How Blue Cross Blue Shield Hurts Kids with Special Needs

The road just got longer and harder for families of children with special needs. Cartoon by Marcia Liss

Published in ChicagoNow, September 28, 2015

Shame on Blue Cross Blue Shield (BCBS) for making life even harder for parents of kids with special needs. And shame on our country for putting up with a healthcare system that is all about profits and doesn’t give a hoot for providing either health or care.

According to Crain’s Chicago Business (note, this is coming from a business publication) BCBS of Illinois plans to drop the plan many individuals and families on the Obamacare exchange have purchased. This is the plan that covers most of the providers and therapists who see children with special needs in Illinois. And I am only talking about those who even take insurance. Lots of them don’t, making it hard for uninsured families to afford help for their children.

So now self-employed workers will have to choose between finding new therapists who will accept a different plan (good luck with that) or paying out of pockets for the services their children desperately need, which is largely unaffordable to families already burdened with huge expenses associated with the care of their children. Changing therapists or stopping treatment for kids with special needs is a huge deal. It should not be dictated by an insurance company looking to increase its bottom line.

Families received letters last week informing them of this change. If their children’s providers will accept a different Blue Cross Blue Shield plan that pays them less, the kids and their parents win but the therapists lose a considerable amount of income. If their children’s providers will not accept what amounts to a substantial pay cut, the kids will lose their therapists or their parents will lose a considerable amount of their family income. In either case, guess who wins? BCBS.

For now, folks who have the BCBS PPO plan through their employer are safe. But odds are employers may stop offering the plan because Blue Cross Blue Shield is hiking the premiums so high. Supposedly, the Illinois State Insurance Board has already okayed this. The federal government may also have to approve, and chances are it will. After all, who has the biggest lobby, BCBS or families of kids with special needs?

In Illinois, as many as 350,000 self-employed folks who had to purchase their insurance through the exchange are being dumped. The most vulnerable will once again be hurt in service of making more profits for BSBC. How much profit? Well, in California BCBS had its tax-exempt not-for-profit status revoked a few months ago because of “criticism over its rate hikes, executive pay and $4.2 billion in financial reserves.” I hate to be a cynic, but I’m sure some folks are making money in Illinois as well.

Of course, the biggest losers will be the children. I’m talking about kids whose therapists or pediatricians can’t afford to take much smaller payments from BCBS or another insurance company. Kids whose families can’t afford to pay out of pocket and will have to drop therapies. And kids with special needs whose families were willing to pay higher premiums but were not given the opportunity. But I guess that’s the point of insurance. You can use it, but not if life hands you a lemon and the company needs to pay out more than you pay in premiums. Then, after years of paying your premiums, the company refuses to make lemonade and drops you.

Parents and providers were told they may now enroll in the BCBS Blue Choice plan. Not much of a choice here, is there?