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SANJAY GUPTA MD
Insurance: Denied; Seeing with Sound; A Shocking Experiment
Aired December 10, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning. And welcome to SGMD.
This morning, I'm sharing an amazing piece of the past and also trying to sort through a health insurance mess.
GUPTA (voice-over): A live-saving treatment, but the insurance company says no. When the bill came, it was more than a million dollars.
And if you like science, you might know that animals like bats and dolphins can navigate by sound. We recently came across something remarkable. A man who trained himself to do the same thing.
Plus, would you deliver an electric shock just because a scientist told you to push the button. The experiment that shocked us all. And now, a man who was there is speaking out.
GUPTA: Millions of Americans know what it's like to wrestle with insurance companies. I cover these stories a lot. What you're about to hear is a problem that I have never run across before something quite like this.
In 2008, the woman you're going to meet was diagnosed with a rare autoimmune disease that caused a scarring on her insides. It was sort of choking off her trachea, her windpipe and her ability to breathe.
She was treated at the University of Miami Hospital. And her doctors believe that the treatment that she received there kept her off a breathing machine and probably saved her life. But she was left after all of this, facing bills of more than a million dollars.
Now, her story is complicated but we want to try and break this down because we think it's important. And there are some important lessons here.
Joan Gagliardi is joining me now from Miami. First of all, thank you for joining us. It's a remarkable story.
I just want to ask right off the top, how are you feeling? I understand the condition you have is a life-long condition. You've started more treatment recently. How's it going?
JOAN GAGLIARDI, SUFFERS FROM RARE AUTOIMMUNE DISEASE: It's going good. I've been into the second half of the treatment for two months. I go for another treatment next week for two days at the University of Miami. I'm hoping to make a difference in how I'm feeling. But these are -- it's an ongoing process.
GUPTA: I want to sort of break this down a little bit for our audience, the simple version of what happened here. You received this treatment initially and insurance said it was covered. Six months later -- I have a letter right here -- they notified the hospital that, no, the claim is being denied that essentially you were on the hook for about $50,000 per treatment, a few hundred thousand dollars at that point.
Now, you didn't hear about any of this for another year, is that right? Do I have that right?
GAGLIARDI: Yes, that's correct. I was notified approximately 19 months into the treatment that the provider would not be covering the treatment and that I was essentially responsible for everything that had been previously billed to them.
GUPTA: Just to reiterate --
GAGLIARDI: At that point, it was --
GUPTA: It was a treatment your doctor recommended. It was a treatment that the insurance company initially approved and then you started getting these letters saying you're essentially on the hook. You got letters, other letters -- explanations of benefits letters showing that you could face billions of $1.2 million in total.
To finish the story, the insurance company eventually paid the hospital $382,000 and settled the case. You're no longer on the hook for a million dollars.
You know, it's a little bit hard to believe. And I mentioned off the top, Joan, as you heard, I'm a doctor. I treat patients. I get things preapproved on behalf of my patients all the time. But I haven't run into a situation like this exactly.
I mean, we asked the insurance company what happened here. And this is what they wrote for us. I'm going to get your reaction.
They say, "Based on our review, this service is not approved because it does not satisfy the criteria for establishing medical necessity and appropriateness." They say there was a patient benefit booklet that specifically outlined the benefits that would be covered and that are appropriate.
I'm sure you've seen letters like. This I'm sure you've been told this.
What's your reaction to that letter? GAGLIARDI: Correct. I have that letter and they told me it is not a covered benefit. I did ask for a booklet. I never received that. I still haven't received it.
They do cover the treatment. It is an approved treatment for other illnesses and they certainly do cover it for the other illnesses.
They're saying that my illness specifically is not covered because it's not medically necessary.
GUPTA: Again, you know, Joan, we're not talking about people who don't have insurance. We're not even talking about people who were denied a claim. Your claim was actually approved initially and then not approved and you were on the hook for a lot of money for a period of time.
Look, I'm glad you're feeling better. I'm glad you're getting the treatment. I hope we can check in for you to see how all of this goes for you, even early in the next year.
Good luck. I think there's a lot of lessons that we're going to talk about.
GAGLIARDI: Thank you very much.
