Sicko Page #4

was to remove it.

Surgery was scheduled

for December 9.

There is a test that you can take

that will show whether or not

you would benefit from chemo.

(Moore) They got their treatment. But not

before battling their insurance companies.

Investigated whether or not

this was a preexisting condition.

"It's not medically necessary."

They claim that it's experimental.

"We don't consider that life-threatening."

(Moore) Diane died

from her non life-threatening tumor.

Laurel's cancer is now spread

throughout her body.

Her "experimental test"

proved that Caroline needed chemo.

While vacationing in Japan.

Maria became ill

and got the MRI that BlueShield

of California had refused to approve.

The doctors in Japan

told her she had a brain tumor.

BlueShield had said repeatedly

she didn't have a tumor.

That's when she said:

"Well. I'm pretty sure I have a lawyer."

(man #3) March 13, 2003.

I'm gonna direct your attention

to exhibit one.

Please describe for me what it is.

It is a denial for referral

to an ophthalmologist.

- (man #3) Is it your signature on this?

- Yes.

(man #3) I'd like to direct your attention

to exhibit two.

This is a denial

of a request for referral

for a magnetic resonance imaging test

of the brain.

- (man #3) It has your signature?

- Yes.

(man #3) Directing your attention

to exhibit three. Please read this document.

This is a denial of a referral

to a neurosurgeon.

(man #3) Can you explain for me

how you came to sign the denial letter?

This is a standard signature

put on all denial letters.

- (man #3) Is it your signature or a stamp?

- That is a stamp.

(man #3) Did you ever see a denial letter

before your signature was stamped on it?

No, but the denial letters

are fundamentally the same.

The denial letters that are sent out...

- (man #3) The answer is no.

- No. All right.

The definition of a good director was

somebody who saves the company money.

(Moore) Dr. Linda Peeno

was a medical reviewer for Humana.

She left her job because she didn't like

their way of doing business.

(Dr. Peeno) I was told when I started

that I had to keep a 10% denial.

Then they were giving us reports weekly

that would have all the cases we reviewed,

the percent approved

and the percent denied.

And our actual percentage denial rate.

Then there would be another report that

compared me to all the other reviewers.

The doctor with the highest percent

of denials was gonna get a bonus.

(Moore) Really? So you, as a doctor,

working for the HMO,

if you denied more people healthcare,

you got a bonus?

(Dr. Peeno) That was how they set it up.

Any payment for a claim

is referred to as a medical loss.

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