By: Chris Conte

2/27/2020

NASHVILLE, Tenn. (WTVF) — Nearly a dozen doctors have written a letter to BlueCross BlueShield of Tennessee asking them to reconsider a new policy that could limit patients access to critical medication during emergency situations.

In early February BlueCross announced that in effort to save members money they would be implementing a new specialty pharmacy program. The company says this new program will help employers save around 20% on specialty drugs. But many doctors say the change in policy will put their patients at risk.

At a recent visit to her eye doctor Elisa Hertzan was being examined for macular degeneration, a disease which caused blindness in her left eye at age 35. Eliza now regularly gets shots of the drug Lucentis to help keep her from going blind in both eyes. The drug is often administered to Elisa on an emergency basis when she suddenly loses sight because of the disease.

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Insurers are a new threat to doctors and hospital systems that have made big investments in physician practices

By: Anna Wilde Mathews

The Wall Street Journal

Some of the largest health insurers are capitalizing on recent massive deals by steering patients toward clinics they now own, controlling both delivery and payment for health care.

The trend creates worries for rival doctor groups and hospital companies that have invested deeply in buying up physician practices, which now increasingly compete against offerings from insurers.

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By: Lauren Weber

Kaiser Health News

The more than $34,000 in medical bills that contributed to Darla and Andy Markley’s bankruptcy and loss of their home in Beloit, Wisconsin, grew out of what felt like a broken promise.

Darla Markley, 53, said her insurer had sent her a letter preapproving her to have a battery of tests at the Mayo Clinic in neighboring Minnesota after she came down with transverse myelitis, a rare, paralyzing illness that had kept her hospitalized for over a month. But after the tests found she also had beriberi, a vitamin deficiency, Anthem Blue Cross and Blue Shield judged that the tests weren’t needed after all and refused to pay — although Markley said she and Mayo had gotten approval.

While Darla learned to walk again, the Markleys tried to pay off the bills. Even after Mayo wrote off some of what they owed, her disability and Social Security checks barely covered her insurance premiums. By 2014, five years after her initial hospitalization, they had no choice but to declare bankruptcy.

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