After Philly

When we finally reached CIGNA HQ, CEO Ed Hanway chose to shut his door to Dawn, and to the thousands of people who stood with her in the journey to Philadelphia. Instead, Dawn had a conversation with CIGNA’s Chief Medical Officer, who met her with a fistful of half promises and partial admissions of guilt. She certainly has their attention, but still doesn’t have any guarantees as to whether she’ll actually get the care she needs. Dawn and her companions on the journey will be heading home this weekend, but her fight isn’t over.

I’m convinced Dawn’s story can’t be heard enough — every time she tells someone about her illness and what CIGNA put her through, I see them starting to think differently about our health care system. Even when you already know how broken it is, hearing Dawn speak deepens your commitment to change. Each person thinking differently is a grain of sand tipping the scales of the national debate towards reform. But we need to keep pouring the sand on.
Dawn’s trip shows that the messy distractions and lies of the anti-reformers can’t withstand the voices of real people wronged by a broken health care system. It’s up to all of us to keep sharing their stories and piling on the grains of sand that will tip the scales and make health care available for all Americans.

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18 Awesome Comments So Far

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  1. Stuart
    October 16, 2009 at 11:18 am #

    I am so sorry! However, after spening hours on this blog, reading the posts and comments, watching the videos, reading the timeline– I *still* cannot see how Dawn was ‘wronged’ by ‘the system’. If certain providers are considered out-of-network, then a patient has to make a decision whether to seek in-network care (in spite of it allegedly being less desirable), or work to raise the funds to get care out of that network on their own accord. Neither of these outcomes implies a practical or moral failure of the heathcare system.

    If each of the 100,000+ signors had given a little pocket change to Dawn’s cause, then she could have already been whisked off to the Cleveland Clinic.

    There are millions and millions of ‘success stories’ whereby people who are covered via private insurance receive all of the comprehensive care they need at the costs as outlined in their coverage plan, and only a much smaller percentage where they do not.

    I just received 8 months of intensive high-dose chemo at Emory and was cured of aggressive cancer — all thanks my coverage with United Healthcare. If the plan I had been paying for did not cover this treatment, I would’ve been very mad, indeed- but lashing out at them simply because the service I purchased didn’t have all the bells and whistles that I ended up wanting or needing just doesn’t seem to be the most viable case against ‘the man’. There would have been no real breach on their part: just frustration on my own part.

    Plese read my words with kindness and a tender heart, as that is how I feel: often the context is lost over the internet! I simply hope for a balanced dialogue on the real issues, rather than a one-sided entitlement best-case for everyone panacea which, unfortunately, can never happen.

    I am certainly open-minded to all sides, but honestly just don’t see the strong case being here on behalf of Dawn.

    Be well, everyone! Hang in there…

  2. Jonny Rotten
    October 16, 2009 at 1:00 pm #

    Neither of these outcomes implies a practical or moral failure of the heathcare system.

    I disagree. A single payer option would remove the whole in/out-network concept so that you can just go to the provider who gives you the best care possible. While current in-network providers are usually quite good, I am forced to see a dermatologist who is out-of-network because he is the only one (out of 7 in-network that I’ve seen) who was able to properly diagnose and treat my condition.

  3. muffler
    October 16, 2009 at 1:43 pm #

    It’s not a failure of the system as designed.. it’s a systemic failure as a whole. The design of the system is to maximize the insurance company’s profit and not provide the best care for the patient. So yes the system works as designed BY THE INSURANCE COMPANIES.

    The in-network provider might not be the best one for the patient, but the rules (as to ensure profit) enforces in-network. That is a death panel to Dawn.

  4. Stuart
    October 16, 2009 at 11:47 pm #

    Just want to issue a quick follow-up to my initial comment, lest there be any uncertainty about how I feel regarding Dawn’s situation, or any other person who finds him or herself in a similar situation. It really stinks. I hate it and it’s saddening and horrible. I don’t like one single thing about it.

    We all agree that something systemically needs to be changed, and I hope that we can be collaborative to find the BEST and smartest talking points to effect the necessary change.

