DISQUS

FunMe · 6 months ago

John: You really need to make this your new "Stop Dr. Laura" campaign.

Your passion is there. But sadly, you have gone through the horrors of Blue Cross. As a PAID private insurance carrier!

Enough is enough.

PLEASE start a campaign to

STOP BLUE CROSS.

I am sure you have the backing of the majority of us here. Just let us know what to do. Start a new campaign.

Gaston · 6 months ago

Blue Cross of Missouri will not pay for the latest breast cancer treatments--IMRT (Intensity Modulated Radiation Therapy). We've been doing it for nearly a decade in small town in southern Missouri. IMRT is more expensive because it's more labor intensive and there is significant capital investment in sophisticated machinery and software; so in order to weasel out of payment, Blue Cross says that IMRT is still "investigational" and they won't pay for experimental treatments. They'll only pay for 3d conformal treatment--a good, but out-of-date modality. We have 15 years of data proving the superiority of IMRT--it is the current gold standard. Still, they are constantly refusing IMRT and our doctors are continually of the phone screaming begging and advocating to only occasional avail.

NAVDOC3rdMAR · 6 months ago

It's criminal. Single payer health care for all. Tell the Insurance companies to go fuck themselves. SEMPER FI!

munjoyfan · 6 months ago

Sullivan, the Blues are regulated businesses. In each state where they operate, they apply for rate increases to the state insurance commissioners or equivalent structures, and they are granted those increases to include a GUARANTEED PROFIT every year. This is public record, and should be reported in you daily newspaper each time it happens. Sadly, the Blues used to be owned by their subscribers, but they hoodwinked the public except in a couple of shining example states like Massachusetts, and grabbed the entire assets of the corporation for private owners. The subscribers are now customers.

ndtovent · 6 months ago

I'm in! What do I need to do? Who do I contact?

stefanzo · 6 months ago

EXCELLENT POST. Thanks, John, you're great when you're mad! You can post all the Mormons-Stealing-Our-Souls articles you like, and I promise not to complain any more :-)

sullivan · 6 months ago

Where can we find how much profit BCBS makes? I just got my new plan which is full coverge by the state BUT now I pay a hugh co-pay and 50% of everything else! Mind you, they are supposed to be a no-profit in my state.

cowboyneok · 6 months ago

Its like TORTURE, there really should be NO DEBATE on this issue. The American people already SPOKE VERY LOUDLY on this issue with the election of Obama. If Universal Health Care does not happen its only because the politicians don't have the political will to do it. The people have spoken and we DEMAND Universal Health Care like many of us have enjoyed while visiting Europe and Canada.

sullivan · 6 months ago

And you know if it doesn't happen we will take to the streets! There will be big time demonstrations over this issue!

ndtovent · 6 months ago

My shitty company cafeteria plan is a bsbc careLAST ppo, which would be a little better than the old hmo was (this one is open access, so no referral needed to see a specialist), BUT I have a $1200 deductible across the board now, not just for certain dr. visits/procedures. At least with the hmo, the copays were low.

Zorba · 6 months ago

*Sigh* We have Blue Cross-Blue Shield, too, John. I won't even go into the problems we've had (or that our son, also BC-BS, has had). All I have to say is that it is way past time for single-payer. All overall health statistics available show that Western countries with some form of socialized medicine (whether totally socialized or with a public plan with some private options) far exceed the USA. I'm sick and tired of hearing the old saw "But with 'socialized' medicine, you have to wait for care! Or it's denied!" I'd like to hear from people with regular plans in this country who have never had to wait for care, who have never been denied, or have never had to fight tooth and claw with the insurance company to get the necessary care or get their emergency care paid for. Been there, done that. I'm tired of it for my family, and I'm sick to death of the problems of all the under-insured and non-insured in this country. Health care is a fucking RIGHT, not a way to make money for bloated HMO's, insurance companies, drug companies, and so on. Health care is not a commodity that you can either buy or do without. It is a basic human right. Period.

sullivan · 6 months ago

Why are the fucking republicans against this?

Gridlock · 6 months ago

THIS is why

http://www.americablog.com/2009/03/bill-kristol...

judybrowni · 6 months ago

Fuck Blue Cross.

I had to wait three months for a work-related healthcare to kick in, so contacted an insurance broker for something to tide me over.

This was 15 years ago, and I'd yet to get into quite so many battles with health insurance companies, so I didn't believe the broker when he advised me not to include the prescriptions I was on my application.

I hadn't been hospitalized since 1958 (appendicitis), and other than an inexpensive prescription, no major illness or longterm, so I foolishly didn't believe him and included the prescription.

