably just collecting some easy money before he completely retired.

I also looked up PDA, to see who in the hell would hire such a careless medical consultant. That’s when I confirmed what I instinctively knew to be true—that there was nothing independent about any of this bullshit.

PDA’s business profile at Inc.com describes it as “a consulting company that provides specialty risk resources including medical and vocational consulting services to disability insurers and self-insured employers.” If you wipe the bullshit spin off that statement, what you’re left with is something like “We sell medical opinions for cheap to help you get out of paying claims.” And it’s not like PDA denies that this is what they do. On their own website they explain: “We are trusted advisors dedicated to providing expert opinions that help companies make better decisions.”

I made sure to point this out in my first letter to Lincoln Financial Group. Not that they cared. In response to my appeal, they paid for another sell-out doctor’s opinion. The new guy, Lee P. Hartner MD, doubled down on the Samuels nonsense. But instead of lazily focusing on errors and omissions in my medical records, Hartner really went for it. He read a disability determination written by my actual doctor and decided—even though she had conducted a complete medical examination and he possessed nothing more than documents—that he knew what was really up. Now, not only was I fit to work full-time, I was also, to my complete surprise, in remission.

A perfunctory online search for Lee indicated he wasn’t any better than Brian. Though he’s reported significantly less money from pharmaceutical companies, he pops up in more court filings. Always the “independent expert” for a big insurance company, though not always in connection with the same review outfit. Whether Lee had to move companies because his opinions always led to lawsuits or whether he was just trying to cash in on every available opportunity is anybody’s guess. But neither scenario paints a particularly noble picture of him. Especially when you remind yourself that his paid opinions are stripping disabled people—stroke, brain cancer, and leukemia patients, for example—of their financial security in a health care system so broken they’re probably already drowning in run-of-the-mill medical debt.

For my appeal review, Lee was contracted by Reliable Review Services out of Boca Raton, FL. Bloomberg’s profile of the business describes them thusly: “The company caters to employers, third party administrators, and disability insurers.” So, yeah, there’s no chance I’m being screwed by any of these guys. No chance at all.

I guess I’m writing all of this for a couple of reasons. Firstly to my fellow disableds out there fighting a similar nightmare perpetuated by unscrupulous doctors who see us as medical records and not people: what’s happening to you is wrong. What they are doing may be legal, but it is not ethical. Don’t let them convince you that you’re a faker or a taker.

Second, to my doctors and to my primary physican in particular: I’m sorry you spent so much time trying to do right by me only to have some pissant sellout halfway across the country deny you the professional courtesy of presuming you know what you’re talking about.

Open Letter to Castle Connolly Medical Regarding “Top Doctor”

Open Letter to Castle Connolly Medical Regarding “Top Doctor”

This is an open letter to Castle Connolly Medical, published at: emilysuess.com/open-letter-castle-connolly-top-doctors

I am writing about a concern I have regarding Lee Hartner, a doctor named in your Top Doctors list at www.phillymag.com. If there is a better place to direct this communication, please let me know whom I should contact, and I will write them directly.

My name is Emily Suess, and I am a disabled brain cancer patient who lives in Urbana, IL. In March of this year, my long-term disability insurance carrier, Lincoln Financial Group, cancelled my disability claim and stopped paying my benefit. Following the cancellation of my benefit, I, as the claim holder, have been forced into a lengthy appeals process while I go unpaid by my insurer. 

During that appeals process, Lincoln Financial Group acquired the services of Reliable Review Services (RRS). In exchange for payment, RRS provided a doctor to support LFG’s denial of benefits. That doctor was Lee Hartner, MD, PA – MD423656. 

That Dr. Hartner accepted money to wrongfully claim my brain tumor is not disabling and I am able to return to work not only has consequences that are devastating to me financially, it calls into question the reputation of Castle Connolly and the “Top Doctors” designation.

In the report Dr. Hartner was paid to provide, he casually dismissed my primary physician’s determination of disability–which is meticulously supported and documented in progress notes–and told the insurer that I am able to return to work.

Dr. Hartner’s report claimed that I am in “remission.” Having never heard this from any of my treating physicians, I was shocked to first see it in a report which attempts to discredit my primary physician’s observations so that Lincoln Financial Group can justify cancelling my claim.

