Blue Cross/Blue Shield Surprises

I’ve never paid that much attention to Health Plan marketing, until a few days ago when a few surprises from Blue Cross/Blue Shield kind of hit me upside the head.

Blueshield_man First, a few mornings ago at the gym (of all places), I caught a TV spot from Blue Cross, urging uninsured folks to sign up for their independent medical coverage — “which will cost you just a few dollars a day — about what you’d spend on a video rental, or a chew toy for your pug,” the ad posed. The ad was cute, catchy, and thoroughly professional. Thoroughly commercial. Thoroughly American. Frankly, it kind of blew my mind.

I’ve spent a good chunk of my adult life living in Europe, where health insurance is provided by the state and considered a basic human need, rather than just another product to be marketed and sold. Opt-in independent plans are naturally far superior to being uninsured. Yet as a person with a chronic disease, the idea that I might end up essentially working for my disease is unsavory, to say the least. And the idea that a Health Plan would cough up the kind of money required for flashy TV ads hinted at a Big Business approach to healthcare that I’d rather not think about at all…

Then today we get a postcard from Blue Shield (our current coverage plan) picturing six happy, healthy-looking adults, arm-in-arm, grinning. The tag-line reads: “Which person in this photo is at risk for pre-diabetes?” The content on the flip-side explains “They may all be — and not even know it,” followed by the stats that about 40 percent of Americans ages 40 to 74 have pre-diabetes, and urging readers to contact the company for a free Pre-Diabetes Facts and Risks brochure.

Now think again about that tagline: “… at risk for pre-diabetes?” Do you realize what this means? This is a costly direct-mail campaign for Pre-Pre-Diabetes — the state of affairs before you’re even told you have Pre-Diabetes, defined by the way, as fasting glucose of over 100 but under 126 (which sounds like a triumph to a Type 1 like myself, but let’s not go there for now). The point here is that Blue Shield, for one, is so concerned about the spread of diabetes that they’re out to nip it in the bud before the bud even emerges. Wow. I’d sure like to know how many people react to the postcard and actually request the Pre-Diabetes information packet!

All this proactive recruitment on the part of healthcare is good and bad, I suppose. The profit motives lurking in the background make me a little naseous, to be honest. But if the outcome helps patients — in obtaining vital coverage and avoiding chronic conditions — then maybe the free market does manage to sufficiently regulate itself.

Meanwhile, we’re preparing for our annual family sojourn to Europe, and I’ll be on the lookout for similar developments over there — although I’m pretty convinced that in a more “socialized” world, spunky TV commercials and glossy postcards for Healthcare Plans would just seem downright CRAZY.


12 Responses

  1. Hamish
    Hamish July 18, 2006 at 3:05 pm | | Reply

    Hi Amy

    I’ve got Blue Shield cover and they also sent me an invitation to use their “Chart Your Course” diabetes management program. They really don’t want me to get complications – because they care about me, I understand that.
    In much of Europe state healthcare is so good that private healthcare insurance really is superfluous – sadly not in the UK though. Spend much time watching UK TV commercials and you will see many very well produced advertisements for BUPA / PPP /HSA – a multitude of providers. All emergency care is provided by the state so uninsured people can get run down / shot / stabbed and relax because they are assured of excellent healthcare at no cost, but if you want vaguely competent diabetes care or elective surgery this side of 2010, you’re going to need private health care. The silver lining is the UK’s social security rate for business is 12.8%, compared with the crippling 40%+ it is in many European countries. Well, as a CFO I think that’s great, maybe others would differ.


  2. Nick
    Nick July 18, 2006 at 4:46 pm | | Reply

    I used to have BCBS coverage. But I no longer have ***any***health insurance coverage. Please let me know, Amy, if you find a way to get BCBS coverage on the cheap. It paid for insulin, syringes, test strips, prescription drugs, and routine blood tests. You know what a big pain in the wallet it is living with type 1 diabetes, even if you remain free of complications for the rest of your days (my earnest wish for you and for me).

  3. Felix Kasza
    Felix Kasza July 18, 2006 at 8:28 pm | | Reply

    Hi Amy,

    [...] Europe, where health insurance is provided by the state and considered a basic human need [....]