Sure enough, Blue Cross turned me down for a 3 month supplemental insurance plan, for a $25 a month prescription.

munjoyfan · 6 months ago

This is where the rubber meets the road. We aren't going to get single payer health care this time around; what we can get is a choice equivalent to the non-profit government employee plan. And this is what the republicans and insurance companies have dug their heels in over. Why? Why can't they stomach "competition"? Because the record shows the competition will offer better products at a lower price. Exactly what competition is supposed to do. In Maine, workman's comp was brought under control by exactly such a device. And I'd like to remind each and every one of us that the administrative overhead of Blue Cross is about 5 times the administrative overhead of Medicare (golf getaways to the Bahamas for top sales teams, anyone? Million dollar bonuses, anyone?)
The insurance companies will threaten not to write business in a competitive environment. Let them. They are for-profits now (Blue Cross having given up its cooperative member-owner structure) and they will only be bluffing.

Steve Mich · 6 months ago

If they pull a Harry and Louise again this time, bury them. We've waited decades too long for this and we're not going to wait another year. Health care is a human right

Steve_in_CNJ · 6 months ago

some of us still remember the harry and louise ads from 1993 that condemned us to almost 2 decades of confiscatory insurance scams like the ones you describe. i think there is enough anger out there by now to run an effective counter-campaign. obama's website is asking for contributions to resist these bloodsucking corporate thieves. i gave a little money and will probably give more. let us know if there are any other advocacy groups.

libertydan · 6 months ago

If blue cross is so bad why cant you drop them and get someone else? If not then it seems a lack of competition is the problem. Competition is proven to reduce costs.

Steve_in_CNJ · 6 months ago

there is no other consumer item analogous to health insurance. insurers are sitting on a cash cow because you would pay anything for your hypothetical cancer treatments, but when they are no longer hypothetical, the company finds a way to desert you. by then it's a little late to shop around. imagine a life-insurance company that refuses to pay up because you're dead. that is how this industry works. for-profit health insurance is cruel and inhuman and does not work.

Christie Keith · 6 months ago

Are you really that clueless, libertydan? Most people are tethered to their health insurance due to a job, or imprisoned by it due to pre-existing conditions. I had a simple yeast infection three years ago and when I applied for a lower rate with a health screening, they rejected me because of that. A single uncomplicated yeast infection. Seriously.

John has asthma. Pre-existing condition. Private, single person policy. He's lucky he got insurance at all. If he was my age, he wouldn't have.

There IS no competition for any customer they think will ever make a claim. The model is flawed and it's anti-competitive.

ndtovent · 6 months ago

In this area, there very few companies one can even go with for health insurance these days. BCBS has the market pretty well monopolized here in the DC area..... Many different names fly around, but they're all subsidiaries of BCBS. The only other major player here is Kaiser. And what company is going to just 'pick up' new members if there's even a hint of a pre-existing condition. If they will even consider insuring in the first place, it won't cover shit, and the premiums will be beyond reach. There is NO WAY I could get coverage on my own, outside my employer plan.

Christie Keith · 6 months ago

Unbefuckinglievable. My mom, who has excellent health insurance, ROUTINELY has to wait for months to get seen, days to get a call back from the doctor to MAKE the appointment, cannot ever get through to the doctor, EVER, on the phone -- they only give you voice mail or fax. They literally don't ever answer the phone, by design. It's not "we're too busy to get there" -- that's their system, on purpose. No phone appointments, no asking questions. Just leave a message and days later we'll get back to you.

But OMG if we have a government health care plan we'll have EXACTLY WHAT WE HAVE NOW? Screw them.

Not to mention the ultimate rationing, that tens of millions of people can't afford, or get, due to pre-existing conditions, coverage at all.

Chuck · 6 months ago

Blue Cross has spent the last two years claiming "secret" provisions within their regulations that bans them from covering the PT & OT therapy my twins receive due to their premature birth (15 weeks). The official provision is only for speech, but they insist that ANY therapy for prematurity is not covered even when the doctors reclassify it.

Some of this is due to a fight with the provider (Wake Med in Raleigh) over who is going to cover what and by how much. As a state employee, I'm stuck with what comes with my job, unless we want to go out of pocket.

So we went the better part of 10 months with out it because it is $1500 per month for them. Thankfully, the kids aren't in horrible shape, but they would be much better with it. And this is the "humane" system which the Republicans want to protect.

Michael Gass · 6 months ago

My wife's company just went under Blue Cross/Blue Shield. The old insurance company covered all over my medications 100%. Blue Cross decided I only needed 20 of 30 days worth of medication, well, that they would pay for...

