At a House Workforce Committee hearing before the Congressional recess, Rep. Mark Takano (D-CA) asked Founder and President, FCP, LLC. Ali Khawar about staffing cuts at the Employee Benefits Security Administration.
00:00All right, call on Mr. Tocanto from California for his question.
00:09Two gentlemen from California, I wasn't sure which one.
00:13Thank you, thank you, Mr. Chairman.
00:16I want to thank the witnesses for being here today and to thank you for scheduling me, Mr. Chairman, for such an important hearing.
00:24Mr. Calwar, would you like to respond to any of the earlier statements that were made?
00:30Not so far.
00:33I mean, there's a lot to unpack and there's a lot of, I think, problematic statements that were made, but I'll probably reserve the right to do it.
00:40Okay, thank you.
00:42In your testimony, you spoke about an individual who was denied a life-saving heart transplant by his employer-sponsored plan.
00:50EBSA intervened and successfully appealed the denial, something even this patient's doctors could not do.
00:56The doctors tried to get the plan to do this.
01:00If an insurance company refuses to cover an essential treatment for one of the millions of people who have an employer-sponsored health plan, which happens far too often, how does EBSA assist with an appeal like this?
01:14Thank you for that question.
01:16I would love to tell you that this was the only time in my career at EBSA that we had a story like that.
01:21Unfortunately, that's not the truth.
01:23It is too frequent that in the context of employment-based health arrangements, people's benefits are denied.
01:29And one of the things that they can do is contact the EBSA benefit advisors.
01:34We have a toll-free number.
01:35It's 866-444-3272.
01:38And when they contact that number, what used to happen, I should caveat all of this with this is only up until January 20th, because with staffing cuts, I really can't give you any assurance about what kind of service people receive now.
01:51But what used to happen is that calls were answered live if they were made during business hours, and you would get someone that is very highly trained, who would answer your questions if you had basic questions, and then act as an advocate in trying to informally resolve that issue between you and your plan, the service provider, the doctor, the insurance company, and try to get them, if it was appropriate, to get that benefit approved.
02:16You made the example of a heart transplant, there's another example I'm thinking of right now, of a young mother who had cancer and was being denied a liver transplant, and her insurance company essentially gave her a death sentence, and not but for EBSA's engagement, I'm confident that she would have died.
02:36So EBSA is like this government agency that can help ordinary citizens who know about EBSA to call that number and to get help when they have a dispute with their health plan, when that health plan may be refusing to pay on a claim, that even their doctors say that that health insurance company should be looking at it.
02:57Is that right?
02:58That's correct.
02:59Unfortunately, not enough people know about this.
03:01I think of the VA program as a hidden jewel, frankly.
03:03I didn't know about this, I would love to have known about it so I could tell my constituents, this is where you can go when you have a problem with a claim with your insurance company, they're refusing to pay, or they're refusing to cover a life-saving, a vital, urgent, life-saving procedure, this is where you can go.
03:23And you're saying that EBSA has reduced staffing and that you're not really sure that people can connect with a live, technically trained person to guide them.
03:37Yes, representative.
03:38It is truly unfortunate because you have situations like the one that you're describing.
03:43And it used to be a point of pride in the agency that calls were answered live and then it was something like 95% of calls were returned within one business day if someone called after hours.
03:53Okay, we just heard Mr. Kolumbik describe this situation where EBSA, you know, has colluded with plaintiff's attorneys and how unfair it is to these defendants.
04:06And the defendants in this case are mostly these huge health plans or huge pension plans.
04:12Go ahead.
04:13Well, in the health context, it's very frequently, I believe, the bad actor is a health insurance company, even more than the health plan itself.
04:21So the health insurance company that's refusing and stopping the claims, do we think of the little American citizen who's trying to get a heart transplant or a liver, or a liver transplant approved against a big insurance company?
04:38I mean, are they the ones that are such an unfair sort of claimant against this big insurance company?
04:47I mean, do we think that – I mean, I think of this EBSA as kind of a very important advocate for the ordinary consumer.
04:58I agree, representative.
04:59And I think when you're talking about the people that are impacted, it is often, in the health context, individuals with pretty significant health needs.
05:08I also believe that when we are talking about these common interest agreements and what this bill would do, it is a bit more than transparency.
05:18Because, for example, there's a requirement in the bill that before sharing any information with an attorney that that attorney might use in essentially bringing a lawsuit under ERISA, you have to enter into this agreement.
05:30You have to share it with the relevant fiduciaries and all of that kind of stuff.
05:33The problem is, if you think about these benefit advisors, they're getting a phone call.
05:37They're getting a question.
05:38Now we're telling them that, no, you need to make sure that these things are done.
05:42Here's some additional paperwork you need to do.
05:44You can't help this individual.
05:45Thank you, Mr. Cora, I'm sorry for going over, but it just seems like this bill is going to weaken the protections for the consumer, weaken the advocacy that would be so costly.
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