    A complete overhaul of the system may not be necessary, as over 80% of the country is pleased with their current coverage. Something that expands coverage for people like Dawn, breaks down interstate restrictions currently imposed in our employer-based system, offers a public/private competitive dynamic, and incents us all to make the best choices for healthy living that we can control — that’d be just great.

    Now… as if I have a clue how to get us there!
    One step at a time, I suppose. Be well, everyone–

  5. Nellie Moore
    October 17, 2009 at 1:03 am #

    Dawn I am so sorry you were not able to meet with Cigna’s CEO. I hope that the wheelbarrows full of pill bottles went somewhere they might be read. Like to the President or Congress or the Senate.

    You collected those thousands of bottles and the stories (my sisters is one of them) need to be told.

    If it speaks to you I volunteer myself to take every one of those stories and put them into an e-book format with the permission of all of those who submitted the notes.

    There are lots of ways for us to tell our stories. Through public television shows like Sick In America on FrontLine, or SICKO or other ways. We have to keep speaking out until we are heard. Grassroots is what it is going to take.



    Nellie Moore
    WyseWomen LLC

  6. Nellie Moore
    October 17, 2009 at 1:13 am #


    I am so glad that your insurance supported you in getting the care you needed. Unfortunately that is not the case for everyone. I second what Jonny said about in network/ out of network.

    Getting the care that we need should not be a matter of meeting in our out requirements. If the best doctor for your needs happens to not be IN your network are you left with seconds?

    My sister is dealing with a brain tumor. She has insurance and still she has to fight and wait to get her needs meet. Add to that that there are other things she needs care for that she is in a waiting phase for. Like a plane circling for a landing. She is afraid to ask her doctors for more or challenge them and question her treatment because they fill out her paperwork to get her claims met, and she is afraid her insurance company might cancel her insurance. What kind of health care system is that???

    I am glad you were cared for and I wish you the very best, but please know there are many more out there that are going through what Dawn and my sister are.



    Nellie Moore
    WyseWomen LLC

  7. TelltheTruth
    October 17, 2009 at 7:54 pm #

    So are you going to tell the whole truth any time soon

    “January 26, 2009 ‚Äì Giving me only two months notice, CIGNA raises my rates from $366.00 to $753.47 a month.”

    funny how you left out the fact that you were incorrectly being charged for your coverage underpaying your premiums for a while. also you premiums were adjusted due to your conversion to COBRA. these rates i assume are regulated in your home state of GA.

    but you left that part out huh?

    also you are accessing an out of network facility and expected them to cover everything? maybe you should have read about your coverage first i am sure there are many great in network facilities you can go to. oh wait emory screwed up so that somehow is cigna’s fault. oh cleveland clinic won’t sign a contract with cigna because they are a monopoly in the cleveland area…but somehow that is cigna’s fault.

    and then you decide “hey they won’t cover CC let me pick ANOTHER out of network facility”

    and you wonder why you are getting denied?

    insurance is messed up, but you really should come out and tell the whole truth.

  8. Tom
    October 18, 2009 at 6:18 pm #

    The individual IS the patient, but the discussion keeps stuck in treating insurance plans/ providers and institutions as the patient. I spent 15 years as a military health care delivery professional and TEAM member focusing on “patient at the center of care delivered”. As a disabled (but not compensated)US military veteran, I now interact with the biggest HMO in our world, where teamwork is a foreign concept, but divisions based on reams of paperwork assessing eligibility status are endless and prevent direct and actual care delivery to the individual.
    Stuart (well-worded thots!) writes, “I don’t see the wrong here” and compares his great care, and a vague “millions & millions” of ‘success stories’ with “a much smaller percentage” that are not. By so doing he keeps the focus on the media sport of side A (comparative success) vs side B (actual failure and non-care/worsened health minimized to comparative failure), concluding on balance that everything essential is OK. Limiting the issue (actual health care delivered when needed) to a win-lose, my insurance vs your insurance discussion only means the money will win EVERY time (the haves fight the have nots while the rich keep consolidating the wealth for corporate health).
    What is needed is a separation of actual, “patient-at-the-center-of-care” health care delivery/ed from the HMO, corporate product sales (“insurance”)process. There is NO requirement that the latter system must be retained (given priority, kept healthy, “cared for!”) in a discussion of health-care delivery to the human patient. The system has been and IS the problem! Going to a worldwide discussion (the only sensible real-world discussion to have) historically puts the US near the bottom of cost vs actual delivery studies, and will show how meaningless and artificial the A vs B “discussions” are, and how much their purpose is to protect and continue the corporate insurance industry and its non-delivery of care. Suggesting someone can go “off-network” is simply an extension of this failed discussion. All the plastic gold cards in the world will not help you or your loved ones if the actual health care is not there when needed(use your imagination here). “Greatest nation” is as greatest nations DOES.

