Way back in October we experienced a remarkable level of craptastic service at our local drugstore’s flu clinic. Though Laurel and I waited in line for nearly an hour and a half with various representatives going up and down the line to hand out flu shot forms, it wasn’t until we got to the front of the line that we were told:
1. Blue Cross patients had to pay out of pocket and submit reimbursement forms.
2. They only took cash ($30 a shot).
3. They would not vaccinate children (apparently they didn’t find it necessary to pass this message down the line replete with children and their weary parents).
I was mildly annoyed that they wouldn’t take Blue Cross on the spot and it was blind luck that I happened to have gone to the bank that day and had a wad of cash on me. However, having spent the last 90 minutes assuaging Laurel’s fears about the shot, there was no way in hell I was leaving that clinic without getting them. It wasn’t my best or most graceful moment, but my mama fangs came out and I refused to leave until they gave me and Laurel shots. They did. The moms behind me in line were grateful.
Fast forward to January. It took us a while to get around to submitting our receipts and reimbursement forms and we just received word from Blue Cross that our flu shots ($90 for me, Jon, and Laurel) would not be covered. The excuse being that the person who administered the shots was registered in Rhode Island, not Massachusetts.
Even though we were, in fact, in Massachusetts when we got the shots.
WTF?
As Jon wrote in a strongly worded letter to Blue Cross MA, this is a disturbing example of uncoordinated, money-first health care. I should say that in general, Jon and I are non-interventionist when it comes to medical matters; I don’t think we even own aspirin. However, after much discussion, we decided to go ahead with the seasonal flu shot since our understanding is that they are clinically effective and cost-effective to the system (i.e., it would be a far greater financial burden if we didn’t get them then got the flu and needed to be treated), and also since Laurel is 5 and Jon is in contact with at-risk populations at work.
Since Jon and I now are both self-employed we pay Blue Cross MA more than $1,000 out-of-pocket every month in premiums, yet they feel the need to screw us out of $90 worth of care on a random technicality. (And as mentioned, we are the healthy, never-go-to-the-doctor-other-than-well-visit type of people that they’re making a pretty penny off of.) As Jon said, “At best, this seems like an example of a poorly designed or poorly executed system that cannot differentiate cost-effective from non-cost-effective care. At worst, it seems like simple greed. This is the kind of experience that leads members of your plans to feel alienated and mistrustful of your brand.”
Yes, well said. For us, it’s the principle of the matter, not the $90, but what also troubles me is that I can only imagine that there were a lot of other people in that line who followed the same procedures we did, and got screwed out of their reimbursements. And maybe that cash was really critical to them.
Growing up in a large family where we barely scraped by month to month, we never had health insurance. I didn’t even know that people got health insurance until I went to college and had to sign up. We only went to the drop in clinic when it was required for school forms and it is a miracle that with seven kids, the odds rolled so well in my parents’ favor — the only major medical issues in all those years and across all those kids were my tonsillectomy and my brother’s broken leg. Given current regulations, not having health care is not an option, but at this point I’m longing for those fast and loose times.
Because at this point, apparently our $1,000+ premiums aren’t buying us much.
9:53 am on February 3rd, 2010
I think it’s a rule that health insurance companies generally suck. When Camryn was born, I used both a hospital and a doctor affiliated with my health plan. About 3 months after she was born, I received a bill for about $3,000 because the anesthesiologist wasn’t affiliated with my plan. Really? I wasn’t given a choice between different anesthesiologists and chose the one not on my plan, they gave him to me. I fought it and won, but it was a giant pain in the ass. You’re not alone, my friend. I promise.
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10:10 am on February 3rd, 2010
My husband is a teacher, so we have pretty good insurance. However, there are times (when it’s a fight to get necessary procedures covered) that I feel like the whole insurance industry is a scam/hustle!
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10:38 am on February 3rd, 2010
BCBS doesn’t want to pay for my Avastin, either ($30k/treatment), even though it’s the only thing that’s kkeeping my tumors at bay. We had to file a variance or whatever they call it and even then, it’s touch-and-go. ::shudder::
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10:48 am on February 3rd, 2010
Oh Christine!
We too pay $1000+ a month to BCBS because we are self employed. We have yet to run into difficulties, but I am constantly on the lookout for it. I know it’s coming.
Our health care system is broken. Thanks for talking about it.
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11:29 am on February 3rd, 2010
Good job bringing this up. We’re both self-employed, too, and the $12K a year is a major chunk. I think insurance should cover it all without hassle or just come clean and say they hardly cover anything…and charge accordingly. Don’t charge up the wazoo like you’re going to cover things and then pull a switcheroo because of technicalities that your consumers have no control over.
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11:36 am on February 3rd, 2010
[...] a testament to Jon’s strongly worded letter), but a couple of hours after posting about our Blue Cross shenanigans, the phone rang, and Blue Cross showed up in the caller [...]
12:00 pm on February 3rd, 2010
[...] more people covered by insurance, what we’re going to end up with is 30 million more stories like this. Followed by 30 million more stories like this. It honestly boggles my [...]
3:42 pm on February 3rd, 2010
Because my husband and I are self-employed as well, our Tufts plan is $1300 per month and sure to rise in April. $50 copay each time you go to doctor. Had to take my son to Prompt Care this morn. Thought he had strept. They don’t see children. The woman directed me to ER where my copay would have been $300. Proceeded to call the pedi. Squeezed us in. Talking with woman checking me in. Said her copay was $50 too. Started telling me that all the money she and her husband make is not covering health costs and mortgage. They’re starting to sell their things. This us what is happening to so many of us. The only word I have for it is uncilvilized. How did we get here? Thanks for sticking up to BC. $90 means a diff between groceries or no groceries for so many people.
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8:45 pm on February 3rd, 2010
I’m in complete agreement that Blue Cross sucks (in SoCal, they’re independent of BS but married to Anthem). I just got a letter this morning (timing is everything, no?) that they are increasing my monthly premiums by 1/3! How is raising rates over 30% in one year even legal? I didn’t even enter a new age bracket or anything. I’m irate. And I simply don’t have that kind of money. Carrying the insurance I have is a challenge. So, I’m off to research other insurance companies this evening. None of the options are great. And yet, still, our government is bickering and refusing to unhook from the chain the companies keep yanking around its neck. Makes me want to cry.
Good luck with your fight!
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