Diane Sawyer: "...If you have an insurance company policy, a question that you want to raise, you want us to tackle something that you think the insurance companies are doing, you write to us. You let us know about it. ABCNews.com. We are on the case."
And while Cuomo was "on the case" of a woman who had difficulty getting her insurance company to approve a much needed eye surgery, there has been no similar look at Canadian horror stories where government run health care made one woman with breast cancer wait three months for radiation treatment.
A report by the Canadian Fraser Institute found that the average wait time in that country to see a general practitioner was 17.7 weeks. One such incident found a woman waiting over three months to receive radiation therapy for breast cancer:
A similar lawsuit was filed in Quebec on behalf of 10,000 women with breast cancer who were forced into long waits for radiation therapy. Anahit Cilinger was one such patient. After having a lymph node removed in October 1999, she was put on a waiting list for radiation therapy. Three months later and with no end to the waiting in sight, she traveled to her native Turkey and paid $12,000 for the treatment.
Sawyer began the piece by proclaiming "a GMA commitment to take a hard look at the health insurance industry, to get some answers about those policies we keep hearing about, about what happens to sick people in a time of need." One would assume that such a commitment would include investigating long wait times and other ramifications of adopting government controlled plans.
The case of Shannon Dagher, the woman featured in the GMA piece, is certainly sad. After being diagnosed with a rare eye disorder, Ms. Dagher needed a surgery to prevent blindness. Instead, her insurance company, Blue Cross, launched an investigation into her claim. (They ultimately payed for the surgery.) But while unfortunate, it’s no less real then that of Canadians who must resort to leaving the country to obtain treatment. Sawyer describe the "GMA Gets Answers" segment as a new feature, one that viewers should expect to see again. Hopefully, the ramifications of universal health care will also be discussed.
Michael Moore’s appearances promoting his new health care movie, "Sicko," can be found here and here.
A transcript of the segment, which aired at 7:39am on June 18, follows:
7:20am tease
Diane Sawyer: "And we got word this woman's health insurance company was threatening to cancel her coverage when she needed it the most, so GMA went into action. She's not the only one and we're going to get some answers."
7: 30am tease
Sawyer: "And coming up in this half hour, this is one of those stories that has Americans up in arms about insurance companies. You're going to meet a young woman whose doctors say that she needs surgery or she could go blind. But her insurance company threatened to cancel her coverage. Why? A controversial practice. This morning, Chris Cuomo's on the case. It's our new series 'GMA Gets Answers,' for her and for you, for all of us."
7:39am
Sawyer: "Well, today we are announcing a GMA commitment to take a hard look at the health insurance industry, to get some answers about those policies we keep hearing about, about what happens to sick people in a time of need. Today, you're going to hear about something called rescission. It is a controversial practice where insurance companies retroactively cancel the policy, often after you're trying to make a claim. Chris Cuomo here again with the story of a young woman who faced a real crisis. Her sight was at risk."
ABC Graphic: "GMA Gets Answers: Can Your Insurance Be Taken Away?"
Cuomo: "Absolutely. Now, as background, in this country there are thousands of people purchase their own insurance. They don't get it through a union or through their work. The young woman you're about to meet has a story that could happen to any of them. According to the industry's, the insurance industry's own estimates, thousands of similar rescission investigations into policy holders occur every year. And most of them lose their coverage as a result. It's a frightening practices you might miss in the fine print of your health insurance policy. Shannon Dagher, a 22-year-old college student, says she was at the eye doctor for a check-up last November, one month after her new insurance policy kicked in when she received terrible news."
Shannon Dagher (Denied Insurance): "I was diagnosed with a very rare disorder It's called pseudo tumor cerebri. It basically looks and acts like a brain tumor."
Cuomo: "Now, Shannon's doctors say she needs surgery or she may go blind."
Dagher: "I'm petrified of the thought of going blind. I've never been sick before in my life. And now, in the past six months, I've started to lose my peripheral vision and I'll never get that back."