  9. Margaret Welman Paez
    October 18, 2009 at 9:58 pm #

    First of all, Dawn, I am sorry you got the response you did, or rather lack of response from CIGNA. Ethically, they were irresponsible and have been on all counts.

    I would like to address the comments made by Stuart. Your comments, Stuart, read like the insurance shill I highly suspect you are. Only someone who works for a health insurance company, like Chris Curran who is CIGNA’s mouthpiece, would come out with such a diatribe on in-network coverage as you did in your first comment. We aren’t talking about in-network and out-of-network doctors and treatment for acne. We’re talking about brain surgery; a highly skilled operation by a neurosurgeon to remove tumors from Dawn’s brain without irreparable damage. It’s why the Cleveland Clinic is one of a handful of places in the world to handle cases such as Dawn’s.

    Then to go on and say, “If each of the 100,000+ signors had given a little pocket change…” So the premiums Dawn has been paying to CIGNA, as part of a larger risk pool, don’t count? Risk pool. Lots of money coming in, and less money going out. It’s part of their business; why they are in business to begin with. And think how much better CIGNA would have looked had they just taken care of this woman? No PR nightmares, no shills on websites…

    “Millions and millions of success stories..covered by private insurance receive all the comprehensive care they need ‘at the costs outlined in their coverage plan’…” You gave yourself away with that paragraph, Stuart. If this nation has so many success stories, then why is AHIP lobbying so furiously against reform? Why is there a national outcry from the electorate for reform? And don’t point to the fake grassroots movements of the corporate sponsored tea-baggers–Koch brothers sponsored ones (among others) at that, as being the majority voice in our country. That is simply not true.

    And truly, if you do have some aggressive form of cancer, tell us all what kind. We are interested to know. How was chemo for you? Were you able to work through it? Did your employer understand your condition? Were you on disability? How are you now?
    Because to say, when faced with an aggressive form of anything, “If the plan I had been paying for did not cover treatment, I would’ve been very mad, indeed-but lashing out at them simply because the service I purchased didn’t have all the bells and whistles…” Oh dear god, you are not human nor are you who you claim to be. Try, really, being diagnosed with something aggressive and/or life-changing, you just don’t know how it feels to have uneducated corporate-trained grunts reverse or deny what your doctors say–you have no idea–none. With the final nail in the coffin being, “Sorry, the premiums you have been paying, just don’t cover it.”

    And finally, Stuart, “A complete overhaul of the system may not be necessary, as over 80% of the country is pleased with their current coverage.” Where did you pull that number from? A CIGNA memo? FOX News? The repealing of he Fairness Doctrine took all the “fair and balanced” out a long time ago.

    If you really think Dawn’s situation is “saddening and horrible and you don’t like one single thing about it,” then you would be on the side of a national health care plan, like the ones enjoyed by every other industrialized nation in the world.

    Hey Stuart, McCarran-Ferguson can’t keep the monopoly going forever. It will end. Human life is more important than the “business of insurance.”

  10. Stuart
    October 18, 2009 at 11:45 pm #

    Margaret, thanks for your thoughts. Not quite sure why I would have any incentive to dish out mistruths on this blog comment forum; really don’t see what I would have to gain by doing so. But your mistrust and skepticism begs a response, so here we go.

    I don’t work for, nor have I ever, any sort of health insurance (or any insurance, for that matter) provider or affiliate. I have paid my premiums into my employee-sponsored plan for 10 years just like many have, without any real claims, until I was diagnosed with cancer last November. My simple question about in versus out-of-network coverage shouldn’t be too hard to answer, if there is, indeed, a viable answer out there. Seems like the answer just isn’t as simple as I would want.

