Sunday, November 8, 2009

Big Pile On Against BCBSNC: State Employees Association of NC Whams BCBSNC

(I think, maybe, that BCBSNC got more than it bargained for when it decided to use our money to pay for postcards to be sent to Senator Kay Hagan so that she would not vote for the public option....):

From the State Employees Association of NC:

"....To protect its virtual monopoly on North Carolina's health insurance industry, Blue Cross and Blue Shield of North Carolina spent untold thousands of our insurance premium dollars mailing postcards to hardworking citizens to pressure Senator Kay Hagan into opposing health care reform which would create competition and reduce your health insurance costs.

The "non-profit" Blue Cross and Blue Shield virtual monopoly earned $186 million in profits for 2008 - and paid their CEO nearly $4 million.» View document

Why BCBS controls over 70% of our state's health insurance market. Their profits have driven up health care costs and alarmed North Carolina's citizens and lawmakers. Big health insurance monopolies like BCBS bitterly oppose a public option needed to increase competition and put a lid on their corporate profits at the expense of ordinary working people and businesses....."

Friday, October 23, 2009

Call Senator Hagan & Support her Against BCBSNC Whom is Waging War on Her

Here's her D.C. number: 202 224 6342. They'll ask for your zip code.

Call Senator Kay Hagan and let her know that you stand behind her re: making competition available for BCBSNC. If they're so good, then they won't mind the competition....for after all, that's what capitalism is supposed to be about. Better yet: take the nasty BCBSNC postcards and send them to Senator Hagan----ON BCBSNC----w/ a comment that you want her to stand up for a public option and competition for BCBSNC.

Here is what BCBSNC is up to re: Senator Hagan:

Remember: every nasty postcard that goes back to Senator Hagan is money out of YOUR pocket if you have BCBSNC.

NC Blue Cross Sending Nasty Postcards Opposing Health Reform
Posted at 5:57 PM by Adam Searing
NC Blue Cross is sending postcards around the state. The goal? Get people to fill them out and send to Senator Hagan to oppose a “government-run” health plan. Of course, what Blue really wants is not to compete with a public option health plan, despite their 96.8% individual market share and billions in reserves. This sort of nasty, last-ditch effort to oppose real health reform is just what you would expect from the company who brought you the $3.99 million nonprofit CEO salary.

More Rallies in NC for People Who Have Died Because They Have No Health Insurance

PRAYER SERVICE, Thursday October 29th: You and your congregation are invited to join the NC Council of Churches and others in the faith community on Thursday, October 29 from 7:00 to 8:00 p.m. for an interfaith service of prayer and remembrance for those who have suffered or lost their lives due to lack of access to health care. It will be held at the Unitarian Universalist Fellowship of Raleigh at 3313 Wade Avenue. Contact: NC Council of Churches,

Thursday, October 22, 2009

Day of the Dead: those who died because they had no health care

Florida Representative (D) Alan GRAYSON Launches Website To Honor, Name Those Dead From Lack Of HealthCare :

"Every year, more than 44,000 Americans die simply because they have no health insurance.
I have created this project in their memory. I hope that honoring them will help us end this senseless loss of American lives. If you have lost a loved one, please share the story of that loved one with us. Help us ensure that their legacy is a more just America, where every life that can be saved will be saved."

Read more here as it was picked up by The Huffington Post:

"I think it dishonors all those Americans who have lost their lives because they had no health coverage, by ignoring them, by not paying attention to them, and by doing nothing to change the situation that led them to lose their lives," the congressman explained. "So I make this simple proposal. I propose that we identify them. I propose that we honor their memory by naming them. They themselves can no longer speak. But their families, the ones who love them, they can speak. And so I have established a website called"

Thursday, October 15, 2009

'In Loving Memory': honoring those who could not find any health care and so died

Tuesday, October 20, 2009, 7pm-8pm, "In Loving Memory" service to pay respects to those who have died from our broken health care system. First Congregational Church of Christ, 20 Oak Street, Asheville (just off College Avenue at the traffic circle). For information contact Rev. Joe Hoffman at 252-8729 or Leslie Boyd at 243-6712.

Asheville Citizen Times' reporter, Leslie Boyd----her son died from colon cancer within the past 5 years. He could find no health care. He was less than 35 years old.

If he had MEDICARE, he could have had a screening colonoscopy. Think about that as you consider the public option.

BCBSNC PPO offers no reimbursed screening colonoscopies in western NC except for ONE PROVIDER, Appalachian Gastroengerology, BOONE, NC which is hours away from Asheville, a major metropolis.

For over $750/ month, my healthy 3 member family, cannot obtain reimburseable mammograms (for me) not screening colonoscopies in a clinic setting, which is the standard of treatment at this time. The closest 'office based' screening colonoscopy is hours away.


see what Leslie Boyd says about this matter and the picture of her son whom died because he could not afford health care:

"....Mike’s Story

By Leslie Boyd

Every year in America, some 30,000 people die prematurely because they don’t have health insurance and the access to health care that comes with it. Last year, one of those people was my son.

He was at high risk of colon cancer because of a birth defect, but he couldn’t get a doctor in Savannah, Ga., where he lived, to give him a colonoscopy. Several times, even as he began having symptoms, the doctor wrote in his record, “Patient needs a colonoscopy but can’t afford it.”

Tuesday, July 7, 2009

WSJ: NC Mental Health Parity to be 'enacted' 7.1.2009: no commemoration but rather weeping would be in order

Dear Mr. Rosomer, reporter for the Winston Salem Journal:

My BCBSNC policy that my healthy 3 member family has for which we pay $750/ month w/ large deductibles and minimal preventive care (no available screening colonoscopies for those over 50---yes, Medicare does this; no mammograms---yes, Medicare does this) pays only 50% for any mental health care.

The administrative costs for BCBSNC are over 15%. The administrative costs for Medicare are about 2-3%.

I therefore believe that your information is erroneous and would be grateful if you would investigate this matter.

Much information on BCBSNC can be found at my blog which I have steadily maintained for the past couple of years (; there are two blogs: one associated w/ NC Mental Health Reform and the other as associated w/ scrutinizing BCBSNC.

You stated, Mr. Rosomer:

"Published: July 1, 2008

July 7, 2009RE: Commeration of a Bittersweet Victory in NC:


"Starting today, insurance companies in North Carolina must provide the same level of coverage for some mental illnesses that they do for physical ailments.....

“There are costs, obviously, associated with this mandate, but we’re anticipating it to be less than half of 1 percent,” said Lew Borman, a spokesman for Blue Cross and Blue Shield of North Carolina."
I do not understand why you are using BCBSNC to indicate cost matters for they are not required to pay attention to mental health parity. In order (I am told) for NC State Representative Martha Alexander and those assisting her, to drive through mental health parity, a 'deal' was struck w/ BCBSNC.

