There is a parasite (Anthem Blue Cross Insurance) feeding on us…one that uses deception to gorge its grotesque appetite.    It projects a false image of a security, while its network of fibers stab through us, limit us, and deny us access to life-saving care.

  

History:

Years ago, the Kentucky legislature gave monopoly power to a blood-thirsty leech by forcing 300,000+ State Employees to purchase it, and all Kentucky taxpayers to fund this government contractor.   Initially, it seemed like a benefit, and perhaps when the story started, it was a benefit.  But that would change… 

  

Everybody wants to be covered under health insurance. But when the Kentucky legislature dictated which insurance Kentucky employees must purchase, and thereby which insurance all Kentucky taxpayers must fund, they set the stage for a monopoly.   

 

After two or three years, did you notice Humana, Cigna, United, and Aetna were no longer offered on the Kentucky market? Only patients who already had them could continue purchasing them.  Once Kentuckians had little to no other insurance options, ANTHEM began the systematic extortion of Kentuckians.  

  

The monthly premiums rose sharply, leaving patients’ bank accounts depleted. While those carrying private insurance previously received the best care, now they receive no care, because they cannot afford to pay $900/month and meet a $10,000 deductible before ANTHEM starts covering them each year.   

 

People over 65 should not count themselves safe, ANTHEM has moved into the Medicare market too, and is implementing the same strategy.  

  

As working-class Kentuckians have become more impoverished and more sick, ANTHEM has grown rich off their backs.   While Kentucky State employees have been financially raped by ANTHEM, the legislature who forced ANTHEM on them has done little. 

 

ANTHEM has recorded record profits, and is donating heavily to elected officials. The example below outlines in more detail how ANTHEM is extorting Kentuckians… and likely: YOU.

  

​

An Example (True Story):

A colon cancer survivor undergoes a colonoscopy every 2 years.  Her Gastroenterologists has always performed the colonoscopy at an outpatient clinic (at about $3,000 for this exam), and it has always been covered by her insurance company.  Last year, for unknown reasons, her gastroenterologist sold his practice to the hospital.  Now her gastroenterologist has a boss who informs him, “from now on, you will perform all colonoscopies within the hospital’s surgery center.”   

    

The day of the procedure, she drives to the surgery center for the same colonoscopy, performed by the same gastroenterologist, using her same insurance.  But now, it’s no longer covered.  She pays $5,000 to the hospital’s surgery center for the colonoscopy.  She then calls her insurance and learns that they do cover colonoscopies in a gastroenterologist’s outpatient office, but since she “chose” to have the colonoscopy across the street in a surgery center—her insurance covers nothing, until she meets a $10,000 deductible.     

  

What ANTHEM didn’t tell her:  

• ANTHEM has been undercutting her gastroenterologist for the past 3 years, by reimbursing only $1,500—even though ANTHEM knew it cost more than that to provide the colonoscopy service.  After a few years, her cash-strapped gastroenterologist was forced to sell his practice to the hospital, which now has less competition and dictates where more colonoscopies will be performed.

 

• While ANTHEM was under-reimbursing her gastroenterologist, ANTHEM was allowing $5,000 to be paid to the hospital for the same exact service.  Except ANTHEM didn’t pay that, the patient did. 

  • Why?... Because ANTHEM passed a random rule that allows them to “apply the 5K to the deductible” rather than covering the colonoscopy like they did at the gastroenterologist’s office.  Because the patient “chose” to have the procedure in a hospital building instead of a gastroenterologist’s office, she had to pay 5K out of pocket, with zero assistance from ANTHEM (which receives monthly premiums).

  

Eventually, were no gastroenterologists offering colonoscopies in outpatient clinics, because ANTHEM had systematically cheated them until they all sold out to the hospital.  So, the patient couldn’t have had an outpatient colonoscopy even if she had known the rules.  

​

Summary on the Colonoscopy:

• ANTHEM wins because it paid nothing.  

• The hospital wins because the patient paid them $5K for a colonoscopy.  

• The patient lost!  She paid 5K for a service that used to be covered.

 

Anthem has hurt her financially… but it gets worse…

 

Three months later, our colon cancer survivor finds a lump in her breast.  She calls her outpatient breast clinic where she’s gotten care for the past 10 years under a breast subspecialist.  This subspecialist has not sold out to the hospital, but also was being under-reimbursed by ANTHEM and could not afford to stay within ANTHEM’s network.  

 

The patient calls ANTHEM to complain that she wants to be seen by her breast subspecialist, and ANTHEM tells her to go to the hospital (where there are no breast subspecialists).

 

The patient is smart though, so she checks pricing. She calls her breast clinic, and even with no insurance at all, the cost of a workup is $460.  However, the cost of the workup at the hospital is $1,700.

