NC Department of Insurance : mandated colorectal screening is 'covered' but not 'reimbursed': SO WHAT KIND OF DOUBLE-SPEAK IS THAT?

This is a letter to me, in its entirety, from the NC Department of Insurance, Robert Lisson, PhD, Deputy Commissioner, Consumer Services Division.

This is what the Deputy Commissioner is stating: while state law mandates there be coverage of colorectal screening, the Department of INsurance cannot mandate BCBSNC as re: 'place of coverage'----though this results in non-coverage of colorectal screening----which is the law.

These appear to be the important points associated w/ the 'covered' but lack of 'reimbursement' of colorectal screening by BCBSNC except in an office based setting, of which one site is available and that site is in western NC, in Boone, NC.

Important item #1. colorectal screening is mandated to be covered under NC law, specifically, North Carolina General Statute 58-3-179 . Here is the law:

******************

http://www.ncleg.net/enactedlegislation/
statutes/pdf/bysection/chapter_58/gs_58-3-179.pdf

§ 58-3-179. Coverage for colorectal cancer screening.
(a) Every health benefit plan, as defined in G.S. 58-3-167, shall provide coverage
for colorectal cancer examinations and laboratory tests for cancer, in accordance with themost recently published American Cancer Society guidelines or guidelines adopted by
the North Carolina Advisory Committee on Cancer Coordination and Control for
colorectal cancer screening, for any nonsymptomatic covered individual who is:

(1) At least 50 years of age, or

(2) Less than 50 years of age and at high risk for colorectal cancer
according to the most recently published colorectal cancer screening
guidelines of the American Cancer Society or guidelines adopted by the
North Carolina Advisory Committee on Cancer Coordination and
Control.

The same deductibles, coinsurance, and other limitations as apply to similar services
covered under the plan apply to coverage for colorectal examinations and laboratory tests
required to be covered under this section.
(b) Reserved for future codification purposes. (2001-116, s. 1.)

****************

Important Item #2. "The same deductibles, coinsurance, and other limitations as apply to similar services....(are) required to be covered under this section."

Insurance policies have deductibles. Mine is a standard policy with a $2500.00/ year/ person deductible for the usual kinds of things: you get into an accident and you have to stay in the hospital. One expects to pay out of pocket for this. Your son has to have surgery for a condition that was congenital. One expects to pay out of pocket for this. You have to have surgery for something. One expects to pay out of pocket for this. And so are 'similar services' associated with:

a. outpatient services which may be necessary but are not covered by law
OR
b. a service which is covered by law

What is the definition of 'similar services'??

Important Item #3: If a service is covered by law, then why are other matters e.g., 'place of service' allowed to trump the law? If there are no office based gastroenterology practices which provide office based screening colonoscopies within 3 hours of a major metropolis in NC, then de facto isn't there essentially no coverage of the mandated service, specifically, screening colonoscopy?

****************


December 15, 2008
Dr. Marsha Hammond
--------------------------
Asheville, NC 28806

RE: Blue Cross & Blue Shield of North Carolina
------------------- -.­
Dear Dr. Hammond:

Thank you for your recent correspondence to the Consumer Services Division. I am writing in response to your December 13, 2008 em ail message to Becky Thornton, regarding your BCBSNC policy's coverage for colonoscopies in your immediate area.

First, "coverage" and "reimbursement" are two different things. North Carolina health plans subject to North Carolina General Statute 58-3-179 must indeed cover colorectal cancer screening. As you are aware, though, a claim for "covered" services does not always result in reimbursement from the health plan. . For example this could occur when (even after the cost of the covered service) the member has not yet met the applicable policy deductible. In such situations, the cost of the covered service is credited to the member's deductible. If the service were not covered, the cost would not be credited to the deductible.

Second, North Carolina law does not give the Department of Insurance the regulatory authority to dictate place-of-service for this mandated benefit. More specifically, we do not have the authority to require BCBSNC to make the procedure in question available in office-based settings. My understanding is that the procedure can be obtained from in-network BCBSNC providers in your immediate area. Whether the service is available only in contracted clinic settings or also from contracted office-based providers does not affect BCBSNC's compliance with applicable provider availability/accessibility requirements.

We certainly understand your disappointment, and regret that we do not have the authority to further assist you. However, please do not hesitate to contact me at (800) 546-5664 if you wish to discuss the matter.

Robert C. Lisson, Ph.D.
Deputy Commissioner, Consumer Services Division

With the Obama plan, the private insurance companies would HAVE to give the over 50-something access to screening colonoscopies in accord w/ Medicare

HEY! Before someone decides to rescue BCBSNC from its $50 million bottomless pit, you might consider that they will surely go under if they are not able to offer major components of the Medicare plan which are already in place-----like the access to a screening colonoscopy for NC citizens----because citizens will CHOOSE a public plan, like Medicare, over BCBSNC.

*************

http://www.emaxhealth.com/1/72/27785/
public-health-insurance-plan-option-quot-non-negotiable-quot.html

Public Health Insurance Plan Option "Non-Negotiable"

"......Advocates of a government alternative to private health insurance fired the first shot of the new battle to reform the nation’s health-care system on Wednesday, saying that efforts to water down this key component of Barack Obama’s health-care plan should be rejected by members of Congress.

“In the absence of a public plan you would have to so strictly regulate [private] health plans that they would all have to become public plans,” said Rep. Pete Stark, D-Calif., chairman of the House Ways and Means Health sub-committee.

"Stark spoke out on Wednesday because he is concerned that any effort to reform the private health-insurance market will prove ineffective if Americans are not offered the kind of Medicare-style government option contained in Obama’s 2008 campaign proposal.

"Stark’s concerns were echoed by Health Care Now, a liberal advocacy group.

“We agree with Congressman Stark that a health care solution that does not include a public plan would be a non-starter,” said Richard Kirsch, the national campaign manager for Health Care for America Now. “President-elect Obama ran on the promise of giving consumers a choice of keeping the private insurance they have or opting in to a newly-created public insurance plan, and it is the second part of this hybrid reform that ensures we are no longer at the mercy of the private insurance industry which keeps charging us more, giving us less, and lining its own pockets with profits.”

That red line is being drawn for a reason. Insisting upon a public plan option is not ideology for ideology's sake. It's critical to achieve quality, affordable health care for all.

Colonoscopy: sees only right side of colon but still diminishes death from colon cancer by 60-70%

Colonoscopies have blind side, study says
Popular test to detect signs of cancer only effective on left side of colon, review of 10,000 cases finds
December 16, 2008
Megan Ogilvie (cut and paste URL):
http://www.healthzone.ca/
health/article/554384#comments

A popular screening test for colon cancer is less accurate and prevents fewer deaths than doctors commonly believe, Toronto researchers say.

Their study, published yesterday, found colonoscopies are only effective at catching cancers that develop on the left side of the colon, and miss almost all cancers that start on the right side.

"All of the benefit of colonoscopy – and we know it reduces colon cancer deaths – is virtually related to the reduction of deaths from cancers arising in the lower, or left side, of the colon," said Dr. Linda Rabeneck of Cancer Care Ontario, the study's senior author.

For patients with cancer that developed on the colon's right side, a colonoscopy only reduced the risk of death by 1 per cent, she said.

Experts say the study, published in the journal Annals of Internal Medicine, will help doctors understand the limitations of colonoscopy and spur efforts to improve the test's monitoring of the right colon. They say it remains a valuable screening tool and stress the study does not mean people should avoid having colonoscopies.

"This is a darn good test, but it's not perfect," said Dr. David Ransohoff, a gastroenterologist and professor of medicine at the University of North Carolina, Chapel Hill.

Doctors often tell patients a colonoscopy can trim the risk of dying from colon cancer by 90 per cent. But Ransohoff said the new data suggests closer to 60 or 70 per cent.

"The findings of zero protection for the right colon is so different than what we expected, it just grabs you by the lapel," he said. "What it means for the profession is we need to step back and think: `What evidence do we have for the effectiveness of colonoscopy?'"

