tv [untitled] CSPAN June 16, 2009 11:30pm-12:00am EDT
because of a temple, right? >> because what it all started was a red flag is what that means is something suspicious so the red flag and then go back and just cut the chart a part and what they found was on my weight i think i put down what will men is going to tell you what she really played, i weighed more than i put down and they said they might not have given me the policy because i was overweight and then the second thing was i had in my earlier years i had a previous fast beating of my heart, and i didn't have a problem with that anymore, but anyway, that was brought up. everything they could possibly did not in my whole life history got brought up on related to the cancer, and nothing related to the cancer. ..
kidney stones and was treated for kidney stone so when he got that letter he thought it was an air. they must have meant the kidney stones, that he disclosed it. he did have kidney stones and they knew that when they gave him the insurance. he never knew he had minor gallstones, never was treated for any gallstones, and was never treated for any aneurysm. >> so, in addition then to having an unrelated medical condition, it was something he didn't know about at all, so when we hear, as perhaps we will about fraud, from the insurance companies, he had mentioned kidney stones, that he did not have them you are saying? >> he did have kidney stones. he did disclose those and was treated for those and he was given insurance despite the fact that he had kidney stones. but, had they not been able to find his doctor who was retired and on a fishing trip in another
state, they still might not have believed him, because he had no knowledge of it. luckily, they were able to find the doctor, who was able to say, oh yes i never discuss those issues with him. i never treated him for those. they were very minor and they appeared on the ct scan, but we never engaged in any treatment for those whatsoever and i never disclose them-- >> ultimately even that, didn't take the attorney general to get it changed? >> yes it did, it absolutely did. they said the attorney general's office and dr. vance waldman wonderful and their staff for just incredible. they were working daily on his file because they knew that the clock was ticking every day and there investigations-- >> what i'm asking is even if they found a doctor on the fishing trip and the doctor had
said what he thought, that wasn't enough? >> it wasn't. with that point they still wrote a letter saying to bed, it was the material flack of disclosure and then dr. waldman had to contact them again, and discuss it further. >> and, ms. horton your situation is that your policy was rescinded because you were seeking some insurance coverage, or how did that work for you? >> turn on your mic please. >> can you not hear me? i was seeking the policy when i was going over from a group health insurance. >> so this is just a denial from the beginning because-- >> i was accepted in the first
time i went to see a doctor i received a letter from blue cross dating they wanted all of my medical records and it was the bill for just a routine blood work. it was to test my tea for level, which is your thyroid hormone, and so it is routine blood work that anyone who has an underactive thyroid, which i disclosed, would get, and i had paid almost three times more in premiums than they needed to pay out, and they still send me to this post-claims underwriting department, where they went to my medical records. they found mention of something in her notes that she never disclosed to me and both of my doctors wrote letters in support of the fact that they had not discussed this condition with me and they suspect that i had it but could not prove it. and-- >> so we know, it seems obvious that any thing that might relate
to cancer treatment they are going to scour the records. in your case, it might have been something about the blood work that you were having? >> my he just proves there is no condition to small that they are willing to send you to this department for, and i did not have anything even close to life-threatening nor as expensive as some of the people on the panel, and it just shows you that he can't be too young or you can't be too healthy for them to send you to this department. >> thank you mr. chairman. >> mr. burgess for questions please. >> thank you mr. chairman. ms. beaton, let me ask you, blue cross/blue shield came back to you after you need the surgery and said they were taking your insurance and the state of recision was dated back to the date of enactment of the insurance. is that correct?
