State plan offers double talk
Sunday, May 19, 2019
As a physician, I am interested in learning about cost-effective practices. Last year, I attended a conference where the speaker, a physician and chief cancer control officer of the American Cancer Society, spoke about screening tests for colon cancer. He spoke about a non-invasive testing method that is commonly known as Cologuard. For most patients, this test is as good as a colonoscopy and is much cheaper and more convenient.
I asked my physician about the test since I was due to have a screening for colon cancer. My doctor agreed that the Cologuard test was a good one and ordered the test. I had the test done and received the results, which were negative for colon cancer, about a week later. I was very pleased because the test was much cheaper than a colonoscopy and did not require that I take time off work.
Four months passed. I received a letter from Exact Sciences, the only company that does the test, stating that my health insurance company, Blue Cross Blue Shield State Health Plan (BCBSSHP), refused to pay for the test and that I was responsible for the entire bill, which was $649. I called BCBSSHP and spoke with a claims agent. She told me that the test (Cologuard) was covered by my plan, but that the lab (Exact Sciences) was out of network, so that I was responsible for the bill.
This is doubletalk at the highest level. Health insurance companies should be interested in cost-effective medicine. BCBSSHP seems more interested in misinformation to deny claims for its members.
North Carolina state employees deserve better. It is time for the state to get a real health insurance company instead of one that is intent on scamming its members for the benefit of its shareholders.