BCBS Insurance Rules for Infused Drugs in NC Have Changed - what this means

Now for some local news:  Blue Cross Blue Shield has changed some rules that affect many chronically ill patients.  If you have an illness that requires the infusion (at a hospital) of certain drugs, you may be affected by this change.  It also has some interesting implications for those of us who are hoping for more IV services from our doctor's office. The rule also includes other non-outpatient settings such as a larger role for urgent care and in home care.

I think this is significant because it affects teachers and state workers (we love them, don't we?) and BCBS can often prompt similar actions from other insurers because it's such a large insurer (the "follow the leader" effect). 

I've mentioned before that you can get IV vitamins  in some places in North Carolina.  However some chronically ill patients, including those with Multiple Sclerosis and anyone who takes a list of medications outlined in this document (PDF) need an IV of certain drugs to control their illness.  In some cases this was done at a hospital in an outpatient setting.  For some reason, BCBS has now decided that this is not OK anymore, and that after April 1, 2018 (it's not an April fool is it?), people must go to a doctor's office or other authorized location for these infusions.

Well, OK then.  In my more cynical moments I'm guessing this is a honey trap to purge the compassionate doctors from the system.  But in my more optimistic moments I'm thinking it could be a golden opportunity for more compassionate MD's to equip their offices with IV's and offer not only drugs that help the chronically ill, but vitamin infusions that help some of them heal out of the need for excessive drugs.  Am I being too optimistic? I don't think there's anything wrong with hoping that people get well and regain their health.

Unless you're an insurer who worries about investor profits and doesn't care about the lives of human beings. How do we purge them from the system?

Because locations of documents can change, I'm attaching a copy (via archive.org), with the warning that it's only here for record keeping, particularly the list of drugs affected.  All of it is subject to change by BCBS and this copy will surely go out of date over time.

I do hope that this change, while it's a hassle, will lead to more options for chronically ill people to get well.  However, I'm growing more and more concerned by how often the insurance companies are tying the hands of hospitals.  I honestly think that messing around with this is not only causing an access to care issue, but a safety issue that can lead to unnecessary deaths.  I strongly urge that researchers study how many insurance rules affect hospital decisions and whether these affect the wellbeing of patients.


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