Regarding the title of this post: at first I had "evil" instead of "heartless," but I thought that sounded too metaphysical.
And Regence BlueCross of Oregon is definitely part of the material world -- unfortunately, a part that no longer cares about people, which isn't the way a health insurance company should operate.
Here's two examples of Regence's heartlessness, one personal and one general that many Oregonians read about in a headline on the front page of The Oregonian today.
I'll start with my wife's experience in dealing with Regence about the dropping of coverage for a prescription drug, Restasis, she needs for a dry eye problem. Regence has paid for Restasis for over three years.
This spring Regence forced all of its individual plan subscribers, including us, to switch to new Evolve plans. As I noted in previous posts (here and here), the plans actually were a devolution, not an evolution, as they reduced benefits while keeping premiums about the same -- which amounts to a cost increase.
Laurel was able to switch to the top-end Evolve plan after we found a way to get around some pre-existing condition bullshit. She assumed that the prescriptions Regence had been paying for on her low-end Blue Selections plan would be covered by the top-of-the-line Evolve plan.
It didn't take long for us to discover that now we were paying our pharmacy several hundred dollars a month out of pocket for Restasis because Regence was rejecting the claim.
Looking into this, Laurel had some frustrating conversations with Regence employees. They said, "Restasis isn't in our formulary, so we can't pay for it." Laurel explained that they aren't any generic versions of Restasis, and the only alternative for her is tear duct surgery, which naturally she isn't wild about.
Tough luck, said Regence.
Laurel didn't give up. She appealed the decision, supplying a letter from her eye doctor saying that Restasis was medically necessary. Yesterday we learned that Regence still is staying with "tough luck."
We have reviewed all documentation you provided, including any documentation you or your provider's office previously submitted. As a result of the review, we concluded that we must uphold your plan benefit regarding brand name medications not listed on the formulary. According to your plan, brand name prescription medications not listed on the formulary are specifically excluded from your health care plan. No benefits will be provided for this service.
Heartless, bureaucratic, unreasonable. That's today's Regence Blue Cross of Oregon, whose motto seems to be "dedicated to denying needed health care to people whenever possible."
There's no non-brand name medication that acts like Restasis. The Restasis patent expires in 2019. So I guess Regence patients with dry eyes who need Restasis are supposed to suffer for nine more years, by which time, I can only hope, we'll have a national health plan like Canada and most of Europe does.
We're going to continue to appeal Regence's ridiculous denial of benefits.
No medical reason was given, just circular double-talk: your health plan says that only drugs listed in the formulary are covered; the drug you need isn't in the formulary; so we've decided that the plan we wrote won't cover a necessary prescription because this drug isn't in the formulary that we wrote.
Here's the other example of Regence's evil (oops) heartless nature, the Oregonian story: "Regence drops child-only coverage."
Starting Thursday, the federal health reform law stipulates that insurance companies can no longer deny coverage to children because they are sick. But parents hoping to buy insurance for kids received a jolting message this week from Regence BlueCross BlueShield, Oregon's largest health insurer: "Regence is no longer accepting applications for individual coverage from applicants under 19 years of age."
Bastards. That word popped into my head when I read the story, and it's still in my psyche now.
I worked in health planning at the state level in Oregon for about fifteen years in the 70's and 80's. I got frustrated when health care problems looked like they were intractable. The reform efforts passed by Congress this year started to restore my faith that the United States is headed in the right direction, health-wise.
Today the New York Times affirmed my guarded optimism, giving the new health care law an overall grade of "B." But health insurance companies got a sub-grade of "D," saying "they have been dragged kicking and screaming at every step."
That's because Regence Blue Cross of Oregon, along with most other private insurors, isn't committed to providing health care. They're committed to making money. So when given a choice between doing what's right for their subscribers, and lessening their profit margin a bit, they choose self-interest over the public interest.
Why else would Regence stop issuing individual health insurance policies for children? Now an Oregon child whose parents can't afford insurance and is diagnosed with cancer is out of luck if the parents turn to Regence -- and the parents are going to be stuck with a huge bill, assuming they can find health care providers willing to take the child on.