You can look at these Madame Defarge II posts re: that matter:

Item 1:

Wednesday, April 08, 2009

NO Mental Health Parity in NC : BCBSNC makes their own rules (and you'll like it or just shut up, Rep Martha Alexander)

Fitzsimon FileThe special interest health plan, April 8th, 2009

Item 2:

Wednesday, May 20, 2009

WaPo: NOW we know why BCBSNC was stockpiling all that money: THEY'RE TRYING TO KILL ACCESS TO PUBLIC HEALTH INSURANCE

I would also like to bring your attention to this recent NYT article indicating that the 'fine print' in the private insurance policies continues to drive people into health-related bankruptcy.

BCBSNC was allowed by the NC State Legislature to opt out of mental health parity. Over 75% of people who are insured in NC (not including Medicare/ Medicaid) are insured by BCBSNC.

Therefore, there is no bittersweet commemoration but simply failure. We will not get anywhere until there is a public option re: health insurance. THAT and that alone will put the private health insurance companies on notice.

REMEMBER: when one is utilizing a capitalist model, COMPETITION is HEALTHY! (Or did the politicians, Dem and Republican alike, forget that tenet, as they looked simply at the bottom line and watched out for their own profits, much as Senator Kay Hagan is doing in her key position on the HELP Senate Committee which allows the public option matter to go forward---or not?)

Marsha V. Hammond, PhD

Sunday, July 5, 2009

Private Health Insurance Companies are dumping the sick who must file for bankruptcy: SADISTIC LIMITED BENEFITS PLANS

I think we can pretty much conclude that this country is too far down the drain to recoup. The powers that be associated w/ the private insurance companies are going to drown us in the bathtub with most everyone looking on and seeing what is happening and there will simply be a stunned sense of 'there was nothing we could do.'

Just because you have health insurance doesn't mean you cannot go bankrupt depending on the DETAILS & FINE PRINT of your PRIVATE health insurance.

There is no better reason than this for the public option. Give it to us, or we'll die.


Insured, but Bankrupted by Health Crises

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to confuse their customers and dump the sick.

The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance, Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David's Medical Center in Austin, where he went for two separate heart procedures last year, the hospital's admitting office looked at Mr. Yurdin's coverage and talked to Aetna.

St. David's estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for other hospital services, which turned out to include nearly all routine hospital care the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months as long as he did not need an operation or any lab tests or drugs while he was there.

Aetna contends that it repeatedly informed Mr. Yurdin and the hospital of the restrictions in policy, which is known in the industry as a limited-benefit plan.

The company says such policies offer value by covering some hospital expenses, like surgeons' fees or a stay in the intensive care unit. Aetna also says all of its policyholders receive significant discounts on the overall cost of hospital care. But Aetna also acknowledges that a limited-benefit plan was inappropriate in Mr. Yurdin's case because his age and condition an irregular heartbeat made him likely to require more comprehensive coverage....."

Thursday, July 2, 2009

CDC Health Insurance statistics across the US for 2009

So, basically, we've got approximately 40% of the American population uninsured during possible critical times (accidents happen!) with BCBSNC being supported by Senator Kay Hagan of NC in her key position on the HELP committee of the US Senate with an absent Ted Kennedy (cancer happens!). Any Congressperson who understands this---and they all do-----should be voted out next time around re: these statistics whether they be Democrat or Republican.


The CDC National Center for Health Statistics report has been released: "Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2009."
Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2008. National Center for Health Statistics. June 2009. Available from:


v In 2008, 43.8 million persons of all ages (14.7%) were uninsured at the time of the interview, 55.9 million (18.7%) had been uninsured for at least part of the year prior to the interview, and 31.7 million (10.6%) had been uninsured for more than a year at the time of the interview.
v In 2008, the percentage of children under the age of 18 years who were uninsured at the time of the interview was 8.9%.
v In 2008, 60.2% of unemployed adults aged 18-64 years and 22.2% of employed adults in this age group had been uninsured for at least part of the past year. Also, 33.3% of unemployed adults aged 18-64 years and 13.4% of employed adults in this age group had been uninsured for more than a year.
v In 2008, 19.2% of persons under age 65 years with private health insurance were enrolled in a high deductible health plan (HDHP) including 5.2% who were enrolled in a consumer-directed health plan (CDHP). In addition, 18.7% were in a family with a flexible spending account (FSA) for medical expenses.
v In 2008, the percentage of persons uninsured at the time of interview among the 20 largest states ranged from 3.0% in Massachusetts to 22.9% in Texas.

Tuesday, June 30, 2009

(Democrat!) Senator Kay Hagan is key person holding up allowing Public Health option to health insurance in the US

NC Senator Kay Hagan Is The Key Person Holding Up Move to Allow Public Option

By Marsha V. Hammond, PhD: Licensed Psychologist, Asheville, NC

Senator Kay Hagan was ‘carefully’ put into place in order to run against Elizabeth Dole. Guess what: NC Dems now have someone who is less malleable than Dole.

With personal vested interests in the health care industry and a long list of contributions, particularly by the monopolizing BCBSNC, Hagan is a key person holding up the ‘public option’ being made available to Americans as she sits on the influential HELP committee that is currently without the guidance of Senator Ted Kennedy.

Why would the ‘public option’ be good for Americans and in particular people in NC whom, like my family and I, are left with no option but to fund the 5th wealthiest ‘Blue’ with a billion dollar war chest to take down the ‘public option’ ?

Almost 75% of citizens in NC who are insured have BCBSNC. There IS no other viable option, even if one’s family is paying $750/ month/ three healthy members for the BCBSNC Advanta which includes no screening mammograms and no available screening colonscopies.

First of all, as Republicans used to realize prior to becoming the party of the wealthy, competition is good as people can really compare the value of products. Hagan, holding onto her $180,000 personal investment in the private health care industry, as well as her future contributions from BCBSNC, wants to tell us that having a public option would ‘destabilize’ those mom and pop health insurance companies like BCBSNC.

Secondly, we could have cheaper health care as re: a public option as Medicare’s administrative costs are 2% vs BCBSNC administrative costs of 15%.

And here’s stink: Ken Eudy, former chair of the NC Dem Party, best man at BCBSNC CEO recent wedding, is the founder and CEO of Capstrat, which is overseeing the BCBSNC push to sink the public option.

This is gonna cost you the next election, Kay Hagan. But that’s OK: you’ll have a nice appointment to the BCBSNC Board.

Marsha V. Hammond has blogspots associated with documenting problems w/ BCBSNC ( as well as one overviewing NC Mental Health Reform for the past two years (

The Public Health Option: Competition will be GOOD for the $-grabbing Private Health Care Industry

Controlling health care costs isn't just necessary for the health of our economy -- it also likely to boost personal incomes.

