A continuing challenge for sellers of ultraviolet phototherapy products are the insurance companies we have to deal with on a daily basis. One thing for sure is that the insurance companies are there to make money and not help their customers. It is really sad that our customers have to go through hell and back to get anything from virtually any insurance company. Organizations like MEDICARE, AETNA and CIGNA simply do not cover ultraviolet phototherapy for Vitiligo period for home phototherapy.
When you see insurance ads that say “total peace of mind for reasonable premiums’, you are reading total horse sh*t. Each of you should go rent Michael Moore’s movie ‘SICKO‘ and see what you’re up against. Hard to believe that some insurance companies actually pay bonuses to employees who successfully deny claims!
Let look at what happens with Empire / Blue Cross / Anthem / Blue Shield / Horizon and a host of other BCBS (Blue Cross/Blue Shield Companies). Each of these companies have different plans and different coverage depending on which state or region that you are in. Until we call call that particular patient’s Blue Cross office there is simply no way we can guess as to what a customer’s coverage is. How sad is that? There is no uniform policy and I actually believe that the agent that we call has complete latitude to give us any damned answer that they dream up for that particular phone call. If the agent is in a good mood then perhaps we’ll hear, “Yes, the patient is covered.” and if the agent got up on the wrong side of the bed then they can simply lie and say, “There is no coverage.”
In some states, BCBS cover Vitiligo in others they don’t. In some states it’s a cosmetic condition and in others it’s a disease. Sometimes UV Phototherapy is approved and the next day in the same state it’s ‘experimental’ and not covered. It’s a disaster for us and our customers. Sometimes it’s covered at the ‘billed amount’ and at others is approved for some percentage of the ‘allowed amount’. The ‘allowed amount’ is a magic number that BCBS have in some secret file that is only available after filing a claim. A typical ‘allowed amount’ is at least 30% to 50% below the billed amount but one never knows.
One thing we do not understand is the BCBS policy is that they pay their subscriber (you) and not us (the maker) when they settle a claim. They expect us to ship before we file a claim and then (1) hope they send some money to you and (2) hope that you’ll send money to us. We have adopted a policy as have many firms like us, that we only ship product after we have been paid in full. Most other insurance companies pay us and then we contact our customer and ask for payment of the balance before we ship any product.
I think you’ll detect some cynicism in my words and you should. We will do the best job we can and try as hard as we can to get some money from a client’s insurance company but we are not always successful.
Here’s some insurance company math!
- Billed amount = $2500.00
- Allowed Amount = $1400.00
- Customer Deductible = $1000.00
- Pay 60 % of $1400.00 less $1000.00 or $240.00
Isn’t that great!