Blue Cross Blue Shield

Health care debate is a popular discussion lately.  I don’t think anyone has a realistic idea of how it affects their customers though.  I have been covered by some sort of Employee-sponsored health insurance plan since I was eighteen.  What that means to me is as follows.  I have agreed to allow my (or husband’s) employer to deduct a premium from my earned wages.  In exchange, I show the appropriate membership “club card” to my provider.  I do so as I’m writing a check for my copay at the time of my visit.  Now, because I don’t know any better, my bill will be processed incorrectly because I have neglected to pre-approve my visit with my insurance company.  That is because mental health services are “special” and are carved out of a regular health plan and handled by a different (yet branded similarly and in the same building as) entity.  These bills get special treatment, if only that treatment were meant to result in better care.  So, my doctor has submitted a claim on my behalf for the highest tier office visit.  It doesn’t mean I’ve had any additional attention given to my diagnoses.  In fact, my doctor’s office is usually a crowded place.  That’s what happens when you give free health care to non-working people; naturally they have the liberty and opportunity to see our provider whenever as often as they please.  I am limited by the time my employer allows me to take off work, availability in the schedule, and household funds available to pay for the visit.

I am now required to be seen every twelve months.  If not, my provider will not approve my refill request from the pharmacy, and I get to spend a few days feeling like my brain is holding me hostage – but that’s a whole other issue.  This requirement to be seen is not because it is recommended by the American Medical Association to improve my treatment outcomes.  It is mandated by Medicare and having worked in healthcare, I promise you, it is only a concern so far as coordinating the IT department with nursing and billing staff to create a check box somewhere so they can show Medicare how much they care.  For mental health purposes, it requires the completion of a form (by me) allowing my provider to assess my state of being.  You may ask why I don’t just anticipate this and make an appointment ahead of time.  Well, if it works out better for the doctors’ office, they’ll require me to come in at 9 months or eighteen months or not at all for three years.  And if I can’t just drop everything and drive back to my home state (with 3 days’ notice for a 6-month review), well then we are just going to have to request that you transfer your care elsewhere.  I think it’s shameful that a health care provider chooses to make difficult a process for treatment for a mental health disorder.  These difficulties may be minor annoyances to most people.  But to someone with F33.2 Major Depressive Disorder, recurrent severe without psychotic features, it is a huge burden.

So now the latest development, after two years at my present dosage BCBS has decided not to pay for my medication.  I take 300 mg of venlafaxine (generic Effexor XR) 2 – 150 mg capsules daily.  I can only assume at this point that they have a problem with my consumption of 60 extended release pills in thirty days.  It should also be noted that it doesn’t matter that my provider has prescribed the medication; if my insurance company denies it, the pharmacy is not allowed to dispense it.  So I will spend the night ruminating over and tomorrow morning procrastinating before finally calling the insurance company and beginning the process to prove to them that I am worthy of their mercy.  This time.

(written in 2015, when I still had insurance)


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