GUPTA: Thanks again.
Now, it's not usually a million dollars but it's not uncommon for insurers to roll back approval of claims they've already paid. We asked patient advocates specifically about this. And they told us unfortunately, oftentimes there's not much you can do to protect yourself.
But what you can do is make sure your doctor gets a treatment pre- approved before starting. And if coverage is denied before or after treatment, you have a right guaranteed by federal law to appeal. At that point, your best advice is to get help from your doctor or from a nonprofit group that specializes in these cases.
It's going to be very frightening sometimes. We put a lot more information about this at CNN.com/Sanjay.
Up next, a blind man who has taught himself to see using sound.
GUPTA: If you like science, you might know that animals like bats and dolphins can navigate by sound. They use sound waves to help them find their way around the environment, even in the dark.
Now, we recently came across something we thought was pretty remarkable -- a man who has trained himself to do the same thing. It's hard to believe, but seeing, and in this case hearing, is believing.
(BEGIN VIDEOTAPE) DANIEL KISH, PRESIDENT, WORLD ACCESS FOR THE BLIND: The view. What is the view to a blind person? Many people very much mistakenly, very much mistakenly, and tragically so, assume that the view means nothing or little to a blind person.
A view is a composite of experiences. That's what people enjoy, even if they're not conscious of it.
I have been echo locating for as long as I can remember. If my parents think back, I lost my first eye at seven months, my second eye at 13 months, I was probably clicking by the age of 15 months. So I don't remember learning to click. I don't remember really learning to echo-locate.
Around here, there's not lots and lots to detect, but immediately there's this pylon here. I think I can -- there it is. And then there's an object about 20 feet away here and another one and another one about, I don't know, 50 feet away.
The process of echolocation in humans is very similar to the process in bats. In fact, it's virtually identical. The physics is the same. We're talking about airborne sonar either way.
A bat can detect an object the size of a gnat from, you know, so many meters away. For me, the subject has to be at least the size of a softball.
We tend to teach the use of a discrete tongue click which can be as quiet as -- or as loud as -- or even louder as need arises. It's like seeing with dim flashes of light.
Our approach is well-supported in many arenas in many respects. At the same time, there is a lot of controversy and a lot of skepticism relative to our approach.
It takes time for the established convention to recognize and to embrace anything that's new. Convention by its nature adheres to itself and rejects what is not conventional.
Quite frankly, it isn't that difficult to teach. It really isn't. So I believe that the brain is already at least partly wired to do this. All that has to happen is the hardware needs to be awakened. It needs to be activated. We believe we've found ways of doing this.
GUPTA: Now, Daniel Kish who lost his own sight at 13 months has founded a nonprofit called World Access for the Blind. He's teaching the technique.
Now, I'm told this is tremendously difficult and should be considered an experimental approach. Not necessarily a solution for everyone.
Up next, though, a lesson in pursuing your passion no matter what. I love these stories. You're going to meet a cancer patient who got his sight set on running marathons in all 50 states. (COMMERCIAL BREAK)
GUPTA: About eight years ago, Don Wright received the devastating diagnosis of cancer. But he's not letting that get in the way of his passion for running, running marathons. In fact, he's got a lofty goal. And he just turned 70.
GUPTA (voice-over): Don Wright's career spanned engineering, being a company vice president, and the law. And at age 62, he discovered a new passion, marathons.
Eight years ago, just days after running his first 26-mile race, though, he got some devastating news.
DON WRIGHT, MARATHON RUNNER: I had gone to the doctor a couple of times for pain in my back. It was multiple myeloma.
GUPTA: This is a cancer of the blood where the white blood cells invade the bone marrow causing pain, usually in the back or the ribs. And patients are rarely cured.
But Wright refused to let that slow him down, even qualifying for the Boston Marathon.
WRIGHT: I got this devastating diagnosis and we just -- my family and I, we just kept on going. You know, there wasn't any reason to stop and be sorry, you know. We kept running marathons.
GUPTA: Incredibly now, in the last eight years, Wright, who is now 70, has run 60 marathons in 41 states. And his wife and daughter have been by his side for most of them. His goal is to run a marathon in every state.