  

She decides to move forward with her subspecialist doctor for $460.  After the exam, the subspecialist says it looks like cancer, and she needs a biopsy.  The cost at the outpatient subspecialist office is $1,400.  She calls the hospital: the ANTHEM In Network cost is $4,000.    

  

She moves forward with biopsy at the subspecialist’s office (because she knows she will get unbiased advice).  Unfortunately, it is cancer.  The subspecialist advises her she needs a breast MRI to stage the cancer so that the surgeon and oncologist know the best path forward.  Her subspecialist tries to make her the appointment at the hospital for the MRI, but ANTHEM refuses to give authorization for the MRI because the subspecialist is not in “ANTHEM’s Network.”  (ANTHEM won’t even follow a referral from a Dr. outside of ANTHEM’s network)! 

  

When every single day matters, ANTHEM delays her care and prevents the subspecialist from rendering life-saving help.  ANTHEM’s network and processes are putting this patient’s life at risk.  

  

It still gets worse from here… because the patient chose to go to subspecialist (who is now “out of network”) ANTHEM reimburses the patient NOTHING. So even though the patient saved $3,840 by going to her breast subspecialist (and got better care), ANTHEM punished her by imposing another irrational rule:

• If you dare seek care out of “ANTHEM Network,” You pay all—until you meet ANOTHER $10,000 deductible on top of your “IN Network $10,000 deductible.”   

​

Overall Summary on this Example:

ANTHEM continues to financially rape her (while also putting her life at unnecessary risk), and our KY legislature:

• Forces her to buy ANTHEM’s product, and

• Forces all Kentucky taxpayers to fund ANTHEM,

• does nothing.  

   

The Kentucky Department of Insurance, Division of Consumer Protection was notified of the fraudulent, unethical actions of ANTHEM.  It responded that there is “no law in Kentucky that allows them to intervene.” 

​

As a patient advocate… I think there should be a law that allows some “oversight” over Anthem’s monopoly.  I cannot create this law by myself...

 

As a medical subspecialist, my purpose is to help my patients, and I need to focus on delivering health services, and not focusing my energy on fighting Anthem’s ridiculousness, which we don’t see from other private insurance companies.  I believe Anthem’s behavior is directly linked to their monopoly status.

 

Take Action:

If you want change…YOU will have to get involved and put pressure on Anthem via your elected officials who can make new laws that will allow better outcomes for you.

 

Kentucky taxpayers pay legislators: their job is literally to make laws. 

  

Every day we do nothing, it becomes more difficult to free ourselves from this leech.  Already our officials turn a blind eye as Kentucky casualties pile up.

​

Call to Action: YOU have the power to elect (with your vote)...DEMAND that law-makers protect Kentuckians by implementing these policies:

​

1. Fair and Equal Pay:  An exam or procedure costs the same and is covered the same, whether it is performed in office, in a surgery center, or in a hospital setting. 

   • Example: Insurance companies cannot use our tax dollars to pay a hospital $400 for an exam that costs $200 down the street. 

   • If they do, they owe Kentucky Taxpayers a $200 rebate every time they do it.

2. ONLY ONE Deductible: An exam or procedure is reimbursed the same, and counted toward your deductible the same, whether it is performed by an “in network” or “out of network” doctor.

   • No “Out of Network” deductibles for government contractors.

   • No denying Kentuckians covered benefits—just because we choose to keep doctors we trust—who may or may not be in Anthem network.

     • Insurance companies must reimburse patients for qualified medical expenses.

     • Example: If a patient pays $300 for a covered screening visit to their doctor, and Anthem pays the “in network” hospital $400 for the that exam, then the patient has the right to pay their doctor $300 for the exam, and Anthem then owes the patient the same $400 Anthem would have paid the “in-network” hospital for the same exam.

     • Government-Funded contractors cannot force you to pay an additional “out of network” deductible simply because you choose a doctor who is not in their network.

     • Kentuckians have the right to choose their own doctors.

3. No state-sponsored monopolies: State employees must have the option to change insurance companies when those companies are exploiting them.

   1. KY employees should not be forced to purchase over-priced products of one company.  They must have access to an open market with multiple options that bring the best quality at the most affordable price.

​

If we don’t stand up today, we may have no legs to stand on tomorrow.  ANTHEM will not stop until you make them.  Make your voices heard and hold the legislature accountable.

 

Take Action NOW:

1. Sign this new petition:  https://chng.it/9rSYBtmRDx

2. Ask your elected officials if they will fight for “Fair and Competitive Insurance”.

   • Find and contact your legislator: https://apps.legislature.ky.gov/findyourlegislator/findyourlegislator.html

   • Legislature complaint line (you can ask that your legislator take action on the 3 items above): 800-372-7181