Insurance denials must stop!

To: Lily Tyson, Chief Health Insurance Bureau
NJ Department of Banking and Insurance

Re: Horizon BCBS discrimination

Dear Chief Tyson,

This letter is to make you aware that Horizon BCBS and its affiliates are harming a patient with their precertification, prior authorization, appeal and denial of services processes. The patient indicated below has diabetes and multiple medical conditions, which he diligently and routinely follows up at our office. For the past three months, the patient and I have aggressively pursued a continuous glucose monitoring device to assist both of us in getting his blood glucose under best control.

Despite the fact that the patient and I agree on this, Horizon BCBS and its affiliates have denied the patient this medically necessary item. Further, while the Endocrinology Society, The American Association of Clinical Endocrinologists and the American diabetes association clinical societies all recommend continuous glucose monitoring for best management of diabetes Horizon BCBS and its affiliates insist on harming the patient by denying him this medically necessary tool.

Furthermore, Horizon BCBS medical directors have denied this patient the necessary medical monitoring device, thereby potentially causing their insured harm, and may be liable as they are making care decisions and denial of care decisions for the patient.

I ask:

  1. Do they have the patient’s informed consent to make care decisions?
  2. Are they licensed physicians in NJ?
  3. What is their malpractice coverage for this activity?
  4. Are they specialty trained in endocrinology?
  5. As employees of Horizon BCBS, do they have a conflict of interest?

Horizon BCBS precertification, prior authorization, appeal and denial of service processses are harmful to both patients and physician providers of medical services.  Please put Horizon BCBS on notice to case and desist making clinical care decisions for patients through their onerous and harmful money making processes. This is especially critical in light of the pending NJ law that would mandate the purchase of insurance products like those offered by Horizon BCBS.

Sincerely,

Craig M. Wax, DO, Family Physician

Setting the Record Straight on Horizon BCBS

Dr. Wax writes NJ.com columnist Susan Livio  in repsonse to her February 16, 2106 article, “See why Horizon paid $3M in bonuses to N.J. doctors.” 

Dear Ms. Livio

Your article on Horizon insurance’s program to incentivize physicians was not a balanced view of the program or company.  It also misrepresented the so-called “affordable care act.” Neither entity has done anything to bring down the high cost of health insurance but to force Americans to buy it from profiteering high overhead entities under penalty of law.

Horizon Blue Cross Blue Shield of New Jersey is notoriously one of the most difficult insurance companies to deal with. Their denial rates for payment, denial rates for medications and tests, and poor communications skills are just a few of their issues. Both their patient and “provider” help desks are located off shore in the Philippines or India, despite their massive holdings in the state of New Jersey. One must not forget their bankruptcy in the 1990s, where they were forced to change their company from New Jersey Blue Cross Blue Shield to “Horizon.”  Continue reading

HDP/HSA policies cancelled: Yet another #ACA #EpicFail

My personal family business HDP w HSA policy was canceled as a direct result of PPACA/Obamacare. It was replaced with a plan that was double the cost. So, if we do the math, $800 plus $800 equals $1600, that’s a 100% increase. Others have had similar experience. Our states Blue Cross affiliate used to sell over 140 different plans, but now due to the unaffordable careless act, now only sells a dozen or so. Perhaps, we can also discuss the fact that we tax payers, through this government fascist program, pay over $1 million per policy. #ACA #EpicFail