Blue Shield Cares -- About What?

Blue Shield Cares -- About What?
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"Doesn't it suck that even when you have health insurance, you can't afford to see the doctors you really trust?"

--Favrile, Sherman

Oaks CA hairdresser, January 19, 2010

My hairdresser Favrile and the salon where she works are my reality gauge. If Fav's talking about something, so are lots of other people.

She hadn't seen my HuffPo post in December that disparaged Blue Shield's all too frequent bureaucratic thumbs-in-the-eye behavior toward members; and that advocated for Single Payer health insurance (One public insurance agency would make all healthcare-related payments. It would not run or manage actual healthcare -- and we must be vigilant to guarantee that).

Fav's question was the third nudge the universe sent to tell me this story was still kicking. The first sign was the 44 comments my post got, including articulate blog-worthy health insurance horror stories and a dark-mood-comic-relief bit.

Next came a voice mail from Blue Shield rep Tiffany, who coordinates the Special Services Team. After listening a few times to be sure I'd heard correctly, I realized that this giant corporation cares about The Huffington Post (in this case, me. Whoa, How'd they get my number? Oh right, I'm a member.)

When we talked, Tiffany extended Blue Shield's apologies for the half-hour I spent on hold waiting to speak with a supervisor after the first person was, if anything, anti-helpful. "We are investigating," she assured me.

What followed was a surprisingly cordial discussion. She explained the labyrinthine health insurance payment process for people "on COBRA," the acronym for a law Congress passed in 1985 that lets people who've been laid off or fired, stay on their former company's insurance plan. COBRA also applies when a non-employee's link to that insurance -- in my case, a spouse -- becomes an ex-spouse.

Tiffany and Blue Shield are strong supporters of universal healthcare (not Single Payer) -- they think everyone's entitled to health insurance. They agree that people should not be excluded for pre-existing conditions. Blue Shield's CEO came out in favor of the concept in 2002.

Regarding Single Payer, Tiffany said, "I can see pros and cons." At that point I knew this was going too smoothly and remembered to say, "My primary complaint is that I pay more than $700 a month, but most of my doctors have quit Blue Shield. So my healthcare payments are ridiculous."

Replied Tiffany, "We have had questions about the amounts and timeliness of payments" to practitioners. And, even though Blue Shield partially covers its employees' premiums, "we're seeing increases ourselves. We're hoping that universal healthcare will contain costs. We won't know 'till the legislation passes (this was early January)."

She asked if I'd considered an individual plan. "Pre-existing conditions," I answered.

"There's definitely room for improvement," she responded. "That's why I reached out to you. Health is a very personal issue. If Customer Service is not providing a level of care, people are welcomed to contact us." (first step: http:// She agreed to speak with me again if I had more questions.

Afterward I realized that lousy customer service wasn't the issue. Sure, it's unpleasant waiting on hold for any length of time (though new rules may improve that), considering how much we pay for health insurance.

My criticism of Blue Shield (substitute Blue Cross or Aetna or...) is that the medical experts who know and have treated me for many years, got disgusted and finally left. My HMO doc gives me normal prescriptions and orders routine lab tests. But often, normal isn't enough.

For comprehensive treatment that works, I see doctors I trust. The result is huge bills, even though my policy supposedly pays something for this Point of Service (what does that mean?) care.

And I know I'm fortunate. The number of under- and uninsured Americans (now, even the upper Middle Class) has been rising by multiples.;;

I called Tiffany again, with these questions:

What specific universal healthcare policy does she and Blue Shield support? What does she consider the major pros and cons of Single Payer? How is Blue Shield solving my problem -- I pay exorbitant premiums which don't cover the fees of most medical professionals who help me?

I reached her the next day. When she heard my questions, she asked me to email them so she could answer carefully. I did. The week went by. No reply.

I emailed again to say that I couldn't wait any longer to write my follow-up blog. She responded the next day with an apology, and sent a link which, "should give you a lot of the background information that you're looking for." And she offered to "be of any further assistance."

She has been of assistance. Now I -- and you -- know that Big Insurance knows the problems. And that it will not -- it cannot -- fix them. We have to do that. If somebody knows an effective solution -- other than Single Payer-- which will allow every person to get affordable quality healthcare, tell the rest of us. Including Congress and the President.

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