    When we buy an insurance policy, there are puts and takes. Every economic agreement has trade-offs– balances between input and output, risk vs. reward. (Don’t write all this off, simply because we happen to be dealing with delivery of healthcare in this example) We may even pay into the ‘system’ over the course of a lifetime, and never really see any benefit in return. That’s the nature of an insurance-based risk pool. I think we can all agree on this simple concept. Auto or homeowners insurance is not much different, is it?

    In order for any risk sharing to be viable, there have to be ground rules around what is and isn’t covered for potential payouts. It’s not possible or realistic that every procedure from any and all providers would be eligible, unless we all want to chip in considerably higher premiums to cover this sort of agreement. There are plans like this, but they cost quite a bit more.

    Whether we’re taking about acne or brain surgery, the plan makes its own assessment of what is under the umbrella, and what isn’t. Likewise, certain providers agree to provide discounted rates, and others do not. There is nothing inherently good or evil about any of this, in my opinion.

    Of course insurance companies pay out less than they take in. They provide a service and are being compensated for it. Every service comes with a cost. HMO-type insurance plans have net profit margins in the mid 3% to mid 5% range. These returns are paltry compared to other consumer industries against which no one really seems to conjure up such vitriol as insurance. For a company to take home 3-5 cents on the dollar for every dollar of revenue does not seem unreasonable to me, as they do indeed provide a service (Dawn has clearly ‘taken out’ more money than she has put in, as I did with my treatment). She and I both got more from the ‘system’ than we put in. We are net positive in purely financial terms.

    Sure CIGNA could’ve avoided the bad press with this sort of story, but they are not in the business of making contracts with people and then making concessions outside of that contract. If they were to do that, what would be the value, then, of having any sort of agreement to begin with? I honestly still have yet to hear WHY someone (not just Dawn) should get benefits above and beyond what is being contractually offered in their coverage initially. I am certainly open to being compelled that way if there is a reason to, but I have yet to see it laid out in a way that makes it clear. It’s just not as easy as saying, “well, she needs it — so give it to her.”

    Not quite sure what you mean by me ‘giving myself away’. If your intuition is as clever as you portrait it to be, then why are you so way off the mark? Again, I am a consumer just like the rest of you, who happens to just be a success story rather than one who slipped through the cracks. Maybe you’re not used to people saying they’ve had good experience within a system that you attribute to be so underhanded and evil? Well, I am one of those people.

    I don’t know anything about AHIP. I will have to look into it. If you think I am NOT for reform, simply because I asked for a compelling argument why people should get something above and beyond that to which they are contractually entitled, you are mistaken. I am all for reform. The system is broken, indeed. Lots of wasted costs, lack of transparency due to the horrible third-party payor model, no real incentive for healthy living, and a pervasive over-reliance on employer-based care. I hate all this… hope we can change it all for the better.

    I had Burkitt’s Lymphoma that was discovered through an emergency appendectomy last November. I had eight months high-dose inpatient chemo in a regimen called R-hyperCVAD M/A. This involved me getting eight rounds of 7 chemo drugs via a central catheter put in my chest, as well as intrathecal treatments directly injected through a RIckham port which was installed in my brain. I spent over 40 nights in the hospital, had a staph infection halfway through treatment, had an atrial fibrillation in my heart, dozens of platelet and blood transfusions, and my friend who was getting the same treatment for the same cancer died just a few weeks ago. I also had dozens of side effects, some of which will be permanent. I am 32 yrs old.

    Not quite sure if your inquiry was genuine or if you really did want to know more about my situation. But I will gladly tell you all that you care to know.

    I did have to stop working. I was out of work for six months. I went on a short-term disability leave of absence. The week I was set to return to work, my employer was on the verge of filing bankruptcy (and they still are). I had my three-month scan last week and just found out three days ago that I am still in remission. I have a damaged immune system, chronic nerve pain in my feet, sinusitis going on five months straight, and bowel problems that would make you sick. I just grew my hair back, which was a nice sign of ‘returning to life’.

