BC-BS! (another reason that we need healthcare reform NOW!)

I got this letter a while back and it pissed me off so much that I just threw set it on the counter. I was cleaning up around the house today and saw it and it pissed me off again. :mad: Now that we are on the verge of (hopefully) doing something about these sleazy insurance companies and their "precertification process administrators",I thought I would share this letter with DU. We should not have to put up with sleazy third party LLC's telling us when and if we can have doctor ordered procedures! Duplication of effort my ass - how do you like the $100 fine even if it was found to be necessary after the fact? :mad:



These asshats need to be in fear of losing their customers, if not they have all the power and we are simply suckers hoping we will not suffer and/or die due to insurance company decisions based on profits! :mad:

and drop the coverage completely. It would bankrupt many ins. co's and then Public Option would have to happen.

Or better yet, have our own insurance pool AND lawyers to fight the excessive and ridiculous fee structure that hospitals charge the uninsured.

We could kick their fucking asses. I'd LOVE to do something like this.

Immediately, your risk pool would be too small. It would probably be saturated right away with those that needed health care the most and were already weeded out of the system, requiring a high per capita payout.

Most importantly, it would work because health care is unaffordably expensive and out of reach of the average American -- if the top quintile isn't paying unproportionally for the care of the lower quintiles, no one can ever afford it (currently, the top quintile pays 6% of their income while the bottom quintile pays 22% of their income). This is actually the bottom line, as to why the "public option" will not work, because (aside from subsidization), it isn't focused on redistributive health care like the rest of the industrialized world.

to the right and above the center of my collar bone.

Two months, two doctors, one blood lab, one sonograms, one fine needle biopsy, and $750 later, I learned it was a benign cyst.

I was really scared that the lump would be malignant, not so much because I was afraid of cancer, but because I was afraid I would totally bankrupt my family in getting treatment. Thank god that didn't happen, although I still need another $350 fine needle biopsy in October according to the doctor.

The irony here is that even with insurance, I would have been paying the $750.00 as a small part of the $3000 deductible...

Which isn't exactly like loving your doctor and choosing a great way forward.. Its what your stuck with. Most families cannot afford the huge premiums if their employer doesn't help pick up some of the costs.

because I pay "insured people's rates" instead of uninsured people's rates.

I just got the bill for the treatment of a sprained ankle. In short, I'm paying $250 a month for $150 difference from the "uninsured" rate.

You gotta wonder.

I was paying $536 per month to insure four people with a $2,500 deductible and a $5,000 maximum out-of-pocket.

The conversion I was offered was $1,369 per month for three people, with a $3,000 deductible and a $8,000 out-of-pocket. And the coverage wasn't as good.

Tried going with my husband's work insurance, but while they covered half of his costs, we were paying full load for my son and me. When he started bringing home two-week paychecks of $225 because the insurance for us was so high, we dropped it. He is still covered. Two heart surgeries in three and a half years means we have to keep him covered.

When you start rationing x-rays, you are going into some dangerous territory. Doctors should be able to order these and you should be able to get them in the amount of time it takes to go from one office, to the other.

BTW, I can't help but point out, as someone with Canadian healthcare who recently got an x-ray, this is just another advantage of socialized insurance. All diagnostics and procedures are pre-approved. Everyone gets what they really need.

but from reading this letter, they're not seeking precertification for you getting a routine blood test to check your cholesterol here. The radiological procedures listed are all quite expensive. I would venture to say that in some places that have installed these expensive machines, there is pressure on doctors to recommend these tests, so they can make private insurance underwrite the costs of them.

Believe me, if we have public option, or my preference, single-payer, there will indeed be precertification processes in place to prevent abuse of the system for the benefit of the manufacturers of these devices.

I had never had one done in my life, but if these sleazemonkeys had their way, I'd have had to drive home 50 miles and come back on another day (at loss of wages and MUCH higher stress levels due to not knowing my condition). If you want to trust an independent LLC with your life or death decisions, be my guest, I'll leave it to the doctors, thank you very much.

Perhaps your surgeon was one of those who have been bribed by the makers of these expensive devices into ordering CT scans for every possible little thing, whether it was more prudent to try another diagnostic test or not.

Even if your surgeon is Marcus Welby and Albert Schweitzer rolled into one, and is scrupulously honest about this, I'm sure he or she knows other doctors who are not. Anger about this needs to be directed their way.

