[Please scroll down for update]
This one would initially seem to fall under our Stupid Carrier Tricks category, but it also seems to have a “happy ending:”
Hunh?
Apparently, Heather Toplak is a 35 year old breast cancer survivor, who needs annual blood screenings to determine if she’s still in remission. Such tests are generally considered “standard of care,” meaning that they’re usually covered expenses, unlike much more expensive scans. This can save the insurer (and thus, its policyholders) a lot of money, which would seem to be a good thing.
During her battle with the cancer, Anthem apparently had no qualms about paying for various treatments and procedures [ed: Hey, aren't they supposed to fight these types of claim tooth and nail, and then cancel the offending insured's coverage? Looks like someone didn't get the memo!]. The follow-up blood test was denied as “not medically necessary,” and recommended that she instead undergo a (much more expensive) Pet Scan. One presumes, given her condition, that she would have already met most (if not all) of her own out-of-pocket maximum, meaning that Anthem would have footed most or all of that bill.
Now, the twist: Mrs Toplak contacted her local TV-news troubleshooter, who in turn contacted the insurer. Anthem has reversed its decision, and “has agreed to pay for the [blood test]. Not only that, they are changing their policy on paying for these blood tests going forward.”
Kudos!
The story still left a few unanswered questions:
■ Why was an Arizona woman covered by Anthem (since that state is served by BCBS of Arizona)?
■ What type of policy did she have, a co-pay plan or an HSA?
That second question is important because it’s generally presumed that folks with HSA plans are more attuned to these issues.
I’ve emailed the reporter for clarification. So far, I haven’t heard back. We’ll let you know if and when we do.
[Hat Tip: FoIB Rick B]
UPDATE: In the comments, reader John H tells us that Mrs Toplak is most likely covered under the “Bluecard” program, which enables folks who live in states served by other “Blues” to have essentially seamless cover.
And we’ve heard from Carey Peña, the reporter on whose work we based this post. She tells us that she appreciates our “posting the story and hope that it helps advance the conversation.”
In response to our question regarding the type of coverage involved, she writes:
“I’m not at liberty to answer your questions due to the privacy that I extend to my interview subjects. However I am more than happy to forward your link and request to Mrs. Toplak and if she wants, she can contact you directly with additional information.”
That’s an entirely reasonable response; we’ll let you know if we hear from Mrs Toplak.
Sourced from: InsureBlog
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