Sent to you by David Byrom, Ph.D.:
Got Health Insurance? Fighting for a Public Option Might Just Get You a Raise!
By Joshua Holland, AlterNet

Posted on June 29, 2009, Printed on June 29, 2009

The best argument for overhauling our ridiculously expensive and dysfunctional health care system -- an argument one doesn't often hear in the corporate media -- is that fixing it would put more dollars in your pocket, even if you already have health coverage.

If there's enough pressure on Congress, we'll add a well-designed public insurance option to the current mix of private insurance and government health care programs. It would be like (the highly popular) Medicare program, but open to all comers. We'd end up with a very large insurance pool that would lower costs through efficiencies of scale. The plan would be able to drive a hard bargain with providers and cut down on overhead costs, which amount to about 30 percent of spending in the U.S. right now.

And it wouldn't just contain costs. A publicly administered insurance program would also protect Americans from the kind of health insurance nightmares we hear about so frequently, with families bankrupted by out-of-pocket expenses or stuck in jobs and relationships they hate in order to hold on to their insurance....

See entire article at:

Monday, June 29, 2009

Senator Hagan, like Joe Lieberman, increase their personal health insurance market share by denying public option

What Senator Kay Hagan says:

nothing on her web page about her key position on the HELP committee which will allow movement towards national health insurance and the 'public option' or not...........and she has $180,000 her own monies (if not more) invested in the health care industry as per the Washington Post..................

HOWEVER, her stance appears to be in keeping w/ Joe Liberman's---- whose wife has profited by working as (one of those) consultants re: private health care:


Hadassah has worked for the lobbying company, APCO Associates, that had many pharmaceutical and healthcare corporations among its clients, as well as four major drug companies such as Pfizer. In March 2005, Hadassah was hired by Hill & Knowlton (another healthcare lobbyist) as "senior counselor" in the firm's "health care and pharmaceuticals practice." Hadassah's close relationship with pharmaceutical and healthcare corporations while her husband introduced legislation benefiting these exact companies has raised questions about improprieties and conflict of interest. (Wikipedia -- --though there are substantially more sources for her and Joe's perfidy.)But it's all the same, what Lee Stranahan illustrates -- follow the money and you'll learn why healthcare reform (to say nothing of public option) is opposed so adamantly by those who "work with the public's interest at heart."


Run time: 00:42 Posted on YouTube: June 29, 2009By YouTube Member: StranahanViews on YouTube: 309 Posted on DU: June 29, 2009By DU Member: Eric J in MNViews on DU: 513 Video by Lee Stranahan.Lieberman says he's against a public option to compete with a public plan because there is already enough competition.However, there has been consolidation in the health insurance industry.

Saturday, June 27, 2009

Senator Hagan: protecting her own $180,000 in private insurance company investments

In the best of all possible worlds, we would have people who are public servants who do not have vested, selfish interests that they protect. Would that we lived in that place.


from: NC Health Report/ Adam Searing

Senator Kay Hagan is unsure whether she wants a public health care option in national health reform or what it means.

Call Senator Hagan at 1-877-852-9462 (toll free) or 202-224-6342 and tell her exactly what it means:

1. It means a real alternative health insurance plan for NC families if people are sick of NC Blue Cross and want another option.
NC Blue Cross insures 3.7 million people out of the 5 million with private health insurance in North Carolina. With 75% of the overall market, NC Blue enjoys a virtual monopoly in our state - especially in the small business and individual markets where their share of business is even higher. Don't North Carolinians - especially individuals and small business owners - deserve more choice?

2. It means discipline and cost control for private insurers.
Nonprofit NC Blue Cross paid its CEO $3.99 million last year after he got a $759,000 raise. If NC Blue had to compete with a health plan that didn't pay its executives such high salaries perhaps they'd be a little more careful with our premium dollars.

3. So-called compromises like "health co-ops" or state public plans won't work.
These are smaller entities that are being put forward as a substitute for the public plan. But the whole point of the public plan is to put pressure on insurers, drug companies, and others to lower costs because of its nationwide reach and buying power. Without a true nationwide public plan we can't keep down costs - which is the whole point.

Want it on video? See Adam Searing and President Obama each explain why a public health care option is crucial for health reform.

Call Senator Hagan at 1-877-852-9462 (toll free) or 202-224-6342 and tell her North Carolinians need a real public health care option.

Wednesday, May 27, 2009

PEEYOO! What's that smell leaking from the NC Dem Party re: Capstrat handling BCBSNC adds WHEN CAPSTRAT'S BOSS WAS THE NC DEM PARTY CHAIRMAN?

As a Dem, I feel distinctly smelly, and I'm not talking pleasantly fragrant-----like someone w/ a bad stink just ran thru the room.

So, Eudy, who was BCBSNC's CEO's best man at a recent wedding of his, was also the Chair of the NC Dem Party----and Capstrat is the public relations firm behind trying to sink the Obama health plan or any health plan, really, that would allow citizens to choose a public health insurarnce---like Medicare----which will actually make available reimburseable screening colonoscopies or mammograms----you know---the BASICS or preventive health care.

"...Blue's rise in recent years has also coincided with a similar rise of Capstrat - the state's most high-powered Democratic Party-connected public relations firm. Over the past several years, Capstrat has parlayed its connections with Democratic establishment to win a bevy of extremely lucrative contracts with Blue as well as various government and government-funded entities. Ken Eudy, Capstrat's founder and CEO, is the former head of the state Democratic Party and was apparently even the best man at the wedding of Blue's grand poobah, Bob Greczyn.

Monday, May 25, 2009

Tough Love for BCBSNC since they can't compete w/ Medicare: 15%administrative costs vs Medicare's 2%

Blue Cross Millionaires are Scared to Compete With a Public Plan
May 25, 2009 by Dean Baker

".....Specifically, the administrative expenses of a public plan like Medicare are far lower than the expenses for Blue Cross of North Carolina. According to its Annual Report, Blue Cross of North Carolina spent almost 15 percent of its premiums on administrative expenses in 2008. That came to more than $1.8 billion. This money would have been enough to cover the costs of insuring almost 600,000 kids through the State Children's Health Insurance Program (SCHIP). Just five years earlier, Blue Cross of North Carolina spent more than 22 percent of premiums on administrative expenses.

By comparison, Medicare spends only about 2 percent of its revenue on administrative expenses. Unlike Blue Cross of North Carolina, Medicare doesn't earn profits and doesn't pay high salaries to its top executives. According to the Raleigh News and Observer, Robert J. Greczyn Jr., the chief executive of Blue Cross of North Carolina, earned $3.2 million in 2007. That's enough to pay for a year's worth of SCHIP for 1,000 kids. Other top executives also drew salaries well in excess of $1 million, a pay range that exceeds the top levels in the public sector by an order of magnitude.

Given the high salaries that Blue Cross of North Carolina pays its top executives and the other administrative expenses that it bears as a result of being a private sector plan with high overhead, it is not surprising that it would be afraid of a public plan. A public plan would likely charge much lower prices, thereby pulling away a large share of Blue Cross of North Carolina's business. Insofar as it was able to hold on to its patients, Blue Cross of North Carolina would probably be forced to lower its prices - slashing its profit margins - in order to be able to compete. This is not a happy picture for any business: fewer customers and lower profit margins.

