Blue Cross puts the squeeze on docs

Tuesday’s hearing of the Assembly Health Committee gave a glimpse into the ways Anthem Blue Cross not only squeezes consumers, but providers as well.

We’ve all heard by now that Anthem Blue Cross of California has in its hip pocket a double-digit premium hike to whip out for individual-policy holders come May 1. And that Anthem’s parent, WellPoint Inc. of Indianpolis, blessed its CEO, Angela Braly, with a 51% raise in compensation (with some lesser execs getting up to 75% boosts). That was just last Friday.

We can’t say we’re surprised — though we are amazed at the utter brazenness of it all.

The other half of the financial equation that fattens Anthem and WellPoint at the expense of consumers and corporate responsibility is revealed by how they manage to collect money by shorting providers — doctors and others who provide medical care.

Members of the Assembly Health Committee got their glimpse of Anthem Blue Cross’ methodology on Tuesday when Dr. Marsha McKay, of the modest Sonora Pass town of Twain Harte, explained to committtee members how she can no longer provide treatment to all of her patients because Blue Cross fails to reimburse her even for the cost of supplies.

Take vaccinations, for example. An MMR vaccine costs Dr. McKay $59 to buy for her patients. Blue Cross refuses to reimburse her more than $57.61 for that same vaccine, nickle-and-diming her practice. The doctor charges a $25 fee to administer the vaccine, and Blue Cross only reimburses her $11. She can get another $3 from Medicare, but …. well, add up the math. She says she falls up short.

A combination DTaP vaccine that covers diphtheria, tetanus and pertussis costs Dr. McKay $40.90 to buy for her patients. It’s given to kids 11 and up to boost the immunity of vaccines given in early childhood. Blue Cross pays her only $28 for this $40.90 vaccine. The IPV is an injected polio vaccine. Dr. McKay buys it at a price of $31.80; Blue Cross reimburses her $29.50 per dose.

Dr. McKay told Assembly members that Tuolumne County is an underserved area. Recently there was a small pertussis outbreak in Twain Harte, a place with a healthy dose of historical literary value but little widespread wealth. “I wonder if lack of access to vaccines was a contributing factor,” Dr. McKay told lawmakers.

She’s taken to sending her young patients in need of vaccination to the local health department. Because she can no longer afford to allow Blue Cross to add to her pile of medical debt. That’s the local doctor’s pile of medical debt — not the usual, by now legendary, consumer medical debt we are used to hearing about.

Anthem Blue Cross, the middleman between care and coverage, is making a game of squeezing both sides. They have only a short amount of time to keep this game going. We should all look forward to the day when federal health care reform starts to put a stop to this egregious practice.

Health Access California promotes quality, affordable health care for all Californians.

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