The Ontario-wide study looked at more than 10,000 people diagnosed with colon cancer between 1996 and 2001, and who had died of the disease by 2003. Researchers then matched each patient with five other similar individuals who did not die of colon cancer. By comparing the two groups, they were able to evaluate the effectiveness and limitations of colonoscopy.

A colonoscopy is used to detect and remove polyps, the small growths on the inner surface of the colon which can turn cancerous. Colorectal cancer is the second leading cause of cancer death in Canada, and is 90 per cent curable if detected early enough.

Dr. Nancy Baxter, the study's lead author and scientist at the Li Ka Shing Knowledge Institute at St. Michael's Hospital, said colonoscopy is still one of the most effective cancer detection tests available."

*****************
Comment on this article by:

(cut and paste): http://www.thedoctorschannel.com/video/1225.html

"....In an accompanying editorial, Dr. David F. Ransohoff, from the University of North Carolina, Chapel Hill, discusses several possible explanations for the findings -- including the possibility that colonoscopies listed as complete did not actually reach the cecum, or that colon preparation was inadequate, or that right-sided lesions tend to grow more rapidly and arise between screenings.

Overall, Dr. Ransohoff concludes, "Colonoscopy is an effective intervention, but as Baxter and colleagues suggest, we must realize that current evidence is indirect and does not support a claim of 90% effectiveness."

He adds that "until we have better data, we can be grateful and optimistic to have a useful intervention to offer our patients, but we should be realistic and cautious when talking with them about the magnitude of both benefits and risks."

Reference:
Ann Intern Med 2009;150. ...."


Toronto Star

My e mail reply to any employee of the NC DOI is sent back as undeliverable: writing the Commissioner, Jiim Long

Marsha V. Hammond, PhD Clinical Licensed Psychologist, NC
E mail: hammondmv@netzero.com fax: 828------------
Cell phone: 404 964 5338

RE:

I received the following reply from Ms. Thornton at your office, the DOI; I tried to e mail her back but my e mail is rejected. I tried to report the rejection to the ITS department and THAT was rejected.

Here is the issue: (first here is the letter from your employee, Ms. Thornton):

"Dr. Hammond:
I have been reviewing the information you were previously given by Ms. Edwine with other Divisions within our Department to ensure proper information was relayed to you regarding your concerns with BCBS. The information you have been given was correct and I hope this further explanation helps.
NCGS 58-3-179 requires a health plan to provide coverage for colorectal cancer screening with the same deductibles, coinsurance and limitations as apply to other services covered under the plan. There is nothing in the law that addresses where the colorectal screening must take place in order to be covered under a health plan.
The NC Department of Insurance is limited to ensuring the company complies with the provisions of its policy contracts as well as complies with relevant insurance statutes and regulations that have been enacted by our Legislature. We do not have the authority to require BCBS provide benefits above and beyond that which is stated in the contract.
Thank you for the opportunity to respond further to you.
Becky P. Thornton, AIRC, ACS, HIA, MHP
Life and Health Supervisor
Consumer Services Division"

*********************

Here, from your own department’s website, is the statement about coverage of colorectal screening:

http://www.ncdoi.com/LH/News/Documents/HMOBasicAndStandardPlans_MentalHealthUpdate.pdf

EVERY STANDARD HEALTH BENEFIT PLAN THAT IS DELIVERED, ISSUED
FOR DELIVERY, OR RENEWED ON OR AFTER JANUARY 1, 2002 SHALL
PROVIDE COVERAGE FOR COLORECTAL CANCER EXAMINATIONS AND
LABORATORY TESTS. THIS COVERAGE SHALL BE AT LEAST EQUAL TO
THE COVERAGE REQUIRED BY NCGS 58-3-179.

****************

Here is my reply to Ms. Thornton’s letter and I submitted this also at your website, specifically: http://www.ncdoi.com/Consumer/Complaint.asp

“In my e mail letter which was rejected, this is what I said and this is the kernel of my complaint here---to which I would like a reply:

"I am not asking the NC Department of Insurance to demand that BCBSNC exceed the terms of the agreement in place as per my family's coverage. I am asking that the NC Department of Insurance attend to the law which you sited which states that there be adequate network availability. And there is NOT network availability for screening colonoscopies which are covered, by law. There are no screening colonoscopies that are reimbursed by BCBSNC PPO within two hours of Asheville, NC, a major metropolis.

I have a standard policy. There is a $2500 deductible for INPATIENT services. I understand that. There is a gastroenterologist in Boone, NC, apparently, who offers an 'OFFICE BASED' screening colonscopy who is part of the BCBSNC network. This is over two hours away from Asheville, NC, a major metropolis w/ a number of gastroenterology services. There are no other colonoscopies in western NC, other than CLINIC BASED, which is defined by BCBSNC as INPATIENT, available in western NC.

If the service is demanded by law to be covered by an insurance company, and if the insurance company avoids offering the coverage as per its policy---by placing the by-law covered service----then why don't one of two things take place?

1. BCBSNC creates a relationship w/ other gastroenterologists in western NC, something they told me over a year ago they were intent on doing----BUT HAVE NOT
2. BCBSNC pay for the by-law covered service within a reasonable distance to the major metropolis?

I would like to know if the NC Department of Insurance is going to attend to the law which requires BCBSNC---- as associated with NCGS 58-3-179 in terms of 'providing coverage for colorectal cancer examinations which is at least equal to the coverage required by NCGS 58-3-17', which is associated with the notion, Network Adequacy---to provide coverage for policy-holders.

You indicated that there is nothing in the law that attends to WHERE the procedure is to be obtained. However, the law does specify that specialty services must be covered in a manner 'at least equal' to other coverage. "

THANK YOU AND I AM LOOKING FORWARD TO YOUR RESPONSE.
cc: Representative Susan Fisher”

NC Department of Insurance provides coverage to BCBSNC for not making accessible screening colonscopies as per NCGS 58-3-179

Marsha V. Hammond, PhD: Licensed Psychologist: NC
fax: 828 ---------e mail: hammondmv@netzero.com http://madamedefarge2scutinizingbcbsnc.blogspot.com/

RE: BCBSNC policy which does not cover screening colonoscopies as they are not available in western NC

December 12, 2008

Dear Ms. Thornton (Becky P. Thornton, AIRC, ACS, HIA, MHP
Life and Health Supervisor Consumer Services Division: "Becky Thornton" ) and Luann Muntz (Luann Muntz Clinical Review Analyst
Healthcare Review Program (919) 807-6863 Lrmuntz@ncdoi.net), of the NC Department of Insurance:

Thank you for your e mail letters regarding my concern about the lack of BCBSNC PPO coverage in western NC as per screening colonoscopies. (I enclose a copy of that below under 'item 1').

I am not asking the NC Department of Insurance to demand that BCBSNC exceed the terms of the agreement in place as per my family's coverage. I am asking that the NC Department of Insurance attend to the law which you sited which states that there be adequate network avaibility. And there is NOT network availability for screening colonoscopies which are covered, by law. There are no screening colonoscopies that are reimbursed by BCBSNC PPO within two hours of Asheville, NC, a major metropolis.

I would like to know if the NC Department of Insurance is going to attend to the law which requires BCBSNC---- as associated with NCGS 58-3-179 in terms of 'providing coverage for colorectal cancer examinations which is at least equal to the coverage required by NCGS 58-3-17', which is associated with the notion, Network Adequacy---to provide coverage for policy-holders.

You indicated that there is nothing in the law that attends to WHERE the procedure is to be obtained. However, the law does specify that speciality services must be covered in a manner 'at least equal' to other coverage.

And so as pertaining to the matter of 'as apply to other services covered under the plan', I might speculate that if I had to travel over 2 hours to go to my son's pedicatrician, that would be not in keeping w/ the plan, would it? Or if I had to go to a gynecologist over two hours away, that would not be in keeping w/ the plan, would it? And so, in keeping w/ other services which do not require a two hour trip, I believe that the answer is that BCBSNC must have a provider who can make available the screening colonoscopy service.