>> i am kind of hard of hearing. >> your recision was effective on december 2007 which was the date the insurance was initiated? is that correct? >> they gave me back all of my premiums. i never cashed the check because mr. barton told me never to cash it and i never did that they resented all my money back to the day, in simple language they wanted nothing to do with me and they gave me back and a penny that i'd given to them and they considered never being injured by them. >> and ms. raddatz what about your brother situation? was there a refund of premium back to the date of the recession? >> yes, they didn't actually get to that point because it got resolved before they refunded the money but they sent a letter stating yes, you are rescinded to the date of the original contract, which was before my brother had any cancer treatments at all and $200,000 back, so my brother would have had to pay out of pocket over
$200,000 in medical expenses. >> but they never got to the point where they sought that refund from your brother? >> well, again the to wonder thousand dollars was the amount that his medical bills-- >> so those for subsequent bills? >> right, that would have been what he had to pay out because they were rescinding their contract, and so they were then stating, we are rescinding all the way back to the original date of the contract so you have never had any insurance at all for the entire time you of head concert. you now have no insurance. >> so that retroactive for announcement also dealt with the money that they had used to pay for his cancer treatment today? is that correct? >> that is correct. >> in your brother's situation also, i think he said that he was told he would have to have a certain sum of money are you couldn't get the bone marrow
transplant. is that correct? >> that is correct. >> that was not the insurance company, that was the medical facility? >> that was the hospital coordinator. when i called her to literally schedule the stem cell transplant because my brother was on pins and needles, being ill and going through progressive chemotherapy and readying himself for this transplant which is a long step, a procedure medically. then it would not schedule him because the insurance company said, he is no longer ensured so we will not schedule you for your stem cell transplant, that you were supposed to have within the next three weeks. we will not schedule you, so i got on the phone and literally begged her, and no. >> let me ask you a question that doesn't have to do with the subject of the hearing today, but it figures into a larger discussion that we are having. was any other plan delineated
for you then for another option you might have medical school at northwestern are cook county or were there any other options? >> no, there really weren't because my brother's dr. was one of the most renowned doctors and the whole world on the specific routine of treatment, and he had a very specific type of cancer that really had to be treated by that dr. macanack hospital at that time, any can't just, you can't just the well, you can have a couple of months down the road or you can wait. again, the attorney general's office realize thankfully, because it is headed by a medical doctor, that time was of the essence. >> just i can recall multiple times when i was in practice, he would come up on these situations and you find a way to make it work for the patient and i guess i am little frustrated with your situation. your situation is that you were
essentially allowed or offered no other option and i appreciate the fact that particularly for that type of non-hodgkin's lymphoma that it may require a very specialized types of care. my frustration is as the physician, i just cannot tell you the times i found another hospital or another way to make it happen and not wait links of time that you all are discussing. there is, there is a county hospital. was that ever-- did anyone ever tried to help you through the that fangled, to try to get care through john peter smith? >> i could not qualify for that but what they did do is i moved in with my sister for a while so i could declare residency and went to parkland hospital and
the dallas county hospital, tried to get help there. i was on a waiting list for a mastectomy and 34 times that went there and they lost my medical records. they said, why are you here? i have cancer and i need to get a mastectomy. they said we will put you on the waiting list. i believe with all my heart my name would still be on the waiting list because they never contacted me that but i'm thankful to say come and try to get help like he said going to the county hospitals, applying for the state programs, doing all that kind of stuff mr. barton got my insurance reinstated and i was able to have insurance with the original dr. you went to have insurance with. >> i appreciate that and i believe that is continuity of care and i believe that is important. again, the other aspect is largely a part of our discussion today but it is part of our broader discussion as we talk about strategies for the future. i want to thank every one of our panelists for being here today.
ms. beaton i did not give to you because i didn't have an opportunity but thank you for your testimony too. was all very important today. thank you mr. chairman. i yield back. >> mr. gingrey for questions. >> mr. chairman i'm going to direct my question to ms. beaton. in my pronouncing that right? >> it does not matter. it is a hard name. >> miss beaton, we of course heard and listened very intently to your testimony and quite compelling. i wanted to take one quote from your written testimony and i think he said, when you get on a waiting list, the cancer grows and i think that was in reference to the fact, as you just testified to dr. burgess, that you were on the waiting list that the county hospital. there was an alternative but thank got your congressman and
my colleague, joe barton, was able to intervene and you were able to get the care in a private hospital and in fact your position that you trusted and that he wanted to do the surgery. this statement that he made is absolutely right. i don't know if you know it but i am a physician too, and ob-gyn physician before being elected to congress. your statement is a profound one indeed. when you get on a waiting list, the cancer grows and when we look at statistics of countries where you have routinely been put on a waiting list like the u.k. and others, in particular, in the treatment of breast cancer, in our country where hopefully you don't get put on a waiting list when you have got breast cancer, you get operated on quickly. your overall survival rate for breast cancer is 90%, but in the u.k. system, where you
frequently get put on a waiting list, a five-year survival rate for breast cancer is 78%. that is a significant change and as you described to us, a 2-centimeter mass grew to 7 centimeters and lo and behold you had to have your lymph nodes removed and i guess some of those for positive by the time he finally got operated on. is that the case? >> yes. >> well, let me, with that information, let me just add this question, and it relates to hugh in particular but it relates to everybody in general and i would appreciate your thoughts on ways that you think that we could strengthen the private market, so that other people, anyone with chronic illness can find affordable health insurance or do you think we should turn over our
healthcare system lock, stock and barrel to the compassion and efficiency of our federal bureaucracy? >> me? all i can say is that i did go many many different places trying to get help and i spent hours and quit working and did all of my focusing, instead of focusing and getting well and focusing on my cancer eye focused on trying to get treatment and i went to every hospital in dallas. i went to county hospitals, i went to fort worth, i went everywhere and i don't know how to fix it. all leno is there's something terribly wrong with the healthcare system because when you go to the big hospitals and there's so many people waiting for help, i went to all of the clinics and set with all the people. i can't imagine how many people are waiting for help. you spend hours and hours. you probably spend the whole day trying to see a doctor.
