Mismanaged Care, Part 1
Anthony Capasso thought he'd done everything right before having painful surgery to replace both knees.
He notified his insurance company, Blue Cross Blue Shield, and even got their preapproval for 4 days in the hospital and 8 days at a rehabilitation center, as ordered by his doctor. But literally on his way to rehab, he was told that Blue Cross had suddenly reneged on their agreement to pay for it--with no explanation, reports CBS News Correspondent Sharyl Attkisson.
"I was shocked and my doctor was upset. He went crazy. But they said, 'We're the boss. We'll do what we want,'" said Capasso.
So Capasso, who is legally blind, went home instead, and immediately fell just trying to get up the stairs. He hit hard on the 40 surgical staples in each knee and barely managed to get to his bedroom, where his knees began to swell.
Days later, when it became clear he was getting worse, he says Blue Cross finally agreed to let him go to the rehab center. But the therapist wouldn't touch his knees because by then they were in such bad shape, and instead sent him back to his surgeon, Dr. Kevin Lynch.
"He was the last person you should ever think about sending somebody directly home after having their knees replaced. I was beyond irate. He had nobody to help him. He was blind," explained Lynch.
Lynch says more and more insurers are overruling doctors and harming patients. He's so fed up, he's now joined 7,000 other doctors in one of the broadest legal challenges to the health insurance industry. And it's happening in Connecticut, of all places--the insurance capital of the world.
The lawsuit claims health insurance giants Cigna Healthcare, Oxford Health Plans, Connecticare, Aetna US Healthcare, Physician Health Services, and Anthem Blue Cross/Blue Shield are harming patients by denying crucial medical care, illegally denying and delaying claims, and using unfair and deceptive trade practices.
"These are stock-held companies, so their priorities are entirely different than mine. They want healthy stock. I want healthy patients," said Lynch.
And it's not just doctors in Connecticut. Doctors in Texas, California, and Georgia have launched legal assaults against Cigna, Humana, Aetna, Pacificare, Prudential, United Health Group, and Wellpoint. All of the lawsuits seek a massive change in the way healthcare is managed.
"We are in an increasingly dysfunctional healthcare system that is dangerously out of balance, and we must alter the face of medicine. And we feel this is our best chance to do that," said Tim Norbeck of the Connecticut State Medical Society.
The whole concept behind managed care was that insurance companies would deal with the billing hassles and doctors could devote all their time to patients. But critics say managed care created a monster: insurers that too often dictate cheaper, lower-quality care.
The insurance companies being sued won't talk about specific cases because of patient conidentiality. But they say the system, for the most part, works. Any mistakes are honest ones, and the only thing the legal battle will do is cost doctors and patients money.
Keith Stover lobbies for the insurance industry. "Frankly, let's just be honest. It is never in the interest of an insurance company to have a patient get sicker. It's catchy rhetoric, but the fact is it is not in our interest."
But patients like Anthony Capasso say their situations offer proof that the system isn't working. Two years after his knees were replaced, he's back on his feet. But there's no way to know how his long-term recovery will be affected because he didn't get the therapy his doctor said he desperately needed.
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