LymeNet Flash: bc/bs changing insurance?

This is topic bc/bs changing insurance? in forum General Support at LymeNet Flash.

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Posted by geniveve (Member # 8646) on :

i don't know if any of you are familiar with bc/bs federal plan but i need some help.

i got a letter today saying that members have access to the "disease management program which is designed to help manage chronic medical conditions such as diabetes, congestive heart failure or asthma. the program will be administered by Lifemasters, a leading health management company."

"effective january 1, 2007, your participationn in the disease management program will be administered by them. the program provides educational materials and support specific to your condition between doctor office visits, when you need it most."

so i called them and said "what the heck is going on?" they assured me i was not loosing my insurance but had been enrolled in this program BY bc/bs. i asked who decided this and how did i get enrolled? they said bc/bs did and they would not release this information to me.

i asked if it was because i had lyme and she said lyme was not considered a "chronic medical condition by bc/bs and you have to ask them."

sooooo, does anybody know what's going on here? i asked if my husband was being changed and they said no, just me.

mike never ever gets sick and never goes to the doctor, i go all the time. so is this because i go too much or what?

this is making me a little nervous. can they do this and why won't they give me the reason?

Posted by tickedntx (Member # 5660) on :

Have you tried calling the Texas insurance commissioner? Or, if you are a federal employee (which I assume you are) the Office of Personnel Management?

Posted by bettyg (Member # 6147) on :

Geniveve, good suggestion by Suzanne; if that doesn't work, AFTER TUESDAY'S ELECTION, contact your local house of reps/senator for your area for their assistance in getting answers.
Bettyg [Big Grin]

Posted by BugBarb (Member # 210) on :

I just had to laugh when I read FEDERAL bs/bc.
I changed to my husband's federal policy in January. It is a great policy. BUT it is like crossing "government efficiency" with "insurance company insanity". Sometimes everyhing goes smoothly, other times, they [bonk]

just can't get it together.
I am "very complicanted" medically, and utilize the benefits weekly or more.

Posted by pamyla (Member # 8575) on :

Hi, My insurance is not the Federal version of BC/BS but I am familiar with disease management programs. When I was on Cigna's plan I went to a chiropractor for my back and was "suddenly enrolled" in the program for chronic back pain. They had me fill out a questionnaire and then a nurse calls you. I talked to the nurse briefly and the call ended with her saying she would send me a letter with back exercises in it. The exercise sheet came, it was basic stuff like 'touch your toes' - Not real helpful [Roll Eyes]

Honestly, with all my other health issues, I found it a waste of time. After that I simply ignored the letters and calls and they eventually stopped. From my understanding the program is optional, but they are there in case you have questions.

hth,
Pam

Posted by Aniek (Member # 5374) on :

Most disease management programs are a voluntary aspect of your insurance. You should call again and ask if it is voluntary. It sounds to me like the letter was just informing you about the program and the management change, not that you have to participate.

I received a call recently from the disease management program of my insurance, also Cigna. They said their records show I have low back pain (hmmm...Cigna pattern here). I told them I work closely with a doctor and do not want to participate.

Most likely, a doctor put a low back pain diagnosis code down and it probably is automatically flagged by the computer system. A similar thing probably happened to you. Whether it be lwo back pain or another diagnosis.

The programs are usually limited to common diagnoses that can have costly complicatons if not managed well. Like diabetes, high blood pressure and low back pain.

For certain illnesses/injuries these programs are actually very good. People with diabetes or high blood pressure who use the programs tend to take their medicine and follow a diet more closely, therefore having fewer complications.

It's done to save the insurance money, but really can help manage the manageable diseases.
Lyme is a different situation and they clearly can't work for that. If it's voluntary, just elect not to participate.