Guaranteed Healthcare

My husband (a pharmaceutical chemist) and I moved to NJ back in October '07 after he had been laid off by Bayer Healthcare when they decided to close doors on its headquarters and send all research to Berlin. His new employer provided us with Blue Cross Blue Shield of NJ, Direct Access plan at a cost of $200 a month. A bargain? Maybe. However, what few doctors I can find who ACTUALLY accept coverage through this plan are unreliable and although their Find A Doctor list is enormous, most their contracted physicians want full payment up front and state that reimbursement is so poor (less than Medicaid) they will keep any difference between the companies payment and their fee schedule. Although this is a breech of contract between the doctor and BCBS, neither party will contact the other to resolve matters. To give you an example of what I have been dealing with: I recently developed systemic poison ivy (this occurs whenever I come in contact with the plant. I was itching and covered in blisters on my arms, torso, legs, and back. My doctor back in CT would call in a prescription of prednisone to clear this up without question. My new doctor down here said she would only treat me if it was on my face, as if I make a habit of diving into it face first. I sought treatment from a neurologist to follow up on brain lesions causing short and long term memory loss. In CT a MRI was performed every six months to track any new developments or hopefully improvements in my condition. MS was ruled out. The doctor's first words to me in NJ were, "Well what do you want me to do about this?" Duh!!! He has the medical degree, I gave him my records, explained I needed monitoring of the lesions. What more did he need? He made excuses for not doing an MRI until I went through neuropsychological testing. This is where the nightmare begins. The doctor he referred me to would not accept my insurance (Testing take 11 hours over a period of two days and cost $3000 ) so I contacted BCBS who provided me with a list of psychologists who provide testing and are in contract with them. I would have to pay a $25 copay per hour. Out of the list they provided only one doctor was willing to see me. He was a gentleman in his eighties who after the first evaluation asked me to write out my history as he couldn't keep up with taking notes. At first BCBS declined coverage. After two appeals they agreed to pay him. (This after they referred me to him). Once I won the appeal the doctor said they would only pay him $36 an hour which was not enough to make it worth his while to keep his practice open for those two days. I called BCBS and they convince him he was required to accept the contracted amount. He then called me and said he would do the testing but then I would have to pay $250 for the results! In spite of warnings from BCBS he would not budge. Needless to say it was time to move on. This all began in October. Now it is May and I still do not have a doctor who will see me. I complained to a higher up executive of the company. They set up an appointment with a doctor for me (30 minutes away) and expressed that they would accept my coverage. I called today to "make sure". I was told that they would accept the insurance for an initial evaluation; however I would have to pay for the testing up front. Their argument is the testing is for medical reasons therefore they don't want to be involved. However, the only doctors who do this testing are neuropsychologists! BCBS said my problem is I fall between the cracks of medical coverage and mental health coverage and they do not have policies se3t up for that. Once again I am in limbo and the neurologist refuses to follow up on my care until I have this testing. Meanwhile, I also suffer from insomnia (the stress of dealing with the NJ insurance and medical care system doesn't help this much). My internist refuses to treat me for this and told me I needed to see a psychiatrist. Again the list of referrals proved fruitless. There were doctors that only treated geriatric patients or children, ones who ran a network of social workers and required you to see one of them weekly for 4-5 weeks before seeing the psychiatrist (talk about money schemes) and again those who refused to accept the insurance even though they were in-network. I have been seeing an out-of-network psychiatrist who has prescribed natural supplements along with the sleeping medication I have been on for 6 or more years. He charges $300 for a 30 minute visit. Again I contacted BCBS and was referred to a doctor who called me to set up an appointment just to tell me, without knowing my history or currant condition that I would have to go on mood stabilizers, antidepressants and anti consultants if I was to see her. When I reiterated that I was in recovery for many years and haven't needed psychotropic drugs for a long time she stated that she refused to see me if I refused to be treated! Can we say mal-practice??? By miracle BCBS finally found an in-network doctor 30 minutes away. I spoke to him and he is willing to accept the insurance and monitor my meds, respecting my ability to advocate for myself. I have contacted the State Attorney General's office, the State Commission for Insurance, my husband's benefits department and now a lawyer. We are paying premiums for nothing!!! And don't get me started on the poor medical care in this state. With a large community of seniors on fixed incomes and those living in poverty I can't imagine how they survive here.