The answer, of course, is tough love. We just have to tell Blue Cross of North Carolina than it will have to learn to compete. If it can't beat out a public plan in market competition, then the public and the economy would be better served if it went into another line of business. ..."

Saturday, May 23, 2009

Innoculate yourself: BCBSNC is going to try and scare you out of government sponsored health insurance e.g., Medicare

Health scare

Health care reform needs thorough discussion of different approaches, but not ads mainly meant to frighten.

Published: Fri, May. 22, 2009

Does Blue Cross and Blue Shield of North Carolina really want to participate in a constructive debate over how to provide accessible, affordable and quality health care for all Americans? A strategy for videos in the planning stages for the company, as reported by The News & Observer, indicates it prefers more of the same old tactics used to thwart health-care reform in the past.

Those tactics include simply trying to scare people. At least, that's one way of looking at plans for commercials that would, for example, have a receptionist telling a caller that under a government health care plan, an appointment with a doctor would be more than two months in coming. In another instance voice-overs would talk about "rising premiums" and warn, "a lot like Medicare" (not that Medicare isn't well-regarded by most of its elderly beneficiaries).

The plans were leaked to Adam Searing, healthcare access director for the N.C. Justice Center, and he shared "story boards" for the videos with The N&O. The videos are being created by Capstrat, a Raleigh public relations firm.

When asked about the videos, Blue Cross promised that "positive information" would be included. But the insurance industry is standing firmly against suggestions from the Obama administration that one part of health-care reform might be a government-sponsored plan that would compete with private insurers. That, the private companies say, would be disastrous....."

I wanted to invite all who are concerned about this to comment at the Raleigh News Observer----an excellent paper w/ provocative investigative reporting. Not difficult to register.

Just as psychologist Phil Zimbardo outlined the fear mongering tactics associated with the levels of warning which served a purpose of scaring Americans, thus inviting a loss of yet more civil rights and freedoms: see:

The Threat Level Is Elevated! The Threat Level Is Elevated!

July 01, 2003 — CSO — In his treatise on the psychology of terrorist alarms, Philip G. Zimbardo, a professor of psychology at Stanford University, outlines what he calls the "Paul Revere paradigm for successful dissemination of public alarms." He bases his theory on four reasons for the success of Revere's famous ride to alert the colonials of the British approach.

Revere was known to be a credible communicator.
His alarm was focused on a specific event.
It was designed to spur citizens to act.
It called for a concrete set of actions in response.
This is gonna be a fight to the death, I think, this matter of getting access to government sponsored health insurance e.g., Medicare.

APA's in a unique position to influence this matter but I would bet my bottom dollar that they wouldn't touch it w/ a ten foot pole. Its no different than the matter of the confounding matter of the Division of Military Psychology / the PENS committee being stacked w/ military psychologists and the storm which continues to crank ever higher re: what psychologists should be able to do who are members of the military.

I'd suggest that the Division of Independent Practice is gonna have to really crank things and is in a unique position to do so----if the Board members don't wimp out.

I'd appreciate info on that. Or I'll assume that this is just another instance of 'we can't kick up a fuss.' ---same old tired story.

marsha v. hammond, phd, asheville, NC

Raleigh's flim flam Capstrat PR Firm works for BCBSNC and against public health insurance:'We help corporations advance regulatory interests'

Every so often you get a glimpse of the machinations behind the curtain and this is one of those pieces of investigative reporting. You GO Raleigh News Observer.

See it shine here, detail after detail re: this Mr. Eudy, co-owner of Capstrat & supporter of Obama. Listen to the low hum of those big wheels as they make mincemeat of the common person's desires for their government...... winding up his advertising merry-go-round, sneaking around the periphery of Obama's universal health care initiative-----in his sheep's clothing----all the while doing the work for BCBSNC, his boss-man.

This is all you need to know about Mr. Eudy:

"We help corporations advance regulatory interests"

"Eudy was the best man at the wedding of Bob Greczyn (CEO BCBSNC)"

"CAPSTRAT'S LARGEST CORPORATE CLIENTS: Blue Cross and Blue Shield of North Carolina"

"Ken Eudy is one of Barack Obama's key supporters in North Carolina."


Couple that to this week's WaPo article outlining how BCBSNC is using the ill gotten gains from not paying for patient care (as a BCBSNC Advanta insured member, in a 3 member healthy family, I cannot get reimbursed screening colonoscopies or mammograms; and there is no mental health parity tho a law was passed last year: BCBSNC was allowed by state legislature to OPT OUT) and this is what you got:

'North Carolina's Blue Cross Blue Shield Trying to Kill Key Plank of Obama Plan.'

"......the company has hired an outside PR company to make a series of videos sounding the alarm about a government-sponsored health insurance option, known as the public plan...."


Marsha V. Hammond, PhD Lic Psychologist, NC

Wednesday, May 20, 2009

WaPo: NOW we know why BCBSNC was stockpiling all that money: THEY'RE TRYING TO KILL ACCESS TO PUBLIC HEALTH INSURANCE

Godalmighty: get me away from this vicious company: we need PUBLIC INSURANCE as a possibility---CAN YOU SAY: MEDICARE WILL GIVE ME ACCESS TO SCREENING COLONOSCOPIES? BCBSNC is in the top 5 wealthiest Blues in the US (out of 28 Blues) and they have been stockpiling YOUR money and MY money in order to undo us as re: having access to government sponsored health insurance:

"North Carolina's Blue Cross Blue Shield Trying to Kill Key Plank of Obama Plan

By Ceci Connolly

One week after the nation's health insurance lobby pledged to President Obama to do what it can to constrain rising health costs, Blue Cross Blue Shield of North Carolina is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama's reform platform.

As part of what it calls an "informational website," the company has hired an outside PR company to make a series of videos sounding the alarm about a government-sponsored health insurance option, known as the public plan. Obama has consistently maintained that a government-run plan, absent high-paid executives and the need for profits, could be a more affordable option for Americans who have trouble purchasing private insurance. The industry argues that creating a public insurance program will undermine the marketplace and eventually lead to a single-payer style system.

In three 30-second videos, the insurer paints a picture of a future system in which patients wait months for appointments and can't choose their own doctors, according to storyboards of the videos obtained by the Washington Post.

One video titled "Waiting" shows a receptionist fielding a request from a patient enrolled in the new program.
"The government plan. Okay hold on...let me see what's available," the woman says into the telephone. On the screen, with the caller on hold, the receptionist rearranges items on her desk, looks at a wide- open calendar and then fibs: "It looks like the first time we can fit you in is in two-and-a-half months."

