Blue Cross is trying to kill my wife, Chapter II
May 04
I’m fairly certain Blue Cross will be the lucky recipient of it’s own category here very soon. Today’s madness involves blood test strips. BCBS made her doctor fax in a justification for why she uses 300 strips a month. The BCBS limit is 204 a month. (They come in vials of 50 so who knows where the 204 number came from). One test at each meal and one test every time you get in the car easily consumes the 7 tests a day that the accountants at BCBS believe to be sufficient. I guess diabetics should just guess at their blood sugar the rest of the day. Or maybe not test before driving and just hope they don’t cause an accident. Low blood sugar in many diabetics is very similar to intoxication. In fact in VA, Michelle can be held liable if she is in an accident and her blood sugar is below 70. It is probably obvious to anybody that doesn’t work for BCBS that the ER costs on one diabetic coma or accident would easily eat up years of savings from skimping on testing.
Michelle called today and BCBS claimed that they never got the fax, even though her doctor has the received receipt that proves it made it to the destination on Wednesday. Then they decided they were refusing her blood strip prescription not on the quantity, but on the brand. They want her to use a brand that does not work with her meter, and the meter communicates wirelessly with the pump, so it’s not like we have any option on the meter. Ultimately, the doctor ended up on the phone screaming at them. He told them that if they were suggesting that Michelle needed a new $7000 insulin pump that would work with the meter that made more money on, he had time right now to start the paperwork for a new pump.
So, her prescription goes back into review for Monday, and they approved a provisional prescription to get her through the weekend. They approved 20 strips. They come in vials of 50. The pharmacist had to explain to them that it would be a violation of federal law to break open the package to sell 20.
What’s really scary is that we are on the most expensive option BCBS has. Between myself and my company we are paying about $1000 a month for this level of service. I’m afraid to even think about the service the poor folks on the cheaper plans are getting.
Also, just think about all the time doctors are wasting justifying their medical decisions to accountants 3000 miles away. Or all the time pharmacists spend on the phone getting prescriptions though the system. It’s no wonder we are facing a doctor shortage around here. Who the hell wants to spend 4 years in medical school to get stuck fighting insurance companies over every patient decision they make?
Given just how bad BCBS seems to be at containing costs, I wonder if it wouldn’t be cheaper for them to fire 90% of the staff and just approve every claim that comes through.
The icing on the cake is that at the discount online pharmacy linked to BCBS, a box of the strips that Michelle needs is $87.00. That is full retail, so much for that discount. A box of One Touch (the brand they are pushing her to) is $96.00.
Update: Michelle went to the pharmacy to pick up her emergency supply of blood strips. They gave us 300 and didn’t charge a copay because they haven’t decided what it will be. WTF? Oh, and apparently we’ll have to go through this every single month as her case will be reviewed with every refill as though there is no history. I’m convinced that it is a strategy designed to wear us down to the point that we quit trying. They will never win that battle. I’m going to document every little thing here so I have the timeline for the inevitable class action lawsuit.
National health care is looking better all the time.
I’ve had a few run-in’s with BCBS and my daughters allergy medication. They apparently didn’t understand why the dosage 1T when she was 5 wasn’t enough for a 8yo. The doctor prescibed 2T based on her weight.
My mom had problems getting her blood pressure medication. They wanted her to use a brand that didn’t work for her. The doctor had to do quite a bit of yelling about that one. Once the approved it, they would only fill it mail order and she had a hard time getting enough medicine to last until the mail order arrived. Needless to say it wasn’t very good for her blood pressure.
Oh, I almost forgot the time quite a few years ago when my MIL was going over seas for a month and they wouldn’t refill her prescriptions because she hadn’t used up 90% of her prescription yet. I think the pharmacist ended up giving her the medication and post dating the refill date.
Or the time my obstetrician called and I had to call them because they didn’t want to pay the hospital bill from when I had my daughter. No reason, they just didn’t feel like paying it yet. I believe my daughter was eating solids.
I hope they get everything worked out for Michelle. It’s not like she’s mass ordering morphine or something.
You’re scaring me.
Our insurance sucks (we’re self-employed). We have been considering a switch *to* BCBS because in an informal survey of other self-employed folks, they seem to have the most customer satisfaction.
Of course, that could be because the other companies who sell plans to the self-employed are even worse.
We’re on BCBS because of my husband’s employment. It costs about as much as my COBRA insurance did for my daughter and me, where I never had a care in the world when I visited the doctor. I HATE going to the doctor now and put it off as much as possible. They denied a stupid $65 doctor visit because the doctor indicated my DD’s swollen tonsils were from allergies. The doctor’s billing person told me she doesn’t want me to pay it, but I’m angry…it’s the principal of the thing. It seems insurance makes our lives worse, not better. I sliced my finger with a bread knife a few weeks ago, and my husband — thirty minutes later — said “You’re going to need stitches.” I looked at him and told him he was crazy (we’d just gotten all the unpaid/deductible bills from DD’s broken arm.) I dread the true emergencies!
