Blue Cross is trying to kill my wife II

Posted on 05/06/2007 in misc

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.

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