migrainesurvivalblog

Dear BCBS and My Apology to Health Care Consumers

on October 11, 2014

I have had health care insurance through Blue Cross Blue Shield of Kansas City (BCBS) for the 2013 and 2014 calendar years, and I feel fortunate to have coverage in this economy. While the premiums for enrollment and co-pays for doctor visits and prescriptions continue to rise each year, I am still blessed, I do not feel that it is my right or that it is owed to me. While I am happy to have insurance, I am furious with BCBS and the coverage guidelines and contract exclusions due to a recent appeal that I submitted for surgery. I also apologize to other consumers whether BCBS covered or other, because I believe my situation is one of the many that adds to the rise of health care expenses that directly affect consumers year over year. This is not something I am proud of, but something that needs to be brought to light.

With a chronic disease, it is to be expected that you will have on going medical and pharmaceutical expenses. In 2013, my migraine expenses including both medical and pharmacy, totaled approximately $13,000. For someone with a chronic medical condition, this dollar amount is extremely low, and the bulk of the expense was for one ER visit. That said, I was blessed in 2012 to have had a Neurostimulator implant that was life changing and gave me my life back, and was a direct correlation to the decrease in these expenses.

Conversely, as of October 2014, my migraine medical expenses have exceeded $85,000 and this number will undoubtedly continue to grow in the next couple of months through the end of the year. In fact, I anticipate this number to reach over $100,000. At this point my medical bills are 6.5 times higher than they were last year. This is a staggering increase. I submitted an appeal for a surgery that costs approximately one day of an inpatient stay in the hospital; I use this as an example because I’ve had three recent inpatient stays in the past three months. BCBS denied the surgery but paid for the hospitalizations without question. This is again where the apology comes in as this is a poor use of funds for any health plan and unfortunately a big reason why YOU will be paying more in the following years for your own health benefits. Legally they are obligated to pay for my hospitalizations that is without question. But after three in such a short time, I would think they would be looking for ways to decrease the expenses for themselves; this simply is not the case.

My appeal to BCBS was for a revision surgery for my Neurostimulator to help improve my health with the hope of decreasing this number for all parties involved. My appeal was not only denied, it was not even reviewed in detail. I know this because I received a verbal denial over the phone in less than 48 hours of submitting the following: a letter from my Neurosurgeon, a letter from my Neurologist, a document that I put together outlining the detailed medical expenses. Instead, they indicated that this is not a covered expense due to contract exclusions that were agreed upon by my husband’s employers and BCBS when the plan was negotiated. There are 58 total contract exclusions in the policy. “Stimulation” is number 57. I’m not suggesting that these exclusion are in the document in any particular order, but it did seem like an after thought, and the wording of the exclusion was very open for interpretation. Stimulation is still new to many people. As someone who now has one of these invasive devices, I understand the technology. Others may not. I don’t believe that my husband’s employer understands the exclusion after having a lengthy exclusion with them about it. I was nicely told by my husband’s HR that it is my legal right, but that BCBS won’t budge and that it likely isn’t worth my time to keep fighting this appeal, and so I’m not. We will be paying for the revision surgery out of pocket.

I can’t change what was done in 2014, and unfortunately the 2015 health plans are final. Open enrollment is about to begin. And yes, we will be with BCBS once again. While I’m still furious about the way things were handled, I understand the need to put parameters around plans, don’t get me wrong. I just feel that an appeal should be treated more openly, and should actually be reviewed. Call me crazy.

 

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