Feeling blue with Florida Blue: How insurers play God

florida blue 2

Ever wonder who would inhabit the deepest reaches of hell were Dante to return and rewrite his famous Inferno?

The easy choices, if we’re looking at it collectively, are surly DMV employees, self-aggrandizing school board members and self-righteous do-gooders who miss no opportunity to sing their own praises while informing you of your own missteps.

As if the above alone wouldn’t fill up at least a couple of circles of hell, there’s another group which deserves its own special place in perdition: health insurers who make life insufferably difficult for those with serious illnesses.

I have a friend who is battling leukemia. She is in her early 40s and she and her husband have a beautiful 7-year-old daughter. She has traveled to MD Anderson Cancer Center in Houston, Texas, many times for treatment but lives in Florida. Beyond the unfairness of a wonderful person with a great husband and sweet young child having to battle of a life-threatening illness, she also has to fight insurers which routinely deny her coverage for needed cancer-treatment medication.

My friend’s medical team has sent documents in triplicate to her insurers – Blue Cross/Blue Shield of Florida (Florida Blue) and Prime Therapeutics – several times and each time insurance representatives have claimed that “they have no way to attach the documents to each other” or that they “have not received them.”

Screen shot from friend's Facebook feed as she expresses her frustration with insurers who won't pay for approved cancer medication.
Screen shot from friend’s Facebook feed as she expresses her frustration with insurers who won’t pay for approved cancer medication.

The folks at Florida Blue – whose slogan is, ironically, “Here For You, in Your Pursuit of Health” – have decided not to cover my friend’s prescription even though it’s on their list of approved medications.

Because of this, my friend has been without anti-cancer medication for a month, obviously not a good thing for someone with leukemia.

Her doctors, nurses and health care providers have been working diligently to get the correct papers into their hands for several weeks. Yet, a month later she is still without needed medicine and no answers.

I understand insurance is a business, but I don’t understand how paper pushers in any corporation can deny coverage to someone whose life is at stake when the needed medication is on the list of those already approved by the insurer.

At what point does someone within the company say “Enough!” and blow the whistle on this sort of unethical and, most likely, illegal, activity?

How many other examples like this are going on at health insurers across the nation?

Finally, how do the people who knowingly deny insurance coverage, and most certainly understand that they are jeopardizing lives in doing so, live with themselves? Can it be that easy to suspend ethics, compassion and decency?

Dante would have a field day with folks like those at Florida Blue and Prime Therapeutics.

18 thoughts on “Feeling blue with Florida Blue: How insurers play God

  1. It makes me livid and incredibly sad that making a little money is put above a person’s life. Her doctors are clearly in agreement that she needs this medication, it’s on #bcbsfl ‘s approved list, and she has a serious illness. For logical, ethical, and compassionate reasons at the very least, they should have approved her weeks ago.

    • I’m with you, and not just because this happens to be a friend of mine. Companies have an ethical responsibility to ensure that they do what’s best for customers when customers have met the guidelines the companies set forth. The troublesome thing is, who knows how widespread this practice is?

  2. Thank you so much for your article. We are Monica’s Aunt and Uncle in California. This happens all the time. Insurance companies do play GOD with cancer patients. We lost our daughter (Monica’s cousin) to cancer in April of this year. She experience similar problems with insurance denials. Enough is enough. What can we do to help Monica get her medications?

    • I am sorry about the loss of your daughter. I can’t imagine losing a child, never mind having to wage a battle with insurers who seem only interested in their own bottom line while your child suffers.

      I wish I knew what we could all do to help Monica. I suppose if there is enough negative publicity, Florida Blue may actually take notice. I think if we can keep up a steady stream of publicity, the company will be forced to rethink its actions. At least, I hope it will.

  3. Cotton Ball,

    My name is Kate Hamerlind and I’m the Manger of Clinical Review Support – Medicare D and I work for Prime Therapeutics.

    I’m sorry to hear that your friend has experienced this with my company.

    Our mission statement at Prime Therapeutics that we as leaders speak daily is, “Helping people get the medicine they need feel better and live well.” I truly believe in our mission although it sounds as though you and your friends have not experienced the same thing.

    I would like to be able to give my contact information and encourage your friend or her husband to contact me and I will make best efforts to get this resolved, and give them an understanding of what has happened that resulted being in this situation.

    My number is 651-263-3964.

    Wanting to help get the medicine your friend needs to feel better and live well.

    Kate Hamerlind

  4. Love it!!!!
    Thank you for writing this!!! I know everyone that loves Monica really appreciated you doing this!!!

  5. I was wonderfully surprised that your blog posting actually made Prime Theraputics approve the payments.

    — Phil Leigh

    • Well, I think it was more a case of people taking to Twitter and talking about how Florida Blue and Prime Theraputics weren’t upholding their end of the bargain that made the difference. Big companies have learned to monitor social media and know the detrimental effects of negative publicity, especially if it goes viral. But I appreciate your comment. I’d like to think I was able to do something to help Monica.

  6. Pingback: Social media provides needed kick in rump to insurers | The Cotton Boll Conspiracy

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