My understanding is that the law has to attend to the 'network availability' and there are no screening colonoscopies to be had in western NC except in Boone, NC, where there is an 'office based' screening colonscopy-----which is all that BCBSNC PPO will pay for. (see Item 2 below).

I noted this at the law's site, the number which you indicated to me in your e mail, specifically:

(per google):

[PDF]

1 NORTH CAROLINA’S SMALL EMPLOYER GROUP BASIC AND STANDARD HMO ...
File Format: PDF/Adobe Acrobat - View as HTML
THE COVERAGE REQUIRED BY NCGS 58-3-179. EVERY STANDARD HEALTH BENEFIT PLAN THAT IS DELIVERED, ISSUED. FOR DELIVERY, OR RENEWED ON OR AFTER JANUARY 1, ...
www.ncdoi.com/LH/News/Documents/HMOBasicAndStandardPlans_MentalHealthUpdate.pdf - Similar pages -
http://www.ncdoi.com/LH/News/Documents/HMOBasicAndStandardPlans_MentalHealthUpdate.pdf

NORTH CAROLINA’S SMALL EMPLOYER GROUP BASIC AND STANDARD HMO HEALTH BENEFIT PLANS BENEFITS AND EXCLUSIONS

"EVERY STANDARD HEALTH BENEFIT PLAN THAT IS DELIVERED, ISSUED FOR DELIVERY, OR RENEWED ON OR AFTER JANUARY 1, 2002 SHALL PROVIDE COVERAGE FOR COLORECTAL CANCER EXAMINATIONS AND LABORATORY TESTS. THIS COVERAGE SHALL BE AT LEAST EQUAL TO THE COVERAGE REQUIRED BY NCGS 58-3-179."

*************************

I would like to hear from you or someone at the NC Department of Insurance about this matter which surely impacts thousands of NC citizens.

In accord w/ Ms. Rudd-Muntz's suggestion, I have filed a complaint. I would like to know what happens to those complaints. Thank you for letting me know. Please feel free to pass this e mail to any pertinent party.

Sincerely,

Marsha V. Hammond, PhD

*************************

Item 1: your letter re: my letter to you as pertaining to this matter:

Dr. Hammond:
I have been reviewing the information you were previously given by Ms. Edwine with other Divisions within our Department to ensure proper information was relayed to you regarding your concerns with BCBS. The information you have been given was correct and I hope this further explanation helps.
NCGS 58-3-179 requires a health plan to provide coverage for colorectal cancer screening with the same deductibles, coinsurance and limitations as apply to other services covered under the plan. There is nothing in the law that addresses where the colorectal screening must take place in order to be covered under a health plan.
The NC Department of Insurance is limited to ensuring the company complies with the provisions of its policy contracts as well as complies with relevant insurance statutes and regulations that have been enacted by our Legislature. We do not have the authority to require BCBS provide benefits above and beyond that which is stated in the contract.
Thank you for the opportunity to respond further to you.

Becky P. Thornton, AIRC, ACS, HIA, MHP
Life and Health Supervisor
Consumer Services Division





--------------------------------------------------------------------------------
From: Luann Rudd-Muntz
Sent: Thursday, December 11, 2008 8:21 AM
To: hammondmv@netzero.net
Cc: Becky Thornton; Doris Edwine
Subject: RE: Possibly spam: req to investigate BCBSNC no screening colonoscopies available in west ern NC


Dr. Hammond,

The Healthcare Review Program assists consumers who have been denied payment of medically necessary benefits by their insurers.

The Consumer Services Division can best address your concern, and investigate your complaint. I have forwarded your e-mail to them. Consumer Services can be reached at 800-546-5664 .

You may also complete a consumer complaint on the web-site at www.ncdoi.com. by selecting the first bullet in the center column, you will be taken to the information you'll need to complete the complaint.

Sincerely,

Luann Muntz
Clinical Review Analyst
Healthcare Review Program
(919) 807-6863
Lrmuntz@ncdoi.net

*************************
Item 2:
[PDF]

C 24 ONSUMER ROTECTIONS
File Format: PDF/Adobe Acrobat - View as HTML
There are special consumer protections built into the laws governing small-group ...... [N.C.G.S. §§ 58-3-179, 58-50-155]. Contraceptives ...
www.nciom.org/hlthinspgms/C24.pdf - Similar pages -

http://www.nciom.org/hlthinspgms/C24.pdf

Network Adequacy

Insurers that operate network-based plans (like HMOs or PPOs) must have systems to ensure the adequacy of the network. Insurers must set their own access standards and monitor how well the network meets these internal standards. The health plan’s access standards should include information about how long enrolees must travel to obtain primary care, specialty care, hospital-based services and other facilities."

With no answers from Rep Fisher or someone in the Department of Insurance, asking for f/u by External Reviewers of NC Department of Insurance

Marsha V. Hammond, PhD e mail: hammondmv@netzero.com cell: 404 964 5338 BCBSNC PPO policy-holder NC Department of Insurance case number: : 2008-10-01135

December 11, 2008

Hello NC Department of Insurance, External Review Department: (snestor@ncdoi.net,kshortt@ncdoi.net,lrmuntz@ncdoi.net,cmckoy@ncdoi.net)

Can you find out why the below is taking place and how I can get to a clinic based screening colonoscopy----which is what gastroenterologists offer? They cost about $1200.00, are to be had, unless one has polyps, every 10 years, are preventive, and BCBSNC will not cover a clinic based screening colonoscopy.

Specifically, I, my husband, and 14 yr old son, all in good health, have BCBSNC PPO. It is time for me to have a screening colonoscopy. I have bought my complaint to someone in the Department of Insurance, specifically, Doris Edwine, tel 919 807 6773. I wrote her a letter outlining these matters. She was presented by BCBSNC, I guess, w/ a list of gastroenterologists in western NC---none of whom will do a screening colonoscopy as a office visit----which is what BCBSNC will pay for. And so there are no screening colonoscopies available tho BCBSNC is (appropriately) sending me a letter stating that I should have one!

Can someone help me w/ this? I have asked my representative, Susan Fisher. I get no reply. The Department of Insurance has assigned me a number but nothing is taken care of.

I have been investigating this for over a year now.

Imagine all the people w/ these policies who will come down w/ colon cancer just in time for Medicare to pick it up. It will have been/ could have been so prevented by early detection.

Pass this e mail to any pertinent party. You can see a compendium of my attempts to get this service here where you can see that I have repeatedly contacted BCBSNC government liasons. http://madamedefarge2scutinizingbcbsnc.blogspot.com/

Sincerely, Marsha V. Hammond, PhD

*********************************

This is what I have sent to my representative, Susan Fisher:

hammondmv@netzero.com

Monday, November 24, 2008
Dear Rep Fisher: Insurance Commissioner’s office cannot get past lies of BCBSNC PPO re: non-availability of colonoscopies in western NC

Letter to Representative Susan Fisher: Fisherla@ncleg.net

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville/ Waynesville, NC

e mail: hammondmv@netzero.com cell: 404 964 5338

RE: NC Department of INsurance cannot see past the song & dance of BCBSNC re: screening colonoscopies

November 24, 2008

Dear Susan Fisher, my NC House of Representatives person:

There are still no screening colonoscopies for citizens of western NC w/ BCBSNC insurance plans….2.5 million of us across the state. Most lately, the NC Department of Insurance has fallen for their song and dance which seems to be associated with coverage, but in fact, is not.

To make it all the more hilarious, BCBSNC just sent me a letter suggesting that I have a screening colonoscopy!

I talked to the insurance commissioner’s office, specifically, Doris Edwine, tel 919 807 6773. I wrote her a letter.

BCBSNC simply sent her a list of the gastroenterologists in Buncombe county. As I have done before, I called them. They told me what they have told me before, namely that their practices will not do office based screening colonoscopies. They do only clinic based screening colonoscopies…like they told me a year ago.

