Sandy Honig's Visceral Appeal to Anthem BCBS
August 30, 2022 2:44 PM Subscribe
Comedian Sandy Honig has a stomach condition called gastroparesis, “which causes me to vomit almost everything I eat”. The condition can be managed with a Botox shot to the pyloric sphincter. Unfortunately Anthem Blue Cross Blue Shield denied her claim for this treatment on the grounds they don’t cover “cosmetic procedures." So Sandy went to appeal in person... (CW: A LOT OF REAL VOMITING. SERIOUSLY, A LOT.)
Palate cleanser: Fashion! with Three Busy Debras, Sandy’s amazing comedy group.
Palate cleanser: Fashion! with Three Busy Debras, Sandy’s amazing comedy group.
Hey--no more disgusting than most of what's on Three Busy Debras*.
* Which I love.
Do not love the thought of convincing the insurance company to see reason.
posted by polecat at 3:20 PM on August 30, 2022
* Which I love.
Do not love the thought of convincing the insurance company to see reason.
posted by polecat at 3:20 PM on August 30, 2022
How did Anthem get cops to come to her home?
posted by macrael at 3:23 PM on August 30, 2022 [1 favorite]
posted by macrael at 3:23 PM on August 30, 2022 [1 favorite]
@macrael -- I wondered the same thing. The hand-written report that flashed across the screen towards the end of the police segment (police report perhaps?) looks like it might say "wellfare check".
If so, I'd clock that as a retaliatory passive-aggressive move by Anthem.
posted by neuracnu at 3:34 PM on August 30, 2022 [4 favorites]
If so, I'd clock that as a retaliatory passive-aggressive move by Anthem.
posted by neuracnu at 3:34 PM on August 30, 2022 [4 favorites]
How did Anthem get cops to come to her home?
How did the largest insurance network in the nation get cops to someone's home?
posted by Thorzdad at 3:36 PM on August 30, 2022 [18 favorites]
How did the largest insurance network in the nation get cops to someone's home?
posted by Thorzdad at 3:36 PM on August 30, 2022 [18 favorites]
Big wow.
posted by PistachioRoux at 3:49 PM on August 30, 2022
posted by PistachioRoux at 3:49 PM on August 30, 2022
Had a bad time a few weeks back on a hike, vomited, and boy is that sound fresh in my ears. Makes you realize in most TV/movies they are making/adding a noise that sounds kinda like vomiting but more over the top, completely fails to capture the visceral true sound that triggers memories of doing it yourself. Good call, comedy sound people. (although in this case, it works!)
posted by JauntyFedora at 3:49 PM on August 30, 2022 [1 favorite]
posted by JauntyFedora at 3:49 PM on August 30, 2022 [1 favorite]
The speediest look-in I ever got at urgent care was when dyshidrosis (do not image search unless you have a strong stomach) plus contact dermatitis turned my hands into something out of a creature feature. I waited a lot longer the time I thought (incorrectly, fortunately) it was a kidney stone.
Shouldn't be this way.
posted by humbug at 4:13 PM on August 30, 2022
Shouldn't be this way.
posted by humbug at 4:13 PM on August 30, 2022
Yeah, the little bit of flashed writing mentions a welfare check and possible 5150 psych hold.
posted by drewbage1847 at 4:20 PM on August 30, 2022
posted by drewbage1847 at 4:20 PM on August 30, 2022
Anthem referring to a cosmetic treatment is a red flag that her doctor's office made a mistake when submitting the request (possibly just not submitting the necessary evidence). There's a whole back and forth process for the insurance company to get the info they need to make a decision.
