A lot has been changing in my life over the last 12 months, and it has been a while since I have written a post. I have been staying pretty busy with work and family, the business has been growing and I’m about to hire a new full-time employee. My family is also growing, as I my wife and I will be having our first son come August. Having a growing family means that health coverage has become a new priority for me, where I have been without health insurance for the last ten years or so. While I can’t say that I know anybody who loves insurance companies or their practices, I can certainly say that of all I have worked with BlueCross BlueShield of Tennessee is the worst so far.
I’ll have to give a bit of a preface and I’ll start by saying that my wife has had health insurance through BlueCross BlueShield of Arkansas for a couple of years. We had no issues with them when it came to doctors visits, prescriptions such as Nexium for my wife’s chronic heartburn, Advair for her asthma, or anything else that she needed medically. My wife does have terrible acid reflux to the point of her aspirating acid into her lungs resulting in damage and regular asthma flareups. She has been on Nexium for about two years and over those two years her asthma has gone from putting her in the hospital almost every few months to almost non-existent. That is, until we changed to BlueCross BlueShield of Tennessee…
My wife went to refill her Nexium prescription at CVS and was told that BlueCross BlueShield of Tennessee was requiring prior authorization for the prescription. They claim that without a “level 3 esophagus erosion” that Nexium is not necessary and that over the counter Prilosec, which is effectively half the effectiveness and twice the out of pocket price, is all that she needs. Keep in mind that she already had chronic acid reflux resulting in chronic obstructive pulmonary disease, COPD for short, and now she is pregnant which is known to cause acid reflux in those who have never had heartburn in their lives.
Taking this all a step further with my wife being pregnant, having chronic acid reflux, and asthma she now also has gestational diabetes. Gestational diabetes is essentially, as the doctor explained it to us, where her body cannot quite keep up with the insulin demand of her and the baby and, as such, she is effectively diabetic for the duration of the pregnancy. The doctor wrote my wife a prescription for a meter, test strips, etc… When we went to CVS Pharmacy to fill these prescriptions as they are required to monitor her blood sugar to avoid serious complications such as diabetic coma, damage to her and the baby, and a long list of other side effects of diabetes CVS informed us that BlueCross BlueShield of Tennessee is rejecting the prescriptions and that BlueCross BlueShield of Tennessee requires “prior authorization.”
For whatever reason BlueCross BlueShield in what appears to be every attempt they can make to keep every penny they are paid, seems to require prior authorization for every prescription my wife has been written. I am beginning to wonder what the point of having insurance is, if they are going to reject all claims while continuing to accept payments for the insurance coverage. We never faced this issue with BlueCross BlueShield of Arkansas, so it’s obvious the administrators in Tennessee are, at the least, greedier. If a doctor writes a patient a prescription for a blood sugar meter and test strips, what does the insurance company think? Do they think that we are making this up so that we can get one over on them when it comes to a $110 prescription of blood glucose test strips?
Why is BlueCross BlueShield of Tennessee requiring prior authorization from the doctor for a brand new treatment on a brand new medical issue, especially gestational diabetes? None of this makes any sense at all to me. I thought it was in the best interest of the insurance provider to make sure issues such as these are taken care of to avoid other, bigger issues down the road that result from lack of treatment.
At the end of the day, if you are looking for a health insurance company and BlueCross BlueShield of Tennessee is on your list, you may want to look at alternative options.
Disclaimer: All information contained within is factual to the best of my knowledge. Any information that is not purely factual is my opinion. In the event that information is presented as factual when in reality it is not, there is no malice intent and I will be happy to make an update or correction when it is brought to my attention.
Update 1 – 06/13/2012 2:30 PM
The blood glucose meter that my wife was provided by her OBGYN was a OneTouch Ultra Mini, however, the insurance company is absolutely refusing to pay for the test strips for this meter. They have informed us that our only option is to choose a testing strip that they will pay for (read: cheap) and then to go buy a matching meter out of pocket although we already have a perfectly functional blood glucose tester.