I have been researching this for a year now (please see the blog which does not reflect the six months prior to the first post in June, 2008). Nothing has changed. I would like to know what the NC State Legislature which oversees BCBSNC is going to do about this.

BCBSNC PPO will not pay for clinic based screening colonoscopies and the gastroenterologists will not do the office based ones, I assume, as associated w/ the risk of having a patient move around on the table and then puncturing their colon which means that —literally—-you better have created your will cause you’re a dead person.

My file number: 2008-10-01135.

It would be useful to have my NC State Representative check on this matter, I believe.

Thank you.

Marsha V. Hammond, PhD

NC State Legislature gives up on monitoring NC BCBS: 'Get a new home please'

NC Spin: http://www.ncspin.com/

"....The State Health Plan will be a subject of discussion in this legislative
session. Most all agree the Health Plan needs to find a new home, that the
legislature is neither qualified nor able to adequately oversee and administer
the plan that is now considered to have a projected $500 million shortfall. ..."

Dear Rep Fisher: Insurance Commissioner's office cannot get past lies of BCBSNC PPO re: non-availability of colonoscopies in western NC

Letter to Representative Susan Fisher: Fisherla@ncleg.net

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville/ Waynesville, NC

e mail: hammondmv@netzero.com cell: 404 964 5338

RE: NC Department of INsurance cannot see past the song & dance of BCBSNC re: screening colonoscopies

November 24, 2008

Dear Susan Fisher, my NC House of Representatives person:

There are still no screening colonoscopies for citizens of western NC w/ BCBSNC insurance plans....2.5 million of us across the state. Most lately, the NC Department of Insurance has fallen for their song and dance which seems to be associated with coverage, but in fact, is not.

To make it all the more hilarious, BCBSNC just sent me a letter suggesting that I have a screening colonoscopy!

I talked to the insurance commissioner's office, specifically, Doris Edwine, tel 919 807 6773. I wrote her a letter.

BCBSNC simply sent her a list of the gastroenterologists in Buncombe county. As I have done before, I called them. They told me what they have told me before, namely that their practices will not do office based screening colonoscopies. They do only clinic based screening colonoscopies...like they told me a year ago.

I have been researching this for a year now (please see the blog which does not reflect the six months prior to the first post in June, 2008). Nothing has changed. I would like to know what the NC State Legislature which oversees BCBSNC is going to do about this.

BCBSNC PPO will not pay for clinic based screening colonoscopies and the gastroenterologists will not do the office based ones, I assume, as associated w/ the risk of having a patient move around on the table and then puncturing their colon which means that ---literally----you better have created your will cause you're a dead person.

My file number: 2008-10-01135.

It would be useful to have my NC State Representative check on this matter, I believe.

Thank you.

Marsha V. Hammond, PhD

Medicaid Primary Care Providers fall short of recommending cancer screening: WHILE BCBSNC PPO offers no affordable screening colonoscopies to insured

Cancer Screenings Are Available For Many, But Not Used
October 22nd, 2008 by allsoch
Medicaid recipients age 50 and older are falling short of national cancer screening objectives. According to a report published in the October 13 issue of Archives of Internal Medicine, only about half receive colorectal, breast, and cervical cancer screening tests that the government recommends.

(cut and paste):
http://www.canceraids.org/2008/10/22/
cancer-screenings-are-available-for-many-but-not-used/

**************




BCBSNC PPO plans (families pay close to $700/ month for these, as does my 3 member family) will not pay for screening colonoscopies within 2.5 hours of major metropolis, specifically, Asheville, NC. BCBSNC gives song and dance and run-around which state legislators, who are supposed to oversee BCBSNC, fall for again and again. BCBSNC PPO plans (3/4 million peoplein NC have this plan) will only pay for OFFICE BASED screening colonoscopies and gastroenterologists mostly do not offer these but rather CLINIC BASED screening colonoscopies.

CLINIC BASED screening colonoscopies are not the treatment of choice or medically necessary treatment as patients who squirm w/o anesthetic IV Versed (part of CLINIC BASED screening colonoscopies), run the risk of colon perforation and DEATH.

I have a question into the NC Insurance Commissioner as to this matter as I have not been able to get any state legislator to act on this pressing matter.
Marsha V. Hammond, PhD: Clinical Licensed Psychologist
blogsite overseeing BCBSNC: http://madamedefarge2scutinizingbcbsnc.blogspot.com/

Can the NC State Insurance Commissioner help re: no screening colonoscopies for BCBSNC PPO insured???

Here is the letter I wrote to the insurance commissioner of NC:

"BCBSNC has been telling me for almost 2 years that there is no office based colonoscopy (they will only pay for this; they will not pay for a clinic based screening colonoscopy) available anywhere in western NC except for Boone, NC, over 2 hours away. It is impracticle to try to go for a colonoscopy full of Fleet's enema or some similar preparation, trying to drive to get to the appointment, having to stop everywhere along the way in order to use the bathroom---for 2 plus hours. I have written them; I have talked to my state legislator; I have talked to OTHER state legislators; I have talked to the NC STate Legislature Standing Committee via e mail. I get no where. I would like for my $700/ month/ 3 family members who are healty---to pay for a clinic based screening colonoscopy---only has to be done every 10 years unless there is something detected-----closer to home---as in Asheville, NC, a city of over 100,000 people. Can you help or what do you say about this matter? For more detail information---more than you want to know---I have created a blogspot specific to BCBSNC and these problems....."

Will BCBSNC be accurately audited in terms of reasons for asking for hand-outs----whileas NC State Legislature looks the other way?

At least someone is watching the matter----and it sure is not the NC STate Legislature which is supposed to be doing that as associated w/ its 'standing' (maybe they're lying) committee:

".....The auditor has not shown the same deference to BCBSNC that legislators exhibit, so hopefully the report helps explain the higher administrative charges.

Word is that the auditor could release one or both of the audits in early November. We'll be watching....."

http://pulse.ncpolicywatch.org/?p=1533#more-1533

****************************

more from that fine article at NC Policy:

September 30, 2008
State Health Plan is singing the Blues
Posted at 1:59 PM by Adam Linker

I haven't seen much media coverage of the latest news from the North Carolina State Health Plan, which insures more than 650,000 people across the state. The only documents I've seen are not encouraging.

In reports to the General Assembly and the SHP Board of Trustees , Executive Director Jack Walker projects that the plan will lose between $264 million and $280 million for fiscal year 2008/2009.

The original budget estimated that the SHP would have a $228 million cash balance by the end of July 2008, according to Walker. The actual cash balance at the end of July was $72 million.

Why the shortfall?

Dr. Walker stated that both medical and pharmacy claims increased 7.2% during the past fiscal year as opposed to the projected increase of 1.9%.

And what accounts for the original rosy projections? Higher than expected administrative payments to Blue Cross and Blue Shield of North Carolina. That's right, the same insurer that was overcharging the state's Health Choice program is also sinking the SHP....."

BCBSNC: poor coverage AND NOW THEY SAY THEY'RE IN THE RED : State Auditor Merritt to look at BCBSNC books

July 24, 2008
Les Merritt will examine the State Health Plan
http://pulse.ncpolicywatch.org/?p=1343#comment-18407

Posted at 1:30 PM by Adam Linker

State Auditor Les Merritt says he is going to look into the problems at the State Health Plan to figure out what is behind the $115 million "disparity between the initial forecast and the current projection and will focus on oversight and financial forecasting."

There is still a great deal of confusion about what happened at the SHP that led to lawmakers ousting the former Executive Director George Stokes.

Merritt says there have been "many calls" to the auditor's office asking about the shortfall.

The SHP is overseen by a board of trustees and the legislative committee on employee hospital and medical benefits. ....



_______________________________________________________

Dr. Hammond's reply to that blog



While not in the domain of 'getting to the bottom of what happened to that money', Mr. Merritt, what happened to our coverage under BCBSNC PPO out in western NC?

Seems that nothing gets noted unless it happens in Raleigh.

