Yesterday I helped arrange a meeting with Hilda Sarkisyan, a Consumer Watchdog Hall of Famer, and health insurance industry whistleblower and Deadly Spin author Wendell Potter, with Senate staff on Capitol Hill. Hilda's 17-year-old daughter Nataline died after her insurance company CIGNA refused to pay for a potentially life-saving transplant. The Sarkisyans tried to take CIGNA to court and hold the company accountable but were turned away because a decades-old law and a bad Supreme Court decision prevents most people who get their insurance through an employer from suing their insurance company. (Read more about this law, called ERISA, here.)
Hilda is such a joyful presence that it is easy to forget for a few moments why we met and simply enjoy her company. But she was in Washington yesterday to make sure no one in Congress forgets what happened to her daughter, and ask them to make sure the same tragedy doesn't happen to another family.
Wendell shared with the Senate the constant pressure on insurance company employees to meet profit goals and Wall Street expectations. A few expensive procedures like Nataline's can mean the difference between hitting the quarter's profit goals or falling short. What's the financial incentive for a company to pay for a procedure when they can't be held accountable in court if they refuse?
We are just a few days away from a Supreme Court decision on whether to uphold or overturn the federal health reform law. Whatever the court decides, nothing will have changed for family's like Hilda's who are denied justice under ERISA.
In fact, the health reform law created significant protections against many of the tactics that health insurers have relied upon in the past to avoid paying expensive claims – like cancelling an insurance policy when a patient gets sick. I fear we may begin hearing even more ERISA horror stories from the health insurance market because insurers will start relying more on tactics like delay and denial of claims that they can't be held accountable for. Forcing consumers to fight for every benefit (even more so than we do now) could be the new frontier of insurance industry abuse.
For anyone in the Baltimore area this Sunday, the Maryland Center of Fashion Design is holding a fashion show honoring the Nataline Sarkisyan Foundation for the work it does to carry on Nataline's legacy and help other young people achieve their dreams. You can find tickets or support the event here.