WRIGHT: Finally, after Boston, we started to pick-off states, never imagining -- well, imagining, yes, but never expecting to be able to finish all 50. Now, I'm really hoping for it.
GUPTA: Never expected that he could fulfill his dream, because the median survival for his cancer is just five years. He's had a number of treatments that failed. But for the last three years, Wright's taken an experimental drug. It's just one pill at night, and it's kept the cancer at bay.
WRIGHT: And it doesn't cure the cancer, but it keeps it stable, so it's not hurting me. And I can still run. And I can still enjoy life. And I'm riding that for all it's worth.
GUPTA: He has advice to others facing what seemed like insurmountable odds: take charge of your own destiny and never give up hope.
GUPTA: Don Wright isn't making any excuses about his health. How about you? Why not consider joining us on the 2012 CNN Fit Nation Challenge. You can log on to CNN.com/Sanjay. You can submit a two to three-minute video about why you should be picked to join next year's six-pack.
If you're selected, we're going to give you everything you need to compete in the race, plus six months of training, three all expense paid training trips as well. In the end, we'll race the Nautical Malibu but triathlon together. That's next September.
GUPTA: What do you eat on a typical day? Can you take a guess how many calories you consume? That number may teach us something about each other.
In a new book, "What I Eat Around the World in 80 Diets," we learned that a simple snapshot of a day's worth of food can tell a story about the circumstances a person's life.
GUPTA: (INAUDIBLE) is a herder in Kenya. But a prolonged drought has taken a tool on her family's livestock, limiting their food supply. On this day, she eats porridge, a banana, black tea, and whole milk. Just 800 calories total.
Head to China to meet extreme gamer Cho Riping (ph). He lives at his computer station day and night. He even sleeps there. He eats about 1,600 calories a day, mostly takeout. Rice, tofu, chicken.
And 3,200, that's a typical day's worth of food for Todd Kinser (ph) who is a coal miner in Kentucky. A pop tart for breakfast, bologna and cheese sandwich for lunch, and hamburger helper for dinner.
Handel Matson (ph) is just one of 700 people who live on the central east coast of Greenland; 6,500 is his number. He eats what he hunts. Typical day's worth of food for him, seal meat, rice, soup, rye bread, and marmalade.
Joan Magtagi (ph) in Great Britain woman consumes nearly double that, 12,300 calories. She says she's replaced her food drug addiction with food addiction. And all this food, well, it's her typical day of binge eating.
GUPTA: Fascinating stuff.
Up next, as his biographer calls him, the man who shocked the world.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Three hundred and thirty volts.
(END VIDEO CLIP)
GUPTA: It is difficult to watch, but we're marking the 50th anniversary now of Stanley Milgram's famous Obedience Experiment. His graduate research assistant is going to be joining us with the inside story. That's next.
GUPTA: Well, it's a study that challenged human nature. That's the best way to describe it. Stanley Milgram's experiment back in 1961 about obedience to authority. The experiment was outwardly a study of memory and learning. But the whole thing was rigged as we learned afterward.
The volunteer would always assume the role of teacher. And one of Mr. Milgram's associates would be designated as a learner.
Now, the teacher was instructed to deliver an electric shock to the learner every time he or she answered a question incorrectly, pressing a button would deliver a shock, as you can see here, you're looking at the machine, everything from a light shock to a moderate shock, strong shock, intense shock, extreme intensity shock.
Take a look here at the very end. This was -- these switches were literally labeled xxx. They were the danger shocks, maximum possible shock, 450 volts. And it was remarkable how many times that button was pushed, the danger shock.
But here's the thing. The learner wasn't actually being shocked at all.
So here to help explain what this is all about is Alan Elms. He was one of Stanley Milgram's graduate research assistant at Yale University 50 years ago and he helped run the experiment.
Thanks for joining us.
You know, I'm fascinated by this study for some time. So these people thought they were delivering shocks and people would -- I mean, they would moan, they would act as if they're getting shocked.
What was your first impression when this experiment was under way and when they got started?
ALAN ELMS, STANLEY MILGRAM'S GRADUATE RESEARCH ASSISTANT: I was startled, amazed at the emotional involvement of the people who participated and also at the extent to which they were mostly willing to shock the victim.