Adam Sears has stated that as far as he knows, the state legislators have BCBSNC 'The State Plan.' Are the state legislators from western NC getting access to screening colonoscopies, as covered by BCBSNC, while the citizens and their families with the BCBSNC PPO plans are NOT?

There are NO screening colonoscopies available, which will be paid for by BCBSNC PPO, short of almost 3 hours from Asheville, a major metropolis in western NC.

I therefore assume, as some cynically waxing physicians out here, if BCBSNC isn't just assuming that by the time that colon cancer is diagnosed for some of this, well, heck, we'll be using Medicare and they'll be out of the picture.

For more details see: blogspot:http://madamedefarge2scutinizingbcbsnc.blogspot.com/

Marsha V. Hammond, PhD Clinical / Health Psychologist,
Asheville/ Waynesville, NC

BCBSNC 'The State Plan' gets $100 million rescue from NC STATE LEGIS WHICH WAS SUPPOSED TO BE OVERSEEING BCBSNC

BCBSNC 'The State Plan'/ 'Blue Options' and BCBSNC PPO,appear to be the SAME PLAN.

When reporters/ journalists cover stories about BCBSNC's The State Plan, without mentioning the connection to BCBSNC, citizens do not get that we are talking about a PRIVATE insurance company which is supposed to be overseen by the NC STate Legislature but which, in actuality, does pretty much as it pleases and just like the big banks, once they have made all their private money, come the SHORT FALL, the citizens are supposed to PAY FOR IT.

See:

http://pulse.ncpolicywatch.org/?p=1321

July 17, 2008
State Health Plan Crisis: Were overseers asleep at the switch?
Posted at 3:49 PM by Adam Searing

The House Appropriations Committee met this afternoon and passed out a bill to authorize $100 million from the state’s rainy day fund to backstop the state health plan which is reportedly facing a serious shortfall. Apparently this shortfall was completely unexpected and now has the General Assembly in an uproar. Any clear information on the amount of the shortfall and why the shortfall happened is simply not available – at least not publically. Apparently the General Assembly is looking into the matter with auditors and other staff, but this oversight role is just beginning.

Why hasn’t this happened before however? The State Health Plan isn’t a small part of government. It insures over 600,000 state employees and their families. Good oversight should not allow shortfalls like this to happen. The software health insurance companies use now can accurately project claims and costs for years. There is a structure in place to oversee the plan so no one person – like the recently fired executive director – is solely in charge of the plan.

BCBSNC Gets Shielded by Professional Organizations: no parity for BCBSNC PPO 'State Plan'

BCBSNC Gets Shielded by Professional Organizations : no parity for BCBSNC PPO ‘State Plan’

IMPLEMENTATION OF MENTAL HEALTH PARITY - HOUSE BILL 973

EFFECTIVE DATE OF PROVISIONS JULY 1, 2008


I would like to know why, when people talk about this vague ‘State Health Plan PPO’ (see below, Cameron statement), they do not mention the fact that we are talking about basically the only game in town in terms of group plans for families and individuals who are not members of group plans (read: they have no employer sponsored health insurance).

State Health Plan PPO = BCBSNC PPO Plan.

They are avoiding stating that it is associated w/ BCBSNC, that’s why.

It is unbelievable that BCBSNC is supposedly overseen by NC State Legislature. When you call a state legislator’s office, they advise you to call the BCBSNC ‘Government Affairs’ employees.

These ‘Government Affairs’ employees are hired by BCBSNC to keep a lid on complaints while the state legislators apparently look the other way.

My 3 member family has BCBSNC PPO. We pay over $650 month for this PPO. There are over 2 million PPO BCBSNC members in NC.

BCBSNC PPO plans will not pay for clinic based screening colonoscopies (see referenced information at: http://madamedefarge2scutinizingbcbsnc.blogspot.com/).

There are NO gastroenterologists in western NC who will do an ‘office based’ screening colonoscopy except for one practice in Boone, NC, fully 2-3 hours away from the most populated part of western NC, specifically, Buncombe county, the location of Asheville.

Now you’re telling me that BCBSNC somehow got out of having to adhere to mental health parity (H973) which was signed into law.

Moreover, NC Psychological Association is stating, as per Sally Cameron, Executive Director:

“…The parity law does not cover the State Health Plan PPO plans…. a strategic decision because the PPO plans have a broader benefit and includes parity for substance abuse…..”

Physicians are able to bill BCBSNC at an 80/20 formula with the patient or other carrier picking up the 20% while mental health providers are stuck at the 60/40 level as associated with mental health coverage.

Furthermore, in terms of ‘implementation problems’ how are state funded clients as managed by the LME’s included----(OR NOT)-----as mental health parity ‘supposedly’ created this (as per Cameron):

“HB 973 provides that nine (9) diagnoses are covered at full parity with physical illness “ bipolar disorder, major depressive disorder, obsessive compulsive disorder, paranoid and other psychotic disorder, schizoaffective disorder, schizophrenia, PTSD, anorexia nervosa and bulimia. The means there can be no durational limits set in insurance/managed care plans for these nine diagnoses. Insurance/managed care plans can use utilization review criteria to manage a mental health benefit.”

Western NC has 2 LME’s which cover 25% of NC 100 counties. They manage state funded mental health clients, the 'working poor' who have no health insurance.

Governor Easley, and assumably subsequent governors are advocating that these LME’s also manage Medicaid. This means that their ability to impact psychologists is going to INCREASE not decrease.

Western Highlands Network LME has stated that only Personality Disorders will receive more than 8 sessions of therapy and then only if Dialectical Group Therapy is included.

I would like to know how H973 applies to this matter.

Smoky Mountain Center LME has stated that no Basic Level Services are available for state funded clients. All therapy is subsumed under Community Support Services which is being rapidly defunded; is scrutinized under post payment reviews; and requires people who utilize it to undergo 20 hours of unpaid training.

I would like to know how H973 applies to this matter.

You asked, Sally, that NCPA members give you some feedback re: this implementation matter:

“Please note the FOLLOW-UP section and let us hear from you about an implementation issue. “

This is my statement about this implementation: BCBSNC is being shielded by professional mental health organizations in this state.

CO PASSES 'COLORADO COLORECTAL SCREENING GUARANTEE': no more than 10% of the cost of the procedure is passed to those insured

House Bill 1410, the Colorado Colorectal Screening Guarantee, by Representative Andy Kerr, the Colorectal Cancer Screening Health Insurance Mandate Bill. The bill would require small group and individual plans regulated by the state to include coverage for the range of screenings as recommended by the U.S. Preventive Services Task Force. Additionally, it provides guaranteed coverage for folks younger than 50 who have a family history or exhibit other chronic conditions. While policy deductibles no longer apply to colon cancer screenings, co-payments and co-insurance will continue to. HMO’s are limited to a fee of no more than 10% of the cost of the procedure. ACS supported this bill.

http://action.acscan.org/site/PageServer?pagename=ActionCenter_CO

Medicare offers colonoscopy at any age re: colorectal cancer screening : HOW BCBSNC SKIRTS THE ISSUE OF PROVIDING FOR COLORECTAL CANCER SCREENING

The following information was gathered from: GAO-04-713 Colorectal Cancer Screening Test Coverage : http://www.gao.gov/new.items/d04713.pdf : Government Accounting Office: GAO

What is the purpose of screening for colon cancer?:

"...Surviving colorectal cancer is greatly enhanced when the disease is detected and treated early; however, only 38 percent of colorectal cancer cases are diagnosed at an early stage, according to ACS...."
********************

How preventable is colon cancer when utilizing screening?:
http://www.medicare.gov/health/awareness.asp

"Colorectal cancer is one of the most preventable cancers. Screening tests can help prevent colorectal cancer by finding pre-cancerous polyps so they can be removed before they turn into cancer. "
**********************

How do you screen for colon cancer?:

