My Blue Cross to Bear

BluecrossZyrtec, my beloved allergy medication, keeps me human. Claritin and Clarinex make my heart pound the way it did the first time I met Clyde. (Nice back then, but not so nice when you’re trying to doze off at night.) For all the good they do me, I suspect Allegra tablets are, in fact, oddly-shaped TicTacs. Zyrtec — and only Zyrtec — soothes my itching eyes, dries out my runny nose, and keeps me from coughing and wheezing. Without it, I’d be mistaken for a snot monster.

So I’m at the CVS, getting my monthly fix. The pharmacist hands me a bottle of pills in a wax paper bag and says, “That’ll be $100.00.”

My eyes bug out (more than usual). “There must be some mistake,” I say. “Zyrtec has always cost me $25.00 a month.”

She checks her terminal and shakes her head. “Blue Cross isn’t paying for Zyrtec any more, so now it’s a hundred bucks. You’ll have to call them to find out why.”

Still convinced someone at Blue Cross has her wires crossed, I wander over to the health and beauty aid section and phone up customer service. The following conversation — recorded here almost verbatim — is an example of exactly how much service Blue Cross customer service reps in the Jackson, MS, office are able to deliver:

BluecrossZyrtec, my beloved allergy medication, keeps me human. Claritin and Clarinex make my heart pound the way it did the first time I met Clyde. (Nice back then, but not so nice when you’re trying to doze off at night.) For all the good they do me, I suspect Allegra tablets are, in fact, oddly-shaped TicTacs. Zyrtec — and only Zyrtec — soothes my itching eyes, dries out my runny nose, and keeps me from coughing and wheezing. Without it, I’d be mistaken for a snot monster.

So I’m at the CVS, getting my monthly fix. The pharmacist hands me a bottle of pills in a wax paper bag and says, “That’ll be $100.00.”

My eyes bug out (more than usual). “There must be some mistake,” I say. “Zyrtec has always cost me $25.00 a month.”

She checks her terminal and shakes her head. “Blue Cross isn’t paying for Zyrtec any more, so now it’s a hundred bucks. You’ll have to call them to find out why.”

Still convinced someone at Blue Cross has her wires crossed, I wander over to the health and beauty aid section and phone up customer service. The following conversation — recorded here almost verbatim — is an example of exactly how much service Blue Cross customer service reps in the Jackson, MS, office are able to deliver:

Me: Hi, this is Mark M. I’m —

BlueCrossLady: Group number, please?

Me: Okay. [Group Number Here]

BlueCrossLady: How can I help you today?

Me: I stopped in CVS for my Zyrtec fix today, and, instead of $25.00, they’re telling me my co-pay is now $100.00.

BlueCrossLady: That’s correct, sir. Zyrtec is a Class Four medication with a $100.00 co-pay.

Me: Wait. How did it go from being $25.00 to $100.00 overnight?

BlueCrossLady: Because it’s now a Class Four drug.

Me: What’s a Class Four drug?

BlueCrossLady: We divide drugs into four classes, and a Class Four drug is a drug in the fourth class.

Me: Um, okay. Let’s try this another way. What makes a drug a Class Four drug?

BlueCrossLady: We have a committee of doctors and pharmacists who look at all the drugs and classify them as Class One, Two, Three, or Four.

Me: And … ?

BlueCrossLady: And what, sir?

Me: What criteria do they use to establish a drug as a Class Four drug?

BlueCrossLady: It doesn’t fall into Classes One through Three.

Me: So … what you’re telling me is that Zyrtec is a Class Four drug … because it’s a Class Four drug?!?

BlueCrossLady: That’s correct.

Now, of course, I also need some Aleve for my terrible headache.

As a public service — and to keep other Blue Cross customers from wasting their time with what Blue Cross calls “service” — I’ll save you the trauma of the call and give you the straight dope on why my co-pay quadrupled.

Last year, a slew of prescription allergy medications — including Allegra and Claritin — were very suddenly transformed into over the counter drugs requiring no prescription at all to acquire. Is that a testimony to the safety of these drugs? Nope. It’s a testimony to the greed of insurers, who lobbied the FDA to shift these very common, very widely-prescribed allergy medication to over the counter status … so insurance companies could save billions and billions of dollars a year by not having to cover them any more.

If you can get ’em over the counter, you see, insurers (like Blue Cross) can shift the entire burden of payment to you.

With two over-the-counter alternatives on the market, Blue Cross is now in the business of trying to force all its victims clients to start taking Allegra or Claritin. You don’t have to comply … but if you don’t — if, for example, you want to take Zyrtec because it just works — you’ll pay through the nose for it. In the end, that’s all a Class Four drug is — a shorthand way of saying, “This is a drug that forces us to actually spend some of your monthly premium on you instead of Italian marble tiles for our lavish new facility in Flowood, so if you want it, we’re going to set a co-pay for it that’s designed to screw you over.”