GUPTA: Yes. I mean, I think that was the most stunning thing. Again, even when you watch these experiments, beforehand, what did you expect to see?
I mean, you were obviously a graduate student at the time. You had some interest in this area. What did you think was going to happen? ELMS: Right. I assumed we would get some obedience, but probably not very much. And Stanley Milgram himself made the same assumption. He thought he would need some very fine measures of subjects' responses in order to get any differences between different conditions. As it turned out, he didn't find those at all. All he needed was how many people obeyed completely and how many broke off at some point before the end.
GUPTA: And again, the study was in some ways a study about obedience to authority. And as you know, Mr. Elms, the vast majority of people kept going all the way to the end of the shock board even though they were clearly uncomfortable, sometimes the people delivering the shock, they would start fidgeting in their chairs. They might start laughing nervously.
Let's take a look at how one of your participants.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Three hundred volts -- 345 volts. Something's happened to that man in there. We better check in on him, sir. He won't answer me or nothing.
UNIDENTIFIED MALE: Please continue. Go on, please.
UNIDENTIFIED MALE: You accept all responsibility?
UNIDENTIFIED MALE: The responsibility is mine, correct. Please go on.
(END VIDEO CLIP)
GUPTA: I mean, it's unbelievable. I mean he's asking, obviously, but he keeps going even after he stops getting any responses from the learner. For all the subject knows -- I mean the guy, he could be dead in the other room.
I mean did it surprise you in retrospect how many people went so far, as you saw there?
ELMS: Oh, it surprised us very much, yes.
GUPTA: I mean, were people rationalize their actions? When you talk to them afterwards, did they try to rationalize why they did what they did to you or Mr. Milgram, Dr. Milgram?
ELMS: Yes. They tried to rationalize. They tried to deny that they really did as much as they did. They used various kinds of psychological defenses to in effect convince themselves, not us, but to convince themselves that they really hadn't done anything bad.
GUPTA: Yes, I guess that's a good point. The psychological trauma even to the person who is administering the shocks could be significant.
Here's how Stanley Milgram himself summed it up. Take a listen. (BEGIN VIDEO CLIP)
DR. STANLEY MILGRAM: The results, as I observe them in the laboratory, are disturbing. They raise the possibility that human nature cannot be counted on to insulate man from brutality and inhumane treatment at the direction of malevolence authority.
(END VIDEO CLIP)
GUPTA: A lot of people who concluded do what they're told if they perceive the command comes from a legitimate authority -- if a person they never met before can convince them to subdue a 50-year-old man with pain and shocks against his protest.
What do you think that this experiment taught us about ourselves as a society?
ELMS: Well, what it taught us essentially was in the words of the title of the novel by Sinclair Lewis, it can happen here. And that was Stanley Milgram's major point, I think, was that we knew that things like that could happen in a place like Germany during World War II. But Stanley showed that just average Americans could potentially be obedient through destructive authority as well, and to what appeared to be very destructive authority.
GUPTA: It's a fascinating study as I told you, a frightening one as well. I appreciate your time, Mr. Elms.
This is something I've been -- this study is something I've known about and thought about for some time. I appreciate learning more about it from you. Thank you.
ELMS: OK. I appreciate you talking to me.
GUPTA: All right, Mr. Elms.
We'll be right back.
GUPTA: Sunday night, I'm going to be live at CNN.com, backstage at CNN Heroes. It's an all-star tribute, and it's going to go from 8:00 to 10:00 p.m. Eastern.
You can scan this code over here to get a jump-start on the action. It's really amazing. Take you to a site where can you meet the top 10 CNN heroes, you can learn about their causes and even donate. The program itself is hosted by my colleague Anderson Cooper and it's going to air live this Sunday night at 8:00 p.m. Eastern on CNN.
And also, join me with your laptop at CNN.com for your backstage pass. Hope to see you there.
That's going to wrap things up for SGMD this morning. Thanks for being with us. Stay connected with me throughout the week on my Lifestream at CNN.com/Sanjay. Also, join the ongoing conversation on Twitter at SanjayGupta.com.
Hope to see you right back here next week weekend.
And time now though to get a check of your top stories in the "CNN NEWSROOM."