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by Meg White
Tue, 06/16/2009 - 2:29pm.
After President Obama spent Monday wooing the American Medical Association in Chicago, the healthcare story in the media turned swiftly to the conflict between doctors, who don't want to take a pay cut, and Democrats, who want to get the government involved in providing cheaper health insurance coverage to uninsured Americans.
But at a hearing convened by the House Energy Committee's Subcommittee on Oversight and Investigations titled "Terminations of Individual Health Policies by Insurance Companies," the more harrowing healthcare conflict between patients and insurers came into full view.
That's not to say doctors weren't involved. The two committee members who touted their real-world experience as doctors seemed determined to make the hearing about healthcare reform, using the hearing to voice their opposition to a public health insurance option.The hearing was supposed to be about the practice of "post-claims underwriting." This occurs when an insurance company cancels an individual's coverage only after a doctor has already submitted a claim, also known as "policy rescission." The committee conducted an investigation looking into insurance companies rescinding policies retroactively because of inconsistencies between a patient's medical history and their application for coverage.
The first panel at the hearing consisted of three witnesses who testified about the patient side of a policy rescission situation. The second panel consisted of representatives from three of the leading companies that engage in [post-claims underwriting]" according to Committee Chair Bart Stupak (D-MI).
The representatives of the three companies -- Assurant Health, UnitedHealth Group and WellPoint, Inc. -- disagreed with that characterization, insisting that they only rescind policies in cases of material fraud or misrepresentation. But the patient witnesses stood as powerful evidence to the contrary.
Robin Beaton, a 59-year-old retired nurse from Texas bought a private individual health insurance plan from Blue Cross Blue Shield (BCBS) when she opened her own business after 30 years as an RN. She had recently seen a dermatologist who misleadingly classified acne she had as precancerous, but did not tell Beaton about the diagnosis.
When Beaton later developed an aggressive form of breast cancer that required costly medical intervention, BCBS used her dermatologist's report to deny her coverage for the life-saving double mastectomy she needed. Beaton said they disregarded letters from her dermatologist explaining that the precancerous misconception did not amount to a willful omission of pertinent information on her insurance application, to no avail. Beaton was denied coverage on the Friday before the Monday on which her surgery was scheduled.
"Can you imagine having to walk around with cancer growing in your body with no insurance?" Beaton asked tearfully in her opening statement. "I can't even say how bad it was."
Her congressman, Rep. Joe Barton (R-TX), and his staff stepped in and worked "day and night," as Beaton described it, to get her coverage reinstated. By the time she was again eligible for treatment, her surgery was much more expensive and invasive than it would have been originally. She is still undergoing chemotherapy every few weeks, something she said would have been less lengthy of a process had she gotten the surgery earlier.
"You just get on a waiting list, and when you're on a waiting list, your cancer grows," she said.
Another witness on the panel said her problems with Blue Cross showed that even those without serious medical issues can be targeted for rescission. Wittney Horton said that because her doctor had merely suggested in her medical records that she might have polycystic ovaries, a condition that is proven only by a diagnosis of exclusion, she was retroactively denied coverage for routine blood tests.
"In my case, it just shows there's no condition too small," Horton said. "You can't be too young and you can't be too healthy for them to send you to this [post-claims] department."
Now, though she is still young and healthy, she says it is "impossible" for her to get individual health insurance from anyone.
"Every healthcare insurance company asks if you've had healthcare rescinded," she told the committee, a barrier to coverage later confirmed by the health insurance representatives in the second panel.
Peggy Raddatz testified on behalf of her brother Otto, who passed away from complications from non-Hodgkins lymphoma in January. Otto's individual coverage was stripped from him just before a costly stem-cell transplant for which he had only a three-week window to have successful surgery. Because a former doctor had written in Otto's chart that he had kidney stones for which he was never treated and about which he was never told, he was somehow ineligible for insurance coverage.
"My brother's hope for being a cancer survivor was dashed," she said, adding that the hospital told her, "Unless your brother brings in cash -- and a bundle of it -- he's not going to get the surgery without insurance."
Raddatz told the committee that it was only because she is an attorney and because her state's attorney general made two written appeals on his behalf that Otto was reinstated and got the life-extending surgery he needed.
"There couldn't be any better memorial to my brother than what this committee is doing," Raddatz said.
Beaton said that without the support of an elected official, she probably wouldn't be alive today. She said she'd seen some in her cancer group whose insurance was unexpectedly rescinded lose the will to keep fighting.
"They get these letters. They just give up and they fade away and they die," she said.
As was to be expected, though, the committee was not narrowly focused on post-claims underwriting in the individual insurance market. With the specter of healthcare reform hanging over them, two Republican congressmen couldn't help but make a strained effort to use the rescission problem as a reason to oppose a public option for health insurance coverage.
Rep. Phil Gingrey (R-GA), a former Ob/Gyn, asked Beaton whether her experience trying to get care without insurance at county hospitals convinced her that government-run care was a bad idea.
"I don't know how to fix it, but all I know is there's something terribly wrong with healthcare," Beaton replied. "You can't even imagine how many people are there waiting for help... It's something that's broken."
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