Another spot in the series, being developed by Capstrat media in Raleigh, shows a woman and child wandering down a darkened hospital doorway "as if they're starting to realize that they've lost their way," according to sketches of the video. "We can do a lot better than a government-run health care system," the narrator concludes.

Blue Cross Blue Shield spokesman Lew Borman said the videos are still in the draft stage. On the question of creating a public option to compete with private insurers, he said: "We believe an unchecked government-run plan would lower payment to doctors and hospitals, forcing them to attempt to charge private insurers more and thus further eliminate private insurers' ability to compete against the government."

On its Web site, Capstrat touts its "agility in turning complex issues into simple, powerful and persuasive stories." Company president Karen Albritton declined to comment.

Blue Cross Blue Shield of North Carolina has 3.7 million members and processed more than $10.7 billion in medical claims last year. Get a first look at the video storyboards here."

Saturday, May 16, 2009

NEJM editors: runaway hlth care costs due to administrative overhead & excessive use of expensive technology

We don't need a BCBSNC that has millions of dollars 'in escrow' (read: padding the pockets of investors and CEO's and managers) if we're going to have an efficient health care system.

Take your pick: one or the other.

From the NYT:

David Leonhardt, in his May 13 column (“Health Care, a Lesson in Pain,” Economic Scene), is quite right that “the only way to have a sustainable universal health care system is to control costs.” But in analyzing the experts’ testimony before the Senate Finance Committee on how to pay for health care, he did not mention a solution that neither the experts nor the committee wants to consider: major reform of the system.

Runaway costs are due largely to high overhead expenses throughout the system, and to the excessive use of expensive technology. Both of these result from a health care system that is organized like a profit-seeking industry instead of a social service.

If we want health care to be a universal entitlement, it cannot be controlled by market forces and the financial interests of insurers and providers (and the investors who own such a large part of the system).

Some kind of government-regulated single-payer insurance plan and a reorganized nonprofit medical care delivery system may be “off the table” for policy makers right now, but we will never achieve affordable universal coverage without major reform that deals with the real causes of medical inflation.

We don’t need more money; we need a new system.

Arnold S. RelmanMarcia Angell Cambridge, Mass., May 14, 2009

The writers, medical doctors, are former editors in chief of The New England Journal of Medicine.

Monday, April 13, 2009

Medicare or BCBSNC? : gee, which one should I choose?

What a hoot. Or a screech. That's the sound of their tires veering off the road paved w/ the millions of $$$$$$$$$ of NC citizens who have no reimburseable (via BCBSNC Advanta Plans: $750/ month my healthy 3 member family pays for BCBSNC) access to :

1. screening colonoscopy
2. mammogram
3. mental health parity

I dunno: what a tough decision: Medicare or BCBSNC?

Here is what Medicare pays for re: those 3 important items which would affect many people over 50.


SCREENING COLONOSCOPY, recommended by the American Cancer Society, beginning at age 50. Price of screening colonoscopies in Asheville two years ago was $1200; not inclusive of any necessary biopsies:

"If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department or ambulatory surgical center, you pay 25% of the Medicare-approved amount. "

So that means that the Medicare insured would pay .25 X 1200 = $200

Here is what BCBSNC pays for re: screening colonoscopy (bear in mind the lovely state law requiring colorectal screening which impacts not a whit on the non-availability of screening colonoscopies in western NC):

"Colonoscopy is a covered benefit for Blue Cross and Blue Shield of North Carolina (BCBSNC) members. Below is a summary of the standard benefit for colonoscopy screening.
• The out-of-pocket cost of a colonoscopy done in an office based colonoscopy center is a member’s specialty co-payment for Blue Care, Blue Options and Blue Advantage members.
• Colon cancer screening is an enhanced preventive benefit for Blue Options HSA members. Screening must take place in an office location to meet the Blue Options HSA preventive benefits.
• Members can have a colonoscopy in a hospital or ambulatory care center, subject to deductible and coinsurance. Colonoscopy screening in a office based colonoscopy center can lead to significant out-of-pocket cost savings for members. .."

If you go to the website, and type in 'gastroenterology, you'll turn up dozens of physicians, most of them at the same dozen or two practices (looks like more that way) but the only one that does the REIMBURSEABLE office based screening colonoscopy is in Boone, NC, two plus hours away from major metropolis Asheville w/ 100,000 people.

And WHY do gastroenterologists mostly do only clinic based colonoscopies? Because people need anesthesia. Why do they need anesthesia? Because they might squirm w/ discomfort during a colonoscopy. And what happens if they squirm? They might get their bowel punctured. And what happens if you get your bowel punctured? You're DEAD.

Screening mammograms:

What do we get re: Medicare:

"Medicare pays for screening mammograms once every 12 months for women age 40 and over. Eligibility is based on the date of your last screening mammogram. You do not need a doctor’s order to get a screening mammogram. The Medicare Part B deductible will not be applied to a screening mammogram. However, you will be responsible for the 20% coinsurance. "

OK, so mammos cost a couple of hundred $$; 20% co insurance would be $20.


Funny how difficult it is to turn up information at the BCBSNC website. :

The answer is this: under the Advanta plans, which are those that families have who pay for their health insurance, specifically, the Advanta plans, you have to meet your yearly deductible before BCBSNC will pay for your mammogram. For my healthy 3 member family, w/ $750/ month, the reimburseable for EACH MEMBER is $2500.

Mental health?

I can answer this one as I am a medicare psychologist:

90806: 45-50 min therapy: medicare pays approx $60; usually there is wrap around to other insurance policies such as Medicaid or AARP, etc, in order to make the co pay; otherwise, the patient pays the co pay. Usual fee is $100-150/ session.

96152, Health & Behavior CPT codes e.g., 96152: therapy associated w/ medical issues which includes correspondence and wrap around to physicians: approx $25/ 15 minutes up to 7 units/ session. I commonly see people for 1.5 hours so that would be approx $150.00.


Remember NC Mental health Parity big brouhaha? didn't touch BCBSNC Advanta members. They simply continued w/ what they were doing as per my policy announcement which indicated that therapy would continue to be paid at 50%.

Only if you were 'fully insured' would you be able to get to mental health parity rates:

"Effective July 1, 2008, or upon a group's subsequent renewal date, the Mental Health Parity Act changes the way that fully-insured groups and MEWAs (multiple employer welfare arrangements under ERISA), can administer benefits for the treatment of mental health conditions."

Are there 96152 codes reimburseable per BCBSNC?

dunno: can't find any information using any normal means of obtaining info as per their websites. I assume no. Humana does not cover 96152 but only 90806 at the ridiculous rate of $55/ session.

I can't wait to see BCBSNC go away.

So, sorry, WSJ (Wall Street Journal): making the government look like the bad guys in this case simply won't work.

What they said:

"....Congress will finish the job with regulatory changes. Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge. ..."

Oh, boo hoo hoo.

