Lanchester.net ...musings of an old nerd

The bright sandy beaches of South Carolina are a sight to behold. If you watch the ocean closely, you might see a few dolphins chasing their supper just off the beach.

The muddy waters of health insurance in South Carolina are a sight to behold as well, as least the Blue Cross Blue Shield (BCBS) variety. All this became apparent when my adult daughter, a four-month policyholder, tore her ACL recently playing volleyball with some friends.

I suppose if I didn't know any better I might think it was standard practice in health insurance to DENY EVERY SINGLE CLAIM PRESENTED, but I've had more than my share of orthopedic injuries and surgeries, and not one has ever been denied. Not once. Never. Not even by BCBS in my state.

In the few short weeks my daughter has been actively using her health insurance, she has also been denied coverage for an MRI of her knee, an MRI she was pre-authorized by BCBS of South Carolina to get, for failing to be pre-authorized. Hmmmm...I can only conclude BCBS of South Carolina has run out of money, and is trying to find a few suckers who will actually pay instead of fight. (Yes, we called BCBS of South Carolina to give them THEIR OWN pre-authorization number after the fact for the MRI to enter into their computer system so they would pay the claim, but they just transferred the call to the National Imaging Association. Much confusion! BCBS didn't listen to my daughter's explanation. The call-taker thought she wanted to obtain a pre-authorization!)

Side note: BCBS of South Carolina's website is http://www.southcarolinablues.com, presumably because the policyholders spend so much time singing the blues.

But my daughter's situation gets better (worse!). Every one of the "preferred providers" my daughter has used so far has "overcharged" her, acccording to Blue Cross Blue Shield. So she is apparently responsible for all these overcharges, which are significant. Why are these doctors and facilities listed as preferred providers if they are overcharging?

BCBS of Illinois, on their explanation of Benefits (EOBs) would subtract out the "overcharge," signifying (I assume) BCBS of Illinois had pre-arranged with the provider to be charged the "proper" amount. This is what I expected to happen in South Carolina.

Why are things handled so differently between Illinois and South Carolina for health insurers with the same name? And what is the insurance comissioner's number in South Carolina? I have a call to make.

"About 75 percent of spending, for instance, goes to taking care of chronic disease."

Read about it and get the facts at Factcheck.org.

I'm quite sure any bill put together by politicians will be full of provisions aimed at pleasing powerful special interest groups, but people need affordable health insurance. Is the health care bill a good first step? I don't know, and it will be hard to tell until it all shakes out.

It's definitely been interesting to see the hatred generated during the drafting and the passing of this bill. Can't we all just get along?