My wife and I each recently received letters from Blue Cross Blue Shield of Massachusetts, our health insurer through my employer. These letters introduced us to a program being run by BCBS which, to put it bluntly, is wrong, wrong, wrong.
Here’s what the letter said:
Blue Cross Blue Shield of Massachusetts and Blue Cross Blue Shield of Massachusetts HMO Blue(R) are pleased to offer our Blue Care(R)Connection programs, which are designed to help our members and their families manage certain conditions that may adversely affect their health. These programs provide individualized, enhanced support for members who may be at risk for, or have been diagnosed with, certain chronic conditions. We would like to work with you in support of your physician’s treatment plan by providing you with care management support and educational information. Your physician will also receive information about the program and your participation.
Blue Cross Blue Shield of Massachusetts is working with Healthways, Inc., to administer this program. Healthways is an organization with over 20 years of experience in providing chronic disease management support to people and their doctors. Please be assured that Healthways adhere to the same important confidentiality guidelines as Blue Cross Blue Shield of Massachusetts.
What You Can Expect
- We provide the enclosed materials, designed to help you monitor your condition; assist you in establishing personal health goals; help you keep track of your medications, tests, and reports; and develop exercise and action plans.
- A Blue Care(R)Connection program representative will call you at (___)___-____ to introduce you to the program and review these materials with you in greater detail. if this is not your current phone number or if we did not list a phone number for you, please call us toll free at 1-877-301-1430, Monday through Saturday, between 8:30 a.m. and 8:30 p.m. (multi-language translation services are available) to give us your correct phone number.
- Throughout the year, you will receive care calls and other important health information, including reminder cards and newsletters, to help you better understand and manage your condition.
- Based on recommendations from providers, selected members suffering from heart failure may receive a scale and blood pressure monitor to measure their daily blood pressure, weight and pulse.
What You Can Do
- Review the enclosed materials and keep them for future reference.
- Confirm that (___)___-____ is your correct phone number.
- If you have questions, if you want to begin participation immediately, or if you choose not to participate in the program, please call us at 1-877-301-1430, Monday through Saturday between 8:30 a.m. and 8:30 p.m. (multi-language translation services are available). Hearing-impaired members may call 1-866-291-0605 (TTY/TTD).
Please note your participation in these programs is entirely voluntary and is available to you while you are an active Blue Cross Blue Shield of Massachusetts member. If you choose not to participate, your eligibility for benefits will not be affected.
Thank you for choosing Blue Cross Blue Shield of Massachusetts. We wish you the best of health.
Accompanying each copy of this letter was an “action plan” for a chronic condition from which Blue Cross or its agent Healthways had decided each of us suffered, based on our insurance claim data in their databases. Yes, you read that right, they diagnosed chronic medical conditions for my wife and me based on our insurance claim histories.
The chronic condition for which they diagnosed me is one from which I may very well suffer, although none of my doctors have, as far as I recall, explicitly told me so. In contrast, the condition for which they diagnosed my wife is one from which she does not suffer, has never suffered, and has never been diagnosed as suffering by any of her doctors. If she actually did suffer from this condition (which, again she does not!) it could interfere with her ability to get a job or insurance coverage in the future. It should be obvious that having her medical records indicate incorrectly that she suffers from this condition could cause the same problems.
My wife immediately contacted her primary care physician to discuss the letter she had received. Her PCP was at first amused (“If I had a patient with that condition, I think I’d know about it!”), then appalled. She said it was outrageous for a health insurance company to be sending letters to patients telling them they had conditions that they didn’t have. She also said that she thinks it might actually be illegal, both because (a) diagnosing a medical condition constitutes practicing medicine, and it’s not at all obvious that the people who generated and sent out these letters are licensed to practice medicine, and (b) there are legal issues with even a licensed practitioner to diagnose someone with whom s/he does not have a formal doctor-patient relationship. After being amused and appalled, she was concerned, and she warned my wife that she’d better contact the insurance company ASAP to make sure that they don’t have something in her records claiming that she has a serious chronic condition that in fact she does not have.
Health insurance companies should not be diagnosing patients. This is true whether or not their diagnoses are correct, but it is much more outrageously wrong for incorrect diagnoses. Prior informed consent from patients to allow the insurance company to look at their records and make such diagnoses might make the program OK, but it is certainly not OK to run patients’ medical data through computers and send them letters of this sort without such prior concent.
Before contacting the insurance company as recommended by my wife’s PCP, I decided to speak with my employer’s Vice President of Human Resources directly about what had happened. He agreed with me that the program was ipso facto inappropriate and that it was outrageous that my wife received a letter about a severe chronic condition which she does not have. He said he would contact the insurance company immediately, and that he might ask them to contact me to discuss it further.
A few days later I got a call from a woman at BCBS. She informed me that the letter my wife received had been sent in error, as a result of an error in the logic used to determine which customers should receive letters about that particular condition, and she apologized for the “error.” She said that other people had received erroneous letters about the same condition, and that as a result, that portion of the application had been shut off and no further letters would be sent out about that particular condition until the problems with the logic were fixed.
In response, I informed her that while I appreciated her apology, my complaint was not with the specific letter that my wife received, but rather with the entire program, i.e., with BCBS diagnosing customers based on claims histories, quite possibly in violation of the law (she professed no knowledge of such a possibility, and I suggested that she might want to look into it). She tried the old, “No one else has every complained!” canard (this is what companies that are wrong tell everyone who complains about a particular issue until somehow the lid gets blown off how many people are actually complaining), but obviously didn’t get very far with me on that one. Then she tried, “This is a service that we’re providing to our customers that many of them appreciate,” to which I responded, “The only reason you have to provide such services is because you pay the doctors so little for their services that they have to see thirty patients a day to break even and don’t have time to pay enough attention to any of them.” She refused to acknowledge that it was ridiculous to assert that now that they’d turned off the logic for this one condition, there weren’t any other incorrect diagnoses being made by the computers. I didn’t seem to get through to her when I explained that just as they didn’t know there were problems with the logic for this particular condition, there was no way they could know whether there were problems with the logic for other conditions as well, unless of course they felt it was OK for them to send letters to patients with incorrect diagnoses until someone bothered to complain about it. In short, according to her, BCBS doesn’t think there’s anything wrong with this program and intends to keep running it.
She had a similar conversation with our VP of HR with a similar outcome. He’s planning on raising the issue with our insurance broker and trying to get them to turn off the program completely for all our employees. I’m planning on filing a complaint about the problem with the Insurance Division of the Massachusetts Office of Consumer Affairs and Business Regulation, as well as running this by the health reporters at the Boston Globe and Herald to see if I can get them to pay some attention to it. We’ll see what comes of it.