Heart-breaking, Wrong, and Not Quite Accurate

Sep 30, 2009 12:50pm

Fact-checking the legitimately heart-breaking anecdotes of real Americans is a thankless task. Health insurance companies make callous decisions that hurt real Americans, and no reporter wants to belittle those outrageous tales of bureaucratic bean-counting. Pointing out inaccuracies in versions of these anecdotes told by the president feels like not seeing the forest for the trees. The larger issue is clearly that insurance companies are making decisions like these.

Earlier this month, when the President addressed a joint sessions of Congress to push health care reform, he said:

"One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about.  They delayed his treatment, and he died because of it.  Another woman from Texas was about to get a double mastectomy when.  By the time she had her insurance reinstated, her breast cancer had more than doubled in size.  her insurance company canceled her policy because she forgot to declare a case of acne. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America."

Both stories were shared at a House Energy and Commerce subcommittee on oversight and investigation hearing in June. It turns out that while it's impossible to defend the behavior of the insurance companies in either instance, the stories, as the president told them, were not accurate.

The White House declined to comment, but White House senior adviser David Axelrod previously told the Chicago Sun-Times about one of the stories that the president got "the essence" of one of the stories "exactly right," and "the point the president wanted to make and did make" was that "insurance companies look for excuses to rescind their coverage just when [a person] needs it the most. … And that practice has got to stop."

But, as the Chicago Sun-Times' Lynn Sweet was first to report, Otto Raddatz, the Illinois man who lost his coverage in the middle of chemotherapy didn't die because of any delayed treatment, as President Obama stated.

Otto's sister Peggy told his story to the House Energy and Commerce Committee earlier this year.

"My brother was told he was canceled during what they called a 'routine review' during which they claimed to discover a 'material failure to disclose'. Apparently in 2000 his doctor had done a CT scan which showed an aneurysm and gall stones. My brother was never told of either one of these conditions nor was he ever treated for them and he never reported any symptoms for them either.

"After months of preparation, the stem cell transplant could not be scheduled. My brother's hope for being a cancer survivor were dashed. His prognosis was only a matter of months without the procedure. When I called the hospital to see if I could schedule the stem cell transplant for him I was callously told 'unless your brother brings in cash, he is not going to get the procedure without insurance.'

"My brother was accused by Fortis Insurance Company of falsely stating his health insurance history, despite the fact that he had no knowledge of ever having any gall stones or aneurysms. Luckily, I am an attorney and was able to aggressively become involved in solving this life threatening situation. I contacted the Illinois Attorney General's office and received immediate and daily assistance from Dr. Babs H. Waldman, M. D., the medical Director of their Health Bureau.

"During their investigation, they located the doctor who ordered the CT scan. He had no recollection of disclosing the information to my brother or treating him for it. After two appeals by the Illinois Attorney General's Office, Fortis Insurance Company overturned their original decision to rescind my brother's coverage and he was reinstated without any lapse. Without the help of the office of the Illinois Attorney General, this would not have been possible."

I spoke to Peggy Raddatz, who supports President Obama's health care reform push and didn't want to say anything to take away from the fact that Fortis Insurance Company mistreated her brother, who died three and a half years later. That was the important thing, she said, and the fact that she was an attorney who was able to devote her life to his case, and get the attention of the Illinois Attorney General, shouldn’t take away from that.

“He did indeed receive the stem cell transplant,” Raddatz testified in June. “It was extremely successful. It extended his life approximately 3-1/2 years.”

Peter Duckler, a spokesperson for Assurant Health, the former name of Fortis Insurance, told ABC News that “due to privacy issues we never comment on the case of an insured.”

President Obama's second anecdote also features an American mistreated by the health insurance industry — and again, the story is not as he represented it.

Robin Lynn Beaton of Waxahachie, Texas, testified:

"In May 2008, I went to the dermatologist for acne. A word was written on my chart and interpreted incorrectly as meaning pre-cancerous. Shortly thereafter, I was diagnosed with Invasive HER-2 Genetic Breast Cancer, a very aggressive form of breast cancer. I was told I needed a double mastectomy. When the surgeons scheduled my surgery I was pre-certified for my two days hospitalization.

"The Friday before the Monday I was scheduled to have my double mastectomy, Blue Cross red flagged my chart due to the dermatologist report. The dermatologist called Blue Cross directly to report that I only had acne and please not hold up my coming surgery. Blue cross called me to inform me that they were launching a 5 year medical investigation into my medical History and that this would take approximately 3 months.

"I was frantic. I did not know what to do or where to turn. I knew I could not pay for the surgery myself Shortly thereafter I turned to my Congressman Joe Barton for help. Mr. Barton and Christy Townsend worked tirelessly to help me. Next, I found out that my insurance was completely cancelled; this was devastating. I had to completely refocus on what to do where to turn because my insurance cancelled me. Cancer is expensive and no one wanted to pay for it. This is America and we deserve good Health Care.

"Earlier in my life off and on I had a fast beating of my heart which was not a current problem, just something that happened when I was upset. I truly did not even think about this when I applied for insurance; I even offered to go take a physical they said no. The sad thing is Blue Cross gladly took my high premiums and the first time I filed a claim and was suspected of having cancer they searched high and low for a reason to cancel me. There is a nurse who attends my church who works fulltime for Blue Cross and all she does is read medical records looking for reasons to cancel people. After she heard what happened to me, she told me how very sorry she was.

"Blue Cross will do anything to get out of paying for cancer. Another sad fact is anyone who has a catastrophic illness who is not part of a group stands a great chance of being left out in the cold without insurance."

Again, the story is horrific, the actions of Blue Cross/Blue Shield of Texas indefensible.

Margaret Jarvis, a spokeswoman for Blue Cross/Blue Shield of Texas told ABC News that privacy laws preclude her discussing details about a client’s health insurance.

But President Obama's description that Beaton’s “insurance company canceled her policy because she forgot to declare a case of acne" is not accurate.

As Beaton’s congressman, Rep. Joe Barton, R-Texas, testified, the Blue Cross/Blue Shield letter “informed Ms. Beaton that an investigation into her claims for benefits resulted in the company reviewing her medical records in which they discovered she had misinformed them on several pieces of information. One of them was that she did not list her weight accurately, and the other, that she failed to disclose some medication she had taken for a pre-existing heart condition.”

Blue Cross discovered the previous condition after her visit to the dermatologist for acne, but her insurance was not canceled because she didn't declare a case of acne.

"It's become a political imperative to find real-life examples of people helped or hurt by the issue of the day," the Associated Press's Calvin Woodward writes. "People relate more easily to a story than to abstract policy. But such stories often suffer in the retelling. Corners are cut, complicated situations made sound-bite simple."

– jpt


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