Which isn't to say it wouldn't get denied eventually but if it did it they wouldn't call it a request for a cosmetic procedure because at that point it would be clear that's not the case. Anthem is well aware that Botox can be used for non-cosmetic conditions (e.g. migraines).
posted by duoshao at 5:09 PM on August 30, 2022 [3 favorites]
Which isn't to say it wouldn't get denied eventually but if it did it they wouldn't call it a request for a cosmetic procedure because at that point it would be clear that's not the case. Anthem is well aware that Botox can be used for non-cosmetic conditions (e.g. migraines).
posted by duoshao at 5:09 PM on August 30, 2022 [3 favorites]
And the point is, all of this is nonsense, and incredibly demeaning and wrong, to treat people this way.
posted by tiny frying pan at 5:11 PM on August 30, 2022 [7 favorites]
posted by tiny frying pan at 5:11 PM on August 30, 2022 [7 favorites]
Sandy Honig is a gift. And the first season of Three Busy Debras was gold.
posted by Tom Hanks Cannot Be Trusted at 5:23 PM on August 30, 2022 [1 favorite]
posted by Tom Hanks Cannot Be Trusted at 5:23 PM on August 30, 2022 [1 favorite]
Anthem is the worst.* I've had them straight up deny medically effective treatments, sometimes without warning. Once I received three letters from them, all dated the same day, one approving treatment and two others denying.
There's a whole back and forth process for the insurance company to get the info they need to make a decision.
Imma stop you right there. There should not be any back-and-forth. There should be a board-certified clinician operating in the scope of their practice saying "This is the treatment that is most effective/has least side effects/meets whatever the patient's goals are" and the payer being like "Sounds good, here's how much it will cost." Whereas the goal of a for-profit insurance company is to deny as much as possible, regardless of actual cost, in order to save $$ for shareholders and the C-suite. There has been a noticeable uptick in spurious denials since covid, because insurance companies lost a shitton of money being required to cover covid-related costs, and they are trying to recoup by nickel-and-diming everything else. I believe in shared decision-making, but in 2022, the only decision maker for most Americans, is someone who has never met them and is operating off some flowchart algorithm put together in 20 minutes by a Powerpoint-savvy intern.
*All the commercial insurance companies are the worst. I recently had to do a peer-to-peer (i.e. beg the company doctor to cover a medication) where the person on the other end had never heard of the FDA. She literally said, "What's that, it's not on the flowchart, oh maybe it's on the other page" and then I had to wait while she fucking googled it. This was for a medication that has been around since 1971, costs pennies to manufacture, and is on the WHO List of Essential Medications for a functional health system. Functional being the keyword there. These are the people making your healthcare decisions in America.
posted by basalganglia at 6:02 PM on August 30, 2022 [44 favorites]
There's a whole back and forth process for the insurance company to get the info they need to make a decision.
Imma stop you right there. There should not be any back-and-forth. There should be a board-certified clinician operating in the scope of their practice saying "This is the treatment that is most effective/has least side effects/meets whatever the patient's goals are" and the payer being like "Sounds good, here's how much it will cost." Whereas the goal of a for-profit insurance company is to deny as much as possible, regardless of actual cost, in order to save $$ for shareholders and the C-suite. There has been a noticeable uptick in spurious denials since covid, because insurance companies lost a shitton of money being required to cover covid-related costs, and they are trying to recoup by nickel-and-diming everything else. I believe in shared decision-making, but in 2022, the only decision maker for most Americans, is someone who has never met them and is operating off some flowchart algorithm put together in 20 minutes by a Powerpoint-savvy intern.
*All the commercial insurance companies are the worst. I recently had to do a peer-to-peer (i.e. beg the company doctor to cover a medication) where the person on the other end had never heard of the FDA. She literally said, "What's that, it's not on the flowchart, oh maybe it's on the other page" and then I had to wait while she fucking googled it. This was for a medication that has been around since 1971, costs pennies to manufacture, and is on the WHO List of Essential Medications for a functional health system. Functional being the keyword there. These are the people making your healthcare decisions in America.
posted by basalganglia at 6:02 PM on August 30, 2022 [44 favorites]
Oh, good times!
I remember that time I was on life support and I was being billed somewhere north of $400K when BCBS decided to stop paying altogether. Apparently when your billing gets beyond a particular threshold, commercial insurers check with a third party research group to see if there's ANY legal reason they can justify not covering you. And the research group found something.
