Marsha V. Hammond, PhD Clinical Licensed Psychologist, NC
E mail: firstname.lastname@example.org fax: 828------------
Cell phone: 404 964 5338
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):
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:
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”