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CAM Shafted.
Oct. 5th, 2014 03:59 pmLonger-time friends of either this blog or my wife's will be familiar with the fun and games we've encountered over the past few months with one of her health care providers and its interaction with her health insurer. The tl;dr version of it: since mid-July, she's had a course of treatment that included periodic lab tests. It took over a month for us to realize that Blue Cross was declining to pay for several of these tests, potentially leaving us with a bill from Quest Diagnostics of close to $600 for each of as many as four rejected testings. That's when the runaround really began in earnest.
Eleanor has spent hours going among the provider that ordered the tests (which had no idea they would not be covered and which offers an alternative version for about $15 per test for its uninsured patients), the Blue Cross people (who have ranged from kind to utterly clueless) and her patient advocacy representative. That's right- somebody who gets paid to argue with the insurance company on the patient's behalf when the insurer doesn't pay.
If this sounds suspiciously similar to a Monty Python sketch, it's because it's that absurd. Being Hit On The Head Lessons are sure to follow.
We've now become semi-proficient at the language of this field. Mind, Eleanor's got the "good insurance" among the three of us; mine, and Emily's now that she's eligible for it, are high-deductible deals that pay little or nothing until we hit fairly high annual nuts of out of pocket expense. Eleanor's $750 annual nut was stored and eaten as of March, and everything except her prescriptions should now be covered in full for the rest of the year. Except when they're not- such as when an EOB on an OUTPT LAB/PATH gets an NG due to a finding that it is not covered by medical guidelines found under CAM 038.
WTF is a CAM? A Carolina quarterback? A commercial lease provision? An expensive thing to break on your car? I still don't know what the DAM thing stands for- but at least, thanks to a sympathetic BC/BS employee (overriding others who treated the definition as some kind of trade secret), we have seen wot it say.
No, I'm not telling you. But I will point out two things about the site providing the guideline.
First: At the top of the page with the guideline, Blue Cross says:
We recently made changes to policy CAM 038.... These changes become effective July 1, 2014. The changes are in the management of chronic non-cancer pain, in the outpatient setting, for monitoring ....
well, what it monitors. That's not the point. The point is that these changes, which became effective July 1 (conveniently about three weeks before they became relevant to any of us for the first time in our lives), were announced on June 25th. And by "announced," I don't mean they told us, and probably not that they told the providers. It was probably buried in a 900-page blinding-black-type bomb of data if it was promulgated to providers at all. So it's no wonder that this provider had no idea it was repeatedly, and expensively, exposing its patients to the cold hard reality of potentially uncovered lab expense.
(And it's not just medical peeps who pull this shit. Last week, a major new piece of consumer-protection rulemaking, which will affect my practice in a big way, thankfully only in a small corner of it, took effect immediately. I learned of it from a press release that another lawyer in my building was kind enough to post on the bulletin board by the copier. Nothing through the dozens of emails I get from the state court system every week. Nothing from the bar association committee I participate in to learn of such changes. I've been signal-boosting myself to let affected clients and fellow practitioners know about it, but not everybody has someone as nice as me to do the town-crier job for them, so it REALLY sucks to be them right now.)
Second: Atop the news of the policy change itself (mostly consisting of the words CAN'T, WON'T and DON'T), Blue Cross splatters its logo. Specifically, this is the Rochester-headquartered BC/BS licensee that Wegmans uses for all of its employees, known as Excellus. The EOBs all refer to BC/BS Florida, but THIS explanation of the CAM-shafting comes with this outsourced header:
Never mind the whole question of why Excellus is sending its decision-making policy decisions to the land of Obamacare haters. It's the slogan that's just rich with irony. Because it obviously doesn't matter to them how you're actually treated for the condition your condition is in, as long as they have a catchy slogan and a good customer service rating with J.D. Power to make them feel good about themselves.
At least they're better than the local BC/BS competition, which still uses this as their primary slogan (here's me wearing it before we headed out to this year's Shore Leave convention):
In fairness, they're starting to introduce a new ad campaign which is less likely to result in your death on an unknown planet's surface, but even it's a bit weird. After spouting some promotional fact about their latest marketing effort ("Get a rebate every time you purchase fresh fruits and veggies at Tops which is fithier than the garden they were grown in!), they end with:
Independent Health.... keeping you well.... informed.
Sheesh. Even THAT's got Shatner's diction going on.
