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Another coverage “error” for BlueCross BlueShield

Funny how benefit glitches always seem to cut coverage for patients, isn’t it?

Health insurance is a tricky business.

In most lines of work, you can’t just say one thing and then do another. But as it turns out, if you’re a big enough insurance company, you can!

According to an article by WBTV News, Blue Cross Blue Shield of North Carolina (BCBSNC) has earned itself a reputation of waffling when it comes to speech therapy coverage. In December, the health insurance company announced that it would no longer cover speech therapy for children with a developmental delay diagnosis—shocking families (and physicians) across the state.

Mother Juliana Porter and daughter Lily were one such family affected. Lily was born with a chromosome anomaly and has epilepsy and cognitive impairment. Speech therapy proved to be helping Lily developmentally; that is, it was until the family got word that speech therapy would no longer be covered.

To add insult to injury, BCBSNC even sought repayment for two years of claims from one provider at speech therapy clinic, Speech Matters. According to the article, Ashlyn Lelej—speech pathologist and owner of Speech Matters in Charlotte, North Carolina—said she even received more than 50 letters from BCBSNC requesting demands for payment. Lelej shared, “I don’t even have a choice to default on paying it because they will take it out of my current direct deposits from my current client.”

But wait! There’s more! Before the ink could even dry, the behemoth of a health insurer released another statement clarifying (err, changing their mind?) that the withdrawal of coverage was a mistake. So, did they have a change of heart? Blue Cross claims that their earlier denial of speech therapy coverage was “an incorrect benefit change in our system that caused claims to reprocess in error.”

An incorrect benefit change that sent 50 letters demanding payment? Seems suspicious. But then again, insurers seem to have a knack for letting errors and glitches cause serious stress for patients.

It gets better: “A spokesperson for BCBS would not provide any more details on how the mistake happened.”

Something’s awry, in our opinion.

It goes to show why we care so much about health insurance company control. The truth is, only a handful of carriers control health insurance for most of the country. In this case, BCBSNC is already North Carolina’s largest insurer. In fact, it dominates more than half the state insurance market—and it landed another 11 percent growth in members between 2020 and 2021.

And while we can shake our heads over the “clerical error” or roll our eyes over the sudden change of heart, we’re still deeply bothered by the issue. Because while BCBSNC did walk it back—and the families preserved coverage (for now)—it doesn’t address the fact that Blue Cross, and other big insurers like them, can make decisions about patient care almost without consequence and with very little notice—despite how much harm it causes.

Consumers continually find themselves with limited insurance options, which is a problem when the carriers they do have access to try to limit their care. In BCBSNC’s case, the company’s about-face regarding speech therapy coverage shows just how much power they have over a patient’s life, treatments, wellbeing, and family.

How can one health insurance company have so much power?

Original Article:

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