An Alabama insurance story

My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. — Barack Obama

My health insurance is with Blue Cross Blue Shield of Alabama, the company Obama referred to in his speech to Congress last night. It’s no accident that the company enjoys the passive goodwill of most Alabamians. With its constant image advertising, its near-ubiquity, and its faint patina of New Deal-era benevolence, the company feels a lot like a public utility.

A company rep tried to build on that perception at a local forum on health-care reform this month. He assured us that with its dominance of the Alabama health-care scene, Blue Cross of Alabama is not like those other companies. Denial of claims is really pretty rare, he said. Things may be bad elsewhere, but Alabama doesn’t need reform. We shouldn’t trouble our pretty little heads about such things.

It was a Saturday morning in May. I had planned to go in to the office, but my head was killing me and I felt weak as a kitten. I didn’t know it yet, but I was having an arrhythmia that reduced the oxygen in my blood and nearly caused me to lose consciousness. I called an ambulance and was rushed to an emergency room. I received pure oxygen (“an excellent drug,” according to my nurse) and something to make my rapid, irregular heartbeat settle down. Then they ran tests and kept me under observation for two days.

The hospital and the insurer did their usual bizarre dance of claimed costs and accepted charges. When they were done, I found that Blue Cross, while kindly agreeing with my doctors that I really had been sick, refused to pay anything for my emergency room care.

I called Blue Cross to find out why.

A young woman explained that my emergency room physician was not a “PMD.” This is a code word indicating that the doctor in question is on a list of practitioners approved by Blue Cross Blue Shield of Alabama. (One wonders how any physician successfully practices medicine in Alabama without being on this magic list.)

I admit I was taken aback by this answer. Did Blue Cross expect me, then, to sit up on my gurney, remove the oxygen mask, and demand to know whether the attending physician was a PMD? And to refuse to allow him to treat me if he was not?

“Yes,” said the young woman from Blue Cross.

I paid the bill. It wasn’t easy to come up with the cash.

My story is not a heart-breaker. Maybe it made your jaw drop or your head shake. Maybe you shrugged it off.

I offer it as an example of the routine nonsense we Americans have become accustomed to whenever we need a doctor. Even in the state where Blue Cross pretends to take care of us so well.

UPDATE: Blue Cross of Alabama disputes the president’s statistic, claiming that they actually cover about 75% of insured Alabamians. They explain the 90% estimate as due to the fact that they have customers who reside outside the state.

UPDATE 2: A Blue Cross spokesman quoted on the evening news in Birmingham claimed that actually the 90% estimate was based on the proportion of federal employees in Alabama who are covered by Blue Cross Blue Shield of Alabama.

Whatever.

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2 thoughts on “An Alabama insurance story

  1. It’s interesting reading this because I grew up in the Virginia health insurance system and am now in the Canadian health care system. It seems absolutely bizarre to imagine that 70-90% of the insurance could belong to one company, and yet that company could say that this physician was not covered. I can’t imagine an uncovered physician here- actually, I don’t think they could practice. On the other hand, I can’t imagine being kept under observation for that long- they’d pretty much send you home that night in Canada.

    This is the key to understanding public health care- there are trade offs to be made in the reforms. Personally, I was fine with them, and I’d suspect you would be too. But it’s hard to say about middle America.

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