I kept getting these letters that said BCBS proved I was covered by another insurer and that they didn't have to pay. But I had no other insurer. My bills kept inflating, turning from white copies to pink and yellow. I called and wrote BCBS, got 40 minute wait times, every operator said that they'd noted my call and not to worry, but the letters kept coming and the bills kept mounting up.
Meanwhile, I begged BCBS in a half dozen letters, registered, to tell me who the other insurer was so I could track it down and send them proof. Nothing. No response at all. And why would they? The proof, once provided, would put them on the hook for my care, which that particular year billed at just over $1 million, though the negotiated rate was quite a bit lower.
I'd done COBRA for a while, two of the companies I'd worked for within that decade had been bought and sold and technically no longer existed. So I did three-way calls with BSBC operators and my COBRA, thinking that was the most likely source. The BCBS operators kindly marked it as resolved and assured me no more denial letters. I got more denial letters. Piles of denial letters. And I was so sick I could barely think, much less figure out how to resolve it.
I was somewhere north of 600K when I got one of my bigger medical providers to intervene. Turns out I'd been tuttlebuttled by an insurance company from two employers and five insurance carriers before. My name had been on a decommission list and had never been removed. The database person probably spilled their drink or got a phone call while my name was being processed and mine was the only name in the entire company that hadn't been submitted. I was on their rolls even though I hadn't paid them a dime since 2007. And so BCBS, confident that they had found another active insurer, stood their ground until they were forced to yield.
So that's my fond story of BCBS, a company that for months on end ignored the begging and pleas of a woman on life support. I wasn't barfing on demand at that point, that came later, but maybe that would have gotten their attention. Good on Sandy Honig for thinking of that.
posted by mochapickle at 6:42 PM on August 30, 2022 [37 favorites]
I remember that time I was on life support and I was being billed somewhere north of $400K when BCBS decided to stop paying altogether. Apparently when your billing gets beyond a particular threshold, commercial insurers check with a third party research group to see if there's ANY legal reason they can justify not covering you. And the research group found something.
I kept getting these letters that said BCBS proved I was covered by another insurer and that they didn't have to pay. But I had no other insurer. My bills kept inflating, turning from white copies to pink and yellow. I called and wrote BCBS, got 40 minute wait times, every operator said that they'd noted my call and not to worry, but the letters kept coming and the bills kept mounting up.
Meanwhile, I begged BCBS in a half dozen letters, registered, to tell me who the other insurer was so I could track it down and send them proof. Nothing. No response at all. And why would they? The proof, once provided, would put them on the hook for my care, which that particular year billed at just over $1 million, though the negotiated rate was quite a bit lower.
I'd done COBRA for a while, two of the companies I'd worked for within that decade had been bought and sold and technically no longer existed. So I did three-way calls with BSBC operators and my COBRA, thinking that was the most likely source. The BCBS operators kindly marked it as resolved and assured me no more denial letters. I got more denial letters. Piles of denial letters. And I was so sick I could barely think, much less figure out how to resolve it.
I was somewhere north of 600K when I got one of my bigger medical providers to intervene. Turns out I'd been tuttlebuttled by an insurance company from two employers and five insurance carriers before. My name had been on a decommission list and had never been removed. The database person probably spilled their drink or got a phone call while my name was being processed and mine was the only name in the entire company that hadn't been submitted. I was on their rolls even though I hadn't paid them a dime since 2007. And so BCBS, confident that they had found another active insurer, stood their ground until they were forced to yield.
So that's my fond story of BCBS, a company that for months on end ignored the begging and pleas of a woman on life support. I wasn't barfing on demand at that point, that came later, but maybe that would have gotten their attention. Good on Sandy Honig for thinking of that.
posted by mochapickle at 6:42 PM on August 30, 2022 [37 favorites]
wait. they called the police. what a country we live in.