".....To facilitate early diagnosis, ACS recommends regular colorectal cancer screening for certain individuals using at least one of four key tests: FOBT, flexible sigmoidoscopy, DCBE, and colonoscopy. These tests are used to find potential signs of colorectal cancer, including polyps—abnormal growths in a person’s colon—or blood in a person’s stool. FOBT is a laboratory test used to detect blood (that is otherwise not visible) in stool samples that are collected by patients at home. Using a flexible sigmoidoscopy, a physician can find and take samples of polyps in a patient’s lower colon and rectum. DCBE detects polyps by providing x-ray images of a patient’s entire rectum and colon. Finally, a colonoscopy allows a physician to find and take samples of polyps in a patient’s rectum and entire colon as well as remove most polyps found during the test."
*****************

What is the recommended frequency of screening?:

"....ACS guidelines recommend that, beginning at age 50, all average-risk individuals be screened annually using an FOBT; every 5 years using a flexible sigmoidoscopy or DCBE; or every 10 years using a colonoscopy...."
*********************

Why does American Cancer Society (ACS) recommend that screening start at age 50? http://www.medicare.gov/health/awareness.asp

"Risk increases as we age. The risk of developing colorectal cancer increases with age. In fact, most cases (92%) occur in people 50 and older.'
**********************

Does Medicare cover colorectal screening?: YES

"Medicare helps pay for colorectal cancer screening tests. People with Medicare Part B coverage who are age 50 or older are eligible for colorectal cancer screenings. However, in the case of colonoscopy, there is no age limit. Several different screening tests can be used to test for polyps or colorectal cancer. Each can be used alone. Sometimes they are used in combination with each other. The following screening tests are covered by Medicare."
************************

Is there colorectal screening utilizing colonoscopies for those insured with BCBSNC PPO? Not as associated with clinic based screening.
*************************

How many states, by law, cover preventive care re: colon cancer? (as of 2004):

"Twenty states had laws requiring private health insurance plans to cover colorectal cancer screening tests as of May 2004. In 19 of these states, the laws generally applied to group or individual health plans, and required coverage of all four tests—FOBT, flexible sigmoidoscopy, DCBE, and colonoscopy—typically consistent with ACS guidelines.
*********************

Was NC one of the states stated by the GAO to 'require by law private insurance coverage of colorectal cancer?: YES

Table 1: State Laws Requiring Private Insurance Coverage of Colorectal Cancer Screening Tests : Scope of state laws States Number of states

Apply to fully insured group or California, Connecticut, Delaware,
individual plans and screening test coverage according to ACS guidelines District of Columbia, Georgia, Illinois, Indiana, Maryland, Minnesota, Missouri, New Jersey, Nevada, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Virginia, West Virginia
********************************

Table 5: State Colorectal Cancer Screening Laws for Private Health Insurance
p. 18: http://www.gao.gov/new.items/d04713.pdf

State Law generally applies to group/individual Law generally requires coverage consistent
w/ ACS guidelines

North Carolina (2002) Yes Yes
****************************

So, how does BCBSNC get away with not providing colorectal cancer screening in NC?
ACS Comments : The GAO report states itself, as associated with criticisms of its report: "(we) did not independently verify the responses of the insurers and employers we contacted. "
******************

BCBSNC offers no colorectal screening in western NC except in Boone, NC---ONE gastroenterology practice. And that is an office based procedure, not clinic based.
************************

How big is western NC?
http://en.wikipedia.org/wiki/Western_North_Carolina

Western North Carolina generally consists of 23 counties. NC has 100 counties.
********************

274-6151 INFO:JUNE 13, 6 pm,N. Bunc. Middle Sch: Amer. Cancer Society 'Fight Back Tour': PLEASE LOBBY BCBSNC FOR SCREENING COLONOSCOPIES IN WESTERN NC

Thanks for your note American Cancer Society!

There are no screening colonoscopies for BCBSNC PPO insured.

There are over 2 million BCBSNC insured in NC.

You indicated that the Fight Back Tour bus will be coming to the North Buncombe Middle School baseball field. The relay for life event starts at 6 pm.
http://citizen-times.com/apps/pbcs.dll/article?AID=200880605135

Address: 51 N Buncombe School RdAsheville, NC 28801(828) 645-7944: near Exit 8, Home Depot exit, Asheville, NC

Come early and enjoy music, food and lots of fun and games. The American Cancer Society Advocacy Bus will be there to distribute information on how you can be an advocate for family and friends dealing with the many types of cancer. All proceeds benefit the American Cancer Society. Call 274-6151 for more information.

"American Cancer Society Cancer Action Network (ACS CAN) 2008 Fight Back Express
National Tour

.
__________________________________________________________
May I suggest that you lobby BCBSNC to create for citizens of NC screening colonoscopies.

I pay over $600/ month for BCBSNC PPO.

There are no colonoscopies available for NC citizens within 2.5 hrs of Asheville, NC, a city of 100,000 people.

BCBSNC attempts to understate the problem by creating mumbo-jumbo working associated with 'policy talk.'

This does not hide the fact that unless I pay $1200.00, I cannot obtain a screening colonoscopy by ANY gastroenterologist in western NC.

The $1200.00 does not include any matters like biopsies or tests that might be associated with such an preventive medical exam-----which is recommended by the American Cancer Society and gastroenterologists. .

marsha hammond, phd

http://madamedefarge2scutinizingbcbsnc.blogspot.com/

BCBSNC: Smoke & mirrors re: no screening colonoscopies in western NC (and across NC)

I talked to "Lynn Tennant (Rep. Fisher)" on May 22, 2008 regarding the persistent run-around that BCBSNC has created since the Fall of 2007.

It appears you can complain forever about this lack of a critical health service but nothing gets done and indeed, BCBSNC's 'Government Affairs' employees serve to throw the NC State Legislature representatives off the track by implying that something is being addressed----when it is not.

Interestingly, in one of the NC State Legislature's representatives' offices, a relative of an aide died a couple of years ago from a BCBSNC colonoscopy----done as an office based procedure wherein no anesthetic is given and the patient might be agitated related the pain of the procedure. The procedure was associated with a nicking of the colon wall, sepsis set in, and the person died.

VIEW MESSAGE

SUBJECT: Congressional Inquiry: Dr. Marsha Hammond
FROM: Nell.Boone@bcbsnc.com
TO: Fisherla@ncleg.net
SENT: Mon 19 May 2008 11:58:23 EDT
EXPIRES: Mon 23 Jun 2008 11:58:23 EDT
Reply
Reply to All

Dear Representative Fisher:

This is in response to your email of May 7, 2008 regarding Dr. MarshaHammond as it relates to concerns she has with there being no screeningcolonoscopies available in Western North Carolina per Blue Cross andBlue Shield of North Carolina (BCBSNC). I appreciate the opportunity toassist you.

I have spoken with Dr. Hammond on several occasions, most recentlyforwarding her concerns to BCBSNC's Provider Networks and CustomerSatisfaction Departments who have advised they would be following upwith her soon. BCBSNC is working to provide Dr. Hammond answers to herquestions and concerns brought to our attention by your inquiry on herbehalf.

I hope this information is helpful to you in your response to Dr.Hammond.Please let me know if I can assist you further.

Thank you.
Sincerely,Nell BooneGovernment Affairs CoordinatorBlue Cross Blue Shield of North Carolina(919) 765-2680

BCBSNC Round-Robin / Pass the Buck : Mismanagement by their 'Network' re: Screening Colonoscopies in NC

May 20, 2008

Dear Jonathan Givens (supervisor, Customer Service: 919 765 3951) :

I appreciated you calling me back today and spending time on the phone re: my query associated with non-availability of screening colonoscopies in western NC.

As was revealed by earlier conversations w/ supervisors at BCBCNS, the closest screening colonoscopies----of any sort--- be they office-based or clinic-based-----is in Boone, NC and Charlotte, NC.

Additionally, as you apparently scanned your provider information while we talked on the phone, you acknowledged that there seemed to be a general lack of this service across NC.

