Madame Defarge II : Scrutinizing BCBSNC

2011-11-18T17:19:00.001-08:00

Supreme Court to Review State Officials' Refusing to Provide Records When Someone Dies in State Mental Hospital Facilities: Remember Steven Sabock

2010-06-22T06:49:00.000-07:00

Where's Bob Dylan when we need him. Remember Steven Sabock:

Steven Sabock

Steven Sabock, age 50 and not a happy man,
sat in his chair unfed for 22 hours at Cherry Hospital in Goldsboro, North Carolina,
choked on his medicationand died.
A few feet awaythe staff watched TV and played cards.
It was not reported what programs they watched
or who won at cards,but maybe that was not important,and neither was Mr. Sabock.

Tom Greening, PhD

see earlier Defarge:
http://madame-defarge.blogspot.com/2008/08/steven-sabock-unimportant-man-who-died.html
_______________________________________________________________
http://www.wbtv.com/global/story.asp?s=12681923

"...High court to review mental health advocacy suit

Posted: Jun 21, 2010 10:10 AM EDTUpdated: Jun 21, 2010 10:30 AM EDT

WASHINGTON (AP) - The Supreme Court says it will decide whether Virginia's advocate for the mentally ill can force state officials to provide records relating to deaths and injuries at state mental health facilities.

The justices agreed Monday to review a federal appeals court ruling dismissing the state advocate's lawsuit against Virginia's mental health commissioner and two other officials.

Backing the appeal, the Obama administration said the ruling by the 4th U.S. Circuit Court of Appeals in Richmond "threatens to undermine the enforcement of federal laws that Congress designed to protect especially vulnerable individuals from the abusive and neglectful practices that can result in injury and death."

The Virginia advocate's office, like those in the other 49 states, was created under two federal laws that give states federal money for monitoring the treatment of the mentally ill in state facilities. The first law grew out of public reports in the 1970s of crowded, filthy conditions and abusive treatment of mentally retarded children at the Willowbrook State School in New York.

The issue for the court is whether the Eleventh Amendment prohibits a state agency from going to federal court to sue officials of the same state. The state itself could not be sued in the same circumstances...."
_________________________________________________________________
Bob Dylan writing about a man unjustly charged w/ murdering someone (while the evidence was undoubtedly shuffled under a bigger pile, where it would be hidden):

"All of Rubin's cards were marked in advance
The trial was a pig-circus, he never had a chance.
The judge made Rubin's witnesses drunkards from the slums
To the white folks who watched he was a revolutionary bum
And to the black folks he was just a crazy nigger.
No one doubted that he pulled the trigger.
And though they could not produce the gun,
The D.A. said he was the one who did the deed
And the all-white jury agreed."

http://www.chasingthefrog.com/reelfaces/thehurricane_lyrics.php

Younger People Blamed for Making Private Insurance Market Prices Soar by Industry's Trade Group

2010-06-22T06:38:00.000-07:00

Sorry, Mr. Robert Zierkelbach, you have no evidence that younger people are dropping their health insurance leaving the older beached, whales to be washed up on shore.

This simply looks like a good time to drag out that excuse so that the industry can continue to make its massive profits prior to 2014 when pre-existing conditions will no longer be admissable evidence for denial of insurance.

Business
Costs soar for individual health coverage
Insurance premiums increase average of 20%, Kaiser Family Foundation report says
By Guy Boulton of the Journal Sentinel
Posted: June 22, 2010 (57) Comments

http://www.jsonline.com/business/96854979.html

".....The market for individual insurance has long been considered the most problematic in the industry, and it is the target of many of the most sweeping health care reforms recently enacted by Congress....

"Many people see the individual market as the most broken part of the insurance market," Drew Altman, president and chief executive of the Kaiser Family Foundation, said in a teleconference....

America's Health Insurance Plans, the industry's trade group, tracks premiums in the individual market and does not have information on how the recent increases compare with those of past years.

But Robert Zirkelbach, a spokesman for association, said the premium increases stem from higher medical costs and from younger and healthier people dropping their health insurance during the economic downturn.

People who are young and healthy basically subsidize the cost of health insurance for people who are older and sicker.

But Kaiser's Altman noted that there is not good data on whether younger and healthier people have actually dropped their coverage or on what is behind the sharp increases in premiums in the individual market....."