i did that for weeks. i never got help, so the best thing about that is when you go to to run hospitals they give you different opinions. every time i went to a different hospital mike tambor was a different size. every time i went to another hospital one person one to do one thing in one person wanted to another and you get a different diagnosis and a difference in treatment plants for guhu do you know to listen to? i don't know how to fix that battalino is when you have to go through this and like everyone of us has been through what we have been through, you just realized-- >> ms. beaton i'm going to reclaim my time but i really thank you for that testimony and i think you are absolutely right. if there is something that needs to be fixed, something is broken and when we hear from the second panel, from the insurance companies i'm going to make some suggestions to them how we can fix the system but is of my firm belief ms. beaton, the other
two, ms. horton and ms. raddatz that we can fix this system without, as they say turning it over lock, stock and barrel to federal bureaucracy that routinely is going to ration of the people on the waiting list, but we will get into that later and i want to thank all three of you for being here today and giving us such compelling testimony. >> please do not accept mr. gingrey's description of a possible healthcare plan for a nation based upon those comments. some of this on your side see the little differently but mr. walden for questions please. >> thank you mr. chairman. i appreciate the-- another hearing i am involved then upstairs but i read your testimony this morning, and so i appreciate, appreciate what you have been through all the none of us can understand what it is like to be in your shoes or that of your loved ones. it is not a good thing.
and so, i want to thank, we had to physicians here, both dr. gingrey had and my colleague from texas, dr. burgess and i think that is good to have. i hope that some point come a given cms-- cms's role in overseeing hipaa and perhaps we have a family to see that has a role in this to come before our subcommittee as well to find out their take on what is happening. ms. horton he stated that you think the applications are deliberately confusing and i have looked through some of those and i understand what you mean. but could be of little bit more specific to the kinds of questions that you found difficult and confusing? >> i haven't looked at the application in four years since i first buildout so i can't be soopers specific but i do remember them, you know after looking at it again with my sister and brother-in-law of the votes said he would have to be a
doctor or lawyer in order to figure out the up sulfation and fill it out to 100% accuracy. >> how would each of you improve that application process because it seems to me like that is kind of the crux of the argument here, is there are things that you didn't know that or run your medical records or your loved ones medical records that they didn't know and i don't know how you ever disclaimed knowledge of something you have no knowledge of. that to me is one point here. and then the second is to know as a layperson if you are on some medication years ago and you haven't been taking it, it would be easy to forget that i would think or perceive that you know longer have whatever that was when you took the medication for it, so you don't know it or your faux got it. and yet, we also know there are cases of fraud and those people that bearlike kiewit individual policies, paying more because
people were deliberately trying to get on the roles in our files that we got from the companies indicate that too so i'm trying to figure out how do we get a pellets were people like you and your loved ones are not rescinded from coverage and yet find this balance. it seems to get back to the initial application process, the re queue of those applications and a better understanding for those of us who may be signing up for that type of health insurance so i am curious, how would you fix at least that part of the process? anyone want to tackle that? >> i wish to state that the insurance company at the time you apply for insurance and you disclosed your doctors, they should be the ones that do the investigations. if they don't do the proper investigation at the time you apply, they shouldn't have the right to go back years later. there is two years, there is a two year window for the
insurance companies by which they can do their investigations. no, that is wrong. they should have to investigate before they give you your insurance. they have all the opportunity to investigate them. you disclosure doctors, let them get their records, let them look at and calm the records at that time. were they doing that later on-- >> when you have a big claim? >> pardon me? absolutely. if that is intentional what is? they want to save money and wait until you have claims before they have done the investigative money to do what they should do at the beginning, so all this time, they haven't done their job. they are taking the consumers money and the consumer things, i am ensured but i am not insured. that is not right. that law needs to be change. >> ms. beaton do you want to comment on that? >> , yes, just like myself, i
want to have a physical for insurance and they said no we don't do that so i even offered to let them have a physical on me which to me that would be a good thing. that way of the there is anything-- >> we have that medicare thing. >> they don't do that at all so they don't want to spend the money for a physical to give it to you, to rule you out then so you don't get your hopes up and think you have insurance. >> i completely agree with what ms. raddatz said and just went after this practice happens which hopefully we are going to stop it from happening in the first place but when your physicians bright letters on your behalf and help you an appealing to these insurance companies the fact that they give no weight whatsoever to what these physicians who have been treating you for years say, it is totally unconscionable. >> i was reading through some of those examples who were rescinded and their positions of the patient would have no idea of this.
