Blue Cross and Blue Shield of North Carolina informed me that they have denied coverage for a medication that they covered last year.
The reason? Blue Cross referenced a test that was administered nine months after I began taking the medication, which showed my levels are normal. They claim that since my levels are normal, I don’t need the medication.
The test merely shows that the drug is working! The same test administered before I began taking the medication showed subnormal levels.
Now I must go without my medication during an appeals process, which I hear from fellow customers can take months.
This is not an isolated incident. When I complained on Facebook, others came forward and told me that Blue Cross and Blue Shield of North Carolina was doing the exact same thing to them, denying medication based on the results of tests administered after they had been taking their medication!
I suspect this is a deliberate practice designed to deny BCBSNC customers the medications they need while their appeals are processed. In the meantime, Blue Cross saves huge sums of money, since they don’t have to pay for the medications.
If Blue Cross is doing this intentionally, then it is a criminal act.
If anyone else is experiencing the same denial of medication from Blue Cross, please let me or the Mountain Xpress know about it.
— David Lynch
Editor’s note: When contacted by Xpress, Blue Cross and Blue Shield of North Carolina spokesman Lew Borman responded via email that he couldn’t comment on whether Mr. Lynch was a BCBSNC customer or about the allegations raised in his letter without a medical release from Mr. Lynch (who declined to provide the release to protect his privacy). “Without Mr. Lynch agreeing to sign a [Health Insurance Portability and Accountability Act] release, BCBSNC is unable to comment,” Borman says. “That would be a violation of this federal act.”