NM BCBS Raises Rates on Consumers One Hour Before Public Meeting: 24% HIKE in Rates

2010-04-27T12:05:00.000-07:00

NM Blue Cross Hikes Premiums Before Public HearingPosted:

April 27, 2010SANTA FE, N.M. --

Blue Cross and Blue Shield and the New Mexico insurance superintendent have signed off on a rate hike on insurance premiums, less than an hour before a state Public Regulation Commission hearing to hear opposition to the plan.Public Regulation Commissioner Jason Marks calls Monday's agreement a back room deal announced before the public had a chance to comment.

The hearing was called after a 24 percent increase in Blue Cross and Blue Shield premiums in December.

The revised rates allow the company to raise premiums by an average of 21 percent.A spokeswoman says that will affect 40,000 New Mexico customers.Read more: http://www.kfoxtv.com/news/23279227/detail.html

NC 2010-2011: $500 MILLION Unanticipated Medicaid Growth: We Don't Need No Stinkin' Public Option

2010-04-26T03:04:00.000-07:00

Amazing figures in the just published NC Justice Center, BTC Reports, Volume 16 No1 April 2010.

Naw: we don't need no Public Option when it comes to health insurance for $500,000,000 'unanticipated budget pressure' as associated with people going onto the Medicaid roster is surely no indication that people have health insurance that they can afford (or even obtain).

page 7 : http://www.ncjustice.org/?q=node/474

Projected FY 2010-11 General Fund Budget Gap

Anticipated Budget Pressures

Unanticipated Medicaid growth $500,000,000
Unanticipated Community College Enrollment growth $85,000,000

_________________________________________________________
Also, as associated w/ Community Suport Services (Mental Health: NC DHHS) in NC, they had this to say:

".....Cuts to programs that fall under the Health and Human Services (HHS) portion of the budget have also impacted individuals and communities. The deepest outright cuts to HHS programs were to community support services for people with mental illness and substance abuse issues and to personal care services that help individuals with medical conditions to remain in their homes and out of institutional settings. The mental health association of North Carolina estimates that 10,000 to 15,000 individuals currently need community support services but are unable to access them to due to funding constraints. ..."
________________________________________________________
The Treasure of the Sierra Madre (film)
http://en.wikipedia.org/wiki/The_Treasure_of_the_Sierra_Madre_(film)

"....The bandits then reappear, pretending, very crudely, to be Federales, which leads to the now-iconic line about not needing to show any "stinking badges". After a gunfight, and the fourth American is killed, a real troop of Federales appear and drive the bandits away.,,,"

Top 5 Insurance Companies increase profits by 56% over 2008: We don't need no stinkin' public option

2010-02-17T16:34:00.000-08:00

NAH: we don't need no stinkin' public option. I lost my BCBSNC insurance when the family premium hit $1000/ month for 3 healthy members. I just can't pay that kind of money out.

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Friday, February 12, 2010 - Top insurers reap billions as health costs soar

By Noam N. Levey

http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document_id=2011050573&zsection_id=2003905675&slug

Tribune Washington Bureau

WASHINGTON As the nation struggled last year with rising health-care costs and a recession, the five largest health-insurance companies racked up combined profits of $12.2 billion, up 56 percent over 2008, according to a new report.

Based on company financial reports for 2009 filed with the Securities and Exchange Commission, the report said insurers WellPoint, UnitedHealth Group, Cigna, Aetna and Humana covered 2.7 million fewer people than they did the previous year.

The report also said three of the five insurers cut the proportion of premiums they spent on customers' medical care, committing relatively more to salaries, administrative expenses and profits......

Industry analyst Sheryl Skolnick, a senior vice president at CRT Capital Group, said many of the insurance companies likely would benefit from more customers.

But they are driven to increase prices for their products to satisfy investors, which in turn drives away more and more customers.

"It is a terrible thing to run your business for Wall Street," Skolnick said. "It creates very bad incentives, and it ultimately prevents you from doing the thing that is in the best long-term interest of your business. ... There is no way that as long as these businesses are publicly traded, they can have the best interest of their customers at heart."

Federal Mental Health Parity Act Proposed by Obama Administration: (remember how BCBSNC got around parity in 2009)

2010-02-17T15:59:00.001-08:00

People who think the Obama administration is 'doing nothing' are not paying attention. He could beat on his chest and create some fan-fare but all this will create is more tea-bagging. Comments are due by May 3, 2010.

Here are my comments:

"As a doctoral level psychologist whom treats people w/ Severe Persistent Mental Illnesses, the passage of federal mental health parity is an absolute necessity.

In North Carolina, in 2009, for instance, BCBSNC was allowed to OPT OUT of mental health parity by the NC State Legislature due to their undue influence on the NC STate Legislature. BCBSNC is the largest private insurer in the state of NC. BCBSNC is supposedly monitored by the NC State Legislature.

