Regence: No Pity for Policyholders

OPINION -- April 25, 2012 -- Regence Blue Cross of Oregon has notified individual subscribers that beginning in October they no longer will be able to buy coverage with a deductible lower than $2,500. The new plan also slashes benefits and raises co-payments and co-insurance.

You thought the Enron guys who joked about victimizing Grandma Millie were bad? To me, Regence Blue Cross of Oregon is even worse.

I've had an individual health insurance policy with Regence for the last 17 years. Every year, they have come up with more and more ways to chip away at the coverage in the medical plans they offer to individuals like me. Of course, this is at the same time that they have been raising
premiums and hiding their true rates of return on premiums by stashing money in places where it won't "count" as profit.

I am very afraid that the draconian plan they're imposing on us in October will be the straw that breaks the camel's back for me – that I'll be forced to consider being uninsured.

Regence's annual cuts in benefits became much worse a few years ago--at about the same time that they lost the teachers group contract. They even started making cuts mid-year; one year I had three different sets of benefits, each one worse than the last.

My poor husband dreaded every envelope from Regence in our mailbox, because he knew I would be so upset when I read it.

In individual medical policies in Oregon, anything goes. There is no ERISA to rein in the companies. So I already don't have any mental health coverage in my Regence plan. I already have a limit of $1,500 a year in prescription coverage. Regence will help pay for X-rays and other imaging tests only up to certain, very low, levels. Forget dental or vision care -- my teeth can fall out and I can walk around unable to read the street signs.

For this, I'll be paying Regence at least $6,000 a year – probably more; they haven't notified us yet – but I won't see one cent of coverage from them until I've spent at least $2,500 on doctor's visits, lab tests, and hospitals.

However, I predict that I'll actually be shelling out maybe $3,000 or more before Regence will spend anything on my medical care – because their latest scam is to give credit toward the annual deductible only for a smaller, "allowed" amount, even if the full price is already very low.

I am making this prediction because that's exactly what they did this year when I needed an MRI on my knee.

Rather than have both Regence and me pay more for a scan in Portland, where MRIs run $2,000 to $2,500, I drove to a low-cost center in Lebanon and paid the full amount, $485, myself.

Then, when I asked Regence to credit $485 toward my annual deductible, they gave me credit only for $363.75, which they called the "Regence member rate." What member rate? They had nothing to do with the transaction.

I paid retail for the services, but Regence gave me credit only for the discounted amount THEY would have paid wholesale -- if they dealt with that MRI center at all.

Which they don't.

The decision was based on a Regence fantasy. But they still refused to give me credit for $121.25 of what I actually paid.

That kind of cynical, self-serving manipulation of every rule is why I say:
With Regence, the bottom line is No. 1, and they don't care who is hurt along the way.

I guess those well-paid executives can look in the mirror every day and congratulate themselves for being Masters of the Universe. But what I would see is a bunch of money-grubbing fat-cats who don't care how much harm they do, or how much anguish they cause people like me. Just as long as their numbers look good to the Investor Class.

Basically, I think Regence is gaming the new system that the Obama healthcare reform law is trying to put into place.

They're reducing their benefit plans as much as possible, to establish a new and eroded "normal," and in order to make as much money as possible before they must comply with the new law (if it survives the Supreme Court).

Meanwhile, healthcare economists predict that premiums won't be going down when the law takes full effect -- so Regence will come out on top again.

Just like in Las Vegas, the house always wins.

Linda Roach is a Portland-based medical and science reporter who writes primarily for a physician audience. Previously, she was in the inaugural group of journalists awarded a prestigious Kaiser Media Fellowship in Health, which gave her a close view of the failed Clinton
health care reform effort. A former science editor and city desk editor at The Oregonian, she also wrote about medicine, public health and health care for The Los Angeles Times and the Miami Herald before going freelance. She recently was appointed to the Oregon Geographic Names Board.