English transcript

I am here primarily 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 cost his

death. No person and no group has held me accountable for this. Because, in fact, what

I did was I saved a company a half a million dollars for this. And furthermore, this particular

act secured my reputation as a good medical director and it ensured 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 and that was to use my medical expertise for the financial benefit

of the organization for which I worked. And I was told repeatedly that I was not denying

care, I was simply denying payment. Let me explain to you the ways that I was a good

medical director. I was regularly consulted by marketing on ways to change expensive benefits

or change the language to give me loopholes to make denials when requests came. I turned

pre-existing exclusions into a game as I tried to connect almost any prior medical complaint

or visit as a reason to deny payment. What kind of system have we created when a physician

can receive a lucrative income for adding to the suffering of patients? I became a physician

to care for and not bring harm to my patients. And I'm haunted by the thousands of pieces

of paper in which I have written that deadly word, denied. Dr. Linda Pino denied a medically

necessary operation back in the late 80s. The patient died, but she saved the insurance

company she worked for as a medical director, half a million dollars. Then she got promoted.

Her job, use your medical degree for the company's financial gain, not for patient care. She was

told you're not denying care, you're denying payment. Denying payment for necessary treatment

is denying care. She made a lot of money by writing one word thousands of times, denied.

She testified to Congress in 1996 that this haunted her. The insurance system, it's only

gotten worse without any congressional intervention to break up this monopoly. Insurance companies

increase their profits all the time by denying claims. 30 years, both parties. We've allowed

this to get worse with zero reform. To every denied patient, someone you have never met

is paid to deny your claim, appeal it. The system counts on you giving up. And a denial

will, that can be a death sentence. Ask Dr. Linda Pino.