Cuomo: "But instead of authorizing the surgery, here insurer, Blue Cross of California stopped processing her bills. The company, whose slogan is 'Put the power of blue to work for you,' instead launched and investigation into Shannon. It threatened to cancel her coverage if she had failed to disclose accurate information about her health, like headaches on her original application. But look at Shannon's Blue Cross application. It lumps headaches with more serious conditions like epilepsy, paralysis, stroke, all in one question. She didn't have any of those serious conditions, so she checked no."
Dagher: "I never lied to Blue Cross on my application. At the time when I got the insurance, I had no knowledge that anything was wrong with me."
Cuomo: "Legislators around the country are paying attention to this little known practice. The state of Connecticut has just passed a law to make it harder for health insurers to pass rescind policies."
Connecticut Attorney General Richard Blumenthal: "These instances are hardly isolated or random. They are part of a pattern, a prevalent practice in this industry that very simply has to be stopped."
Cuomo: "Just getting an insurance company to talk about rescission is not easy. It's Chris Cuomo from ABC News. The best we could do was get Blue Cross on the phone. Why do you rescind a policy?"
Voice of Shannon Troughton (Wellpoint Spokesperson): "It's an very important tool for us to address any identified issues of abuse or misrepresentation. Anyone who causes fraud in the system increases the costs of health care for all of our members."
Cuomo: "We called eight other insurers. None would talk to us on camera and referred us to their trade group. Isn't this about saving money for the company?"
Susan Pisano (America's Health Insurance Plans): "Health insurers pay large claims and pay millions of dollars in claims every day."
Cuomo: "Isn't it a little fishy though that this rescission review process only begins after someone files a claim? Isn't that suspicious? You know, why don't you just do it when I'm applying in the first place, figure out whether I'm telling you the truth, like most industries. Here, I filed a claim because I'm sick and now you start looking at me?"
Pisano: "Well, here's the way it- Here's the way it work. Here is the way it works. A policy is rescinded only if someone could have known that the condition existed, they were asked about it on the application and they didn't provide the information."
Cuomo: "GMA went back to Blue Cross for clarification on Shannon Dagher's case. What really surprised us was that shortly after we asked about Shannon's policy, she learned that her investigation was complete and her policy would not be canceled. Then, Blue Cross denied Shannon's policy had ever even been considered for rescission. It said in a statement to GMA, 'Although she may have received a letter from us indicating a review was being conducted in the past, her policy was not rescinded. For you to report that this member's issues are in any way linked to rescission would be erroneous and misleading.' But Blue Cross had sent Shannon multiple letters telling her that the, quote, 'rescission review process was under way.' And while Blue Cross says it sent Shannon this letter telling her the review was complete, Shannon tells us she never got anything in the mail."
Cuomo: "You're the trade group. You're speaking for them. They don't want to talk to me about it. All they say is 'Don't say she was rescinded,' but she was going through that review process. She wasn't getting her claim paid."
Pisano: "The companies we represent understand full well the impact of the process of rescission. It must be terribly disruptive, especially at a time when somebody is sick."
Cuomo: "Like Shannon, who recently had to drop out of college because of her sickness and hopes her insurance company will not add any more to her troubles."
Dagher: "To be accused of fraud when I have no defenses, when I'm sick and when I'm relying on the coverage that they promised me and that is due to me, it really shakes my faith in humanity and the good of people."
Cuomo: "But there is some good news. The company authorized the surgery. Shannon, who has a basic policy with a high deductible, did not file suit. And just recently, Blue Cross of California did authorize the surgery that surgery that may save her vision, so remember that. And a California attorney is currently settling a class action suit against Blue Cross of California. The settlement will require the insurer to prove there was intentional misrepresentation before they can cancel a problem. The insurer is denying any wrongdoing but has agreed to revise and clarify the application policy filled out by potential clients."
Sawyer: "So, after we started looking into it, word came-"
Cuomo: "Yes. We're not saying cause and effect, but we started looking into it. All of a sudden they started saying that's not even going on what you said was going on, but Shannon certainly thought it was."
Sawyer: "Well, we want to let everyone out there know that if you have an insurance company policy, a question that you want to raise, you want us to tackle something that you think the insurance companies are doing, you write to us. You let us know about it. ABCNews.com. We are on the case."
