November 2000
Aggregate Anonymous Data

About Blue Cross of California...It's interesting to me that they would be visiting this website...This is the insurance provider that paid for mine and hundreds of other women's uterine artery embolizations up until 6 months ago here in California but now claim they've never paid for this procedure and will ask for all funds to be returned to them from past patients and medical institutions. Incredible. (Note: sometimes subscribers log the details of conversations held with insurance staff. In fact, it's one of the items I HIGHLY recommend when appealing denials.)

Currently denying all patients the right to insurance coverage for uterine artery embolization and citing the ACOG technical letter indicating the procedure is "investigational." What's most interesting about these denial letters, is that they then go on to frequently recommend laparoscopic or hysteroscopic myomectomy or hysterectomy. What's interesting about that? Both laparoscopy and hysteroscopy treatment for uterine conditions has been around only about 11 years in the U.S. -- less time than the procedure of uterine artery embolization -- and has never undergone any clinical trials. NONE. In fact, in terms of myomectomy (any kind of myomectomy), there has never been a prospectively controlled clinical trial. Never. Not anywhere in the world.

Lack of clinical trials is one of the primary reasons that UAE is being denied, according to the technical assessors at Blue Cross. (Of course, with the recent rejection of a clinical trial proposal for UAE and myomectomy by the NICHHD, it's not likely that any prospective controlled clinical trial on UAE or myomectomy will be done any time soon.)

Why is a gynecological treatment that is technically still "investigational" better than an interventional radiology procedure deemed "investigational"? Why are insurance providers willing to pay for the gynecological procedures but not the lesser invasive procedure of uterine artery embolization? Especially when neither meet technical assessment criteria identified by insurance providers as necessary before approval is authorized or payment made for the procedure. Doesn't seem logical to me at all. Hmmmm. I wonder. Does the professional background of the reviewer (which is usually gynecology) of procedural pre-authorization requests have anything to do with this? Or, is it simply about money? Am I missing something here? Because I just don't understand any of this. Is there anyone out there who can explain this to me?

BLUE CROSS UPDATE: More Internet research on Blue Cross has revealed some interesting information from all across the United States on this particular insurance provider. I just KNEW y'all would be interested in the following links to stories that were submitted to me by visitors to this website.

Holding Patients Hostage

SAN DIEGO PHYSICIAN / JUNE-JULY 2000 (On May 25, 2000, CMA filed a federal lawsuit against California's three major for-profit HMOs (Blue Cross/Wellpoint, Foundation/HealthNet, and PacifiCare) challenging their fraudulent and unfair business practices which improperly interfere with and control the physician-patient relationship. The lawsuit, entitled CMA v. Blue Cross, et al, was filed in the United States District Court, Northern District of California, case no. C001894 VRW. -- Gee, it almost sounds as if they've seen some of the denial letters I've seen that redirect patients to specific alternative treatments in opposition to what was recommended by the physician requesting authorization. I've seen denial letters from two of the above providers which were outrageous in content in terms of telling the patient what procedure she "should" undergo instead of the one being requested.)

Blue Cross alters surgery decision

Minnesota attorney general sues Blue Cross (I found this lawsuit filed on 10/5/2000 particularly interesting. You see, I had a conversation (or rather, disagreement) with Blue Cross of MN earlier that week about the issue of "consumer fraud" and "false advertising" on their Blueprint for Health website. They identified uterine artery embolization as a treatment alternative for uterine fibroids on their health information pages for patients -- but, guess what? They don't provide insurance coverage for UAE! You'll note that today they do not discuss UAE as an option for fibroids anywhere on their website. Score one for the consumer in terms of removing false advertising -- but score one for the insurance provider for continuing to deny coverage for this procedure. Sigh.) UPDATE 02/03/01: Blueprint for Health is back to offering information about UAE and even bought a medical paper on UAE previously published in American Family Physician to post on their site. They still do not, however, cover UAE or consider it anything other than "investigational."

Chiropractic Associations File Suit Against Blue Cross Blue Shield

LOGAN v. EMPIRE BLUE CROSS AND BLUE SHIELD

WYMAN SUES BLUE CROSS/BLUE SHIELD TO RECOVER $270 MILLION PROFIT SURPLUS FOR CONNECTICUT CUSTOMERS

The Blue Cross and Blue Shield of Missouri Settlement

Somerset Orthopedic Associates, P.A. v. Horizon Blue Cross Blue Shield of New Jersey, Inc. N.J. Superior Ct. Case No. L00051100 (filed 3/24/00)

Psychologists File Suit Against Blue Cross/Blue Shield of the National Capital Area and CapitalCare

BLUE CROSS BLUE SHIELD OF MICHIGAN PAYS U.S. $27.6 MILLION FOR SUBMITTING FALSE MEDICARE DATA

Blue Cross was my medical insurance plan of choice for many, many years. Wow. Don't know what to say after visiting all of these links. Oh, did I forget to mention that the above is only a sample of the links found online? Using the Google search engine, type in "Blue Cross lawsuit" and you'll get page after page of links....thousands of links to check out and read...after being directed to do this by a visitor to this site, I stopped reading after reviewing only the first 100. Geez.