What perplexes me is that I have brought up this topic w/ over a dozen individuals within BCBSNC----and everyone appears to be surprised at the non-availability of screening colonoscopies in NC.

Does the left hand know what the right is doing at BCBSNC----or has the administration of BCBSNC created a set response for those wanting to choose health over possible disease, disease which is entirely addressable in its early form?

I appreciated, Mr. Givens, you stating that you believe that the problem is with the ‘BCBSNC Network’ as pertaining to lack of providers. I would like to suggest that BCBSNC has known about this problem for some time now-----at least the past 9 months that I have been following up on this matter.

I wrote the BCBSNC CEO in October, 2007 and all I received back was a letter indicating that the ‘problem’ was with the providers.

Sorry: its BCBSNC’s problem. And until they own up to this, it’s my problem.

And as I commented, I would be elated if you came up w/ a solution.

However, all I have gotten from BCBSNC for the past 9 months-----as associated with various chains of supervisors----and the ‘Government Affairs’ supervisor, Nell Boone, is a passing of the buck, with no one willing to tackle the problem for BCBSNC’s ‘state plan’ insured (you indicated to me that PPO---which I have----and ‘state plan’ is one and the same thing).

While Nell Boone appeared curious about my speculation that gastroenterologists have evolved to the place where they believe that ‘clinic-based’ screening colonoscopies are to be preferred over the office-based, non-medicated/ stick it up your arse, treatment, apparently BCBSNC does not believe that their insured should be accorded treatment which has been deemed medically appropriate.

There are literally thousands of BCBSNC insured who have no access to screening colonoscopies, medicated or non-medicated-----indicated by the American Cancer Society and gastroenterologists----as a critically important screen. With over 2 million PPO insured as per your website, I believe that this would translate into literally hundred of thousands of consumers w/o this important service.

I am looking forward to you finding a gastroenterologist----someone within a reasonable travel time----not 2-3 hours as is currently available----in western NC.

You owe it to your insured. Can we not move to a more reasonable manner of procuring health care which---in the long run----costs less, assures consumer satisfaction, and increases the quality of life of BCBSNC consumers?

Marsha V. Hammond, PhD: ‘insured’ by BCBSNC

5 weeks to hammer on BCBSNC via 'short session' NC State Legislature re: no screening colonoscopies in western NC

Marsha V. Hammond, PhD, Clinical Licensed Psychologist
e mail: hammondmv@netzero.com cell: 404 964 5338

Public Health blogspots associated w/ Dr. Hammond

NC mental health reform blogspot: http://madame-defarge.blogspot.com/

Scrutinizing Blue Cross/ Blue Shield North Carolina (BCBSNC) blogspot: http://madamedefarge2scutinizingbcbsnc.blogspot.com/

May 17,2008

Dear Nell Boone (nell.boone@bcbsnc.com) , Government Affairs, BCBSNC, Supervisor:

Thank you, Ms. Boone, for calling me this past Thursday, May 15, 2008, as associated with my persistent querying regarding the lack of screening colonoscopies in western NC.

As you know, I have been investigating this and getting nothing but run around by BCBSNC, since September, 2007.

In that you came up with no solution, but apparently have passed the buck to someone else, I am speculating that BCBSNC is going to continue to try and avoid their lack of coverage for colon cancer screening, the 3rd leading cause of cancer deaths in the US.

You stated, as per the phone message you left me, that 'someone' from Customer Satisfaction and BCBSNC Network, would be in touch w/ me 'soon.' You stated that you would be calling my NC House Representative, Susan Fisher, whom I notified about the lack of screening colonoscopies for BCBSNC consumers.

I am letting Susan Fisher know by this e mail that yes, indeed, BCBSNC is continuing to avoid addressing this critical public health issue.

In that the NC State Legislature will meet for only 5 more weeks, I am asking that someone from BCBSNC contact me by May 20, 2008. If I do not hear something positive about the creation of screening colonoscopies for citizens of western NC who have BCBSNC family plans----for which they pay premium $$----I will then escalate my activism.

BCBSNC continues to be under scrutiny by NC citizens who care about public health matters.
Moreover, BCBSNC's so far actions indicate a distinct attempt to avoid providing screening for colon cancer.

This cannot possibly be good public relations for a company that continues to attempt to get out from under the thumb of the state legislature.

However, I guess that BCBSNC simply cannot manage its company in a way that would suggest that this would be a good idea. Thus, I'm stuck to this issue like glue.

I'll be the first to herald your forward thinking when you create screening colonoscopies for western NC citizens paying over $600/ month for BCBSNC PPO health insurance.

My husband and I cannot afford $2500 for the two screening colonoscopies.

This does not even take into account if there were biopsies or other procedures which are not uncommon as associated with this important preventive care.

Thank you for passing this on to pertinent parties.

Sincerely,
Marsha V. Hammond, PhD

Is NC losing its critical coverage of BCBSNC by its NPR stations supported by BCBSNC Foundation? : Mr. Nesbitt don't make me spill my machiato

Marsha V. Hammond, PhD : Clinical Licensed Psychologist, Asheville, NC
cell phone: 404 964 5338 e mail: hammondmv@netzero.com
NC Mental Health Reform blogspot:
BCBSNC blogspot:

May 16, 2008
RE: lack of screening colonoscopies in NC

Dear WUNC radio, Laura Leslie of WUNC (hunters.tavern@gmail.com <hunters.tavern@gmail.com>), and its affiliates; other NPR stations in NC; and WCQS, NPR station in Asheville, NC (info@wcqs.org):

Thank you for covering news about BCBSNC over the years.

Adam Searing of NCJustice (adam@ncjustice.org) tipped me off to Laura Leslie and WUNC coverage, over the years, of BCBSNC.

Dear WUNC radio, Laura Leslie of WUNC, and its affiliates, covering news about BCBSNC:
Adam Searing of NCJustice tipped me off to Laura Leslie and WUNC coverage, over the years, of BCBSNC.

I would like to alert you to a very problematic matter associated with BCBSNC at this time. This has been going on for some time. For me personally, I have been seeking a gastroenterologist in western NC to simply do a screening colonoscopy, something that is recommended by American Cancer Society and experts throughout the US.

Colon cancer is the 3rd leading cause of cancer deaths in the US.

I have BCBSNC PPO plan as associated w/ myself, my husband, and our 13 yr old son. We pay over $600/ month for what I thought was a good plan.

I have been trying to obtain this procedure for almost 8 months now. Please see the details in Item 3 below as associated with my post at my BCBSNC blogspot.

Over 7 months ago, upon recognizing the problem of no available screening colonoscopies in western NC, I contacted the CEO, Mr. Bob Greczyn, who sent me back a letter which indicated, essentially, that BCBSNC was not in control of having extremely limited numbers of gastroenterologists to do screening colonoscopies.

I believe that the problem may in fact be endemic and even epidemic, across NC.

I maintain that the problem is that few gastroenterologists want to do office based screening colonoscopies because they do not want to traumatize their patients. Clinic based colonoscopies avail patients of the use of IV anesthetics e.g., Versed, which eases pain and facilitates the procedure.

The cost, out of pocket, is over $1200.00 for a screening colonoscopies. If biopsies have to be taken or polyps have to be removed, there are additional costs.

I hope you can use this information to follow-up on this matter.

I have contacted everyone I know to contact re: this matter, including the Government Affairs supervisor, Nell Boone, at BCBSNC, as well as all the members of the Health Committee of the NC State Legislature. I have heard nothing from any state legislator. I know this is the short session of the state legislature and so I am feeling some pressure to get this resolved----and in the direction of BCBSNC creating relationships w/ gastroenterologists to do this procedure in western NC.

I contacted a string of supervisors at BCBSNC a couple of months ago and got nowhere. I am now 'on hold' vis a vis Nell Boone as 'someone is investigating the matter.'

Someone investigated the matter months ago and the only answer that came back is that there were screening colonoscopies in Charlotte and Boone, NC, several hours from my family in Asheville, NC----not exactly an unpopulated city.

