Blue Shield Cares — About What?

“Doesn’t it suck that even when you have health insurance, you can’t afford to see the doctors you really trust?” –Favrile, Sherman Oaks CA hairdresser, January 19, 2010

My hairdresser Favrile and the salon where she works are my reality gauge. If Fav’s talking about something, so are lots of other people.

She hadn’t seen my post in December that disparaged Blue Shield’s all too frequent bureaucratic thumbs-in-the-eye behavior toward members; and that advocated for Single Payer health insurance (One public insurance agency would make all healthcare-related payments. It would not run or manage actual healthcare — and we must be vigilant to guarantee that).

Fav’s question was the third nudge the universe sent to tell me this story was still kicking. The first sign was the 44 comments my HuffP post got, including articulate blog-worthy health insurance horror stories and a dark-mood-comic-relief bit.

Next came a voice mail from Blue Shield rep Tiffany, who coordinates the Special Services Team. After listening a few times to be sure I’d heard correctly, I realized that this giant corporation cares about The Huffington Post (in this case, me. Whoa, How’d they get my number? Oh right, I’m a member.)

When we talked, Tiffany extended Blue Shield’s apologies for the half-hour I spent on hold waiting to speak with a supervisor after the first person was, if anything, anti-helpful. “We are investigating,” she assured me.

What followed was a surprisingly cordial discussion. She explained the labyrinthine health insurance payment process for people “on COBRA,” the acronym for a law Congress passed in 1985 that lets people who’ve been laid off or fired, stay on their former company’s insurance plan. COBRA also applies when a non-employee’s link to that insurance — in my case, a spouse — becomes an ex-spouse.

Tiffany and Blue Shield are strong supporters of universal healthcare (not Single Payer) — they think everyone’s entitled to health insurance. They agree that people should not be excluded for pre-existing conditions. Blue Shield’s CEO came out in favor of the concept in 2002.

Regarding Single Payer, Tiffany said, “I can see pros and cons.” At that point I knew this was going too smoothly and remembered to say, “My primary complaint is that I pay more than $700 a month, but most of my doctors have quit Blue Shield. So my healthcare payments are ridiculous.”

Replied Tiffany, “We have had questions about the amounts and timeliness of payments” to practitioners. And, even though Blue Shield partially covers its employees’ premiums, “we’re seeing increases ourselves. We’re hoping that universal healthcare will contain costs. We won’t know ’till the legislation passes (this was early January).”

She asked if I’d considered an individual plan. “Pre-existing conditions,” I answered.

“There’s definitely room for improvement,” she responded. “That’s why I reached out to you. Health is a very personal issue. If Customer Service is not providing a level of care, people are welcomed to contact us.” (first step: http:// www.blueshieldca.com) She agreed to speak with me again if I had more questions.

Afterward I realized that lousy customer service wasn’t the issue. Sure, it’s unpleasant waiting on hold for any length of time (though new rules may improve that), considering how much we pay for health insurance.

My criticism of Blue Shield (substitute Blue Cross or Aetna or…) is that the medical experts who know and have treated me for many years, got disgusted and finally left. My HMO doc gives me normal prescriptions and orders routine lab tests. But often, normal isn’t enough.

For comprehensive treatment that works, I see doctors I trust. The result is huge bills, even though my policy supposedly pays something for this Point of Service (what does that mean?) care.

And I know I’m fortunate. The number of under- and uninsured Americans (now, even the upper Middle Class) has been rising by multiples.

I called Tiffany again, with these questions:

What specific universal healthcare policy does she and Blue Shield support? What does she consider the major pros and cons of Single Payer? How is Blue Shield solving my problem — I pay exorbitant premiums which don’t cover the fees of most medical professionals who help me?

I reached her the next day. When she heard my questions, she asked me to email them so she could answer carefully. I did. The week went by. No reply.

I emailed again to say that I couldn’t wait any longer to write my follow-up blog. She responded the next day with an apology, and sent a link which, “should give you a lot of the background information that you’re looking for.”  And she offered to “be of any further assistance.”

wendy-block.gifShe has been of assistance. Now I — and you — know that Big Insurance knows the problems. And that it will not — it cannot — fix them. We have to do that. If somebody knows an effective solution — other than Single Payer– which will allow every person to get affordable quality healthcare, tell the rest of us. Including Congress and the President.

Wendy Block

Reprinted with the author’s permission from The Huffington Post, where it appeared first.

Published by the LA Progressive on January 27, 2010
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About Wendy Block

Wendy Block is an elected rep of the 42nd AD on the DSCC and DPSFV. She’s Recording Secretary of Valley Democrats United, a member of the Kitchen Cabinet of Kitchen Table Democracy, and speaks and advocates to pass the California Fair Elections Act, on our ballots in June.

Comments

  1. jerry dentino says:

    2 weeks ago i sent you guys an email stating that between you and geico you are driving people nuts with your commercials!flo is not funny anymore and in case your not aware of it there are pictures on the internet of the geico caveman having sex with flo.as a matter of fact i have one of these pictures on my cell phone that someone sent me.the reason these pictures are floating around the internet is because everyone is getting tired of your commercials as well as geicos.and both you and geicos commercials always show people clowning around and joking,i dont find anything funny about spending money i work hard for and dont have much of.shame on you!

  2. Sharon Toji says:

    I have been a vocal supporter of Single Payer. As a Medicare enrollee, I now have Single Payer, and luckily was able to keep Kaiser and my excellent physician there of 30 years. (Yes, Virginia, you can choose a doctor at Kaiser, and there are many excellent doctors there. And if you don’t like your doctor, you can change literally in a moment. And, no, he has never had to get permission for me to see a specialist, or have a special treatment or service.) Actually, Kaiser (a non-profit) at its best works a lot like Single Payer, if you were to think of the entire universe of Kaiser clinics, caregivers and hospitals as whatever geographic area you would look in to find medical care under Single Payer. You pay your bill to one payer each month, you pay your agreed-upon co-pay, and you pretty much get what you need. No paperwork, no deductible.

    But enough about Kaiser. I was going to talk about alternatives to Single Payer that might work for a country like ours that appears to be so fearful of the concept. Actually, very few of the universal healthcare plans in other countries are single payer plans. Yes, Great Britain and Canada are, but most others are not. Perhaps the most conservative, and most like the United States in many ways, is Switzerland.

    Their plan has a lot of things I admire. They accomplished the success they have by insisting that private health insurance companies that want to sell one of their government approved policies do so on a non-profit basis. They can have a for-profit division to sell “extras” like cosmetic plastic surgery, luxury amenities that are not remotely medically necessary, for instance — but they have to offer the universal plan to everyone equally, and without profit.

    Another thing I love, as a business owner and former employee myself, is that health insurance is not tied at all to employment. Everyone, by individual mandate, buys a plan privately, and of course the government subsidizes those who can’t afford it. Taxpayers, including businesses, pay taxes that cover those who can’t afford the premium. You can change your job, lose your job, get a divorce, whatever, and you can still keep your insurance.

    As I understand it, after the usual initial complaints from conservatives (and that probably includes a huge portion of the Swiss population!) almost everyone is happy, including the insurance companies. They are doing just fine, and are selling “extras” to enough people who can afford them to keep profits coming in. Why did the Swiss do this? Because they finally saw that no one was going to be able to afford the premiums if they continued with a system that was almost identical to ours.

    I would suggest that everyone go to the PBS.com website and look up the video of the great Frontline program, “Sick Around the World.” It covers the systems in several other countries, and it is an eye-opener. There are also some excellent teaching materials that cover different kinds of health care models, how they work, and the pros and cons of each.

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