Ladies and gentlemen:  

In August of 1995, my husband and I watched in horror as our happy-go-lucky nine-year-old little girl suddenly without warning became school-phobic.  She would constantly cry and beg us not to send her to school.  She would shake so hard in the morning she had no way of being able to get dressed herself.  She would sleep under the bed so that we could not find her the next morning and send her to school.  And finally, she threatened to stab herself in the stomach with her pencils in front of her teacher and the class.

School officials were asking us why aren’t you getting your daughter the mental health care she needs.  Well, according to our PPO plan, that was easier said than done.  The first problem was the only in-network mental health provider that treated children under the age of twelve was booked up for three weeks.  My daughter was getting worse every day.  And with every phone call I made to our PPO plan I was scoffed at by customer service representatives, case managers, and medical directors.

My repeated complaints fell on deaf ears.  They acted like they could do anything they wanted to and I could do them no harm.  I was forced to get a doctor out of the network because my daughter needed immediate attention.  When the out-of-network psychiatrist saw her he immediately placed her in the hospital because she was suicidal with a plan.  The PPO’s case manager constantly reminded us in meetings with the doctors and the therapists what they would and would not pay for.  She laughed at us as she told us that since we chose to go to a provider out of the network they would not pay in-network benefits for the in-network hospital.

Just before Christmas, 1996, I gave an attorney my whole paycheck so that we could file bankruptcy because of our out-of-pocket medical expenses.  The managed care plan had denied all appeals.  The Texas Department of Insurance had closed our complaint file stating there was nothing they could do.

If I had denied my daughter’s treatment, they would take her and my other children away from me and put me in jail for child endangerment or abuse.  Our managed care plan does it.  And they don’t even get a slap on the wrist.

I tried to get lawyers to sue the PPO plan but was told there were no laws against what they had done.  And I wondered why hasn’t the Texas House and Senate done anything.

Well I found out that the Texas House and Senate did do something.  They had passed a bill that would hold managed care plans liable for jeopardizing the life of a child.  But the bill was vetoed by the Texas Governor.  By vetoing this bill, it made it more profitable for our managed care plan to deny medical care and let our child kill herself.

I was told by lawyers that there were ERISA laws that managed care plans use to get around being sued in the state court where a jury would hear the story.   You could sue in a federal court, however the judge had to make a decision based on non-existent laws.  I was told I would have to go to federal court and it would cost a hundred thousand dollars for an ERISA specialty attorney.  It was a two-year battle but after testifying to the Texas Senate Interim Committee on managed care.

The Texas Department of Insurance reopened my file.  They finally made the PPO plan pay in-network benefits for the in network hospital but only after I brought to their attention a pre-existing law on the books.

You see I didn’t believe there weren’t any laws to help us so I went to the law library and did my own research.  Everything every one told me about the law was wrong.

As a public school employee, I was exempt from ERISA.  I could have sued in a state court.  The contract with my employer and the plan had to be rewritten because it broke this law.  I was told that according to that contract they had the right to deny our claim.  Not only was I fighting managed care plans, but I was constantly arguing with professionals who knew very little about the laws and told me “there if nothing you can do”.

To make sure there was a way to hold heath plans liable for other families and their children in the future my husband and I told our daughter’s story to the Texas Senate and House to get the HMO liability law passed.  Texas was the first state to pass such a law, but without our Governor’s signature.

Just when I thought our problems with managed care where over, in 1997 my husband had a back injury and needed back surgery.  Our now HMO plan denied to pay for the surgery or any medical care regarding his back.  Five months later, we found an attorney who gave the HMO plan ten days to reverse their denial or we were suing for liability.  On the 10^th day the HMO representative called and wanted to know from our attorney what the hurry was.

Our attorney was furious.  He said “this man has been in pain for five months.  He cannot work, he has three children and a wife on food stamps and they are faced with losing their home.  And you have the gall to ask me what the hurry is”.

The representative said that they would pay for everything.  It was then that I realized that there are two kinds of patients to managed care plans.   There are those who can sue and those who can’t.

For the past six years, I have used my knowledge in managed care plans to help families with their denials.  What these other families and I have in common is that our managed care plans were blaming us.  When consumers tell their stories the answer for managed care plan is that consumers don’t know their health plans.  They even have statistics that say consumers only hear one word out of every three that you say.  I think that this is because for every question you ask, you can get three different answers.

I tried to become an informed consumer.  I have asked questions in my enrollment session but no one can answer them.  Not my employer, and not the plan’s representative.  How can any consumer learn about their health plan from a shiny “come join our plan” booklet with hidden agendas.   They are not going to tell you what they don’t want you to know.

The managed care plans are telling our United States Congress and the President that if they pass the Patients Bill of Rights that allows patients to sue them then they would have to raise the cost of premiums and people will no longer be able to afford health insurance.

Well, now.  First of all, managed care plans can only be sued if they wrongly deny medical care and cause harm or death.  If they don’t do that, they can’t be sued.  And why raise the premiums?  Why not lower the executives’ salary.  It’s not our fault.

And for people going without health insurance, I have found in three family emergency situations, it was better to have no health insurance at all that to be on a managed care plan.

Twice, we were on food stamps because of the delays and denials of medical treatment.  And twice, we have been faced with being homeless.  Since 1995, someone in my family has suffered and it is all because we have health insurance.

If the President of the United States veto’s this bill, he will once again show us that he favors the decision of managed care plans to deny our medical care treatment and get away with it.  If Bush puts a capitation on lawsuits, that means that the managed care plan can deny to pay for your medical care, have you die, be sued, lose, and they still would pay less than what it would have cost to save your life.  I think that is ridiculous.

When you start costing more than what you are putting in, you become a non-profit member.  It would be cheaper to let you die.

A reporter told me the other day that everyone knows that managed care plans are bad.  That story has been done to death, he said.  What happened to my daughter happened in 1995.  That was six years ago.

We are supposed to be the number one country in the world.  Yet we let our families endure the Hitler-like dictation of what doctor you can see, where you have to go see them, and when you can go see them.  We hear stories every day of how the delays of medical care mirrors that of Nazi medical experiments, to see how long people can live without medication or medical treatment.

Managed care plans are the robber barons of the millennium.  Executives that make the decisions are living in great luxury at the suffering of others.  I for one am going to prove that I can do them harm.  My family is not going to suffer while the medical director that denies their care gets a multi-million dollar salary for doing so.

In order to change the future of mental health care, I am here today to ask you to help.  You must call or write your political representatives and the President.  We are who they represent.

Crowd your national and state capital buildings when pro-consumer, pro-quality bills are being heard.  Let them know that you want to go to whatever doctor you want and the decisions about your care are to be decided between you two of you.

We have to inform all of America.  It’s not going to stop unless we tell them to stop it.  And if they want to know why, then we can tell them why with six little words.  Without your health, you have nothing.

Ladies and gentleman, my daughter lets me tell her story because she doesn’t want what happened to her to happen to another child.  If it wasn’t for caring mental health professionals and consumers like yourselves, she may not be here today.  I want you to know that she has completely recovered and is back to her happy go lucky self.  She wants to be a veterinarian because they don’t have to deal with managed care plans.  Ronnie and I would like to thank you and please help us in this fight.  Thank you.