Monday, Oct. 26, 2009

'Pre-approval' worthless

Real world example of the health care problem: As a Blue Cross of South Carolina client for my family, I pay nearly $1,000 a month. My policy has an annual $5,000 deductible, so no benefit from this policy until we spend an additional $5,000 cash in the calendar year. At that point we do get some procedures covered in our plan, but only until the calendar flips and we start over again.

Late last year, after we did reach our deductible, my wife had day surgery. Her doctor got "pre-approval" by BC. Near the same time, my doctor advised me to get my first colonoscopy. I personally called BC customer service for "pre-approval." Blue Cross made a promise to pay.

Weeks later, we each received letters from Blue Cross. Now, BC had determined that each of our procedures was, "after further review, DENIED." My letter said my colonoscopy was not allowed. My wife's condition was determined "pre-existing." We were each informed that payment would be our responsibility. And, if we disagreed, we could appeal the decisions. Each of us did. What about that "pre-approval"? Does that mean "maybe" or "perhaps"?

Well, my bill was about $2,500. But, my wife was faced with charges of nearly $22,000. Her doctor wouldn't help. The doctor's business office stopped speaking to my wife, and the strain on her recovery was ominous. Finally, after much haranguing, Blue Cross reversed the denials and paid both claims.

Clearly, "pre-approval" is no promise. It is dishonest and it has soured my estimation of Blue Cross for this deceitful behavior. Doctors have told me it happens often.

During my appeal period to BC, I wrote Congressman Henry Brown and asked for his comments, advice and help. Congressman Brown is the ranking Republican on the party's health panel. Sadly, it is the only time in my life that I did not receive a written reply from a personal letter to a politician.

Ed Sellers, chief executive of Blue Cross South Carolina, says that companies such as his own have become the "boogey-man" in the health care debate. I submit, sir, that you have earned the title. If you are unaware of this "false promise" problem with your company, you do need an "overhaul."

The sole reason the doctor, hospital and patient call you for "pre-approval" is for parties to gain a reasonable confidence for coverage. You breach trust between you and your customers' care and protection when you change your mind after the fact. And, now, I wish I had another health care option. I simply do not trust you any more.

And, although I don't want more government in my life, this is the kind of bad corporate behavior that exposes health care problems and it begs oversight. Worse: both political parties have lost the critical level of trustworthiness, leadership and spending sense. Politicians are so consumed with demonizing each other that they simply are not serving the constituency. We are so tired of being shoved around.

Americans: vote the bums out!