Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC email@example.com
NC Mental Health Reform blogspot: http://madame-defarge.blogspot.com/
Scrutinizing BCBSNC blogspot: http://madamedefarge2scutinizingbcbsnc.blogspot.com
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.