Furthermore, in his report for Lincoln Financial Group, Dr. Hartner noted phone calls he made to my primary physician in relation to my case, presumably to lend credence to the assumption he would complete a thorough review. However, after playing phone tag with my primary physician for a bit, he eventually told her office staff that he “did not need to talk with [her] at this time.” He never spoke with her, and this is documented in written correspondence between me and my primary physician’s office.

There did seem to be conflicting information coming from my oncologist’s office at the time of Dr. Hartner’s report that was contrary to my primary physician’s findings. However, Dr. Hartner made no good-faith attempt to investigate further. When I had a chance to ask my oncologist’s office about it, a written statement deferring to my primary physician’s opinion on the matter (citing the infrequent visits required by medical oncology and my primary physician’s familiarity with my full history as reasons for his statement) was provided.

Even if Dr. Hartner wasn’t sure of my primary physician’s disability determination, and he was too busy to bother looking further, I would have expected a finding of “insufficient documentation” or “conflicting reports.” Certainly nothing so ridiculously biased in favor of Lincoln Financial Group as his report turned out to be. Even my own oncologist had the humility to acknowledge he didn’t have the most informed opinion on the matter.

My purpose in writing this letter is to ask that Castle Connolly be made aware of what has happened to me and that your physician-directed research team thoughtfully review whether it is appropriate for Dr. Lee Hartner to keep the designation of Top Doctor. While what he did appears to be legal, I believe—based on the information you present on your website—that you hold those who make your list to a slightly higher standard.

I also ask that you inform me if and how this matter will be addressed, as I believe patients who use your list for finding physicians should know to what extent they can trust it.

Sincerely,
Emily Suess

Open Letter to Dr. Lee Hartner, Oncologist

Open Letter to Dr. Lee Hartner, Oncologist

Dear Dr. Lee Hartner,

Who hurt you?

It might seem like pure snark to ask you that question, but I am one hundred percent sincere. Ever since I received a copy of the report you wrote to support Lincoln Financial Group’s cancellation of my long-term disability claim, I’ve been asking myself, “Why would someone—a doctor no less—do this?” And the thing I keep coming back to is this adage:

Hurt people hurt people.

(It’s trite, for sure. But if you take the time to unpack them, you’ll find sayings like this apply in a lot of circumstances. That’s how clever little baby sayings grow up to be cliches, after all. )

In my ongoing quest to hold Lincoln Financial Group and its “experts” accountable for being greedy, disingenuous shitstains on an otherwise flawless healthcare sys—Bah! I can’t keep a straight face.

Ahem. What I was saying is that a friend graciously offered to help me research the key players in this nightmare of mine, including Lincoln Financial Group, Professional Disability Associates, Reliable Review Services, Dr. Brian Samuels, and you. And so far, your name has turned up in a handful of lawsuits from the last decade where a long-term disability insurer is named as the Defendant and you are their “expert” reviewer. In addition to Reliable Review Services, you have contracted with mcmc, and MES Solutions.

That. We. Know. Of.

There’s this 2011 court filing where a leukemia patient sued Hartford Life and Accident Insurance Company.

Then this one from 2010 in which a patient with Multicentric Castleman Disease sues Coventry Healthcare of Nebraska.

And this one from 2016 where MetLife retained you as an “Independent Physician Consultant” in a case against Babcock & Wilcox Technical Services, LLC Long Term Disability Plan.

I literally read this line from that last filing with my mouth gaping open:

“Dr. Hartner, however, again concluded that Mr. Smith is not totally disabled, despite conceding that he is ‘not qualified to assess whether [Mr. Smith’s anxiety] results in any restriction or limitation as that is outside the purview of my specialty.'”

At this point, all I can do is assume that you’re one of those sick fucks that just really likes doing this sort of thing to disabled people.

So I ask again, Dr. Lee Hartner. Who hurt you? Why are you like this?

Sincerely,
Emily Suess

Open Letter to J. Larry Jameson, Dean, Perelman School of Medicine

Open Letter to J. Larry Jameson, Dean, Perelman School of Medicine

Dear Dr. J. Larry Jameson,

This is an open letter, published at: emilysuess.com/open-letter-j-larry-jameson

I am writing about a concern I have regarding Dr. Lee Hartner, Clinical Associate Professor of Medicine at the Perelman School of Medicine. If there is a better place to direct this communication, such as a board or other governing body within the school, please forward this email as you see fit. Alternately, please let me know whom I should contact, and I will write them directly.

