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ABC’s Sicko
Trevor Butterworth, June 25, 2007
Did ABC’s expose of a vicious health insurance industry practice save a young woman from going blind – or was a letter just lost in the mail?

It seemed like the perfect storm of outrage – a way to show that Michael Moore isn’t the only one in America who’s exposing the health insurance industry for putting profit ahead of patients. In a long segment aired on Good Morning America on June 18, ABC went after Blue Cross (which, ironically, Moore recently praised for being one of the good guys in the insurance business) for the way it appeared to try to wrangle its way out of paying for treatment that would prevent a 22-year old woman going blind.

“Shannon Dagher, a 22-year-old college student, said she was at the eye doctor for a checkup last November, one month after her new insurance policy kicked in, when she received terrible news.

‘I was diagnosed with a very rare disorder, called pseudotumor cerebri. It basically looks and acts like a brain tumor,’ Dagher said.

Dagher's doctors said she needed surgery or she may go blind.
"I'm petrified of the thought of going blind," Dagher said. "I've never been sick before in my life and now in the past six months I've started to lose my peripheral vision and I'll never get that back."

But instead of authorizing the surgery, her insurer, Blue Cross of California, stopped processing her bills.

The company instead launched a ‘rescission investigation’ into Dagher. It threatened to cancel her coverage if she had failed to disclose accurate information about her health on her original application.”

As ABC noted, Dagher didn’t check a box saying she had been suffering from headaches, which can be a sign of pseudotumor cerebri. So when she filed a claim based on her diagnosis (which came a month after she signed up for the policy), she was shocked to find herself in a rescission investigation.

But when Good Morning America staff contacted Blue Cross, they were “surprised” to find “that shortly after we asked about Shannon's policy, she learned that her investigation was complete and her policy would not be canceled.” (Original transcript)

“Then, Blue Cross denied Shannon's policy had ever even been considered for rescission .It said in its statement to GMA:  

‘Although she may have received a letter from us indicating a review was being conducted in the past, her policy was not rescinded.  For you to report that this member's issues are in any way linked to rescission would be erroneous and misleading.’

But Blue Cross had sent Shannon multiple letters telling her that the, quote, ‘rescission review process was underway.’  And while Blue Cross says it sent Shannon this letter telling her the review was complete, Shannon tells us she never got anything in the mail.”

Ultimately, Blue Cross authorized the required surgery, which led Diane Sawyer to say to correspondent Chris Cuomo,

“So after we started looking into it, word came—“

“Yes,” said Cuomo.

“We're not saying cause and effect, but we started looking into it, all the sudden they said, 'we weren't – that's not even going on, what you're saying was going on.' But Shannon certainly thought it was.”

“Well,” said Sawyer, “we want to let everybody out there know, that if you have an insurance company policy, a question that you want to raise, you want us to tackle something that you think the insurance companies are doing, you write to us, you let us know about it, abcnews.com. We're on the case.”

If Good Morning America really did defeat a vicious rescission review by a well-timed investigation, then it’s hard to argue about the worth of the segment. Score one for investigative journalism. But if this story was merely about a letter lost in the mail, and a series of unfortunate coincidences, well, the luster fades, not only on the merit of Shannon Dagher’s complaint, but on the reportorial strategy of using her to illustrate the evils of rescission.

Then, on June 22, ABC appended the following clarification to the web version of the story.

“On June 18th, Good Morning America aired a report about health insurance companies rescinding individual policies because patients had failed to disclose pre-existing medical conditions. The report incorrectly included a graphic stating that Shannon Dagher had been denied insurance coverage. Although Blue Cross of California held her claims payments while she was the subject of an investigation, it never rescinded her policy and insists that it never denied Ms. Dagher applicable care, coverage or reimbursement. Blue Cross says Ms. Dagher was investigated for possible failure to adequately disclose several pre-existing conditions -- not just headaches. Ultimately, the company says she was found to have made adequate disclosures and was sent a letter dated March 27, 2007 informing her that the investigation had ended. Ms. Dagher told GMA that she never received that letter; Blue Cross insists that it resolved the pre-existing condition review weeks before receiving Good Morning America's first phone call.”

But according to Shannon Troughton, a spokeswoman for Blue Cross of California’s parent company, Wellpoint, on May 22nd Blue Cross provided Good Morning America with details of a dozen pre-existing conditions related to Dagher’s pseudotumor cerebri, which she had been suffering from for years, and which were much more severe than headaches. How did they have this information? Dagher’s physician had provided this medical history to Blue Cross. In other words, it doesn’t appear that Dagher was investigated just because she failed to tick off the box marked “headaches.”

And the review into whether Dagher should have had her insurance rescinded (which included the participation of a physician) decided in February that she should not lose her insurance coverage, despite her other medical problems. While Dagher may have never received the letter informing her of this decision, Troughton said internal company documents are able to date the review and the decision. In other words, it appears that ABC’s intervention merely righted a delivery problem rather than pushed the insurance company into paying up.

At which point, one has to ask what is the point of the story? If Dagher’s medical file listing a dozen pre-existing conditions was given to GMA (patient privacy means that STATS is unable to ascertain the contents of that file), and if the review concluding she should have her treatment paid can be dated to February, as Blue Cross claims, ABC has sourced a trend story to a lost letter. Couldn’t it’s investigative team find a second source with a more robust story of insurance malfeasance?

Still, there is one mystery left hanging: why, given the list of pre-existing conditions, did Blue Cross decide to pay Dagher’s health costs? Troughton said the company didn’t like to deny patients care, and that rescission was rare. Incredible? Well, as Michael Moore told the Seattle Post Intelligencer,

“My dad worked for General Motors, we had Blue Cross, it was provided 100 percent, there were no co-pays or deductibles. Whenever any of us got sick, we were taken care of right away.”

(Please note that STATS doesn’t receive any money or support from Blue Cross or any other company it writes about)

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