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Embarrassment-based health care.

Blue Cross Blue Shield Horizon of New Jersey [1] has contributed an interesting new proposal to the national health care debate: Embarrassment-Based Care™.

A few weeks ago, my friend Biella posted an account on her blog [2] of how BCBS Horizon of New Jersey (hereinafter “BCBS”) was denying a claim of hers on the basis that it was a pre-existing condition. She was staying with me at the time, and we talked about the so-called condition in detail then. Now, I’m just a simple caveman, not a health care lawyer, but BCBS’s rejection sure sounded bogus to me, as it did to Biella. (There’s an appeals process by which such disagreements can be settled, and if the parties fail to reach agreement then the case can eventually wind up in court, a prospect Biella was prepared for, though dreading.) Her interactions with BCBS had been pretty bad up till the point of that first blog post: not only were they continuing to reject her claim, they were doing so in an especially opaque and inconvenient manner — you know, shunting her from one service rep to another, demanding new documentation apparently just for the sake of stalling, that sort of thing. She later called it “some of the worst customer service I have ever received”.

Well, within two hours of making that first blog post, she got a call from the Director of Public Relations for Blue Cross Blue Shield of NJ. He “came across her blog posting” and wanted to see what he could do to assist. This is all described in her second blog post [3].

Doesn’t it seem a little odd that the Director of Public Relations would get involved in what is essentially a medical determination? I mean, if BCBS really, sincerely believes Biella’s condition was pre-existing under the applicable definition of the term, there’s nothing the PR department could do to change that. On the other hand, if it’s not clearly pre-existing — that is to say, if BCBS has been exercising their discretion all along in a hard-to-call edge case — then you’d think it would make much more sense for them to just change their decision and pay out the claim, without ever telling Biella why, and certainly without the PR Director calling her. Finally, if BCBS itself doesn’t even believe the condition was pre-existing, then naturally they should have paid the claim in the first place and never put her through this.

So I’m not sure where in all this it makes sense for the PR department to get involved… except, of course, that from BCBS’s point of view, her original blog post was a potential embarrassment, and protecting the company from embarrassment is part of PR’s job.

Maybe they ought to consider the possibility that protecting the company from embarrassment is also the claims department’s job… I’m just sayin’.