Permial Darkling · 6 months ago

At 40 I had a heart attack, my copay through Blue Cross/Blue Shield was 10%, I only had to pay $80,000.00. I've been treated in other countries for simple illness, though I must say that England's health system is much worse than most other public systems, except here.

judybrowni · 6 months ago

ONLY $80,000!

Only?

How about those of us who don't have $80,000 to begin and end with?

Guess we can't afford to have a heart attack in the U.S. -- say what you will about England's system (probably gutted by their evil conservatives) even I could afford to have a heart attack there.

aj17057 · 6 months ago

Here in PA there are four separate BC / BS plans operating, each CEO earning $1M or more. Recently Highmark (western PA) and Independence (eastern PA) attempted to merge, spent untold millions of dollars, million and millions of our dollars on the endeavor only to have the commonwealth shoot the merger down. The two companies had a prior gentlemens agreement not to compete. So now they are still two separate companies and no one except a bunch of lawyers are any better for the experience. All four PA companies claim to be non profit but collectively have 2+ billion, yes billion, dollars in 'reserves'. I luckily do not have any horror stories to share but certainly there has to be a better system than this where as they can flutter away millions of dollars on 'mergers' yet continue to screw their customers. I sure hope this president does not let us down.

ShirleyGoodnessanMercy · 6 months ago

Single payer is all that works.

Cigna and Aetna are so bad I could tell stories to make you cry. They are truly EVIL.

postdamnit · 6 months ago

Yes they are evil, but does anyone but you really care? Does your Congressman? I don't think so. You just don't have enough money for them to care.

FunMe · 6 months ago

HOW do you make them care? Or better yet, how do we CHANGE the system?

People lose jobs and then their debts go up because of HIGH MEDICAL COSTS. Or they can't go bankrupt because of bankrupcy laws, that yes our VP voted for. (Delaware anyone?)

So when do people RISE UP and demand something happen. Are protests really a thing of the past. Or are they not effective anymore.

WHAT can be done?

I rarely get sick. But I do worry for others who get sick and don't have much money for their medical expense.

It is a MORAL CRIME of these jerks in the insurance company and what they do so their company can rake in the $$$dough.

They will get their karma for what they are doing.

:-|

evan_la · 6 months ago

Last time I needed a chest x-ray, it took over a week to get an appointment with my doctor and then nearly an entire day running around from one medical group to another - in the snow - to get the x-ray. All the time I was getting worse. Turns out I had pneumonia - surprised I was able to make all those trips - and by the time I landed in my doctor's office again with x-rays in hand I was literally green and about to collapse and needed drugs immediately. This, with a premium level employer-provided plan - which changes every year - in the sense of higher premiums and lower coverage. I honestly don't know what's covered any more - haven't been to the doctor in a few years. Don't even know my doctor any more - after having to change from plan to plan to plan, there's no continuity of care.

Good thing I got all those psychotherapy visits over with in the 80s and 90s because I'd have to fight tooth and nail for coverage these days. I think they now try to limit them to eight or 10 visits. I had 50 covered visits per year @ 80/20, and needed every one for about six years. Best investment I ever made - it's a shame the barriers are so high for those who need it today.

Wouldn't having covered employees buy into a public plan, or having single-payer, be an enormous cost-savings for employers? Do they deduct their part of the contribution from their taxes? So does that make it cost neutral for business? If it wasn't, I'd think employers would be behind single-payer in large numbers.

Alex in Tacoma · 6 months ago

Blue Cross stuck me with a bill of over 20% of my annual income for a minor, not-entirely-necessary day surgery. I guess I should be grateful that one of the charges I kept getting, for $19,000, finally got knocked down to a mere $2500.

Thanks. Please keep running things.

postdamnit · 6 months ago

I don't mean to be a cynic, but how do you plan to "take them down hard"? Our government is owned by corporations. They call the shots, something that Obama is starting to find out I think.

What is needed is a clean sweep of Congress and elected officials that work for the people. Sounds good but won't happen in my life time and I intend to live a long life.

Obama is finding out that with all his BS he is still tied to the special interests and he can't really do anything about it. One of the reasons that he is always playing the Rodney King card now, "can't we all just get along".

I say a plague on both their houses.

astroworf · 6 months ago

I have Blue Cross through my employer and was just notified they've changed the terms of my prescription coverage, lowering the amount they cover for my cholesterol medicine. Go to the doctor and get a different prescription is their prescription. Bastards.

thebs_flag · 6 months ago

Most reimbursement rates are negotiated between the insurance company and your employer. These change in rates are usually done at the request of your EMPLOYER as a means to control the rising premium costs. Don't solely blame your insurance company, your employer is on the rate changes.