The biggest reason I'm for single-payer is that we will be able to have a comprehensive database that identifies both physicians who recommend too many unnecessary procedures, and patients who threaten to sue doctors for not performing hyper-expensive tests for mere routine headaches.

Ideally, this will allow us to leave things in the hands of honest doctors.

single-payer. Pushing the responsibility back onto the sick person receiving the treatment couldn't possibly be worse though. Why does only the single-payer solution allow for simple digital database checks to see if a procedure is being done twice on a person in a short period of time (would not even have to involve personal information). Why can't the fucking insurance companies and the hospitals get together and solve this? Why push it back on the individual who has NO power? It couldn't possibly be any worse now. Even worse, since insurance is provided by employers, hire and fire decisions are being made based on the cost of your health care versus another healthier employee. If you'll notice, my employer was named on the notice as being a co-conspirator in the sleazy scheme to increase the anxiety of the customer. Government could just as easily tell these insurance companies and hospitals that they can't do this FUCKING SHIT any more to their patients for fear of being taken over by the government. Sure, let them stay as for-profit so long as they follow ethical guidelines and report to the Feds, step over the line and you're done. The government already does this with other industries, why oh why do WE trust sleazy for profit insurance companies and hospitals with our health?

requires people who have been wrongly diagnosed to find ambulance-chasing lawyers from sleazy ads on TV, only to wait years for justice, which is almost always accomplished by having the victim sign non-disclosure agreements that keep the rest of us from knowing exactly what Doctor X or Hospital ABC is doing.

There's no financial disincentive in the tort system for a doctor doing too many expensive diagnostic procedures, in fact, there is a massive incentive for the doctor to over-order tests. I hate having private insurance company bureaucrats in the way of determining who gets a test and who doesn't, but eventually, we will have some sort of gatekeeper in either a public option or single payer plan doing the same thing. As long as we have fee-for-procedure, the incentive to over-order tests will always be there, especially with the tort lawyers always in the doctor's rear-view mirror.

I'm hoping that the electronic means of keeping track of patient records, doctor records, and hospital outcomes will allow a doctor to get approval for a test in seconds rather than days or weeks. Most insurance company decisions to allow tests are based on some criteria that could be examined by a computer many times faster than by the paper-shuffling method. "Problem" doctors could be sniffed out quickly, and patients could be warned.

In any case, we have a LOT of things wrong with the current medical system, and access to quality affordable care is only one of them. If we're going to deal with this effectively, why not deal with all the problems at once, rather than just put the pressure on other parts of the system?

It was specifically a "we're doing this to eliminate some unpleasant possibilities" test too, not a "let's find the bullet" sort of thing, too. Either way, I have trouble with the idea if people screwing around with red tape for procedures that sometimes need to be done Right Now to find problems more serious than the one I turned out to have had.

And I'm in Canada where we aren't quite so much about needing a third party's permission to undergo most medical procedures.

deny the claim because of some technicality, doesn't mean doctors are being pressured for anything. If we had single payer, all those fees and procedures would be outlined ahead of time with the doctors and other health care providers in agreement with the government. That's how they do it in Canada. The provinces meet with the reps of the health care providers every year or every two years depending on the province and they hammer out the details of how things will be ordered and paid. When the patient goes to see the doctor, there is no ambiguity and no delay so all can concentrate on practicing health care and not the game of how to get the insurance to pay.

Just having a government option that will be another payer that gets bilked by the system is not going to solve anything.

single payer won't even be considered. Some time between now and the August recess Americans have to take to the streets en masse and demand single payer, but as long as we are caving, people won't do it. I heard a scary prediction that Congress will pass some kind of health legislation in the middle of the night on the last day of Congress, which is what they do when there is controversial legislation on the floor. It probably won't be what is best for us and the nation unless we start putting on the pressure NOW!

for the people who think they're 'safe' with the private health insurance system before we'll have meaningful change. I can see the private insurance companies finding ways to dump the most expensive people/groups from coverage if there is a public option willing to take all comers. Yes, we can make laws forcing private companies to take people, but we cannot force them to give gold-plated service to the 'best' customers (those that utilize under a certain dollar amount of care) and shoddy service to the rest of them.

To me, public option is like putting a Band-Aid on a gunshot wound.

and last year I decided I wanted a new doctor. So I called the local BC office and was told to make sure my new doctor was on their list and to go ahead and make an appointment and the doctor would give me the forms I needed to designate her as my new PCP. So I gave BC the doctor's name and BC said yes, she is on your HMO list.

