Letter
From: Anthem Blue Cross, Oxnard, California
To: Don McCanne
Dear Don,
Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. …
http://www.anthem.com/
What’s this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.
The three page questionnaire enclosed with the letter asks for extensive detailed information on matters such as employer, number of fellow employees, insurance company, group number, member/plan ID, Rx PCN, Rx Bin, Person Code, etc. The same questions are asked about the spouse’s employer and coverage as well. There are detailed questions about other supplemental drug coverage, about Coal Miner’s Medical Benefits, and about coverage under no-fault or automobile insurance. There is a detailed question about present or pending Workers’ Compensation claims, including the name and address of your attorney. There is another question about any illness or injury for which another party could be held liable, also including a request for the name and address of your attorney.
A quote from the forty-two page booklet on our Blue Cross of California Part D coverage (now Anthem Blue Cross): “… the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage.”
This is not a process that would afford Anthem Blue Cross the opportunity to increase payment for any prescription drugs that qualify. Assuring that you receive the “maximum coverage benefits” refers to the maximum that will be paid after excluding the legitimate claims that they would shift to other potential payers. Under these circumstances, the maximum benefit frequently would be no benefit payment at all.
There could not be a more clear distinction between the business model of private health plans in the United States, and the social insurance models of private health plans used in other countries. Private plans unified in a social insurance program assist patients in paying for the care they need. Our private insurers, such as Anthem Blue Cross, use every devious method they can to avoid paying for the care that patients need. And they add more wasteful administrative complexity to the health care financing process, made even worse by the fragmentation of the financing system.
If we were to adopt a financing system using private insurers that would provide adequate affordable coverage for everyone, then we would have to totally transform the private insurance industry into a social insurance model. For that transformation to be equitable and effective, those who do not want to give up the coverage they have would have to acknowledge that their plan would be transformed anyway to comply with requirements for universal risk pooling, guaranteed issue, prevention of adverse selection, adequate benefit package, elimination of under-insurance, and other measures that define social insurance programs.
That transformation would be both politically and administratively more difficult and more expensive than replacing private insurers with a more efficient and effective single payer national health program. Besides, why do we insist on continuing to protect an industry that thrives by cheating us out of our health care benefits?