Thus, very obviously, until there is PARITY in terms of Utilization Review and what the insurance company can DO versus what they SAY----- little to no progress will be made as regarding mental health parity. Undue influence will continue to trump any efforts to obtain mental health parity.

Marsha V. Hammond, PhD: Clinical Health PsychologyNC Licensed Psychologist"
**********************************************************************Federal Mental Health Parity Act proposed. Comments can be stated here: http://www.regulations.gov/search/Regs/home.html#searchResults?Ne=11+8+8053+8098+8074+8066+8084+1&Ntt=CMS-4140-IFC&Ntk=All&Ntx=mode+matchall&N=8099+8061+8056+8057+8058

3 results for keyword "CMS-4140-IFC" Records Per Page: View By Relevance View By Docket Folder Title Document Type Agency ID Posted Date Actions Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Comments Due 05/03/10 11:59

PM ET RULES EBSA EBSA-2009-0010-0409 02/02/10 Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Comments Due 05/03/10 11:59 PM ET RULES

IRS IRS-2009-0008-0120 02/02/10 Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Comments Due 05/03/10 11:59 PM ET RULES CMS CMS-2009-
0040-0048 02/02/10

"Today the Departments of Health and Human Services, Labor and the> Treasury today jointly issued the following news release:>> Date: 1/29/2010> Media Contact: HHS: (202) 690-6145> Telephone: 240-276-2130>> OBAMA ADMINISTRATION ISSUES RULES REQUIRING PARITY IN TREATMENT OF> MENTAL, SUBSTANCE USE DISORDERS> Paul Wellstone, Pete Domenici Parity Act Prohibits Discrimination>> The Departments of Health and Human Services, Labor and the Treasury> today jointly issued new rules providing parity for consumers enrolled> in group health plans who need treatment for mental health or substance> use disorders.>> "The rules we are issuing today will, for the first time, help assure> that those diagnosed with these debilitating and sometimes life-> threatening disorders will not suffer needless or arbitrary limits on> their care," said Secretary Sebelius.>> "I applaud the long-standing and bipartisan effort that made these> important new protections possible.">> "Today's rules will bring needed relief to families faced with meeting> the cost of obtaining mental health and substance abuse services," said> U.S. Secretary of Labor Hilda L. Solis.>> "The benefits will give these Americans access to greatly needed medical> treatment, which will better allow them to participate fully in society.> That's not just sound policy, it's the right thing to do.">> "Workers covered by group health plans who need mental health and> substance abuse care deserve fair treatment," said Deputy Treasury> Secretary Neal Wolin.>> "These rules expand on existing protections to ensure that people don't> face unnecessary barriers to the treatment they need.">> The new rules prohibit group health insurance plans--typically offered by> employers--from restricting access to care by limiting benefits and> requiring higher patient costs than those that apply to general medical> or surgical benefits.>> The rules implement the Paul Wellstone and Pete Domenici Mental Health> Parity and Addiction Equity Act of 2008 (MHPAEA).>> MHPAEA greatly expands on an earlier law, the Mental Health Parity Act> of 1996 which required parity only in aggregate lifetime and annual> dollar limits between the categories of benefits and did not extend to> substance use disorder benefits.>> The new law requires that any group health plan that includes mental> health and substance use disorder benefits along with standard medical> and surgical coverage must treat them equally in terms of out-of-pocket> costs, benefit limits and practices such as prior authorization and> utilization review.>> These practices must be based on the same level of scientific evidence> used by the insurer for medical and surgical benefits.>> For example, a plan may not apply separate deductibles for treatment> related to mental health or substance use disorders and medical or> surgical benefits--they must be calculated as one limit.>> MHPAEA applies to employers with 50 or more workers whose group health> plan chooses to offer mental health or substance use disorder benefits.>> The new rules are effective for plan years beginning on or after July 1,> 2010.>> The Wellstone-Domenici Act is named for two dominant figures in the> quest for equal treatment of benefits.>> The late Senator Paul Wellstone (D-MN), who was a vocal advocate for> parity throughout his Senate career, sponsored the ultimately successful> full parity act.>> He was joined by former Senator Pete Domenici (R-NM) who first> introduced legislation to require parity in 1992.>> Champions of the legislation also included the bipartisan team of> Representative Patrick Kennedy (D-RI) and former Representative Jim> Ramstad (R-MN).>> The issue of parity dates back over 40 years to President John F.> Kennedy, and was also supported by President Clinton and the late> Senator Edward Kennedy.>> The interim final rules released today were developed based on the> departments' review of more than 400 public comments on how the parity> rule should be written. Comments on the interim final rules are still> being solicited.>> Sections where further comments are being specifically sought include so-> called "non quantitative" treatment limits such as those that pertain to> the scope and duration of covered benefits, how covered drugs are> determined (formularies), and the coverage of step-therapies.>> Comments are also being specifically requested on the regulation's> section on "scope of benefits" or continuum of care.>> Comments on the interim final regulation are due 90 days after the> publication date. Comments may be emailed to the federal rulemaking> portal at: http://www.regulations.gov/ .>> Comments directed to HHS should include the file code CMS-4140-IFC.>> Comments to the Department of Labor should be identified by RIN 1210-> AB30. Comments to the Treasury's Internal Revenue Service should be> identified by REG-120692-09.>> Comments may be sent to any of the three departments and will be shared> with the other departments. Please do not submit duplicates.>> Contacts:>> HHS: 202-690-6145> DOL: 202-693-8666> Treasury: 202-622-2960>