Malcolm · 6 months ago

You are so right about Blue Cross and Georgetown. Georgetown killed my dad through sheer incompetence; they didn't realize until it was much, much too late that he was allergic to heparin. I had a serious injury two years ago that left me unable to walk. Blue Cross stopped paying for physical therapy before I could walk. I paid until I could walk with a cane, and then it just got too expensive to try for complete recovery, which others with similar injuries and more money managed. I'm still walking with a cane, and Blue Cross is still taking $640 a month for my self-insurance. It is completely useless trying to talk to them.

Older_Wiser · 6 months ago

We must have universal health care. Even Medicare leaves many with bills to pay, even those who are trying to live on less than $20K a year. Imagine having to pay thousands of dollars from a pitifully low monthly SS check. The press likes to showcase those retirees who have plump pension plans, investments, etc. which supplement their SS checks, having a ball in some far off place, but the plain fact is, 1/3 of SS recipients don't have any additional income, and a significant percentage have very little extra; and admission to a nursing home costs far more per month than the additional cost of a home care worker. I wouldn't be surprised if the elderly start electing to simply die instead of bankrupting themselves, doing without food, or having to spend the rest of their lives in nursing homes where no one really cares, patients are abused, neglected and allowed to wander off.

Last year I had cancerous growths removed in a 4 hr hospital stay. The "recovery room" alone was over $700 for one hour (in a room far smaller than the shoe closet of some of the wealthy) and of course the IV drip which was removed from my arm was a separate charge. Other charges were similarly outrageous. I was released, still a bit "drunk" from the anesthesia; if a neighbor had not been available to pick me up, I wouldn't have been released and would have kept on being charged. Every service I used, from doctors to hospital, including a nurse anethesist, was full price and had a balance which I was expected to pay out of a $1000/mo SS check. And there are many, many seniors who have even less, much less, than that.

Is it any wonder that we have 50 million people without any form of health coverage? And if your income is over $375/mo for a single person in this state, you aren't even eligble for Medicaid.

"Old age is not for sissies" as they say, but getting ill or developing a chronic condition if you're young is just as bad sometimes when the rest of your life and your future is at stake.

thebs_flag · 6 months ago

What prevents you from visting a doctor at any time? You make the assertion that because you don't have medical INSURANCE that you don't have medical CARE. This is patently false.

"Is it any wonder that we have 50 million people without any form of health coverage? ..."

Most doctors and hospitals will negotiate with patients who don't have medical coverage and in SOME cases will agree to give those patients better reimbursement rates than those folks that belong to established health care plans. Their feeling is that they (the Doctors and Hospitals) would rather receive some payment for services than no payment at all.

Mike · 6 months ago

As a health care provider, I can tell you that things with BC/BS aren't any better on this side. As a matter of fact, we dropped out of the network last month. Our reimbursements for the same services are less than 1/3 of what they were 3 years ago through BC/BS. They won't give any info upfront about what they will cover and for how much, and then when we get the payment, they would underpay for certain services, or not pay for services that they paid for previously. Then the onus is on us to recover the money they is rightfully ours. I had a stack of EOBs in my office that all were shorted $6 (over 100). But considering it took 20 minutes minimum to process a claim for that money (and even then you had to follow up on it a few weeks later in order to get paid), it was not worth our time to chase that money. And that was one small office, for only 3 months worth of claims. $600 of my money in their bank account. And there must be 10s of thousands of docs with the same story. And it is a conscious thing on their part. Of course it's our money, they will say when you have them on the phone. Let us reprocess that for you, and the check will be in the mail. But I've never gotten a check without another followup, after another 20+ minutes on the phone. How many providers never notice the discrepancy in the first place? Of those, how many make the first call? And of those, how many follow up on the first call? And even when BC/BS makes good on the claim, they've held onto what amounts to millions of someone else's dollars for many months, reaping untold profits in dividends from investments made with that money.

Patients may not be happy when providers drop out of their insurance plan's networks, but the only change you may see in the company itself is when the people (or companies) that buy that insurance stop buying it because they can't find any providers who take it.

Preston · 6 months ago

My employer provides Blue Cross. It costs me many hundreds a month to 'insure' my family. What do I get out of it? The 'right' to see a doctor and an average discount on prescriptions that cost me a couple of hundred dollars per month.

It is absolutely worthless. But I don't dare cancel it. Without it, I would not be able to have access to medical care when my family needs it.

It is disgusting and I assure you that it will not change.