Sunday, July 1, 2012

"Blue Cross Rejected My Application for Insurance"

     A friend called today to voice that complaint.  But I hear it all the time.  I, too, was "rejected" by Blue Cross when I applied for health insurance.
     "What's going on?" the friend fumed.  "I'm in excellent health.  I just had a physical, a stress test, and lab work.  I don't smoke and I exercise regularly."
     Maybe it's the stress test.  The simple fact of having had an EKG or a stress test is enough to kick you out of the computer as a "reject" by health insurance carriers.  It doesn't matter whether the test was positive or negative.  If your doctor ordered an EKG or stress test it's likely to spook the insurance company.
     Or maybe it's my friend's age:  most cancers and heart attacks occur in the fifties.  These are expensive years, statistically speaking.  Insurance companies will use the flimsiest pretext for not covering a fifty-something.  In so doing,  they invite applicants to lie.
     The most insurable individual is one who has either never been to a physician, or who went to one and had practically nothing done.  Obtaining and reading medical records is too costly for the screening  process, so intake agents who take down information about an applicant rely solely on the telephone interview.  If the applicant answers questions with complete candor he is unlikely to be issued a policy.
     As a physician with equipment in my office I did a stress test on myself one day, without submitting a charge to anyone, just for the heck of it.  A year later when I applied for health insurance with Blue Cross the nurse at the other end of the line asked whether I'd ever had an EKG or stress test (trick question!)  I told her I had done my own stress test and it was normal.   One week later a different nurse informed me that Blue Cross had refused my application because of the "cardiac problems."
     "What cardiac problems?"
     "The ones that necessitated a stress test," she replied.
     "There weren't any cardiac problems necessitating a stress test," I told her, the pitch of my voice rising.
     "Then why did you have a stress test done?"
     "I didn't have one done.  I did it myself.  I have the equipment in my office."
     "But why did you do it?"
     "I did it because I could."
     "There must have been a symptom."
     "I had no symptoms!"
     I offered to send a hard copy of the stress test, but she said no one at Blue Cross would be able to read it.  I offered to have a cardiologist read it and send an official report.  "That won't make a difference," she informed me.
     She apologized, saying it wasn't her decision. 
     "Whose decision is it?"
     "The computer program makes the determination," she answered coolly.  
     "Who is 'Blue Cross'?" I wanted to know.  "Is it a computer?  Is there a human being making decisions somewhere?"
     "What do you mean?" she asked....
     Sometimes my patients are rejected for health insurance because they've had a chest x-ray, HIV test, or an EKG in my office.  They are angry at me for keeping them from getting health insurance. They want me to write letters to Blue Cross explaining that the tests were normal, and that they, the applicants, aren't high risk.
     I write the requested letters giving whatever information my examination revealed, but the information doesn't make a difference.  Computers don't read letters.

     If you wish to be certain to be approval as an individual for a health insurance policy and you don't drink or smoke, you must meet the following criteria:
          a)  Never have gone to to a doctor
          b)  Never have needed to go to a doctor
          c)  Never have had physical distress of any sort
          d)  Never have had any medical tests
          e)  Be prepared to lie about all of the above.

     According to CBS Chicago, "Blue Cross/Blue Shield  raked in more than $1 Billion in 2010 profits...As profits go up, the company continues to reward top executives...The CEO was paid $8 million last year." 
     Andy Cobbs, former advertising spokesman for Blue Cross, left the company because he was disgusted with what it was hiding, and has since commented, "Private health insurance is the worst product in American history."


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