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

2009-11-08T20:01:00.000-08:00

(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:

http://www.stopbcbs.com/

"....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....."

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

2009-10-23T11:44:00.000-07:00

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:

http://pulse.ncpolicywatch.org/2009/10/22/nc-blue-cross-sending-nasty-postcards-opposing-health-reform/

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

2009-10-23T11:38:00.000-07:00

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, nccofc@nccouncilofchurches.org.

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

2009-10-22T08:26:00.000-07:00

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

http://namesofthedead.com/

"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:
http://www.huffingtonpost.com/2009/10/21/grayson-launches-site-to_n_328956.html

"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 namesofthedead.com."

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

2009-10-15T10:58:00.001-07:00

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:

http://www.theurbannews.com/content/view/806/5/

"....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.”
*********************

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

2009-07-07T07:37:00.000-07:00

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 (http://madame-defarge.blogspot.com/); 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: http://oneinfour.wordpress.com/2009/07/06/bittersweet-victory-in-nc /

RALEIGH

"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

http://madame-defarge.blogspot.com/2009/04/no-mental-health-parity-in-nc-bcbsnc.html

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 planhttp://www.ncpolicywatch.com/cms/2009/04/08/the-special-interest-health-plan/Wednesday, 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.
http://www.nytimes.com/2009/07/01/business/01meddebt.html

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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

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

2009-07-05T09:47:00.000-07:00

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.

NYT: http://www.nytimes.com/2009/07/01/business/01meddebt.html

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....."

CDC Health Insurance statistics across the US for 2009

2009-07-02T08:14:00.000-07:00

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: http://www.cdc.gov/nchs/nhis.htm
At: http://www.cdc.gov/nchs/data/nhsr/nhsr017.pdf

Highlights

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.

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

2009-06-30T09:13:00.001-07:00

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 (http://madamedefarge2scutinizingbcbsnc.blogspot.com/) as well as one overviewing NC Mental Health Reform for the past two years (http://madame-defarge.blogspot.com/)

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

2009-06-30T08:18:00.000-07:00

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

http://www.alternet.org/story/140960/

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: http://www.alternet.org/story/140960/

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

2009-06-29T20:08:00.001-07:00

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 -- http://en.wikipedia.org/wiki/Hadassah_Lieberman --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: 00:42http://www.youtube.com/watch?v=j6CP4ieRiV0 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.

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

2009-06-27T09:28:00.000-07:00

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.

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?

2009-05-27T19:51:00.000-07:00

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.

http://www.ncpolicywatch.com/cms/2009/05/22/veering-dangerously-to-the-right/

"...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.

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

2009-05-25T23:29:00.000-07:00

http://www.truthout.org/052509Y#comment-55968

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. ..."

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

2009-05-23T20:11:00.000-07:00

Health scare

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

Published: Fri, May. 22, 2009

http://www.newsobserver.com/opinion/editorials/story/1537457.html

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!

http://www.csoonline.com/article/218297/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'

2009-05-23T00:03:00.000-07:00

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.

http://projects.newsobserver.com/under_the_dome/obamas_informal_adviser_in_raleigh

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...."

YO: MR OBAMA: THAT BA-BA BLEATING IS A SHEEP DRESSED IN WOLF'S CLOTHING.

Marsha V. Hammond, PhD Lic Psychologist, NC

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

2009-05-20T22:29:00.001-07:00

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:

http://voices.washingtonpost.com/health-care-reform/2009/05/by_ceci_connolly_one_week.html?hpid=news-col-blog

"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."