I'd be happy to pay a bit more for my Regence policy if I knew that those dollars (or maybe even just cents) were making it possible for Oregon children to get necessary medical care, as the national health care reform bill specified.
But Regence has decided that children can be thrown under the medical care rug when they get sick, through no fault of their own, obviously. Nor, almost always, because their parents chose to go without insurance that they could afford.
How many parents think, "I'd rather have a big screen TV than make sure that my child can get needed health care?" Very few. Yet this is what Regence seems to be assuming, because the insuror's fear is that families will sign children up for insurance only when the kid has a serious illness.
Well, duh...that's when a child needs medical insurance, when he or she requires expensive care. Regence of Oregon is indeed heartless. It prefers to set children adrift on the uninsured health care ocean so it can pad its profits.
This disgusting display of health insurance company greed does have one slight bright side: it points out the absurdity of the Republican goal to repeal the requirement that every American needs to have health insurance -- because the Republican leadership wants to keep the ban on denying insurance because of pre-existing conditions.
You can't have one without the other, children being a current (and probably temporary) exception on compassionate grounds.
Many adults almost certainly would take advantage of an ability to buy insurance only after they become seriously sick, which would interfere with the basic purpose of health insurance: spreading risks as widely as possible among both the healthy and the ill.
So in general, Regence is correct in arguing that people shouldn't be able to buy health insurance on demand irrespective of what sorts of pre-existing conditions they have. This is why it's so important that everybody in the United States has insurance, since there's a general consensus that it's unfair to deny coverage to people who need medical care the most -- those who have medical problems.
However, individual policies for children account for only a very small percentage of Regence's business. And plenty of other health insurance companies are continuing to insure children with pre-existing conditions.
Thus the conclusion remains: Regence BlueCross BlueShield of Oregon is heartless. For more reasons why, I'll append an email on this subject that came today from OSPIRG, the Oregon Student Public Interest Research group.
Contact: Laura Etherton, OSPIRG, cell: 503-807-6409, office: 503-231-4181 x305, firstname.lastname@example.org
REGENCE WALKS AWAY FROM CHILDREN-ONLY COVERAGE
Statement of Laura Etherton, OSPIRG Health Care Advocate
Some big insurance companies around the country, including Regence here in Oregon, have announced that they are going to stop offering any more child-only policies. They blame that decision on one of the most popular new health protections going into effect today: the one that bans them from denying coverage to children with pre-existing conditions.
It's outrageous. These insurers have been making money insuring just the healthy children in these plans for years, and now that they need to cover sick kids too, they're taking their ball and going home.
Let’s be clear. This says a lot more about these particular insurance companies than it says about the new health care law. After all, plenty of other insurance companies are gladly picking up the business Regence and others appear willing to turn their backs on. We applaud Providence, Kaiser Permanente, ODS and others here in Oregon for offering plans to children and refusing to deny coverage to sick kids.
Regence and other insurers running from children’s coverage claim that will increase costs dramatically. But that just doesn’t pencil out. The U.S. Department of Health and Human Services has estimated the impact on insurers' costs to be 1% or less for the provision ending pre-existing condition denials.1 That’s peanuts compared with the double-digit rate increases insurers have been dishing out every year to consumers over the last decade.
If these companies say they can’t compete without denying health care for sick children, it raises the question: how sound is their business model? Is it based on cherry-picking customers? How do they hope to compete when, in 2014, insurers won’t be able to deny coverage to anyone?
Whatever the reason, it’s good news that families who want to sign their children up for coverage have options. They can turn to insurance companies that are happy to have their business, and in Oregon, they also have the option of signing up through the Healthy Kids program.
Looking at the full picture of all the protections that go into effect today – from the end of pre-existing condition denials for kids, to families being able to keep their kids on the family plan until age 26, to the end of insurance companies rescinding coverage once you get sick – health reform is off to a pretty good start. Some insurance companies are just going kick and scream a little on the way.
 HHS estimate available in a published federal regulation available at http://edocket.access.gpo.gov/2010/2010-15278.htm
OSPIRG is a non-profit, non-partisan consumer protection organization in Oregon. Visit us at www.ospirg.org