Wednesday, November 26, 2008

Anthem Blue Cross Blue Shield Playing Doctor

I have never been one to jump on the "evil insurance company" band wagon. I believe in the free market system and how it deals with companies who treat their customers the way Anthem Blue Cross Blue Shield treated my wife today.

The beauty of the free market system is that it usually cleanses itself of poor performers, while those that perform according to the market's desires flourish and prosper. Well, after today let's just say that my wife and I will exercise our right as customers in our great free market system to drop Anthem like a bad habit.

My wife, approximately 4 months pregnant, went to see her doctor today because she has had the nagging symptoms of a cold plus horrendous cough off and on for several weeks and it seems to go away just long enough to make a comeback only days later. Finally I convinced her to go back to the doctor. This time the doctor gave her a prescription and I called the pharmacy to insure it had been filled prior to leaving the house to pick it up.

This is where it gets a bit interesting. The pharmacist tells me they have not filled the prescription because the insurance company would not pay for it. I said that must be a mistake because the plan we pay for covers a percentage of our prescriptions (of which we rarely use - fortunately we are blessed with a pretty healthy family and we do not run for drugs every time we think we are sick). The pharmacist said that Anthem will not pay for the prescription OUR DOCTOR prescribed because ANTHEM WANTED US TO USE A CHEAPER DRUG. The pharmacist then proceeded to tell us to get our doctor to write a prescription for a different drug then come pick that up.

I informed the pharmacist that at 7:00pm on the Wed evening before Thanksgiving our doctor was long gone from the office and could not be reached to write another prescription for my wife. So, I told the pharmacist to fill the script and I would just pay for it in full myself.

So let's get this straight; 1. we pay for Anthem insurance and it covers prescriptions, except when they decide to just not pay 2. a certified medical doctor writes a prescription for a sick person - in this case a pregnant woman - and someone from Anthem decides they can save a few bucks, they override the doctors script and tell the pharmacist what we should take, in essence playing the role of the doctor - patient unseen

So after thinking about this I have a few questions for Anthem...
1. Are you a certified medical professional?? Do you have the legal ability to tell people what drugs they should take for their ailments?? From miles away without even seeing the patient??

2. If you have the medical certification to tell people what drugs to take for their medical conditions, do you also carry the appropriate malpractice insurance to cover the law suits you are certain to incur when a patient follows your recommendation and experiences a negative side effect or even, God forbid, worse additional sickness or even death???

3. Assuming Anthem has done this to many people repeatedly, have you experienced a class-action lawsuit from the folks that have been unable to pay for the prescription treatment that their policy was supposed to cover, yet you denied and recommended something else??

4. Could you be any larger cowards and have a worse customer service policy by relying on pharmacists to deliver this news??? Could you not have called your customer yourself to tell them that you would not pay for a prescription that the policy your customer pays full premiums for should cover?? This may very well be the absolute worst customer service predicament I have ever experienced - EVER. You not only blindside your customer - you totally blow off responsibility to a third party pharmacist and leave them to deal with upset, ill, frustrated customers, who I am sure in many cases don't know what to do because they cannot afford to pay the full price for the prescriptions you won't cover, even though your policy says you will.


God bless the free market. What do I do now?? Well, the first thing I do is inform the general public about how Anthem Blue Cross and Blue Shield is a horrible insurer. The next thing I do is switch health insurance providers to my company's provider ASAP. Then I insure the company I own NEVER utilizes Anthem for health coverage for our organization. Then I inform all of the other business owners I know (that is quite a few) to not use Anthem and the reasons why I think they are not worth dealing with. Lastly, I will contact Anthem and let them know how I feel.

What does this all mean to Anthem, I mean I only one guy, what do they care if I drop them?? They have thousands of customers, what is one less??

A few lessons are obvious here:
1. GM, Ford, Chrysler and the UAW all felt the same way at some point in time - now they are all looking at extinction - and rightfully so - decades of taking customers for granted, offering crappy products and sub-par customer service have caught up - I don't see Honda or Toyota looking for a hand out

2. Saving $20 on me just cost Anthem what will end up being hundreds, if not more, existing clients and future clients

3. Their competitors just gained those clients - that doubles the problem for Anthem automatically

4. I would not be surprised if Anthem has opened themselves up for some potential legal ramification by doing this - especially when a patient takes the drugs they tell them to take and has an adverse reaction

5. Tomorrow it may not matter, but treating customers this way will eventually catch up to them - see point #1

So Anthem, I hope the $20 you saved made you feel real good, the damage you caused your brand is severe.


Peter Christie said...

people used to complain the lawyers are ruining everything. I'm here to tell you it's the fcking MBA's to watch out for.

Jacob Leffler presents.............. SHORT ATTENTION SPAN THEATRE said...

You know PJ I may not have agreed with your comments 12 months ago, but in light of all that has gone on this year, and all of the garbage that has reared its head recently with respect to these companies, I say today that you are on to something

Anonymous said...

I hope your wife is better. Anthem is a house of cards and will go the way of Conseco. To your point Jacob, it's just a matter of time. I have my own story with them that resulted in my out of pocket in the five figures because of denial but that's a long point. Finally, Jacob nice rant.

Jacob Leffler presents.............. SHORT ATTENTION SPAN THEATRE said...

Thanks Bill. It is unfortunate. I will follow up with another post because this is developing, but again, they seem to be dropping the ball and those most likely to be negatively affected are their customers - the very people that keep them in business. I guess we'll see.

Peter Christie said...

I fight Anthem constantly as well. We're deciding tomorrow to re-up for another tour with Blue Cross Blue Shaft.

Do you have a credible option for your business insurance at this point? We got to make a decision quickly.

I'm gonna give you a ring in the morning since we are in the same boat.

Jacob Leffler presents.............. SHORT ATTENTION SPAN THEATRE said...

PJ - My company does not use Anthem. Happy to talk to you in the am - we have a pretty good plan, pretty good package we offer our staff.

Give me a buzz and I will be happy to chat. The beauty of the free market - there are a LOT of options and a LOT of insurance companies to choose from. Many of which are as good if not better than Anthem.

Anonymous said...

Anthem is, without a doubt, the worst med insurance company I've dealt with in over 30 years. They refuse to pay for scripts written for over what they consider R&C without them speaking to the doctor directly. Most doctors won't bother with this hassle, as they know the outcome won't be favorable. My wife suffers from Migraines and requires Imitrex tablets. Imitrex tabs cost 25.00- 30.00 EACH. The doctor writes her a scripts for 54 tabs over 3 months since the plan requires 3 month mail order for anything other than emergency meds. We send it off and a week later receive our order of not 54, but 27 tabs. We call up Anthem- hey where's the other 27 tabs. The answer we get is the plan won't subsidize more than 9 tabs per month. The 3 month entitlement is 27 tabs total. That leaves us paying for 27 tabs out of pocket at roughly $25.00 each.
They told us that if the doctor calls them they could authorize more. We speak to the doctor, and he basically tells us to forget it. The doctor doesn't want to deal with Anthem because he knows its a huge hassle, and the outcome won't be favorable. The doctor told that to my wife. I've dealt with this nonsense before with Anthem and it's the same old story. I switched companies and we weren't under Anthem, and I had no problems with the scripts. The company changed to Anthem and I was like- oh great. Sure enough- SOS.

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