Wednesday, March 18, 2009

BCBSNC: they donated $643,000 to state legislators who are then supposed to OVERSEE BCBSNC

"Democracy NC releases report on Blue Cross campaign donations
Posted at 10:08 AM by Adam Searing
See contact information for Democracy NC and the chart detailing donations here. Excerpts from the statement by Democracy NC Director Bob Hall today:
An analysis by Democracy North Carolina reveals that no other company the size of Blue Cross has donated more to state politics through its political action committee –- a total of $643,000 from the 2000 election cycle through 2008. Seven company-backed PACs have given more, like those of the big banks and utilities, but all seven of those corporations operate in multiple states and are much larger than Blue Cross. As a not-for-profit corporation, Blue Cross is in a class of its own…"


YEESS! Now, we're getting somewhere. Let's have the details of which state legislators received the money and I would assume that it is the state legislators who are supposed to do the monitoring as re: the BCBSNC state legislative committee.

Turn on the heat:

I would hope that Martin Nesbitt would lead the way to get BCBSNC overview OUT of the NC State Legislature----given how he used to be associated w/ BCBSNC, via his racing son, 'advantaged' a BCBSNC Advanta car: see the pic here: (from Defarge blog): 'NC losing its critical coverage of BCBSNC by its NPR stations supported by BCBSNC Foundation? : Mr. Nesbitt don't make me spill my machiato':

Here is the list of some of the purportedly 'government affairs' employees associated w/ BCBSNC (ya know: those people who are supposed to 'tell' the state legislators what they want them to know): (Ken Wright, best I understand it, is the lead person, and you sometimes can catch Nell Boone at her desk on a Saturday: I bet she doesn't pick up her phone anymore, though):


Notice that they all have bcbsnc e mail suffixes.

Let's have the list of the state legislators who were 'advantaged' the 643,000 from the 2000 election cycle through 2008.

WE NEED A ONE PAYOR SYSTEM in order to cut down the administrative costs of health insurance. We all suffer because of this.

Marsha V. Hammond, PhD

Wednesday, March 11, 2009

$16 Million paid to BCBSNC Board Members: the Ponzi scheme that the insured have paid into

Look at this pdf:

You will see that the 13 members of the BCBSNC board 2008 reimbursement is approximatly $16 million.

Gee, I wonder why our premiums keep going up?

Gotta keep up with the Greczyn's.

Friday, March 6, 2009

Powered by WebRing.

Change the law to increase NC Department of Insurance ability to monitor health insurance companies like BCBSNC

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC
NC Mental Health Reform blogspot:
Scrutinizing BCBSNC blogspot:
March 6, 2009
Dear Susan Fisher, NC Rep for Asheville, NC:
I have spoken w/ you and your assistant, Lynn Tennant, in the past, Ms. Fisher, about problems I have had---personally----as associated w/ BCBSNC as pertaining to the BCBSNC Advanta Plan that my healthy, 3 member family has. Specific to my own personal concerns,I cannot be reimbursed for mammograms or screening colonoscoopies.
Specific to NC Mental Health Reform and mental health issues, there is no adherence of BCBSNC to mental health parity.
And every state legislator seems terrified of BCBSNC. Its very concerning. Citizens feel impotent to get anything done.
Colon cancer screening is required by law. But if you do not have $1200 to pay out of pocket, and there is only one gastroenterologist 2 hours away in western NC in Boone, NC, it does not matter what the law states. You try driving two hours after taking the fluid in order to keep your colon cleaned out.
I am writing to you to encourage you to support any and all efforts associated w/ strengthening the NC Department of Insurance to oversee & monitor health insurance companies such as BCBSNC. I enclose a scanned version of a letter I received in December, 2008, from obert C. Lisson, Ph.D.Deputy Commissioner, Consumer Services Division. This was also placed on my blog scrutinizing BCBSNC back in December, 2008..

December 15, 2008Dr. 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

Thank you, Susan Fisher. Pass this e mail to any pertinent person or entity.

Wednesday, March 4, 2009

"Health Information Highway" will create efficiency (as will a one payer system reduce massive administrative costs)

It's More Than an Electronic Health Record - Call It a "Health Information Highway"
by RJ Eskow March 3, 2009 - 11:02am

".....Paradoxically, computerizing the health system in this country could make it much more humane than it is today. But that calls for a broad vision of health IT as an "information highway" that stores information, looks for problems, and eases the many routine interactions that make up the health system. A well-designed "health highway" would have features like these:

A common set of programming specifications for coding, storing, sharing, and manipulating health information. Just as XML (eXtensible Markup Language) allowed web designers to create sites that interact with one another, a health markup language or "HML" could allow systems used by doctors, hospitals, patients, and others to easily "talk" with one another.

The ability for systems to "look for" adverse medical reactions together. Certain harmless drugs become deadly in combination with other drugs, or when a person has other medical conditions. One way this technology could be used is to automatically look for these interactions every time a prescription is electronically "written."

Personal convenience. A doctor recommended minor surgery for me last week. What if her office had been able to schedule an appointment for me on the spot, send me a before-and-after personal care plan (tailored to my medical history), pre-authorized the treatment -- and checked my health plan to tell me how much it was going to cost me?

More privacy than we have today. I began tracking health privacy breaches a couple of years ago, but had to stop -- because they're too frequent. Laptops get stolen with medical information on them, storage disks get misplaced, or computers get hacked. (I wrote a paper about potential criminal uses of stolen medical data, but decided not to publish it ...) A comprehensive health IT system would include better protections for health data.

Tools for primary care doctors to manage your health. US and Canadian primary care doctors - the ones who should be managing your overall health -- have historically lagged behind their European counterparts in some vital IT capabilities. Health reform depends on stronger primary care - and health IT can help.

Automatic claim submission. Why shouldn't the health IT network automatically submit my claim after I've received medical treatment? Why shouldn't it tell me how far I've gone in meeting my deductible, and share any other financial information I might need? Our current system is too clerical, too bureaucratic, and too difficult to navigate....."

Wednesday, February 25, 2009

"The path of fiscal responsibility must run directly through health care.": Obama's budget director Peter Orszag

Well, NOW, we may be getting somewhere.


David Byrom, Ph.D., Past President
The National Coalition of Mental Health
Professionals and Consumers, Inc.

".....Wednesday, the Senate Finance Committee is started hearings on health reform.

Thursday, the President releases his initial budget, which will contain important health care cost containment and expansion provisions.

Next week the President has announced there will be a Health Care Summit.

The Administration's message, and what we hear from key Congressional leaders, too, is loud and clear: Health care is next....."


I've been sleeping better lately with the competent person at the helm.

