Stanford earns top billing
Wednesday December 10th 2014, 11:30 pm
Filed under: Crohn's flare,Life,Lupus,Politics

Got some bad guys and some good guys for you today.

Back in September, when I caught the flu with all the autoimmune flaring that went with, I was barfing nonstop from the Crohn’s. The lupus was going nuts, too, my blood pressure was tanking, and I needed IV fluids, fast, just to start. (There would be chest and abdominal x-rays too.)

There were a lot of other people around with early-season flu, too, but for whatever the reason, when we called my doctor her nurse emphatically told my husband not to take me to Urgent Care but rather straight to the ER.

This was not a decision made by us. She insisted. She said if we went to Urgent Care they would simply send us over to Stanford, and we knew what the co-pays on the ambulance they would insist on would be, not to mention it would tie up that ambulance unnecessarily.

Turns out Anthem Blue Cross requires in their fine print that you verify with each health care provider before seeing them each time that they are still in contract with Anthem. Doesn’t matter if they were in-network for all the years you’ve had a policy with them, they reserved the right to yank that at any time. Doesn’t matter if you’re in an emergency with no capability of sitting on hold on the phone for two hours. Etc.

Now, by the contract we’d signed at open enrollment, if you go out-of-network in an emergency they’re still supposed to pay such a percentage and even though it’s less, it’s still a substantial amount.

Anthem and Stanford were in a contract dispute. Anthem never notified us in any way, not so much as an email, nor by their terms do they have to, and our trip to that ER was a life-and-death emergency with my already-very-low blood pressure. As far as I’ve been able to tell since, that day we had and we still have no in-contract hospital to divert to, either; I could be wrong on that but Anthem certainly hasn’t offered us any information to the contrary.

So we are paying for insurance to cover things they will not cover despite selling us a policy on the grounds that they would. I’d call that fraud, myself.

So, out of network, painful, but I thought we’d be out about a grand. Someone on the phone at one point said three. Ouch. But we waited for a bill. And waited. And waited, while the two sides hashed it out.

We got a notice finally last week from Anthem, and a day or two later a letter from Stanford.

And this is what Anthem said:



Except this one unclear thing here that was probably that IV and only that IV, or maybe one individual doctor they were not in dispute with. But whatever, so, one thousand paid towards the claim and that was all it was going to be. “Your responsibility”:

Twelve thousand nine hundred ninety-nine dollars.


Hello? Out of network percentages, at least? How can they…?!

They don’t care.

Then came a letter from Stanford Hospital.

And they said, It is not your fault that we and Anthem Blue Cross are currently out of contract, and your health is more important. We don’t want you to be afraid to get medical care when you need it.

They said they will only charge us what our co-pays would have been had everything been as we expected when we went in there, as if all prior contracts had been in full force.

Multiply that times the whatever number of patients, given that Anthem covers something like a third of all the people in California, and what their bills could be and that Anthem should legitimately be covering and refuses to… Staggering. Just staggering.

I just felt (and these words look so faint on the page compared to how I feel) that Stanford deserves my praise and my thanks as loudly and as publicly as I can offer them.

6 Comments so far
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I completely agree: staggering. Go, Stanford Hospital!

Comment by RobinM 12.11.14 @ 6:52 am

Maybe the insurance companies should take that oath first, “do no harm!”

Comment by Jody 12.11.14 @ 9:08 am

Oh Alison…what a wonderful blessing!!! I’m so grateful too! I have such a negative attitude toward health insurance companies. Why, oh why can’t our nation pass universal health care?!!!!!!!!!!!!!!!!!!!!! How refreshing that a huge medical facility like Stanford would be so humane. Kudos to them.

Comment by Jayleen Hatmaker 12.11.14 @ 3:33 pm

Sending a prayer of gratitude for this outcome and for common sense to prevail – somewhere, somehow…

Comment by Suzanne from Montreal 12.11.14 @ 6:45 pm

whoa….and knowing that this could and does happen. fraud, yes….why do we pay for and allow this?!
Thankful that the hospital stepped up.

Comment by kmom 12.11.14 @ 10:06 pm

Anthem has a monopoly on health care in CA and is trying to bring all the hospitals to their knees on fees. Good for Stanford basically sayin, “Ain’t gonna happen!”
But seriously, this is why single-payer is the only sane solution – nobody’s health should be at risk because of private health care co’s in a dispute.

Comment by Renee 12.12.14 @ 5:19 pm

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