    You are joking, aren’t you? I was born, raised, and educated in Europe and only moved to the US at the age of 39, two years ago; until then, I worked in, lived in, and visited just about every corner of Europe.

    Nowhere was health coverage free. It is usually bought by getting a take-home pay (after taxes and mandatory insurance) of $43 out of every $100 that an employer shells out.

    Those insulin pumps we both are wearing? There are Europeans who got them paid for by insurance — but all (admittedly anecdotal) cases I heard of were either in large part paid for by the user, or by some add-on insurance.

    I am more and more inclined towards tax-supported disaster coverage (say, anything in excess of $10k/year, plus incurable disease), with high-cost, low-benefit items limited (like supporting intensive care; if you haven’t made it out of the ICU in 8 weeks, how likely are you to, ever?).

    But the current European model is failing, and the countries who could barely keep up during the Wirtschaftswunder (“economic miracle”, 50s/60s) years are now groaning under an unsustainable load.


  4. Thomas
    Thomas July 19, 2006 at 4:17 am | | Reply

    Hi Amy

    Both Hamish & Felix have me deeply puzzled. I have been Type 1 for the last 18 years and have received first class care from the National Health Service clinics in Leicester & Nottingham.

    While I admit primary care at the local GP’s surgery has been pretty patchy, the overall standard of advice and care provided by the hospital clinics is first rate, with a strong emphasis upon long term care, education and complication prevention: an example of which is the work that Nottingham Queen’s Medical Centre has been doing piloting the “DAFNE” (Dose Adjustment For Normal Eating) programme in the UK.

    In contrast, I have opted out of the private BUPA insurance provided by my employer, as their coverage does not include any pre-existing medical conditions, which somewhat defeats the object of the exercise in my case!

    Reading US-based blogs and books like the Joselin Clinic’s excellent guide to diabetes, I get the distinct impression that diabetes care in the States does have a technological edge – e.g. access to insulin pumps in the UK is quite tightly rationed (but once you’ve jumped the hoops completely free of charge to the user) – but that the day to day experience of living with diabetes in the UK is far less hassle. For example, in recent posts you have described difficulties getting hold of test strips because your insurer sets a limit on the number of strips that you can use in a day; an almost unimaginable contingency in the UK.

    The biggest problem that we have in the UK, and biggest waste of our resources, is that the NHS is treated as a political football and subjected to a constant barrage of “reform”.

    Finally, on the cost point, surveys consistently report that US healthcare, both as a percentage of GDP and in terms of expenditure by individuals by way of insurance/taxation, is more expensive than the “social” models adopted elsewhere in the developed world. By its “opt-in” nature it fails a greater number of its citizens than other systems as well as focussing upon treatment rather than public health, a fact reflected by the longer life expectancy figures in the UK than the US.

    I’m sorry this is a bit of a rant, but I thought it important to give another view!


  5. AmyT
    AmyT July 19, 2006 at 7:30 am | | Reply

    Hi Folks,
    I admit I may have an overly rosey view of my years in Europe. A lot of money was taken out of my paycheck for health insurance, but was also fully matched by my employer, and I don’t remember ever paying a single out-of-pocket deductible — not even a single cent when I had a C-section in Venlo, NL. At the time, I was still paying off the back-birthing costs for my first child (!), due to a US insurance snafu.

    Also, my relatives over there are always shocked at how much I have to shell out for my basic diabetes supplies in the States. It’s all covered in Europe — although probably not a sustainable system…

  6. Amy H.
    Amy H. July 19, 2006 at 8:53 am | | Reply

    “The point here is that Blue Shield, for one, is so concerned about the spread of diabetes that they’re out to nip it in the bud before the bud even emerges.”

    Yesterday, I got a call from my doctor. She said BCBS believes I have diabetes. My last run-of-the-mill, annual blood test clocked in a BG of 114. I was not fasting of course. In fact, I had a powerbar on the way to my appointment. But I didn’t think to call and brief my insurance company on my breakfast.