Tuesday, February 24, 2009

Administrative Costs of having all the separate insurance companies is what causes American Health Insur to be so expensive: ONE PAYER PLEASE

This was back in 2003. That means that the information was actually taken from 2001 and 2002 year old data. That means that it is ever so much worse today. Picked this up from a (DU) discussion on the accerlating costs of health care:

Here is a statement from a poster on the main page today of DU:

"...The entire 'system' is set up to enrich a small number of people .in the Insurance and big pharma industries. As long as they can charge $15 a pill for drugs that sell for 0.20 each in other counties they'll keep doing it. They own our politicians on both sides, so progress toward lowering costs (outside of lowering care) will never be made..."


Confumer Affairs:

"......The study puts the administrative cost of the U.S. system at $294 billion per year, compared to about $9.4 billion in Canada. That translates to a per-person cost of $1,059 in the U.S. and $307 in Canada. A similar study, conducted in 1991, put per-capita costs in the U.S. at $450 and Canadian costs at one-third of that.

The study by Dr. Steffi Woolhandler of the Harvard School of Medicine found that Americans spend more on administrative costs because of the many private companies supplying insurance coverage. The multitude of companies create increased paperwork while Canadian doctors send their claims to a single insurer...."

Saturday, February 14, 2009

Progressive Pulse video indicates that BCBSNC administrative costs are CONFIDENTIAL

See this video created by Progressive Pulse, NC:

The administrative costs associated w/ BCBSNC ARE CONFIDENTIAL.

THAT----as associated w/ an entity that is supposed to be monitored by the NC State Legislature.

Amazing discussion. The video indicates that no information is available re: the administrative costs that BCBSNC makes.

THAT'S AMAZING. There is a committee within the NC State Legislature that oversees BCBSNC ----a 'non profit'

As a person who pays, along w/ the other 2 members of my family unit, all healthy people, $750/ month/ w/ $2500 deduct for anything other than seeing a doctor or obtaining prescriptions, I find it laughingly deplorable that so few questions are asked by the TERRIFIED State Legislators to BCBSNC.

My representative, Susan Fisher's office, advised me to 'lay off' the NC Department of INsurance as there would be no answers coming from my persistent questions about why there are no REIMBURSEABLE screening colonscopies for BCBSNC recipients in western NC when colon cancer screening is the law (you have to meet the $2500 deduct first; a screening colonscopy is approx $1200). There are no mammograms paid for.

So, I started some research re: just who in the state legislature is receiving benefits from NC BCBSNC such that they are all petrified of standing up to BCBSNC.

This is what I found:

*BCBSNC Spent 18 Million trying to convert to to for profit status in 2002-2003. Since that time they have simply been saving up their money such that they are now the 3rd most wealthy Blue entity in the US. there are 29 BCBS entities in the US.

*BCBSNC has its own way of calculating how much in reserves it needs and it is not in keeping w/ the insurance industry standards

*NC State Legislators get FREE BCBSNC health insurance

*Total membership: almost 3.3 million people;8 million people live in NC; therefore roughly one-third of the population is saddled w/ BCBSNC (you'd think that the state legislature could attend to the people that they supposedly represent)

*Premium costs: increased 35% from 2006-2007

*BCBSNC, not to be undone by the NC State Legislature which forbid it becoming 'for profit' continues to launch 'for profits' units: "Blue Cross and Blue Shield of North Carolina has formed a for-profit subsidiary called NobleHealth"

*Even though BCBSNC is supposedly monitored by the NC State Legislature, in 2006, they stopped making quarterly earnings announcements (as they moved forward with their 'non profit' wealth

Why was BCBSNC allowed by the NC State Legislature to hoard so much money and increase premiums at the same time?

Wednesday, February 4, 2009

Why Does the NC State Legislature keep shielding BCBSNC?? or JUST HOW MUCH $$ DOES BCBSNC GIVE THE STATE LEGISLATORS?

There's stink all over this company BCBSNC. So who knows just how much and who in the state legislature gets funding from BCBSNC?

So, as per the below, there's 660,000 people who have this 'State Plan' managed by BCBSNC.

There's 2.5 million + people who have BCBSNC Advanta plans, such as my family (to the tune of $750/ month w/ a $2500 deductible for anything other than doctor visits and prescriptions).

Not even mammograms or screening colonscopies are reimbursed.

And mental health parity was thrown overboard as re: the Advanta plan. It pays 50% for mental health services; mental health parity was to have created the same reimbursement/ rate schedule as for physical health services (commonly and usually 80%).

And so I asked the 'legislative liasons' (you know, the ones who help the NC STate Legislature and have BCBSNC as the suffix of their e mail addresses), about this mental health matter as I am a psychologist and inquiring minds want to know.

This is what Ken Wright's (BCBSNC legislative liason person) assistant said (in part):

Responding to your questions FROM: TO: SENT: Mon 02 Feb 2009 14:52:49 EST EXPIRES: Mon 09 Mar 2009 14:52:49 EDT

"....Many plans have customized requirements and/or the requirements aresubject to change....With regard to federalemployee plans, these services are determined by the Office of PersonnelManagement in Washington, DC. The FEP benefits are not subject to thenew federal mental health parity law......The new federal mental health parity law also does not apply to theNorth Carolina State Health Plan. State Health Plan benefits are set bythe North Carolina legislature..."

As per the post below from NC Justice Center as associated with a meeting associated w/ the NC State Legislature today:

"....State Sen. Ellie Kinnaird was brave enough to ask if our prescription drug manager Medco and Blue Cross have the best interests of the state at heart. Other than that, there was almost no mention of the insurance company....."

I guess we might conclude that State Senator Ellie Kinnaird doesn't get any money from the lobbying arm of BCBSNC.

Everyone else present just sat on their hands, apparently. So, I guess we might presume that everyone else present from the state legislature DOES get lobbying money from BCBSNC.

So, regardless of this fine 'mental health parity law' which passed in 2008, with main sponsor Martha Alexander, there's no mental health parity for:

BCBSNC Federal employee plans
BCBSNC Advanta Plans
BCBCNS 'State Plan'



update from 2.4.2009, NC Health Report/ NC Justice Center:

"The power of Blue Cross on full display during State Health Plan presentation

Today legislators heard a briefing on the State Health Plan from Mark Trogdon of the state's fiscal research division. Trogdon told legislators that the SHP will need $300 million before March 2009 to continue operations and $1.2 billion over the next two years. Trogdon said that the three options for the General Assembly to consider are reducing benefits, raising premiums, or both.

Once again, there was little time spent on how we got into this mess or creative ways to fill the SHP hole without hurting the more than 660,000 people insured by the state. It's not the fault of state employees and retirees that SHP projections went awry. It should not be up to state employees and retirees to make up for SHP lapses.

The elephant in the room during the presentation was the company that administers the SHP, Blue Cross and Blue Shield of North Carolina. One of the problems with the SHP is that administrative costs paid to the insurer are larger than expected. Another problem is that the savings projected by shifting all state employees and retirees to the Blue Cross network never materialized...."