So I called and made an appointment for a complete physical. Went in for the physical and the receptionist said the bookkeeper would have the forms for me to sign to change my PCP when I came back the next day for blood work.

So I go back the next day and the bookkeeper says who told me she was supposed to give me this form. I said Blue Cross. She said no you have to go through your employer for this, come and use my phone and get your employer to backdate the form so your checkup yesterday will be covered.

So I called my employer (and it still bothers me that my employer has to be involved in a private health care decision) and my employer says no I can't backdate that form and you should have called me in the first place. I say why the hell would I call my employer instead of my insurance company. So she says well hold on and let me call BC.

So she puts me on hold and comes back 5 or so minutes later and says sorry, BC has no record of your call. I said well I didn't give them my name I just asked how to change my doctor. She says but BC records all their calls and keeps a log and they have no record of anyone calling with that question.

So I ask her if she really believes that the largest health insurance company in the metro area really NEVER gets any calls from clients wanting to change their doctor! She says sorry I have no choice but to go by what they tell me. And I say so I am considered a liar so Blue Cross can cover their ass and not pay my claim?

Assholes. All of them.

Holy fucking shit, all you're doing is dredging up memories of the dozens of claims we faxed in and they say they "never received" or;

the time they took of a person from my plan without notifying them, violating federal law! Could I fight it? Of course not - I'd lose my fucking job for being a malcontent or;

all the fucking claims they did not/could not process because some keypunch goon made a typo when inputting my kids SS# or birth date :mad:

Oh, and this is just the tip of the iceberg with issues I've had. Just thinking of the BS they've put my family through makes my blood BOIL! :mad:

My employer has 3 plans we can choose from. All administered by Blue Cross.

Yes I am grateful to have health insurance but it isn't always a guarantee you will receive health care.

...and not want to go for services. (oh, and it's ironic that someone unrecced this thread :eyes:)

How can you tell there were unrecs?

Really, I'm not a rec whore, but I rarely post O/P's and this is personal for me (and many other here) along with being a MAJOR issue of the day.

You ask what they want to do - you are given misinformation, and then they're upset AND PUNITIVE with you or deny your claim, when they are the ones that screwed up to begin with.

It's interesting, my co-worker used to work for BCBS in a state where the population is less technically skilled. The processes at BCBS of that state were all very manual.

When they would go to conferences/meetings with people who worked for BCBS of other states, where the technology was much better, the people of the state using manual processes would be laughed at. It was like they were not even the same company.

Your letter says "Alabama" which makes me think, what is the service and the processes like where the workers are in that state? I'm not dissing the people of Alabama, but it might be a less technically-oriented state.

BCBS is 39 separate, independent companies that all belong to the BCBS Association. Blue Cross of Alabama is an entirely separate entity from Blue Cross of New Mexico, which is separate from Blue Cross of Kansas, which is separate from Blue Cross of Kansas City.

it's that choice you supposedly ahve right now. isn't it grand!!

Heh - more like 9 grand :mad:

but BC/BS of Iowa and South Dakota works very well. I've had one kidney removed, two heart attacks, surgery on cervical spine, surgery on lumbar spine, have stage 3 kidney disease, had gall bladder out, uterus removed, tonsils out, two slipped discs in the lumbar spine, consult with hepatologist for ongoing liver function test results out of normal range, etc. Going clear back to 1970 for the kidney surgery until now in 2009, I've never had the Blues deny coverage for any service. Their Medicare supplement insurance works beautifully, too. Sounds as though Iowa may be the only place in the country getting good service. I can recall only one time where I had to call for preapproval, and the approval was cheerfully extended: no argument, no fuss. They've paid for all lab work, x-rays, CTs, MRIs, mammograms I've had over the years. Maybe you should consider moving to Iowa. ;-) The same holds true for my husband's care over the years, including aortic valve replacement, and brain surgery.

The State of Iowa also has a program for people who are denied coverage through regular insurance providers. It is primarily catastrophic coverage, but at least it can help protect people from health-care-related bankruptcy in the event of a catastrophe.

It's not that the care is bad, it's that it DOES depend on where you live or who you work for or what idiot keypunch operator you get stuck typing your critical information into the system with. It seems your completely missing the point as to why we need healthcare reform in this country.

what will happen is that doctor's will send patients to the ER where there is no prior authorization to get tests done.

A $600 CT scan will now be $4000.