My name is Emily Suess, and I am a disabled brain cancer patient who lives in Urbana, IL. In March of this year, my long-term disability insurance carrier, Lincoln Financial Group, cancelled my disability claim and stopped paying my benefit. As you probably know, this is an industry-standard practice designed to save the insurance company money. Following the cancellation of my benefit, I, as the claim holder, have been forced into a lengthy appeals process while I go unpaid by my insurer. 

During that appeals process, which is ongoing, Lincoln Financial Group acquired the services of Reliable Review Services (RRS). In exchange for payment, RRS provided a doctor to support LFG’s denial of benefits. That doctor was Lee Hartner, MD, PA – MD423656. 

That Dr. Hartner has accepted money to wrongfully claim that my brain tumor is not disabling and that I am able to return to work is not only devastating to me financially, it reflects poorly on the reputation of the organizations with which he is associated–including the University of Pennsylvania and the Perelman School of Medicine.

In the report Dr. Hartner was paid to provide, he casually dismisses my primary physician’s determination of disability–which is meticulously supported and documented in progress notes–and instead he leans heavily on a previous report submitted by another reviewer and said reviewer’s interpretation of conversations with my oncologist. (It should be noted that previous review–by a Dr. Brian Samuels–was also purchased by Lincoln Financial Group, although it was via a different firm, Professional Disability Associates. Apologies if this is getting a bit confusing, it was designed to be that way.) Dr. Hartner also seized on a lack of information–a logical fallacy if ever there was one–in earlier reports to prop up a claim that I am not disabled.

Perhaps the most disturbing part of Dr. Hartner’s report is that he claims I am in “remission.” Having never heard this word uttered by any of my treating physicians, I was shocked to first see it in a report written by a complete stranger who has never even met me, had an opportunity to review my complete medical history, hear from me firsthand, or perform an in-person medical examination. While I realize all such doctors called upon to complete an “independent” review would be equally unfamiliar with my case, I would never expect any of them to make such a claim apropos of nothing.

What’s more, in his report for Lincoln Financial Group, Dr. Hartner notes phone calls he made to my primary physician in relation to my case, presumably to lend credence to the assumption he would complete a thorough review. However, after playing phone tag with my primary physician for a bit, he eventually told her office staff that he “did not need to talk with [her] at this time.” He never spoke with her, and this is documented in written correspondence between me and my primary physician’s office.

After conferring with my primary physician, my oncologist provided a written statement deferring to my primary physician’s opinion on the matter, citing the infrequent visits required by medical oncology and my primary physician’s familiarity with my full history as reasons for his statement.

My purpose in writing this letter is to ask that the School of Medicine be made aware of what has happened to me and that they thoughtfully consider whether it is appropriate for Department of Medicine faculty to consult on behalf of the insurance industry–an industry that has proven time and time again its priority is profit, not patients. 

More directly I ask, Dr. J. Larry Jameson, how important to you is public confidence in your doctors? Are the ethical standards for Department of Medicine faculty and students beyond reproach? If you were in my shoes–broke, disabled, and living with an inoperable brain tumor–would you trust the doctors of the world not to cash in on your tragedy?

Sincerely,
Emily Suess

Audio: Lincoln Financial Group Denied Disability Benefits to Brain Cancer Patient

Audio: Lincoln Financial Group Denied Disability Benefits to Brain Cancer Patient

My last post about LFG canceling benefits on a brain cancer patient (me) contains a lot of text buried in an admittedly difficult to read PDF format. I hate how inaccessible that is, so I have uploaded audio of me reading that post to my YouTube channel. (Apologies that’s it a little rough around the edges, I’m doing the best I can with what I’ve got.)

In the audio file, I even read the progress notes from my primary doctor and the report from Lincoln Financial’s shady hired gun, Dr. Lee Hartner.

I urge anyone considering purchasing a long term disability policy from Lincoln Financial Group to save themselves the trouble and the heartache. They are dishonest and will deny benefits to anyone—including a patient like me who has an inoperable brain stem tumor. If they don’t cover a patient with brain cancer, then who will they cover? I’m afraid the answer is no one.

If you would prefer reading the original post, click here.

Finally, if you have been denied long term disability benefits by Lincoln Financial Group and would like to share your story on this website, please contact me. This is not an isolated incident. The company, its employees, and the third-party doctors who are paid to submit false claims about patients need to be held accountable for their actions.

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