Moreover, from what I see online re: the Insurance Committee of the NC State Legislature, there is no point in me contacting them as they appear to be in the pocket of BCBSNC.
Thank you for your coverage of this public health issue.

Marsha V. Hammond, PhD
*******************************
materials utilized for this post:
Item 1: http://wunc.org/programs/news/Isaac-Hunters-Tavern/thursday-round-up/?searchterm=%22blue%20cross%22
Bob Greczyn proved he still has a lot of friends on the House Insurance Committee, which today turned down a proposal to prevent Blue Cross execs from receiving "excessive compensation." BCBSNC CEO Greczyn hauled in almost 3 million dollars last year in compensation and bonuses. Not bad for a non-profit gig - and evidence, perhaps, that it pays to have friends in Raleigh. According to the National Institute on Money in State Politics, BCBS sank more than $70,000 into state campaign funds in the 2006 election cycle.
****************************
Item 2: http://pulse.ncpolicywatch.org/?p=1102
May 15, 2008
NC Public Radio – Getting too Cozy with NC Blue Cross?
Posted at 3:22 PM by Adam Searing
Driving home yesterday I tuned in to WUNC to hear some of the NPR China coverage and was struck by something else. Referring to health news coverage at WUNC, the station thanked the "Blue Cross and Blue Shield of North Carolina Foundation for their support of WUNC's health coverage."

I was quite taken aback. Isn't it a huge conflict of interest to have the largest health insurance company in the state sponsoring health coverage on a public news outlet that routinely reaches 250,000 people in North Carolina? Can WUNC faithfully report on the campaign to guarantee 100% of kids in NC access to an affordable health plan if one of their major sponsors on health news coverage has a huge financial interest in the outcome of the debate – and has quietly deep-sixed legislative efforts to expand health coverage to all kids?

What about the excellent coverage WUNC engaged in over the past decade the two times nonprofit NC Blue Cross made extraordinarily controversial moves to become a for-profit company? If NC Blue decides to engage in similar behavior again, will WUNC be too fatally compromised to report on this critical issue?

Finally, I have no doubt Capitol Reporter Laura Leslie will not shy away from telling it like it is about Blue in the General Assembly – as she does here in her blog – or the continued great reporting of Rose Hoban on all issues health, but what about the editors and other powers that be back at the station? Will there be pressure to change what stories are reported on in the future if they involve Blue?

I just don't see how the answer to the above questions can now be anything other than a disappointing "yes."

And, before I get jumped all over, here are two points to keep in mind. First, while businesses and some nonprofits often generally sponsor the work of the station and get taglines that help their name recognition, they are rarely – if ever – identified as sponsoring news coverage of their own business area. Imagine the outcry if WUNC was thanking "NC's poultry industry for sponsoring our coverage of working conditions at NC chicken plants."

Second, don't give me any guff that the NC Blue Cross Foundation isn't wholly controlled as an unofficial PR subsidiary of NC Blue Cross itself, despite any pretensions of independence. Blue CEO Bob Greczyn is also Chair of the foundation board and the board is unabashedly Blue:
Our Board of Directors is comprised of executive-level employees within Blue Cross and Blue Shield of North Carolina, in addition to one medical community representative who also serves on the BCBSNC corporate Board of Trustees. Bob Greczyn, President and Chief Executive Officer of BCBSNC, serves as our Chairman.

WUNC should reject NC Blue's donations for health coverage as fatally compromising their ability to fairly and accurately report on an increasingly critical issue for most North Carolinians – the quality and affordability of healthcare.
***************************************
Item 3: Photo of Martin Nesbitt (D-Buncombe; co-chair of the NC mental health reform legislative oversite committee) http://www.martnesbitt.com/photo%20truck.jpg

Monday, May 14, 2007
http://madame-defarge.blogspot.com/2007_05_01_archive.html

H973: save our Senator Nesbitt:the ballad of Nesbitt Jr.'s BCBS ADVANTA race car :PLEASE DON'T MAKE ME SPILL MY MACHIATO w/the clock runnning out

BCBSNC 'Government Affairs' employees work to deny authorization for citizens of western NC, a company SUPPOSEDLY overviewed by NC State Legislature

Marsha V. Hammond, PhD: Licensed Psychologist, Asheville, NC
cell: 404 964 5338 e mail: hammondmv@netzero.com

May 9, 2008

RE: No screening colonoscopies in western NC & no response from BCBSNC

Dear 'Government Affairs' employees of BCBSNC:
Katie.Cook@bcbsnc.com
ken.wright@bcbsnc.com
Kathryn.Millican@bcbsnc.com
Nell.Boone@bcbsnc.com

Katie, you stated in an e mail today: "I spoke with you yesterday and put you in touch with Nell Boone. She and I work in the same department. She is very good at handling customer inquires and will assist you as much as she can. "

I talked w/ Nell Boone yesterday and she stated she would be back in touch w/ me re: when I could expect an answer to 'where are the screening colonoscopies in western NC.'

What do leading experts in the US state re: the screening of CRC (colorectal cancer):

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008

A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology*, the American Cancer Society

1. In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer.

2. Five-year survival is 90% if the disease is diagnosed while still localized (ie, confined to the wall of the bowel), but only 68% for regional disease (ie, disease with lymph node involvement), and only 10% if distant metastases are present

"It is the strong opinion of this expert panel that colon cancer prevention should
be the primary goal of CRC (colorectal cancer) screening."


This passing me from one person to the next----which has been occurring since September, 2007, when I first began to investigate why there were no screening colonoscopies in western NC------will not work.

My family, like many other families, pays a great deal of money in order to have a BCBSNC health insurance policy----over $600/ mo / 3 family members. It is a PPO. It is a high end policy.

And it is not possible to obtain a screening colonoscopies ANYWHERE in western NC except for one gastroenterologist in Boone and one in Charlotte.

The agenda of BCBSNC is to CONFUSE the issue with mumbo-jumbo about 'office based colonoscopies' vs 'clinic based colonoscopies'

BCBSNC will not pay for 'clinic-based' colonoscopies

BCBSNC will pay for 'office-based' colonoscopies

However, no gastroenterologist does any office based screening

colonoscopies in western NC.

Why would that be? Because to do office based screening colonoscopies is not appropriate medical procedure.

No, you didn't speak w/ me yesterday. I got an e mail from you and Kathryn Millican that does not open.

You are utilizing a program entitled 'Tumbleweed' which is not interfacing w/ my Windows system----or most anyone else's system.

Yesterday at 11:21 a.m., Angela Walker called me to give some info re: 'why there are so few office based screening colonoscopies in western NC.'

She can save her breath: I have already spoken to BCBSNC supervisors a couple of months ago and they tried to paint a picture of poor pitiful company that couldn't get any gastroenterology providers to sign on.

On my cell phone she called from 919 489 7431. That number, when you speak her name into the system, does not recognize her. So I got some nurse who had no idea what I was talking about.

Then I called the number she left me (I listed to it x2 and this is the number): 919 765 0634.

That number is not functional.

You, Katie and Kathryn, both sent me identical e mails which went nowhere when I opened the message. This is what I got when I opened up your message:

FROM: Kathryn Millican SUBJECT: Re: Fw: BCBSNC: no screening colonoscopies in western NC

VIEW MESSAGE Note: This message will be available online until 06/13/2008.

Internet Explorer cannot display the webpage Most likely causes:
You are not connected to the Internet.
The website is encountering problems.
There might be a typing error in the address.
What you can try: Diagnose Connection Problems

This is a public health issue, this lack of screening of colonoscopies in western NC.

I am waiting for an answer to this and that answer will include screening colonoscopies in western NC. If the NC State Legislature is supposed to be overseeing BCBSNC in some manner, on the basis of all of the non-action about this public health issue which endangers the lives of thousands of NC citizens-----I'd have to suggest that they beef up what they are doing.

Please feel free to forward this e mail to any salient party.

Marsha V. Hammond, PhDcc: health committee, NC state legislature, western nc health reporters