Letter to Angela F. Brady, Chair of the Board, President, Chief Executive Officer WellPoint Inc.

Letter

Thank you for your letter of May 3rd in response to the letter from myself and 57 other Members of Congress with regard to Wellpoint's practices on rescission of coverage for patients with breast cancer.

Although we may have different views regarding the specifics of the Reuters article, I was encouraged by Wellpoint's announcement that the company would implement the new federal law banning rescissions beginning May 1, 2010. This is an important consumer protection for all Wellpoint enrollees, whether they suffer from breast cancer or any other illness or injury.

In your response, you also noted that Wellpoint has implemented a number of programs to improve care for breast cancer patients. It is with that in mind that I write to you today with regard to another important aspect of breast cancer care: adequate recovery time in the hospital following breast cancer surgery.

In 2009, an estimated 192,370 new cases of invasive breast cancer were diagnosed among women, as well as an estimated 62,280 additional cases of in situ breast cancer. Most of these patients undergo some type of surgical treatment, usually lumpectomy or mastectomy.

As you may know, I am the sponsor of bipartisan legislation, the Breast Cancer Patient Protection Act (HR 1691), which now has 248 bipartisan cosponsors and passed the House of Representatives by a vote of 421-2 in the 110th Congress. This legislation would help ensure that patients have adequate support after breast cancer surgery by guaranteeing a minimum hospital stay of 48 hours for a woman having a mastectomy or lumpectomy. The bill also includes other important protections for patients facing breast cancer, including access to second opinions, coverage of radiation therapy for women choosing a lumpectomy, and access to a third party review process before a rescission can take place. This bill does not mandate a 48 hour hospital stay if a patient chooses to go home sooner, nor does it set 48 hours as a maximum amount of time a woman can stay in the hospital. It simply ensures that any decision in favor of a shorter or longer hospital stay will be made by the patient and her doctor.

A petition in support of this legislation on the Lifetime TV website has garnered 25 million signatures and stories from all 50 states from women who have been forced to leave the hospital following a mastectomy -- sometimes just hours after surgery. Additionally, 20 states have laws protecting patients' rights to an adequate hospital stay following a mastectomy.

I am sure you will agree that the quality of health care provided to patients should not depend on what state they live in or what insurance they have. That is why today, I am writing to ask that Wellpoint and its subsidiaries agree to:

* Provide plain-language information, to my office and to all current and potential enrollees, regarding any policies, standards or guidelines used to determine coverage for breast cancer surgery and follow up care, including length of hospital stays;

* Guarantee as part of all insurance policies coverage for a 48 hour stay in the hospital for breast cancer patients after a mastectomy.

As you are surely aware, breast cancer surgery is not easy, physically or emotionally. Unfortunately, stories from across the country demonstrate that women continue to be discharged with no consideration for adverse reactions to anesthesia, post operative pain, how far they need to travel home still groggy, in pain and nauseated, whether they are awake enough to understand their discharge instructions, or even whether or not there is a responsible adult to care for them at home.

At an Energy & Commerce subcommittee hearing in 2008, breast cancer patient Alva Williams testified that she had a mastectomy on March 6, 2006 and was sent home several hours after surgery. Her insurance company would not cover an overnight stay. Ms. Williams had family to take care of her at home, but they had not received proper training on how to care for her, and she developed an infection in the incisions. Recovering from the infection caused Ms. Williams' chemotherapy treatments to be delayed by six weeks. A woman from Arizona shared this story on the Lifetime website: "I had a double bilateral mastectomy in June of this year. I was discharged within two hours after surgery. I had severe complications that later resulted in being re admitted to the hospital with in the first week post surgery."

A Kansas woman wrote, "I was diagnosed with stage 4 Inflammatory Breast Cancer in May of 2006… I had a modified radical mastectomy with full lymph node removal. I was in the hospital one night… I left the next morning with three drains and pain pills. My husband is an Internist and he was shocked that one night was standard of care for mastectomies. My recovery was very difficult even though my care giver was my husband, a physician!"

Clearly, women deserve the peace of mind that their insurance company will not deny them adequate recovery time in the hospital during the vulnerable time immediately following a mastectomy. That is why the Breast Cancer Patient Protection Act enjoys the support of respected patient organizations including the American Association of Breast Care Professionals, American Cancer Society, American College of Obstetricians and Gynecologists, Breast Cancer Network of Strength, breastcancer.org, Disability Rights Legal Center, Families USA, National Women's Law Center, Oncology Nursing Society, Society for Women's Health Research, and the Susan G. Komen for the Cure Advocacy Alliance.

I hope you will join in publicly extending this very basic consumer protection -- the guarantee of 48 hours in the hospital following breast cancer surgery -- to the patients you insure. I look forward to your response.

Sincerely,

Rosa L. DeLauro Member of Congress

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