Tuesday, January 27, 2009

BCBS's all over the place across the US in terms of pre-author for Mental Health services

Vast amount of confusion as indicated by postings on the Div 42, Independent Practice, of the American Psychological Association, pertaining to BCBS pre-authorization or not.

NC psychologist states that pre-author is being required but it is not clear if this is associated w/ 'federal employees' who have BCBS or BCBSNC across the board.

(Of course if, like me, your family of three pays $750/ month with a $2500 deductibe for anything other than going to the doctor, you don't get mental health benefits except at the 50% vs 80% rate, as you're not in a BCBS group plan).

This post from a mental health provider in Minnesota:

"Although a bit different, BCBS of Minnesota just enacted a similar requirement for Federal plans: they now require a pre-authorization for ANY MH services to be paid, even if you had been seeing the person in 2008. Typically, we got 8 session up front with no questions; we now have toeither call in for a verbal auth # or write a prior to get those first 8sessions. Of course, the announcement of this change came in mail in theform of a letter that looked like junk mail that many providers do not readcarefully. The announcement also was "wrong": it says you must submit IN WRITING, prior to the first session a request (even for people whom you havenever met before); they then retracted the "in writing" requirement with"verbal is ok", but only informed their staff of the change(staff admittedthey too were confused). Some of my colleagues are getting claims denied andwondered why---"you didn't call in"---..."

Department of Insurance NC suggests I could obtain a BCBSNC group policy for my three family members

I had enquired of The NC Department of Insurance as to why my BCBSNC Advantage (!!!!) plan benefits indicated that my mental health benefits were to be paid at 50% reimbursement instead of what I had believed was state law re: mental health parity. I was wrong; mental health parity laws in NC (and I betcha! federally), do not cover families who buy their own expensive health insurance.

There are more than 2.5 million people in NC who have the same kind of insurance that I have.

Because I have an individual plan (my family of three), I do not get this benefit. So, my family pays $750/ month for three healthy individuals and I do not get:

screening colonoscopies
diminished mental health benefits

But I got free medications yesterday!----which would have cost me about $40 out of pocket!

I'm gonna go ask BCBSNC if they can create a group policy for three people, as suggested by the Department of Insurance. I'm sure that will be no problem at all.

I'm gonna do that today and heck, I'll just suggest to my impoverished patients on Medicaid and letem know that all they need is a different frame around their reference points. Why, you could go get a full-time job! Who needs a disability check? Here: I've got the newspaper and we can look thru the want-adds just for fun.......

Or maybe that psychiatrist in the School of Medicine over in Chapel Hill who advocated in his opinion piece that gee, let's just all get some good mental health this year----that should be our goal this year----to which I responded: ahem: one of the matters usually associated w/ mental health is having a job. If people who receive SSI checks cannot work more than about $200/ month or less without wrecking their checks and their lives----and if no one is hiring part-time and if you can't get to health insurance if you are part-time.....

Aw, forget it. Just get a new frame; just go create that group policy for three people in a family.

January 27, 2009

Dr. Marsha Hammond
RE: File Number. 2009-01-01501
Mental Health Parity NCGS § 58-3-220

Dear Dr. Hammond:

Your correspondence to Representative Verla Insko has been forwarded to the North Carolina Department of Insurance since your inquiry pertains to insurance laws regulated by this department.
The legislation regarding the Mental illness benefits coverage can be found in North Carolina General Statute 58-3-220. I have enclosed a copy of this statute for your review.
Review of the information provided indicates that the coverage in question is the Blue Advantage Plan issued by Blue Cross and Blue Shield of North Carolina. The Blue Advantage plan is the individual plan that Blue Cross issues, and therefore does not fall under the attached statute regarding mental health benefits, as the statute only pertains to group coverage. Mental health coverage for the Blue Advantage Plan is as stated in the policy contract. Group plans can range from 1-49 for small employers and 50 and up for large employers. No matter the size of the group, the mental health benefit requirement for group coverage remains the same.
We hope you win understand that our legal authority in such matters is limited to ensuring the company complies with the terms and provisions of its policy contracts and complies with relevant insurance laws and regulations.
I regret our efforts did not produce a more satisfactory resolution for you. If you have any questions or if we can assist you on any future insurance related matters, please contact us.

Nichole Faulkner, PCS,AIRC,ALHC,FLHC (sure a long list of expertise; what in the world do those stand for? I have no idea)
Insurance Specialist 919 807 6774


§ 58-3-220. Mental illness benefits coverage. _
(a) Mental Health Equity Requirement. - Except as provided in subsection (b), an insurer shall provide in each group health benefit plan, for the necessary care and treatment of mental illnesses that are no less favorable than benefits for physical illness generally, including application of the same limits……

Saturday, January 10, 2009

BCBSNC states it will pay for 80% AFTER DEDUCTIBLE for Medical Benefits & 50% AFTER DEDUCTIBLE for mental health benefits

What a joke all the insurance matters have become. Any possible way that the public can be
duped is utilized.

I just received my BCBSNC Summary of Benefits. My family of three has a modest insurance policy. For $750/ month, and a $2500 deductible, we get access to medications for a $15-50 copay; we get office visits for a reasonable fee (under $20). If we have to have surgery, mammograms, colonoscopies (covered by law! ya know), you have to meet the $2500 deductible before you can get reimbursement at 80%-----

all except mental health and substance abuse services.

My Summary of Benefits states:


"Combined in and out of network $2000 benefit period maximum per member, and combined in- and out- of network lifetime maximum of $10,000 per member, provided in all places of service. Any services in excess of this benefit period maximum or lifetime maximum are not covered services."

Covered: 50% AFTER DEDUCTIBLE In Network

Covered: 50% AFTER DEDUCTIBLE Out of Network.


Summary of Benefits:

Outpatient Services: 80% AFTER DEDUCTIBLE
Ambulatory Surgical Center: 80% AFTER DEDUCTIBLE
Inpatient Hospital Services: 80% AFTER DEDUCTIBLE
Maternity and Elective Termination of Pregnancy: 80% AFTER DEDUCTIBLE
Skilled Nursing Facility: 80% AFTER DEDUCTIBLE
Other Services: 80% AFTER DEDUCTIBLE

I dunno: print is pretty black and white. Why do my medical benefits get more extensive coverage (no $10,000 cap) versus what mental health coverage gets and why are services reimbursed at a rate DIFFERENT than the medical benefits when the state law indicates the following:


"New mental-health law to start
Insurance industry must offer equal coverage

Starting today, insurance companies in North Carolina must provide the same level of coverage for some mental illnesses that they do for physical ailments.
That means that someone being treated for depression or schizophrenia can no longer be charged a higher co-payment (or face other inequities in coverage) than someone being treated for diabetes or a broken arm...."


Really? I can't believe they get away with these kind of things.

Think you can get the Department of Insurance interested in these things? NAH.

Think you can get your state legislator interested in what impacts their constituents? NAH.

Been there/ done that. Shame 'em is what I have to aim for.