THE BLOG
07/28/2016 12:43 pm ET Updated Dec 06, 2017

Happy Holidays To All Anthem Blue Cross And Blue Shield Executives!

As an Anthem Blue Cross and Blue Shield healthcare provider, as well as having been both an Anthem Blue Cross and Blue Shield customer over the past three years, I have a very specific list of holiday wishes for Anthem Blue Cross and Blue Shield executives.

Firstly, I wish that they are fruitful and multiply.

And I wish that their children are healthy, noble, intelligent and righteous.

I wish that these children receive the finest educations available in America.

And I wish that when they graduate from university these children want to make the world a better place and believe they can make the greatest contributions by becoming healthcare practitioners.

And I wish that they go to the finest graduate schools to learn all of the necessary and most effective skills to become the best healthcare practitioners possible.

And I hope that doing their 3000 hours of unpaid or underpaid internships serving underprivileged communities are not too arduous on their spirits.

And I hope that the months spent studying for their state licensure exams are educational and inspiring.

And then I wish that all of these noble and righteous and good and just and loving and compassionate and well-intentioned and well-educated children become Anthem Blue Cross and Blue Shield healthcare providers.

Because this is what those noble and righteous and good and just and loving and compassionate and well-intentioned and well-educated children would recount to their parents at Thanksgiving dinner:

Mom, Dad, thank you for spending $200,000 on my undergraduate education and $90,000 on my graduate education. And thank you for subsidizing me while I did my mandatory unpaid or underpaid internship(s). And thank you for paying for the additional courses I needed to take after my internship to pass the state licensure exams. And thank you for all of the money it took to rent and furnish an office and pay for my licenses, my internet service, phone line, liability insurance, slip and fall insurance, website, Psychology Today listing, and other myriad expenses needed to establish a business so that I can help other people.

Now I treat patients who are insured by your company, so please let me tell what my experience has been as an Anthem Blue Cross and Blue Shield healthcare provider:

1. Many times when I call Anthem Blue Cross or Blue Shield healthcare provider support to inquire about mental health benefits for your customers, after waiting on hold for up to 20 minutes and entering my National Provider and Tax ID numbers multiple times, I am told that I have dialed the wrong number. This is because some of your customers (but not all) have had their mental health benefits (unbeknownst to them) subcontracted to other insurance companies such as Magellan (a company with outstanding healthcare provider support) and Optum United Behavioral Health; however, this is not indicated on your customers' identification cards so I have to spend many hours on the phone figuring out what company actually insures your customers even though their insurance cards clearly state Anthem Blue Cross and/or Blue Shield.

2. Your telephone healthcare provider support service was devised by engineers who give five or six options that seldom include the reason why I am calling or the opportunity to communicate with a human being. After I finally figure out which button might get me to the next level of questions, the recorded voice usually tells me to consult your website and hangs up on me. I consult your website but cannot log in without first getting a code or password or at least guidance from a representative via telephone. This is the first of many Catch-22s that leave me speechless, to say the least.

3. Every time I call healthcare provider support the first message I hear is "Due to unusually heavy call volume..." I have called at 6am, 7am and sometimes even at 3am. All of which times your outgoing message states that "Due to unusually heavy call volume, your wait to speak to someone might take longer than usual." Are there really that many healthcare professionals calling at 3am? And after I enter my NPI and Tax ID numbers several times as well as my birthdate and other bits of vital information, your healthcare provider support service informs me that your offices are now closed and that I should call back between 7am and 5pm in another time zone (and enter 5-10 minutes of information all over again). Instead of telling me that you are experiencing heavy call volume and then taking all of my information several times, why don't your systems just tell me that the offices are closed in the first place?

4. In an effort to save money, you have outsourced your live telephone healthcare provider support to the Philippines, which has sub-par digital telephone connections and representatives who read scripts giving answers to questions that I did not ask. If you recall studying Kafka in college, Mom, Dad, trying to discern why an insurance claim was denied by listening to a Filipino reading a script over a bad telephone connection is something that can only be described by the word 'Kafkaesque.'

5. Speaking of which, your company has denied all of the claims that I have submitted. Usually I receive computer generated "Explanation of Benefits" reports with literally $0 benefits, or I receive letters signed by nobody, with no telephone number, that have a box checked stating that I did not submit my NPI number on the CMS1500 form that I submitted. This always turns out to be inaccurate since I have purchased a $500 computer program that automatically fills in all of the necessary boxes before submitting the CMS1500 forms electronically to your company. Finally, after hours of tapping digits into my phone to get through your maze of computerized questions - if I am not hung-up on - if I somehow manage to get a native English speaking representative with a good phone connection, he or she informs me that I did in fact submit my NPI number properly, but that your company no longer accepts the code 90837 for 55 minute hours and that I have to resubmit all claims using the 90834 code (or some other code) for 45 minute hours (even though your customer spent 80 minutes in my office because they were in an extremely serious life-threatening crisis).

6. And for those 45 or 55 minute hours you have "negotiated" a rate that is 1/3 or 1/5 of the market rate for psychotherapy and counseling my area and this flat non-negotiable rate includes the additional time needed to diagnose the patients and write adequate treatment plans and progress notes, and also must include the time spent on the phone learning the client's co-pay, deductible, how many sessions are covered, as well as all future phone calls to the Philippines when I will be trying to learn why the claim was denied - not to mention the aforementioned business expenses of renting an office, purchasing liability plus slip and fall insurance, and thousands of dollars of marketing on websites, etc.

Mom, Dad, I truly love helping other people. And you have supported my dream by investing hundreds of thousands of dollars in my education and internship to become a licensed healthcare practitioner. But by accepting your company's "negotiated" rates on claims that are consistently denied, my income (or lack thereof) requires me to move back in with you.

But that's not the bad news.

The bad news is that now that I am 26 years-old I am no longer on your health insurance policy, but as a healthcare practitioner and Anthem Blue Cross and Blue Shield healthcare provider - get this - really, you're not going to believe this - I CANNOT AFFORD TO PURCHASE ADEQUATE HEALTH INSURANCE FOR MYSELF.

That's right.

The only policies that I may be able to afford are "catastrophic" - i.e. completely useless without a major catastrophe - due to $6,000 in-network and $12,000 out-of-network deductibles. But those policies that I will never use unless I am hit by a bus will still cost me over $4,000 dollars per year. And that is if I am 100% healthy and do not see any physicians besides my annual physical examination which still has a $70 co-pay. (Obviously any dental check-ups and eye exams will cost extra - maybe dental and eye examinations can be Christmas presents that you put under the tree for me???)

So in 2016, as a well-educated, well-intentioned adult working as a healthcare practitioner, I am functionally uninsured. Which means that if I need an appendectomy, a HEALTH INSURANCE COMPANY LIKE YOURS WILL PAY THE HOSPITAL, but that I will have to declare bankruptcy because the $6,000-$12,000 deductible will tank me.

By denying claims so that you can reward shareholders with more dividends, by making the submission process so insufferable that you won't have to pay a decent percentage of claims due to sheer attrition, by outsourcing your healthcare provider support services to the Philippines, and by having computers make decisions regarding the lives and deaths of fellow human beings, you have created a completely dysfunctional system. And until insurance corporations place the priority back on healthcare instead of profits, more and more people will suffer. Maybe even people in your own family.

Happy Holidays!!!

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