House Subcommittee Hearing Focuses on Alleged Insurer Abuses

The chemotherapy was shrinking cancer patient Esther Dardinger's tumors when her insurer, Anthem Blue Cross & Blue Shield, decided to stop paying for it.

The decision was based on a 10-minute review of the case, according to court records. When Dardinger appealed, Anthem's bureaucracy moved slowly but stood its ground, eventually prompting her family to pay for the treatment itself, according to an Ohio Supreme Court opinion upholding a jury verdict against Anthem.

"Anthem had worn them down as surely as the cancer had," the court opined. "Like the cancer, Anthem relentlessly followed its own course, uncaring, oblivious to what it destroyed . . . . The ruination of a life was just a side effect."

Rep. Dennis Kucinich (D-Ohio), chairman of a House subcommittee on domestic policy, invoked the 2002 case at a hearing Thursday, arguing that private insurance bureaucracies wrongly reject medical claims and hassle customers.

The hearing was part of a continuing Democratic effort to promote an overhaul of the nation's health care system by focusing on alleged abuses by health insurers. As Republicans argue that legislative proposals would put government bureaucrats between patients and doctors, the hearing served as a reminder that patients now contend with private insurance bureaucracies.

"The actions of insurance company bureaucrats in causing needless delays and denials of coverage for prescribed treatment can be as detrimental as the disease itself," Kucinich said.

The subcommittee's ranking Republican, Jim Jordan of Ohio, said it was "inexcusable" that insurers cancel policies when the policyholders get sick. But, he added, "I think that most Americans, like me, instinctively realize that trading some challenges with insurance companies for the bureaucracy of the federal government is not the solution."

Kucinich cited a recent report by the California Nurses Association that, from 2002 through the first half of this year, six of the largest insurers operating in California rejected 47.7 million claims -- 22 percent of the total.

In a reflection of the vitriol that has characterized the debate over health care policy, the association headlined its statement about insurers "California's Real Death Panels."

Executives of major insurance companies testified Thursday that they reject much smaller percentages of claims than suggested by that report. The big insurer WellPoint, now the parent of Anthem Blue Cross and Blue Shield of Ohio, said the nurses association used data from a regulatory filing that included claims initially rejected for any reason -- for example, if patients had not met their deductibles or the claims lacked supporting information.

After obtaining more information, WellPoint's Anthem Blue Cross subsidiary in California ultimately denied less than three percent of claims received during the first half of 2009, WellPoint executive vice president Brian Sassi said in a statement to the subcommittee.

"Our mission is to improve the health, well being and sense of security of the customers we serve," Tom Richards, senior vice president of CIGNA, told the subcommittee.