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

2009-05-16T23:11:00.000-07:00

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: http://www.nytimes.com/2009/05/16/opinion/l16health.html

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.

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

2009-04-13T21:26:00.000-07:00

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. "
http://www.medicare.gov/Health/ColonCancer.asp

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. .."
http://www.bcbsnc.com/assets/common/pdfs/Colonoscopy%20Benefit%20Flyer.pdf

If you go to the bcbsnc.com 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. "
http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=896&p_created=1011363202

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

BCBSNC?

Funny how difficult it is to turn up information at the BCBSNC website. : http://www.bcbsnc.com/assets/help/faq/questions-imaging.htm

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.

BCBSNC?

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."
http://www.bcbsnc.com/assets/providers/public/pdfs/Mental_Health_Parity.pdf

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.

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

2009-03-18T11:58:00.000-07:00

"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…"

http://pulse.ncpolicywatch.org/2009/03/17/democracy-nc-releases-report-on-blue-cross-campaign-donations/#comment-32776

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

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': http://www.martnesbitt.com/photo%20truck.jpg

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):

Katie.Cook@bcbsnc.com ken.wright@bcbsnc.com Kathryn.Millican@bcbsnc.com Nell.Boone@bcbsnc.comYou'll

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

http://madamedefarge2scutinizingbcbsnc.blogspot.com
http://madame-defarge.blogspot.com/

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

2009-03-11T13:47:00.000-07:00

Look at this pdf: http://www.ncpolicywatch.com/docs/pdfs/2008SupplementalCompensationExhibit.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.

2009-03-06T11:16:00.001-08:00

This site is a member of WebRing.

To browse visit
Here.

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

2009-03-06T10:45:00.000-08:00

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC hammondmv@netzero.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.

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

2009-03-04T22:28:00.000-08:00

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

http://www.smirkingchimp.com/thread/20563

".....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....."

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

2009-02-25T21:57:00.000-08:00

Well, NOW, we may be getting somewhere.

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

David Byrom, Ph.D., Past President
The National Coalition of Mental Health
Professionals and Consumers, Inc.
http://www.TheNationalCoalition.org

".....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.

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

2009-02-24T12:27:00.000-08:00

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 www.democraticunderground.com (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:

http://www.consumeraffairs.com/news03/health_costs.html

"......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...."

Progressive Pulse video indicates that BCBSNC administrative costs are CONFIDENTIAL

2009-02-14T20:11:00.000-08:00

See this video created by Progressive Pulse, NC:

http://pulse.ncpolicywatch.org/?p=3288#comment-31286

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?

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

2009-02-04T21:59:00.000-08:00

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: Meredith.DuVal@bcbsnc.com TO: hammondmv@netzero.com 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'

SO DOES BCBSNC HAVE TO ADHERE TO ANYTHING ASSOCIATED W/ MENTAL HEALTH PARITY AS GUIDED BY THE NC STATE LEGISLATURE?

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

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...."

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

2009-01-27T11:40:00.000-08:00

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

2009-01-27T10:23:00.000-08:00

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:

mammograms
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……

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

2009-01-10T18:13:00.000-08:00

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:

***********************
http://www2.journalnow.com/content/2008/jul/01/new-mental-health-law-to-start/

"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.

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

2008-12-31T12:00:00.000-08:00

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

2008-12-18T09:50:00.000-08:00

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%

2008-12-16T11:46:00.000-08:00

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

2008-12-13T13:22:00.001-08:00

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

2008-12-12T17:02:00.000-08:00

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

2008-12-10T23:20:00.001-08:00

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'

2008-12-04T23:49:00.001-08:00

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

2008-11-24T16:36:00.000-08:00

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

2008-10-22T21:23:00.000-07:00

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???

2008-10-15T23:11:00.001-07:00

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?

2008-10-13T22:00:00.000-07:00

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

2008-08-01T10:37:00.000-07:00

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

2008-07-20T13:38:00.000-07:00

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'

2008-06-20T12:16:00.000-07:00

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

2008-06-16T11:43:00.000-07:00

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

2008-06-16T11:03:00.000-07:00

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
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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

2008-06-10T22:29:00.000-07:00

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)

2008-05-23T09:33:00.000-07:00

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

2008-05-20T18:55:00.001-07:00

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

2008-05-17T13:19:00.000-07:00

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

2008-05-16T10:27:00.000-07:00

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

2008-05-09T19:16:00.000-07:00

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