Feel free to follow this continuing storrrrreee of a lab test that's gone to the dogs, either on this blog or at the provider website. Which, and I swear I am not making this up, is southcarolinablues.com. Cue B.B. King:
We've got the CAM38 Blues
We've got the CAM38 Blues
Don't know which test they will choose
To send the payment or refuse
We just hate to get the news-
It makes you want to hit the booze!
-We've got the CAM38 Blues....
Eleanor has spent hours going among the provider that ordered the tests (which had no idea they would not be covered and which offers an alternative version for about $15 per test for its uninsured patients), the Blue Cross people (who have ranged from kind to utterly clueless) and her patient advocacy representative. That's right- somebody who gets paid to argue with the insurance company on the patient's behalf when the insurer doesn't pay.
If this sounds suspiciously similar to a Monty Python sketch, it's because it's that absurd. Being Hit On The Head Lessons are sure to follow.
We've now become semi-proficient at the language of this field. Mind, Eleanor's got the "good insurance" among the three of us; mine, and Emily's now that she's eligible for it, are high-deductible deals that pay little or nothing until we hit fairly high annual nuts of out of pocket expense. Eleanor's $750 annual nut was stored and eaten as of March, and everything except her prescriptions should now be covered in full for the rest of the year. Except when they're not- such as when an EOB on an OUTPT LAB/PATH gets an NG due to a finding that it is not covered by medical guidelines found under CAM 038.
WTF is a CAM? A Carolina quarterback? A commercial lease provision? An expensive thing to break on your car? I still don't know what the DAM thing stands for- but at least, thanks to a sympathetic BC/BS employee (overriding others who treated the definition as some kind of trade secret), we have seen wot it say.
No, I'm not telling you. But I will point out two things about the site providing the guideline.
First: At the top of the page with the guideline, Blue Cross says:
We recently made changes to policy CAM 038.... These changes become effective July 1, 2014. The changes are in the management of chronic non-cancer pain, in the outpatient setting, for monitoring ....
well, what it monitors. That's not the point. The point is that these changes, which became effective July 1 (conveniently about three weeks before they became relevant to any of us for the first time in our lives), were announced on June 25th. And by "announced," I don't mean they told us, and probably not that they told the providers. It was probably buried in a 900-page blinding-black-type bomb of data if it was promulgated to providers at all. So it's no wonder that this provider had no idea it was repeatedly, and expensively, exposing its patients to the cold hard reality of potentially uncovered lab expense.
(And it's not just medical peeps who pull this shit. Last week, a major new piece of consumer-protection rulemaking, which will affect my practice in a big way, thankfully only in a small corner of it, took effect immediately. I learned of it from a press release that another lawyer in my building was kind enough to post on the bulletin board by the copier. Nothing through the dozens of emails I get from the state court system every week. Nothing from the bar association committee I participate in to learn of such changes. I've been signal-boosting myself to let affected clients and fellow practitioners know about it, but not everybody has someone as nice as me to do the town-crier job for them, so it REALLY sucks to be them right now.)
Second: Atop the news of the policy change itself (mostly consisting of the words CAN'T, WON'T and DON'T), Blue Cross splatters its logo. Specifically, this is the Rochester-headquartered BC/BS licensee that Wegmans uses for all of its employees, known as Excellus. The EOBs all refer to BC/BS Florida, but THIS explanation of the CAM-shafting comes with this outsourced header:
Never mind the whole question of why Excellus is sending its decision-making policy decisions to the land of Obamacare haters. It's the slogan that's just rich with irony. Because it obviously doesn't matter to them how you're actually treated for the condition your condition is in, as long as they have a catchy slogan and a good customer service rating with J.D. Power to make them feel good about themselves.
At least they're better than the local BC/BS competition, which still uses this as their primary slogan (here's me wearing it before we headed out to this year's Shore Leave convention):
In fairness, they're starting to introduce a new ad campaign which is less likely to result in your death on an unknown planet's surface, but even it's a bit weird. After spouting some promotional fact about their latest marketing effort ("Get a rebate every time you purchase fresh fruits and veggies at Tops which is fithier than the garden they were grown in!), they end with:
Independent Health.... keeping you well.... informed.
Sheesh. Even THAT's got Shatner's diction going on.
Feel free to follow this continuing storrrrreee of a lab test that's gone to the dogs, either on this blog or at the provider website. Which, and I swear I am not making this up, is southcarolinablues.com. Cue B.B. King:
We've got the CAM38 Blues
We've got the CAM38 Blues
Don't know which test they will choose
To send the payment or refuse
We just hate to get the news-
It makes you want to hit the booze!
-We've got the CAM38 Blues....