Blue Cross tells me they will, then won’t, cover my emergency visit to a French doctor today

As much as I write on a blog, and have done a lot of television and public activism, I’m actually quite a private person in some ways. I never really wanted to talk about my various health care problems on the blog because, well, it’s just not something one does, the way I was raised. Not any more. To the degree Joe and I can help advance the health care debate in our own small way, by sharing our own personal stories of people who supposedly have “good” insurance, then so be it.

Today is the day I visit the emergency room of a hospital in Paris devoted to eye care. (I just arrived in Paris to do my annual house-sitting for Chris and his wife Joelle while they’re on vacation.) You see, I’m at risk for a detached retina. Highly myopic. Hitting my mid-40s. Lots of floaters. And my sister already had to have emergency surgery for a detached retina a few years back, then lay on her stomach for 2 weeks – I believe she got like an hour a day to walk around – while her eye healed. It’s all very risky, for your vision, but the alternative is most certainly going blind.

So, a few years back, I went to a retina specialist in DC and, lo and behold, he found two small holes/tears in my retina. He did laser surgery, on the spot, to cauterize the tears (let me tell you how fun that was), in the hopes that it would stop them from progressing to a full-blown detachment. I now regularly go to him for check ups, including one last week, before the recent symptoms.

So, this whole detached retina thing is serious business. That’s why, when I noticed a marked increased in floaters in my right eye the other day, including a very large one (like I’ve never had before) and several small black pin points (also have never had that type before), I got worried. I remember my doctor, my sister, and all the the literature telling me that you should always be on the look-out for two things: flashing lights; and/or a marked increase in floaters. I’ve got one of the two. I called sis, and she confirmed, it’s time to get to a doctor, pronto. You see, with retina problems, you don’t feel pain. You don’t feel anything. Your retina could start detaching, you might notice some symptoms, but you’d otherwise feel fine. And if you don’t do anything about it, in a few days you could be permanently blind.

So, being the good guy I am, I got on the phone last night and called CareFirst Blue Cross Blue Shield in the states to find out if I even have coverage here in France, what that coverage is, whether they have specific doctors I have to/should go to in order to get the best coverage, and whether I even need to get pre-approved from them.

Big mistake.

The first lady at BlueCross was very nice. I told her what was going on with my eye, and she told me that I absolutely positively have coverage. Just go to a doctor, they’ll cover it as they do at home. Wow, I thought, and I’ve been knocking Blue Cross lately – this is pretty good. She then told me that they had an international service, Blue Cross Worldwide that would help me find a doctor and all that good stuff.

I was seriously impressed, and told her so. I told her about the last time I’d called them with a health problem from Paris. I had had a cold or flu that had settled in my chest and gone on for over six weeks. I needed a chest x-ray to make sure it hadn’t turned into pneumonia. Called Blue Cross to find out if they paid for it in Paris, and got a half-hour long runaround from a very nice woman who had no idea what she was doing, other than reading me written instructions that may or may not have applied to my case. In the end, after the woman had told me that my x-ray would, and then wouldn’t, be covered (she asked me if my French doctor was “in plan” – I told her, “I’m in Paris, do you have doctors in plan here?” – she wasn’t sure), I hung up and went anyway (and as the fee was 60 bucks, I didn’t even bother submitting it to my insurance).

When I told this story to the nice lady at Blue Cross yesterday, to show her how a year ago no one even knew they had an international service, she was genuinely surprised, and told me “you know, you should have submitted that x-ray for reimbursement.”

Not so fast, Nice Blue Cross Lady. Because within an hour I’d be passed to Not-so-nice Blue Cross Lady who would tell me the polar opposite.

You see, the original Nice Blue Cross Lady passed me to Even Nicer Blue Cross Lady at Blue Cross World Care. Nicer was going to help me get a doctor, and told me that my coverage would depend on which doctor and all that, and that she’d be happy to assist me in talking to the original Blue Cross folks to determine whether they have any in-plan doctors in Paris, etc. Well. That’s when we discovered Not-so-nice blue Cross Lady. NSN, as we’ll call her, was an expert at mono-tonally reading sentences on a computer screen. With Even Nicer lady still on the phone with me, NSN told me:

We cover “emergency care, urgent care services only.”

Great, I thought, imminently going blind at the age of 45 has to be consider an emergency, or at least certainly urgent, right? Even Nicer Lady concurred, saying something like, well this is clearly an emergency.

That’s when Not-so-nice jumped back in:

“We only cover service rendered on an emergency basis or in an urgent care emergency room,” she told me.

What’s an urgent care center, I asked? It’s an urgent care center, where you go for urgent care, like we have them in the states, she said. Yes, just switch the order of the same words and it would all suddenly make sense. Maybe next time she could just read the same words louder.