    What else would you like to know?

    I had no issues with my coverage. I got three opinions up front, the latter two of which saved my life because they superseded the original pathology. All in all, I estimate that I paid about $5,000 for $300,000 worth of healthcare. I am truly a net benefitter from the insurance system. Thank goodness for situations like mine. My insurance provider did a great job and certainly deserves to be paid for the component of work they did.

    You wrote, “Oh dear god, you are not human nor are you who you claim to be. Try, really, being diagnosed with something aggressive and/or life-changing, you just don‚Äôt know how it feels…” —
    I trust you stand corrected at this point?

    If asking a legitimate question to which I have yet to read a legitimate answer provokes this kind of invective and distrust, it makes all the more sense why this issue cannot seem to be resolved. If you cannot have a productive dialogue on real issues such as these, then what will that do for us? If someone disagrees with you on any given point, then why don’t you make an attempt to show them the supposed enlightenment that you’ve found, as opposed to pushing them even farther away from you by using these sorts of tactics?

    The 80% number– I did indeed hear someone use that figure on a cable news network. I took it as valid. Forgive me if that’s not an accurate assessment. I would think it’s a majority of people, at a minimum.

    I agree with your last statement in that human life is more important than the business of insurance. I think we, as a society, generally act accordingly.

    A national plan would be the death knell of healthcare, in my opinion. That, too, is something about which I have heard no compelling case. I am so happy I was covered by a private plan, as opposed to a large pubic plan when I got sick. I’ve probably been too long-winded already, so I better let that one pass lest I ramble on any longer!

  11. Shane
    October 19, 2009 at 12:24 pm #

    Margaret, I am appalled at the way you attacked Stuart. You should be ashamed of yourself. Stuart, you are a well spoken gentleman. I am thankful you are in remission. People like Margaret give us all a bad name. Your posts were very informative and I too have some questions. After reading these posts, I will take my questions elsewhere.

  12. Cindy
    October 19, 2009 at 1:42 pm #

    Stuart, I hope that your questions get answered. I’m very sorry you were slimed by Margaret. It’s easy for us on the left to attack those who don’t agree with us instead of educate ourselves. I secretly wish our base were like those who watch Fox news and are passionate about educating themselves on what is really going on. You asked a valid question and it never was answered. i tried to do the research to answer your question but was stumped. You make a valid point.

  13. trog69
    October 19, 2009 at 3:06 pm #

    Margaret, you have not one thing to be sorry for. I agree; Stuart sounds suspiciously like a company shill to me. And I suspect the chorus agreeing with his slimy ass are, as well. Scum like them who decide to ignore the bankruptcies occurring in this country due to lack of health care coverage is unconscionable, yet here we have three “people” on a site that is trying to fight for those, like Dawn, who are getting screwed over daily by an insurance monolith that cares only about profit.

    Cindy, you know what you can do with your fellow Fox “news” viewers, don’t you?

  14. Stuart
    October 19, 2009 at 3:34 pm #

    Oh yes, three people who ask sincere, valid questions are ‘company shill’ and must be moles with a corporate agenda. Yeah, that’s it. ‘Scum’ like us are ‘slimy a**es’ [Read with your best whiny, sarcastic voice]. It’s reassuring how people so readily launch into character attacks when they have no basis for doing so.

    Is this the BEST case you (any of you) can make for your assertions? Surely if you have real passion for this, you can convince someone else in a respectful manner, right? I had high hopes, but looks increasingly as though they were misplaced.

    Also ironic is how legitimate questions seem to bring out the best of middle school playground behavior when people really don’t have well-conceived thoughts behind the statements they make. Ah, the veil of anonymity that the internet offers such bright people! Gimmie, gimmie, gimmie! I am entitled to it!

    Someone please answer my question on how, exactly, Dawn is getting so ‘screwed over daily’ by the insurance industry. Despite whatever persona you’ve immaturely and presumptuously chosen for me, I am open-minded and ready to be corrected if it’s just that simple. Calling me names still doesn’t really answer the simple question.

    I’m waiting… put your best foot forward this time.


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