    Today, I called BCBS. They put me right through to a telephone nurse in their wellness program. After a few words of introduction, the nurse said to me, somewhat casually “So: Did your doctor tell you you have diabetes?” I said “No, my doctor told me Blue Cross thinks I have it. My partner has diabetes, so I know a little something here, perhaps I can help you. My blood glucose was 114, which I suppose got me flagged in your system as Pre-Diabetic.”

    She quickly explained how my privacy was not violated (I never said it was, at least not yet), and how she had no information about the 114. I imagine the guys who pay the claims at BCBS work it this way: Tell the doctor they think I have diabetes, then tell their own telephone nurses that my doctor believes it.

    I briefed her on my breakfast. We ended our diabetes discussion. Then she let me know I may receive future calls from them about, say, well…lower back pain…just for example, not that anyone knows anything. (They had just paid for an office visit and an x-ray, I threw my back out and have the very slightest curvature.)

    Big Brother is here. I am sure it will help some people who have trouble with compliance, and that’s great. But I worry that the health insurance business is trying to become the auto insurance business, which can raise your rates for behaviors that put their own profit margins at risk, such as speeding tickets and accidents. And when that happens, god help us.

  7. Hamish
    Hamish July 19, 2006 at 1:05 pm | | Reply

    Just in regard to Thomas’s comments, I admit my experience of diabetes care in the UK is very limited as I was only diagnosed in November 05 before leaving the country in December to come and live in the US. So I have no knowledge of NHS diabetes clinics and it’s good to know they exist and are that good. My GP didn’t mention any such clinics (can you self-refer to them?) and worthwhile treatment only started when I told him I was leaving the country and he referred me like a shot. Presumably the fact that I wasn’t going to become a liability to his practice was persuasive.

  8. Felix Kasza
    Felix Kasza July 19, 2006 at 1:34 pm | | Reply

    Hi Amy,

    the premiums that were deducted from your paycheck were _not_ employer-matched. This is a fiction to make people believe that insurance isn’t so expensive, after all.

    The correct picture emerges once you add in all those little “employer contributions”, together with what shows up on your pay stub as deductions. That is where the “$43 out of $100″ number for take-home pay comes from. If you were willing, in the US, to pay $2400/month, you could get insurance, I am willing to be. That is what health insurance cost me in Luxembourg, only I didn’t even have a choice about it.

    Oh, and the common saying about the state-run insurance in central Europe is “not enough to live, but too much to die”. Thomas’s experience in the UK notwithstanding, the level of care in central Europe cannot compete with even an HMO like GroupHealth here.


  9. Felix Kasza
    Felix Kasza July 19, 2006 at 1:36 pm | | Reply

    Hi Thomas,

    the UK healthcare system is one I have not lived in. But Dr. John Crippen, a British GP writing under this pseudonym, has rather strong opinions about it. One may or may not agree, but generally, his posts are at the very least amusing:



  10. Ron Brown
    Ron Brown July 23, 2006 at 11:31 am | | Reply

    In general, US insurance companies primary concern is money, but this isn’t necessarily evil. Often what saves money for the insurance company will also reduce pain for its insureds. As an on-topic example: insurance companies _want_ doctors to prescribe ACE inhibitors to diabetics with incipient kidney problems. A beneficial side-effect of these blood-pressure medications is a tendency to forstall kidney failure in such cases. This saves the insurance company money. It saves the patient grief. This is a win-win situation. Actually, diabetes prevention makes a lot of sense for insurance companies. Medical procedures to deal with diabetic complications are expensive. Prevention has the potential to save a lot of money. And every dollar a company doesn’t spend will go directly to the bottom line. In this case, we see the profit motive working towards the benefit of suffering humanity. The mind boggles!

    Ron Brown

  11. Florida Health Insurance
    Florida Health Insurance September 4, 2006 at 1:22 am | | Reply

    HSA all the way!

  12. Avin Techno
    Avin Techno October 8, 2007 at 10:08 am | | Reply

    HI, I can Understand your Problem,I think U should go on Different- Differnt Company to ensurae that what are the Plans that they are Providing,, For that REason YOu willl be in need to get the complete list of blue cross blue shield Providers….
    Here is that….

    Best Of Luck …
    Avin Techno

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