Sicko Page #3

So I was prescribed the yeast infection

cream, general cream, and it went away.

She later applied for health insurance

and that's what you're supposed

to be disclosing - serious ailments.

The yeast infection is not a serious ailment.

There was nothing she could have done.

It wasn't until they were gonna have

to spend money that they looked.

If they'd taken five minutes

and wanted to clear up the yeast infection,

they could've looked at her records

or talked to her doctor.

(Moore) Because of the undisclosed

yeast infection.

BlueCross dropped Tarsha Harris.

She thinks she's put this behind her.

And then BlueCross changes their mind,

tells the doctors, "We're taking the money

back, go get the money from Tarsha."

The fact of the matter is

it was a yeast infection, that's all it was.

I'm still a little bitter because

I don't trust insurance companies now.

To me, it seems they're always

gonna be looking for a way out.

What happened to helping

the person that's sick?

Don't make their problems worse.

(Moore) This is Lee Einer.

If they weren't able to weed you out

in the application process.

Or deny you the care

your doctor said you needed.

And somehow ended up

paying for the operation.

They send in Lee. Their hitman.

His job is to get the company's money

back any way he can.

All he has to do

is find one slip-up on your application.

Or a preexisting condition

you didn't know you had.

We're gonna go after this

like it's a murder case.

And I mean the whole unit dedicated to

going through your health history

for the last five years,

looking for anything that would indicate

that you concealed something,

you misrepresented something,

so that they can cancel the policy

or jack the rates so high

that you can't pay them.

And if we couldn't find anything

you didn't disclose on the application,

you can still get hit

with a preexisting denial,

because you don't even have to have

sought medical treatment for it.

In some states, it's legal to have

a prudent person preexisting condition.

And that's a mouthful, I know,

but what that says is

if prior to your insurance kicking in,

you had any symptom which would incline

a normally prudent person

to have sought medical care,

then the condition of which that symptom

was a symptom is excluded.

I know!

It's labyrinthine, isn't it?

But that's how it works.

They're supposed to be even-handed,

but with an insurance company,

it's their frigging money!

So it's not unintentional,

it's not a mistake,

it's not an oversight,

you're not slipping through the cracks.

Somebody made that crack

and swept you towards it.

And the intent

is to maximize profits.

Looking back,

I don't know that I killed anybody.

Did I do harm in people's lives?

Yeah. Hell, yeah.

I haven't worked for insurance companies

for a long time,

and I don't think

that really serves to atone

for my participation in that mess.

I am glad I'm out of it, though.

(Moore) Julie Pierce was struggling

to get care for her husband Tracy.

Who was suffering

from kidney cancer.

Julie works in the intensive care unit

at St. Joseph's Medical Center

in Kansas City. Missouri.

Which provided her family

with health insurance.

Every month, there was a new drug

that the doctor wanted to try.

My insurance denied it. One letter

might say, "not a medical necessity,"

one letter might say, "it's not

for this particular type of cancer,"

and they denied it.

Then we came up with the bone marrow.

It has showed to stop it,

sometimes to completely get rid of it.

(Moore) Tracy's doctors said

this treatment had been successfully tried

on many other patients.

If one of Tracy's brothers turned out

to be a suitable donor.

There were promising bone marrow

treatments for beating Tracy's cancer.

Two weeks later, the bone marrow

nurse at KU called me and she goes:

"We've got the results back. His youngest

brother is a perfect donor match."

We were ecstatic.

You know, I think that's the happiest

I had seen him...

in a while.

So we submitted it

and they denied it.

Said it was "experimental."

So I found out that there is

a board of trustees over our medical plan

that actually work at my hospital.

And they are the final decision-makers

on what gets approved and what doesn't.

(Moore) Julie and her husband

and their son. Tracy Junior.

Demanded a meeting

with the health plan's board of trustees.

The very people

who had the power to approve their claim.

They told Julie that they were

sympathetic to her situation.

I said, "Your sympathy does me no good

when I'm burying him next year."

And I told them, I said if I was...

Bruce van Cleve was our CEO.

I said, "I bet if it was Bruce van Cleve's

wife, it would get approved."

"No, it's nothing like that."

I said, "Or maybe

if my husband was white."

And I got up

and walked out of the room.

When we got home,

I found him up in the bathroom.

And I knocked on the door and said,

"What are you doing in there?" "Nothing."

I opened the door 'cause usually he'll say:

"What do you think I'm doing in here?"

And he was sitting in there

and he was crying.

And he said, "Why me?

I'm a good person."

And I said,

"But we're not done fighting this."

"We're strong, yeah."

And then he said...

You know, he goes,

"I can see now that I'm gonna die."

He said, "I can leave everything,

but I don't want to leave you and Tracy."

The doctor told me

he would die in three weeks.

And...

On January 13th,

which was my birthday,

he went to sleep.

And he died five days later,

here at home.

He was my best friend.

He was my soul mate.

He was my son's father.

I mean, we were to grow old together.

They took away

everything that matters.

I wanna know why,

why my husband?

Why wasn't he given

the chance to live?

You preach these vision and values that

we care for the sick, the dying, the poor.

That we're a healthcare

that leaves no one behind.

You left him behind.

You didn't even give him a start.

It was as if he was nothing.

And I want them

to have a conscience about it.

And I don't think they do.

I don't think it has fazed them one bit.

At all.

(Moore) There was one person

in the healthcare industry

who did have a conscience.

Dr. Linda Peeno.

A former medical reviewer at Humana.

My name is Linda Peeno.

I am here today

to make a public confession.

In the spring of 1987,

as a physician,

I denied a man

a necessary operation

that would have saved his life,

and thus caused his death.

No person and no group

has held me accountable for this,

because, in fact, what I did was I saved

the company a half a million dollars for this.

And, furthermore, this particular act

secured my reputation

as a good medical director,

and it insured my continued advancement

in the healthcare field.

I went from making a few hundred dollars

a week as a medical reviewer

to an escalating six-figure income

as a physician executive.

In all my work, I had one primary duty,

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