[Congressional Record Volume 144, Number 88 (Tuesday, July 7, 1998)]
[Senate]
[Page S7610]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          NEED FOR HMO REFORM

 Mr. DORGAN. Mr. President, our health care system is in a 
state of crisis--a crisis of confidence. Many Americans no longer 
believe that their insurance companies can provide them with the access 
to care or quality of service they need.
  Today I continue our series of stories describing how some managed 
care plans seem to have put cost saving before life-saving. The 
experience of Jacqueline Lee is just one more example of the pressing 
need for Congress to act now to protect the rights of patients.
  Jacqueline Lee lives in Bethesda, Maryland. A lover of the outdoors, 
she took a trip to hike in the Shenandoah Mountains in the summer of 
1996. While walking on one of the trails, she lost her footing, and 
plummeted off of a 40-foot cliff to the ground below.
  Luckily for Jacqueline, she was quickly airlifted from the mountain 
to a hospital in Virginia. Amazingly, she survived the fall, sustaining 
fractures in her arms, pelvis, and her skull.
  Incredibly, her HMO refused to pay the more than $10,000 in hospital 
bills. They said Ms. Lee had failed to gain ``pre-authorization'' for 
her emergency room visit. To this insurer, the fact that she was 
unconscious was no exception. For over a year, she challenged her HMO 
and faced personal bankruptcy. Ultimately, the Maryland Insurance 
Administration ordered the insurer to pay the hospital and fined them 
as well for their initial refusal to cover Ms. Lee's medical expenses.
  Yet her struggle wasn't over. Within a year, after follow-up surgery 
for her injuries, Ms. Lee found herself back in the emergency room, 
fearing that she was suffering complications from surgery. Not wanting 
to go through another ordeal, this time she called her HMO beforehand. 
They told her they would pay only for her screening fees because the 
visit was not considered ``a medical emergency.''
  Mr. President, we must take up and pass meaningful patient 
protections this year. We have a bill, S. 1890, that would prevent 
situations like this from occurring. Under our bill, Jacqueline Lee 
would have access to emergency care without preauthorization, and when 
she feels her life is in danger--not when the insurance company tells 
her it's okay. Under our bill, Jacqueline would have been covered for 
her injuries--she would not have had the rug pulled out from under her 
by the HMO.
  We have only a few weeks of legislative business left to act. 
Whatever we do will not alleviate the stress that Jacqueline Lee has 
endured, but we can ensure that others do not have to spend time 
fighting insurers that would be better spent fighting for their health. 
We must guarantee patients the peace of mind that comes with knowing 
that their health plan will be there to help them recuperate, not deny 
payment because it improves their bottom line.

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