JohnKelly
Member
- Joined
- Sep 11, 2007
- Messages
- 19
- Reason
- PALS
- Diagnosis
- 10/2004
- Country
- US
- State
- California
- City
- Carlsbad
Hello Everyone,
I have had a small group PPO policy with Anthem Blue Cross (formerly Blue Cross California) for over 10 years. The benefit had always been 70% reimbursement for all durable medical equipment if purchased in network, and 50% for equipment purchased out-of-network. I have been in the process of ordering modifications to my motorized wheelchair due to the progression of my hand weakness and got a very disturbing surprise.
As of the renewal date for my small group policy, the benefit for durable medical equipment has been capped at $2000 per year. Durable medical equipment includes wheelchairs, hospital beds, ventilation equipment, catheters and many other supplies needed by people with ALS and other chronic disabling conditions. As all of you know, $2000 is peanuts compared to what these things cost.
I called the company and the representative I spoke to did not know of this change prior to my call, but looked it up and told me that the change took effect with all their small group plans on July 1, 2009. I filed a grievance but know that it will do no good.
Many of you are on Medicare due to the waiver of the two-year waiting period after qualification for Social Security disability for those with ALS. But for those who wish to work as long as they can this will be devastating. It is also devastating for me because my diagnosis is lower motor neuron disease only (my neurologist calls it progressive muscular atrophy with an overlapping peripheral motor neuropathy) and I therefore do not qualify for the waiver.
This is really an outrage because of its impact on the disabled community. Durable medical equipment is largely a benefit for those with disabilities. People with ALS who want to remain productive. The spouse of an insured who has multiple sclerosis. Children who have muscular dystrophy, cerebral palsy and birth defects. Anthem Blue Cross has just pulled the rug out from under all these insureds. I'm not naïve and I know that insurance companies can unilaterally modify benefits. But this time I think they have really gone too far by targeting the disabled.
Those of you who have anthem Blue Cross policies please check your DME benefit. I would like to know whether they have done this in every state and to every type of policy. I am so outraged that I have not been able to formulate a plan yet, but I plan on raising hell about this and would welcome any assistance or ideas you may have.
Thanks in advance, John
I have had a small group PPO policy with Anthem Blue Cross (formerly Blue Cross California) for over 10 years. The benefit had always been 70% reimbursement for all durable medical equipment if purchased in network, and 50% for equipment purchased out-of-network. I have been in the process of ordering modifications to my motorized wheelchair due to the progression of my hand weakness and got a very disturbing surprise.
As of the renewal date for my small group policy, the benefit for durable medical equipment has been capped at $2000 per year. Durable medical equipment includes wheelchairs, hospital beds, ventilation equipment, catheters and many other supplies needed by people with ALS and other chronic disabling conditions. As all of you know, $2000 is peanuts compared to what these things cost.
I called the company and the representative I spoke to did not know of this change prior to my call, but looked it up and told me that the change took effect with all their small group plans on July 1, 2009. I filed a grievance but know that it will do no good.
Many of you are on Medicare due to the waiver of the two-year waiting period after qualification for Social Security disability for those with ALS. But for those who wish to work as long as they can this will be devastating. It is also devastating for me because my diagnosis is lower motor neuron disease only (my neurologist calls it progressive muscular atrophy with an overlapping peripheral motor neuropathy) and I therefore do not qualify for the waiver.
This is really an outrage because of its impact on the disabled community. Durable medical equipment is largely a benefit for those with disabilities. People with ALS who want to remain productive. The spouse of an insured who has multiple sclerosis. Children who have muscular dystrophy, cerebral palsy and birth defects. Anthem Blue Cross has just pulled the rug out from under all these insureds. I'm not naïve and I know that insurance companies can unilaterally modify benefits. But this time I think they have really gone too far by targeting the disabled.
Those of you who have anthem Blue Cross policies please check your DME benefit. I would like to know whether they have done this in every state and to every type of policy. I am so outraged that I have not been able to formulate a plan yet, but I plan on raising hell about this and would welcome any assistance or ideas you may have.
Thanks in advance, John