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 7:07 PM on August 30, 2022 [2 favorites]
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 7:07 PM on August 30, 2022 [2 favorites]
if it did it they wouldn't call it a request for a cosmetic procedure because at that point it would be clear that's not the case
This assumes that insurers are acting in good faith and would not knowingly or carelessly reject a claim if they felt like they could get away with not paying it out.
My experience has been that insurers will absolutely reject things for spurious reasons and then, even after the error has been made obvious, drag their feet or refuse to talk to providers to sort things out.
mochapickle, I am so, so sorry you went through that. I hope things are going at least somewhat better health, billing, and otherwise.
posted by evidenceofabsence at 11:20 PM on August 30, 2022 [14 favorites]
This assumes that insurers are acting in good faith and would not knowingly or carelessly reject a claim if they felt like they could get away with not paying it out.
My experience has been that insurers will absolutely reject things for spurious reasons and then, even after the error has been made obvious, drag their feet or refuse to talk to providers to sort things out.
mochapickle, I am so, so sorry you went through that. I hope things are going at least somewhat better health, billing, and otherwise.
posted by evidenceofabsence at 11:20 PM on August 30, 2022 [14 favorites]
Hey, let's do that thing where we pretend to practice medicine without a license.
posted by a robot made out of meat at 6:47 AM on August 31, 2022 [3 favorites]
posted by a robot made out of meat at 6:47 AM on August 31, 2022 [3 favorites]
Is this one of them Socialised Death Panels I hear so much about?
posted by atrazine at 7:46 AM on August 31, 2022
posted by atrazine at 7:46 AM on August 31, 2022
My experience has been that insurers will absolutely reject things for spurious reasons and then, even after the error has been made obvious, drag their feet or refuse to talk to providers to sort things out.
Mine too. In fact my experience as the person in the doctor's office is that the insurance companies often show no signs whatsoever of having even read what we sent them.
posted by joannemerriam at 7:59 AM on August 31, 2022 [5 favorites]
Mine too. In fact my experience as the person in the doctor's office is that the insurance companies often show no signs whatsoever of having even read what we sent them.
posted by joannemerriam at 7:59 AM on August 31, 2022 [5 favorites]
This is horrible. I'm in a fight with my employer-offered insurance right now, trying to get them to cover the med that allowed me to get my chronic migraine under control and take this job in the first place. After 25+ years of trying different medications with very little improvement, they claim that I haven't shown that no other medication will work for me. Medicaid covered this med, but they won't. It makes me want to spit.
posted by epj at 8:47 AM on August 31, 2022 [7 favorites]
posted by epj at 8:47 AM on August 31, 2022 [7 favorites]
This week I gave two weeks notice to my giant health insurer employer.
posted by paper chromatographologist at 12:27 PM on September 1, 2022 [3 favorites]
posted by paper chromatographologist at 12:27 PM on September 1, 2022 [3 favorites]
As an actuary, I have refused to work for any health insurance company at all ever. I ended up working in reinsurance, which is where your insurance company transfers some of that risk to another company. (There are specialized companies that only deal in reinsurance, which is where I work, and they will cover any kind of insurance that is offered to consumers). However, I can still sleep well at night because both the small mostly Life reinsurer, and the giant multinational all-kinds-of-insurance reinsurer that I have worked for are not involved in the US health business at all.
I could never work for a health insurance company and be ok with myself. However I do say that knowing that I have unlimited choice to work anywhere I want, and my options are not constrained like for others.
posted by LizBoBiz at 12:44 AM on September 2, 2022 [1 favorite]
I could never work for a health insurance company and be ok with myself. However I do say that knowing that I have unlimited choice to work anywhere I want, and my options are not constrained like for others.
posted by LizBoBiz at 12:44 AM on September 2, 2022 [1 favorite]
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Part of my former job was to help patients with these sorts of appeals (well, what she would have done if she weren't doing a bit, I mean), from the doctor's office side, and it was awful.
posted by joannemerriam at 3:09 PM on August 30, 2022 [2 favorites]