I've changed my mind about Regence BlueCross of Oregon. And not for the better. In a previous post I called Regence "heartless," after seriously considering the adjective "evil."
After enduring two more months of bureaucratic bullshit from Regence concerning my wife's dry eye problem, I've decided that stronger words are needed to describe how this company screws over longtime individual policy-holders like us.
As described before, we were forced by Regence BlueCross of Oregon to switch to new policies as of July 1, 2010. These "Evolve" plans actually were a devolution: for the same premium, we got substantially fewer benefits -- so Regence hid a large price increase by making Blue Selections policy holders switch to the crappier Evolve plans.
Laurel, my wife, was able to change from a low-end Blue Selections plan to the top-of-the-line Evolve plan after some arguing with Regence.
Restasis, a prescription drug for dry eyes, always had been covered by Regence under Laurel's basic Blue Selections plan. There was no indication on the Evolve plan application materials that Regence had changed its formulary. And Laurel figured that since she was being switched to a higher-end plan, the drug benefits would be better or the same, not worse.
Wrong. Because Regence is both heartless and evil.
The company seems to be dedicated to providing the least possible health care to its policyholders, so it can keep paying inflated salaries to its executives and continue funding all those employees whose sole purpose is denying claims for needed services.
Such as Restasis.
Laurel has gone through several levels of Regence appeals. She keeps being told that Restasis isn't a covered prescription because it isn't in the formulary. When she asks why it no longer is in the Regence formulary, there's no answer. It just isn't.
Today we got a letter from Regence that said:
Our Pharmacy and Therapeutics committee has determined Restasis is non-preferred (non-formulary) medication because there is no reliable evidence to conclude that Restasis provides any clinical advantages or is safer than other alternative treatment options.
That's a lie.
My wife has researched dry eye treatment options extensively. She's been advised to take Restasis by a opthalmologist at the Oregon Health Sciences University who is a leading dry eye expert. There is no generic alternative to Restasis. Other steroid eye drops have significantly greater risks, as does tear duct blocking surgery, while over the counter don't work very well.
Here's what one eye clinic says about Restasis:
Restasis is the only prescription eye drop proven to help increase natural tear production. Restasis works by decreasing inflammation in the lacrimal glands of the lids. The lacrimal gland is primarily responsible for most of the eye's natural tear production.
Since this is one of the most effective and successful dry eye therapies, we use it as one of the first line weapons in the fight against dry eye. We also prefer Restasis because it has been proven to be safe for long term use, and it increases the bodies [sic] natural tear production instead of relying on artificial formulations.
Yet somehow Regence BlueCross of Oregon, which covered Restasis for years under Laurel's Blue Selections Plan, suddenly discovered that this safe and effective treatment for dry eye didn't provide "any clinical advantages" at the very same time Regence forced its individual policy holders to switch to an Evolve plan that offered worse benefits at the same or higher cost.
Also, Regence still has Restasis in its Medicare formulary. So Regence considers it to be a fine drug for use by people sixty-five or older, but not for those, like Laurel, in their early 60's.
Equally irritating is this fact: Regence pays 50% of the cost of Restasis for those Evolve Plan members with a $1,000 deductible, but 0% for those (like Laurel) who have a $2,500 deductible. On Laurel's previous Blue Selections plan, Regence also paid 50% of the cost of her Restasis.
So even though Regence told us it has concluded that Restasis doesn't provide "any clinical advantages or is safer than other alternative treatment options," this evil/heartless insurance company will pay for it if you have a $1,000 deductible, but not if you have a $2,500 deductible.
Regence needs to contribute to dry eye treatment research by publishing a paper which describes how patients with a $1,000 deductible benefit from Restasis, while those with a $2,500 deductible don't.
Of course, they can't do that. Regence is denying payment for Laurel's Restasis so it can make more money, not for any clinical reason.
That's evil. As well as heartless.