http://www.al.com/news/huntsville/Jan2000/14-e30263.html

The prescription snafu

01/14/2000

At the very least, Blue Cross and Blue Shield needs to get computer backup systems in place so that this week's problems don't happen again.

Tim Dorsey, in his dark comic novel, "Florida Roadkill," has a scene in which an HMO "deniability expert" shows how to make it virtually impossible for eligible clients to collect health benefits.

Trouble is, this isn't fiction for many people. We know, for example, a couple who spent more than a year trying to get a claim for a portion of the cost of prescription glasses paid - and still haven't gotten the problem solved.

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Claims hassles are one thing; not being able to get a health insurer to pay its share of prescription drugs on the spot is another. That's something that pharmacists usually handle easily and quickly. But not this week.

That's because Blue Cross and Blue Shield of Alabama experienced what any organization that relies on computers eventually faces: an unexpected crash. And that left thousands of Blue Cross clients, many of whom have been bitten by the flu bug, and scores of druggists in a quandary.

Clients wondered: Pay full price and hope to get reimbursed promptly? Pharmacists pondered: Guess how much Blue Cross would eventually pay or fill prescriptions partially? In many cases, the answer both came up with was: Let's wait - possibly endangering someone's health - and hope Blue Cross fixes its computer soon.

The problem is compounded by the fact that Blue Cross and Blue Shield doesn't have to worry too much about how its customer service will affect its ability to compete. Industry experts say the firm probably does 80 percent of the health insurance business in the state, and that percentage is probably even higher in North Alabama. It certainly increased earlier this year when First Community, a health insurer in this area, went belly up.

Blue Cross officials, responding to all this, haven't done much to improve consumer confidence.

They say they won't comment on how many prescriptions the company usually handles each day.

They say the firm's computers, which crashed Sunday night, were fixed Monday. Pharmacists say they were still having problems Wednesday.

And, worse, they say Blue Cross had no plans on how to deal with extended network problems. Didn't the company have a program in place if the Y2K bug had proved to be a genuine problem?

America is facing a health insurance crisis. It's too expensive for many businesses to provide or for many individuals to pay for themselves. Premiums keep rising, and so does the number of the uninsured, which puts a financial strain on community hospitals and so on. Democrats and Republicans continually carp about what needs to be done, but no one denies it's a major national problem.

What needs to be done here and now is for Blue Cross and Blue Shield to put computer backup systems in place so clients and pharmacists don't face the prescription quandaries they faced this week.

) 1999 The Huntsville Times. Used with permission.

-- Homer Beanfang (Bats@inbellfry.com), January 14, 2000