it was a noted put the file that i never shared with them, and that doesn't seem right. what it be helpful, and i realize i have run over my time here but would it be helpful-- it seems as though r.e. yes and no columns on these forms. given that i don't think any of you are physicians will be helpful if there was an uninsured, don't know column as well that you could check? which then i would think if i am the insurer would cause me to go, thereay be something here i should look at further. and, because i mean the insurers when you read through their testimony they make the case that look, it is a very small percentage although it is a very painful percentage. i am just telling you what they are telling us. if we did every one it would slow down people getting access to insurance, blah, blah. said they say we investigate those where we have cause or an issue. that is something we will get to with the next panel but there's
this notion that it is a very small segment of the population, and so to get people covered they go this direction. >> i don't believe that it is a small segment of the population. i believe they sent anyone who sends in a claim to this's claims underwriting department and i have heard many people who formerly worked at insurance companies talk about the secret, visit the guiness that are designed to find errors or omissions or whatever you want to call them in people's records so that they can go back and save money. >> i think we get some of that testimony from our final witness from georgetown that says it may be a small percentage but it is perhaps the big percentage of the claim costs. >> i would just like to say, those are the people you know of. there are many people out there who lose their insurance and go on medicaid, go on welfare, go without insurance. those are their numbers. those are not the consumers numbers. we don't know how many people
are out there. and deegan know what? i don't care if there is just the three of us, that is too many. one to many who dies because of insurance company canceled their insurance is one too many. >> alright. ms. beaton, any final comments? i just wondered if you had any final comment on that point? it is okay if you don't. i just wondered if you had any final comments. >> i just agree with both what they said and i know so many people in my cancer group that i wish could be here to talk to you that he would not believe their stories, so it is the common practice and you will never know how common it is. when they hire nurses to investigate, they set their whole shift then do nothing but reviewing medical records to look for things to get rid of people. that just shows you right there. >> thank you very much. thank you mr. chairman for your
indulgence. >> isu hammes consent that-- let me just ask a question. we have focus sort of on what happened to u3, as we should rightfully so but we found close to 20,000 cases where there were recisions over the last few years from three insurance companies will be testifying next panel and people like this those gets in a bicycle accident and has fractured bones and are denied because her husband had back surgery. what daring that ladies fractures is beyond me. but, that is what we are seeing. but ms. beaton one thing i wanted to rescue, in your testimony, you stated and i'm going to quote now, that you live with fear every day of my insurance company. what are you afraid of your insurance company might do? >> without a doubt, someday they will cancel me. some day mr. barton won't be there to protect me and i am
young, and they will find something to get rid of me. somehow i won't have insurance. some day i will be added blue cross/blue shield record and it will find a way to you ridded me. coming here today will may be just about do it. >> if you lost your insurance are you afraid he would never get insurance from another company since you've been rejected once? are you afraid he would not be able to pick up another individual health insurance? >> i am uninsurable. the only way i could get insurance through being a registered nurse, hugo back to work at a hospital in the covered under a group. they cannot deny you that way. i have done a lot of research but as far as individual policies for the rest of my life i am uninsurable. >> because of your preexisting condition? >> because of my cancer. once you have cancer you are uninsurable forever. >> thank you. i apologize. i did not see you there but five minutes of questions. >> that will teach me to wear a
light-colored suit. >> thank you mr. chairman. i want to express appreciation to the witnesses for coming today. >> none of us can condone the abuses in the system and you have pointed out some of these to be in that category. i know that it's a great deal of effort on your part to come and we appreciate your courage and we appreciate your time you devoted to it. i do not have any questions. i think your testimony speaks for itself. thank you mr. chairman and i yield back. >> that was pretty quick. any other-- let me thank this panel for their testimony, your heartfelt testimony and thank you for shedding light on this and bring me a human face to a very serious problem. we will have our next panel but thank you all for coming in thank you for your testimony. >> thank you all. >> thank you very much.