What I Don't Know Yet

Blue Crossed Up

In Uncategorized on September 7, 2009 at 7:45 am

In the fall of 2008, I applied for medical insurance with Anthem Blue Cross. Much to my surprise, I was rejected. Actually, I wasn’t surprised. I was stunned. But I could be philosophical because it looked like I could get insurance in January  through the University of Louisville, where I teach a couple of writing classes. So I decided to hold out a few months. Too bad that didn’t work out. Two of my classes were under-enrolled, making me ineligible for insurance.  In March, I applied again to Anthem. When I was rejected last fall, it was for a particular type of policy — at least that’s how I read the letter they sent me. So I had reason to hope I might be accepted this time if I applied for a different type of coverage.

Silly girl.

I was rejected again. This time I called a number the company provided, and a woman told me I was rejected because of my brain aneurysm. If I would get the aneurysm repaired, and then go three years without any complications, Blue Cross would insure me.

Now I was SURE I could get coverage.

In fact, I had an intact brain aneurysm diagnosed in 2003. It was found by accident during an MRI, confirmed in an angiogram, and repaired that summer by an interventional neurologist at Henry Ford Hospital in Detroit. This doctor went through my femoral artery and into my brain and filled the aneurysm with platinum. I wrote about it, and the story appeared in Reader’s Digest in 2005. I’ve had the required regular checkups since then and the repair is in good shape. My brain circulation is lovely and there is nothing to worry about. So, according to what the Blue Cross woman told me, I was a shoo-in for coverage. My aneurysm had been A-OK for six years, twice the time Blue Cross required. I filed an appeal.

My appeal brought a letter from Kim Ellis, regional vice president of underwriting for Anthem Blue Cross and Blue Shield. Kim Ellis wrote that despite the company’s “careful consideration” I was denied health insurance. “This decision was based on cerebral aneurysm. Per underwriting guidelines the decision stands. We can reconsider with current medical records to include some follow up within the last two years for the cerebral aneurysm.” Perhaps you notice the rather random use of nouns and verbs in this letter. Clearly, one can reach a high position in Blue Cross and still write “we can reconsider with current medical records to include some follow up…”  Or, as Blue Cross Vice President Eliis might write: This decision was based on stupid.

I called Blue Cross to ask them what this letter actually meant. The woman on the phone didn’t  seem to know. Our best joint interpretation was that Blue Cross would like to see records of appropriate follow-up examinations. So, after only a few phone calls wherein confusion reigned, as per underwriting guidelines, my records went to Blue Cross.

Then I hear from Blue Cross in July. It will cover me! Hurray!

But wait, it will cover me, but it considers my effective date to be March 20! So during the four months in which I was terrified that a random accident could bankrupt us, months when I too frightened to get a medical checkup of any kind, months when I worried that something as simple as a tumble down the stairs could empty our savings — for those months, Blue Cross expects to be paid.

In what alternative reality do these people exist?

I appealed. I said, let’s make this policy start in August, and I’ll pay starting in August.

Today is September 7. I just finished another month without health insurance, but the folks at Anthem Blue Cross say that once all the paper work is in, the date of my policy start will be changed. To August. A month ago. A month in which I still feared the appearance of the slightest medical necessity. So last week when I called my dear friends at Anthem to find out when this will be worked out. They weren’t sure. But, I was assured, I could go to the doctor if I wanted. I’d be covered.

But let me ask you something: Would you? I have nothing in writing telling me that I’m covered beginning in August. The only thing I have in writing is that I’m covered retroactively for all those months my application for insurance was rejected, and that I owe a ton of money for those months in which my application was rejected. Would I please pay already: I have that in writing too.

Would you trust this company and go to the doctor?

So, please, if you’re one of those people so frightened that we’ll be stuck with universal health care like every other developed nation, if you’re one of those worried that the United States might be saddled with a system that provides medical care to its citizens, please tell me what is so good about the system we have? What is it about the performance the insurance business that you find so admirable? My case is not unique. It’ s business as usual. Can’t we do better than this? Why wouldn’t we want to?

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  1. jenn
    I wrote ” Anathema : our Blue Cross To Bear” , different details but of course similar nightmares…although we DO have coverage, so there er…isn’t a comparison. Anyway, I LOVED yr Jaak Panksepp story, read further, wante dyou to see my junque too..
    http://www.XO-1.org is one place, jacquiephelan.com is another…yr new fan

    • Hey Jacquie, Thanks for writing. I’ll definitely check out your writing. Sadly, the state of health care today means nightmares like these are viral. I have coverage now, finally, through my husband’s job.

  2. Yup. You’ve summed up our system nicely: the administrative double-talk, the callousness, the ever-present profit motive, and the constant fear of financial catastrophe.

    I was in England about a month ago, and had a close encounter with the British National Health Service. My husband had a sudden pain that made it too painful for him to move, and what we experienced was this: a telephone call that assessed him as not having a life-threatening problem, an in-person visit from a paramedic who decided he wanted my husband to be seen and provided pain medication, an ambulance, an emergency room visit, a full round of tests, a diagnosis, and medication that actually fixed the problem. Time from pain recognition to ER arrival? Less than 40 minutes. Not one person asked for I.D., let alone insurance information; they knew we were Americans, and didn’t care. Everyone we encountered was friendly, helpful, and seemed just like U.S. providers, except the E.R. seemed to be appropriately staffed and we never saw an accounting person.

    Wake up, folks! We don’t have a health care system that works. We have a health care system that is making profits for some and leaving a whole bunch of our countrymen on the side of the road.

    • Interesting story, Shannon, since England is one of those countries people are always holding up to say, “We certainly don’t want what they have.” At the moment, it sounds pretty wonderful. And I’m glad to hear your husband is doing OK!

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