Wednesday, October 22, 2008

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):


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:

Wednesday, October 15, 2008

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....."

Monday, October 13, 2008

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....."


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....."