Your Health Insurer Now Has Plans (and Permission) to Rob You Blind

03/18/2010 05:12 am ET | Updated May 25, 2011

This post is a call to arms, and a warning. The U.S. government's, and the U.S. citizenry's, unwillingness to embrace universal health care coverage (which, as my last post emphasized, is enjoyed by citizens of every other industrialized nation on Earth) is only the first assault on your wallets, and on your well-being. Prepare now for your current health insurance providers to raise rates, and cut benefits, with no fear of repercussions. (After all, with a newly stamped, government endorsed lock on the market, what repercussions will even be possible?)

Unless you're willing to stand and fight.

Here's opportunity one:

Blue Cross of CA website: Our mission is to improve the health of the people we serve.

According to medical professionals who have asked me for help in raising awareness, Blue Cross of California has notified its contracted Physical Therapy, Occupational Therapy, and Speech Therapy providers that it will severely cut reimbursements for services as of February 1, 2010. Blue Cross of California has not, however, notified any of its individual paying subscribers, or any of the unions, corporations, or institutions (such as the Screen Actor's Guild, and the UC school system) who offer Blue Cross coverage to their workers of this scheduled cut in benefits.

Oh, and while cutting benefits available to those that need them, Blue Cross of California will simultaneously be raising the cost to employers of purchasing coverage for their workers.

Charge more, provide less. Nice deal (if you're Blue Cross).

Here are the specifics, as provided to me:

Beginning February, 1, 2010, Blue Cross of California will be capping reimbursement for PT, OT, and ST at $75 per visit, regardless of the treatment provided or its intensity. Depending on specific contractual rates, which can vary from facility to facility, this reimbursement model represents a decrease in service payment of 25% to 200%.

Physical Therapy, when prescribed to help patients recover from, live with, or overcome surgery, injury, autism, cerebral palsy, stroke, vertebral disc herniation, car accident, war wound, or any number of common human mishaps and maladies, is necessarily performed in one-on-one sessions between a licensed therapist, and a single patient. It's common, and essential, for helping small children overcome all sorts of developmental delays in speech and motor skills. I have experienced, as both a patient and a parent, PT sessions provided in an institutional setting, such as a large hospital, and in a private facility, and I can vouch for the fact that private facilities often offer much more space, much better equipment, much more patient familiarity, and far greater expertise than their institutional counterparts. However, with Blue Cross's announced reductions in reimbursements (announced to providers, that is, not to subscribers), private facilities will simply not be able to afford to continue operations. Payment of $75 for an hour of one-on-one treatment, conducted by a highly trained, skilled professional, in a well-equipped and well-maintained independent facility, makes staying in business an impossibility.

To add a bit of insult to the injury, Blue Cross of California announced its intentions to service providers in a letter that stated the hope that "these changes will be viewed by our therapy providers as exciting and positive." I've been contacted by a dozen or so of those providers, and none of them find the changes exciting or positive. They find them terrifying -- for themselves, and for their patients.

Here's what's in the cards for anyone needing PT, OT, or ST: long waits for appointments at large, impersonal institutions (wait; isn't that what all the "no single-payer" people warned would happen with government provided healthcare insurance?); little or no choice of therapist (the same, again); poorly trained and less experienced care givers; small and poorly maintained facilities; limited, old equipment; increased payments for insurance company mandated reports.

Here's what's in the cards for Blue Cross of California: more money from you and your employer.

None of the above seems likely to "improve the health of the people we serve." In fact, I don't see how any of it "serves" the people Blue Cross takes money from at all.

I wrote a letter of protest to several Wellpoint (parent company of Blue Cross) executives last week, letting them know of my outrage, and my intent to spread word of their secretive and harmful plans. I have received no response.

So... I urge everyone to immediately contact Blue Cross of California and let them know these changes (and the others that will surely follow) are unacceptable. Let all your friends and relatives know, in case they're Blue Cross subscribers. Let them know that, as soon as Blue cross starts cutting benefits, ALL insurers will surely follow their lead. Then, without delay, contact your employer, your union, your school, and tell them you do not want health insurance coverage through Blue Cross of California. Better yet (much better), make sure ten of your friends do the same, and that ten of theirs do, as well.

This is the fight we're going to be in, from now on. It's going to be medical care consumers versus insurance companies, with the insurers newly licensed to charge more, and provide less. The only remedy to planned cuts in benefits is to threaten them with significant losses of customers. With the probable death of any meaningful public option in proposed health care "reform," complete control over the future of health care is being given over to "free market" forces. Unless you want companies like Blue Cross of California deciding what you're entitled to, I encourage you to force those market forces your way.

To aid in your campaign, I'd suggest sending notices of outrage, and intent to cancel policies, to the following individuals:

Nidhi Jagani, Director of Network Management
(818) 234-3593

Kathleen Brozee, Senior Provider Network Manager
(818) 234-3399

Paul McBride
Vice President, Health Care Management and Services
21555 Oxnard Street, CAAC08-08A
Woodland Hills, CA 91367

Alissa Fox, Senior Vice President
Office of Policy and Representation
Blue Cross/Blue Shield
225 N. Michigan Ave.
Chicago, IL 60601
Phone: 312.297.6000

Lucinda "Cindy" Ehnes, Director,
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725

Barbara Reagan,
Assistant Deputy Director, California Help Center
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725

Honorable Steve Poizner, Insurance Commissioner
California Department of Insurance
300 South Spring Street, South Tower
Los Angeles, CA 90013 of Managed Health Care State of CA)

And it can't hurt to urge these folks to get involved:

LA Times

Sacramento Bee
Bobby Calvan (identified as a healthcare reporter)

San Francisco Chronicle
Bernie Beck (identified as a healthcare reporter)

San Diego Tribune

Evan Handler's latest book, "It's Only Temporary: The Good News and the Bad News of Being Alive," tells the story of the twenty years since his unexpected recovery from acute myeloid leukemia.