In her best, somewhat annoyed, somewhat bored, computer simulated voice, NSN was telling me and the Even Nicer lady that I would only be covered for emergency room visits.

What?

I said, but the lady before just told me that any visit would be covered, for anything. She even told me that my visit to the doctor a year ago to get a chest x-ray would have been covered, and scolded me for not submitting it. How is it that now I’m only covered for an emergency room visit?

“We only cover service rendered on an emergency basis or in an urgent care emergency room,” she told me again.

Right, but what if I go to an emergency room and they tell me, wow, you’re retina is about to detach, you need to go see our specialist right away, and he’s down the hall, not in the emergency room itself – so you won’t cover that?

“I already told you, we only cover service rendered on an emergency basis or in an urgent care emergency room.”

So, if the emergency room people send me anywhere outside of the emergency room to be treated, I’m not covered.

“Sir, I just read you what it says, I can only tell you what it says.”

Yes, God forbid my insurance be able to actually tell me under varying scenarios what my coverage is and is not.

The thing is, why did the first Blue Cross representative tell me that my visit to the eye doctor, any eye doctor, would be definitely covered? Why did she tell me that my chest x-ray for last year, which was not done in an emergency room, would have definitely been covered? Why does Blue Cross’s own Web site imply that their customers do in fact have some kind of international medical coverage, not unlike the in-plan out-of-plan coverage we have at home? From Blue Cross’s own Web site:

If you need non-emergency inpatient medical care, you must call the BlueCard Worldwide Service Center. The Service Center will facilitate hospitalization at a BlueCard Worldwide hospital or make an appointment with a doctor. It is important that you call the BlueCard Worldwide
Service Center in order to obtain cash-less access for inpatient care except for your usual out-of-pocket expenses (e.g., deductible, coinsurance). The Service Center is staffed with multilingual representatives and is available 24 hours a day, seven days a week.

At this point, I’d had it with Not-so-nice Blue Cross lady and told her to go away. She was not amused. Well neither was I. Even Nicer Blue Cross lady, obviously feeling bad about what she had just witnessed, was quite apologetic.

I explained to her – so, my eye might be going blind. Rather than go to a retina specialist, you want me to go a general emergency room, where they may or may not have a retina specialist to take a look at me. The risk being that we might not catch the detachment in time, I might go blind, and then we’ll be facing $50,000 in surgery when I get back, which Blue Cross WILL cover, all because they won’t cover a trip to a specialist while I’m abroad.

Again, Nicer was sympathetic. She agreed that maybe we should try a third Blue Cross expert back home in the states to see if I got a different, third answer as to whether I’m covered. While waiting 20 minutes for that person to come on the phone, my phone disconnected.

Again, let me reiterate. I have “good” health insurance. I pay nearly $420 a month for a PPO because I didn’t want any of that “socialized medicine HMO garbage” when I started having to pay for my own coverage. I thought paying the extra money guaranteed that I’d be getting better coverage.

What I got was a company whose left hand doesn’t even know what its right hand is doing. A company that can’t even tell me if I am or am not covered when I’m in a situation where I have to go to a doctor.

We’re to believe that this isn’t the equivalent of “socialism,” where some faceless bureaucrat rations out care, telling you what you can and can’t get treatment for, to hell with what you really need, to hell with any chance of appeal? How could a government plan be any worse? At least with a government plan I can appeal to my member of Congress when the insurance provider starts playing games like this.

For all intents and purposes I have no insurance. I have a crap shoot. Not only are the details of my plan unknowable, but they appear to change with the luck of the draw, depending who answers the phone that day at Blue Cross’ 800 number, spin the lucky wheel, headquarters in hell.

So today I’m dragging my happy ass to the eye speciality hospital – I learned how to say “horse shoe tear” in French – and, at the suggestion of Chris’ wife, rather than making an appointment, I’m going to the emergency room, since that’s the only treatment Blue Cross covers, and since even the Nicer Blue Cross lady agreed with me that being in imminent danger of going blind definitely qualified as an urgent emergency.

Stay tuned for Part II of this saga, my experience with the French emergency room culture. And then will come Part III: Submitting the reimbursement to Blue Cross, and them telling me that my visit wasn’t, I bet, urgent.

UPDATE: I got back from the hospital, and had to have emergency eye surgery. Read about that tale, from the land of socialized medicine, here.


CyberDisobedience on Substack | @aravosis | Facebook | Instagram | LinkedIn. John Aravosis is the Executive Editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown; and has worked in the US Senate, World Bank, Children's Defense Fund, the United Nations Development Programme, and as a stringer for the Economist. He is a frequent TV pundit, having appeared on the O'Reilly Factor, Hardball, World News Tonight, Nightline, AM Joy & Reliable Sources, among others. John lives in Washington, DC. .

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