This is quite a day.
After a string of highly negative blog posts about what a crappy excuse for a health insurance provider Regence BlueCross Blueshield of Oregon is (see here, here, here, here, here, here, here, here, and here), I've got something good to say about the company.
Today I learned that Regence is going to pay 80% of the cost of the colonoscopy that I had in February, a big jump from the 0% my Regence Evolve Plus plan originally was going to pay.
I complained about this absurdity in "Health insurance companies discourage colon cancer screening."
The procedure went fine. It was even enjoyable, in a drugged-up sense. A flat polyp was found and removed in the first colonoscopy's "bad prep" area. Once again, it turned out to be benign.
This is the good news. The bad news arrived in the mail a few days ago: an "Explanation of Benefits" form from Regence of Oregon regarding my colonoscopy. Total Regence Paid was shown in bold at the top.
The amount: $0.00
Total Member Responsibility to Provider(s) was right next to it. The amount: $805.69
...Perplexed, I phoned Gastroenterology Specialists of Oregon and talked with their insurance company billing person. She told me that because a polyp was removed, Regence considered the entire colonoscopy a "medical procedure," not a preventive screening.
...the billing person told me that every private insurance company she deals with considers that removing a polyp stops a colonoscopy from being a covered preventive service, even though the patient (like me) has no symptoms of colon cancer and the polyp removal is purely preventive, not curative.
Later I got another bill from the physician who did the procedure. That added $938 to my colonoscopy tab, of which Regence again paid nothing (I have a $2,500 deductible).
I was all set to appeal, since preventive services are supposed to be fully covered by Regence's Evolve plans, and I could provide quite a bit of evidence showing that removal of a benign polyp is an integral aspect of a preventive colonoscopy.
When I phoned Regence customer service to get some information needed for an appeal, the person I talked to said "I need to talk with a supervisor" after I asked why Regence didn't pay for my colonoscopy even though the primary diagnosis code was for a screening procedure.
Coming back on the line, she told me that my provider had submitted an adjusted claim and that I'd likely be a lot happier after it was processed.
While we were on vacation the Portland Oregonian ran a story that casts light on Regence's change of heart about paying for colonoscopies where a polyp is found and removed. Browsing through saved papers upon our return, I was encouraged to come across "Colonoscopy coverage creates confusion."
Because near the end of the piece I read:
In addition to Kaiser Permanente and Health Net, Regence BlueCross BlueShield, which has 3 million enrollees in four Northwest states, initially said it charged members the deductible and coinsurance if a colonoscopy found and removed a polyp. But Regence spokeswoman Rachelle Cunningham subsequently said that was a mistake, there should be no cost-sharing charges, and the company was "re-evaluating and re-processing some claims."
She also said patients "might need to take an active role in appealing a claim they felt was processed incorrectly to receive the benefits they are entitled to under the law."
I'd been checking my Regence account online almost every day the past few weeks, figuring that the adjusted claim should be processed soon. This morning I saw that Regence was paying $644.55 for the facility part of the bill, and $750.40 for the physician part.
Leaving me with 20% co-insurance. I'm not going to quibble about that, since a flawed prep and removal of a benign polyp during my colonoscopy two years ago meant that I had a repeat procedure much sooner than if I'd had a normal "all clear" colonoscopy.
So kudos to Regence BlueCross BlueShield of Oregon for deciding, albeit belatedly, that colonoscopies should be considered preventive even if a polyp is removed. This makes me feel better about the company my wife and I fork over $1024 to every month for our individual policies (we're in our early sixties and can't wait to get on Medicare).
That said, I still think Regence's proposed 2011 22% rate increase is obscene.
Today a couple of Regence guys met with the Salem Statesman Journal editorial board. They did their best to justify their rate increase, but I wasn't wildly impressed with the 20 minutes of the video that I watched.
The presentation started off with an oft-repeated statement that the 22% translates into an average of $36 per month for each individual policy holder. Well, not for people like us, who already are paying over $1,000 a month (as a couple) and would fork over more than $200 a month additional to Regence if the rate increase is approved as is.
I realize that the causes of health care inflation are various and widespread. But the Regence executive correctly told the editorial board that the United States health system (actually, non-system) is broken. Costs can't be controlled until we fix the system.
Yet Regence, along with the rest of the insurance industry, tried to stop Obama's health care reform efforts, a.k.a. the Affordable Care Act. You can't have it both ways, Regence. Don't complain that the system is broken at the same time you're trying to keep it that way.
For that huge bit of hypocrisy, I think you deserve to have your rate increase request slashed substantially by the state. Maybe then you'll be motivated to reform the system, rather than simply trying to suck more premium dollars out of your already-strapped policy holders.