The quality of service BCBS gives does seem to vary from state to state.
Also, my mother has all sorts of trouble with her prescriptions because she has so many allergies that she can’t take most of the “normal” drugs they expect someone with ____ to be prescribed. She’s had a *lot* of luck with simply writing (or threatening to write) the Attorney General’s office. We’ve got a great AG here (again), so the threat does carry a lot of weight, and her letters do actually get a response when she does have to write them.
We are a 9 person company and the unfortunate fact is the BCBS is pretty much the only option for small companies and the self employed. I’ve had BCBS at least two other times and never had a real problem with them. I was actually happy when my new employer told me that had just joined BCBS. The pharmacists indicated that BCBS has become much more difficult to work with over the last couple of years.
WOW. I can say Blue Cross in Canada is not that bad. Then again, national Health Care. Guess there’s a bit of a trade-off.
(although I’m all for socialism up here)
My company switched to a high-deductible/HSA account with United Healthcare this year. As long as I don’t need the whole amount in the HSA to meet my deductible, I can reimburse myself for all of the little things over the year that aren’t covered by the insurance — OTC drugs, glasses, the part of the dental not picked up by the dental insurance, etc. And if I do have to use the whole thing, I can reimburse out of a future year for this year’s expenditures. Liking it so far.
Chris, if I make a somewhat crazy suggestion… why don’t you just haul your family up here? Yeah, I know it seems irrational, but ….
I’m so damn sorry you are going through this. Even sorrier for Michelle! I’m an ex-american and I remember too well the bitching that went on with BCBS when my mom had cancer. She had a pump for her chemo and BCBS actually told her doctor that they weren’t paying for the dosage he’d set for her. “Just adjust her pump lower,” was what they said. It took over a year of phone calls, letters, faxes, documentation out the wazoo before BCBS finally agreed. By that time, she’d amassed a huge bill that they WOULDN’T write off. She was dead a few months later and all of my parents life savings had been poured into paying for her insurance and medical bills.
On the other hand, when my dh’s mother was going through her cancer, they never paid a dime. On top of the Provincial Health plan, Pharmacare paid for all of her meds.
I have a sister-in-law who is diabetic and on a pump. Last time you posted about Michelle’s troubles there, I showed her the post and asked her what she thought of it. They have BCBS supplemental up here and she assured me that she’s never been questioned about anything. It all just gets taken care of without hassles.
The unfortunate fact of health insurance in America when you have a chronic disease is that you will go through this every time you change insurance companies. Back prior to the Healthcare Portability Act of 96ish it was far worse because you absolutely could not change jobs without suffering 6-18 months of non-insurance. At least now as long as you maintain coverage you are guaranteed coverage in the future. If this is just a one time fight it’ll be fine. But we are hearing that we’ll be doing it every month. The amount of money BCBS will be wasting on this every month has to far exceed the $140 bucks a month they are trying to save in the short term.
Amazing how they are allowed to influence – or rather dictate – what the doctor is to prescribe.
We’ve done way too many rounds with BCBS to list. My faves though were them telling me the company I was having an MRI at was not on their provider list, when the MRI tech had an approval code in hand, and the time BCBS marked a lab bill as paid and never sent the check to the provider and the provider sent it to collections and I got harassed. And I had to sign a special release to have my son seen by an ENT because they were afraid BCBS wouldn’t pay and wanted to be sure I knew I was responsible if BCBS didn’t (this was even with a referral and pre-approval from BCBS). The denial letter for Don’s trip to the urgent care clinic today should be here in about 2 weeks.
In the end, they usually end up paying, but the amount of red tape I have to go through for something that is “covered” is ridiculous.
There are quite a few different BCBS companies, and all are operated independently – (sort of like a franchise) – so some are better than others. We’ve gone the other route with them too. The other day they called wanting to enroll Jess in some preventative care program for asthma, even though she hasn’t had an asthma attack in years. The only time she uses her inhaler is before soccer games. So I tell them we don’t need it, and they keep badgering me like a frickin’ telemarketer or something, until after like the fourth time I’ve said NO, I just hung up.
I feel your pain.
All I can say is thank goodness I don’t deal with the Big Blue anymore. In order to get an insulin pump for our daughter, BCBullShit required DD to have three diabetic related hospitalizations in one year. This is completely asinine as I imagine some families actually are having a debate, “Gee honey, do we let Susie have three seizures this year so that she can get a pump? Or, maybe a better option would be to let her blood sugars hit the 1,000s and let her rack up some qualifying ER visits?”
Email me if you need some strips. We have quite the stash now since we no longer have to jump through BCBS hoops.
JudyBat