Just how badly does Blue Cross screw you over with Class Four Drugs? Badly. With a little research (I asked my pharmacist), I discovered that the full-boat, pay-as-you-go retail price for Zyrtec is just $80.00 a month. From an online pharmacy like Drugstore.com, I can get the same 30-day supply for $69.00.

In other words, my co-pay — the special price I get from Blue Cross because I pay them several hundred dollars a month in premiums — is a full $20.00 a month higher than I would pay if I just bought Zyrtec out-of-pocket from the most expensive supplier.

But wait: it gets better. Under pressure, a Blue Cross rep finally told me, “Okay, okay — truth is, we’ve made Zyrtec a Class Four drug because it’s now available as both a low-cost generic and an over the counter brand-name drug. So, you can buy it yourself … or you can get the generic version for a low $10.00 co-pay per month.”

And he was right: Zyrtec is now available as an over-the-counter drug. Oh — and now there is a low-cost generic version. In Canada. Can you get either one, legally, in the USA? Nope … but because Zyrtec is available to someone, somewhere on the planet as a generic, Blue Cross no longer wants to pay for it.

Meantime: several of my other drugs — including blood pressure medications — have also magically become Class Four drugs. But no worries. The helpful people at Blue Cross have a website where you can find out what drugs they will and won’t pay for.

Er, that is, you can try. With the goal of rendering great customer service in mind, Blue Cross has created a website that only works in the latest version of Internet Explorer for Windows. If you use FireFox, Opera, Safari, or any other browser, the site won’t work for you … and if you’re a Mac user (like me), you’re just slap out of luck.

Apparently, over at the Blue Cross offices, clear information and good customer service have also become Class Four drugs. They’re just too expensive for Blue Cross to provide … and if you want ’em, you’re going to have to go elsewhere.

Mark McElroy

I'm a husband, mystic, writer, media producer, creative director, tinkerer, blogger, reader, gadget lover, and pizza fiend.

11 comments

  • All this makes me happy I live in Washington. Our governor just signed into law a provision that makes it illegal for an insurance company to deny or even slow down a claim that is actually covered under the policy – and hits them with triple damages plus other fines if they are found guilty. A blow for the little guys…

  • All this makes me happy I live in Washington. Our governor just signed into law a provision that makes it illegal for an insurance company to deny or even slow down a claim that is actually covered under the policy – and hits them with triple damages plus other fines if they are found guilty. A blow for the little guys…

  • Bottom line is that health insurance basically sucks for air these days. Higher copays; less service; fewer approvable medical procedures to prevent or diagnose a disease. Seems like the only time they want to pay for anything (at least my insurance) is when one is dying. I think we get full coverage for hospice care. It’s easier for the health insurance company to rid themselves of people like us who actually want to live and be healthy. Go figure!

  • From a healthcare provider’s perspective, let’s face it, the ultimate goal of insurance companies is how NOT to pay for something. Get this, BCBS of Alabama requires upfront approval for many imaging tests, including MRI of the breast. In most instances, the procedure is approved, and therefore completed, but BCBS then denies payment, saying it is “experimental”! What’s up with that?

  • Rife wrote: “…the ultimate goal of insurance companies is how NOT to pay for something.”

    Amen. I’ve been telling people for ages now that, from an insurer’s perspective, the Holy Grail is:

    – mandatory insurance, with high monthly premiums, paired with

    – zero chance of payout.

    From what I’ve seen, with:

    – people terrified of being uninsured, since one unsured medical procedure can render them paupers

    – no way for consumers to easily shop elsewhere when premiums rise

    – co-pays rising and payouts dwindling,

    we’re almost there.

  • Keith wrote: Also, reason #101 not to switch to the Mac. Sorry. It may be wrong in principle but it’s true in practice.

    Mark replies: Um, no.

    Links on http://www.bcbsms.com don’t function properly when viewed in Safari, Firefox, Camino, Flock, or Opera for the Mac. They don’t work in Firefox, Opera, Netscape, or Lynx FOR WINDOWS, either.

    The fact that the site works normally only in IE for Windows isn’t a Mac vs. PC issue; it’s a matter of lazy programming choices and a failure of their web programmers to adhere to established web design standards.

    That said: if I were using an Intel-based Mac, I would have the option of launching Internet Explorer for Windows and visiting the site, because Intel-based Macs have the ability to run both Mac and PC-based programs.

    That flexibility is exclusively a feature of the Mac — and this is, in fact, a fantastic reason to switch.

  • I thought you said you were slap out of luck. The cool thing about a PC is if someone else’s site fails in one browser, I can try another (their sin, I know, but at least there’s an option). Not every Mac can run IE, I thought?

  • Hi, Keith.

    Macs, just like PCs, can run multiple browsers.

    Macs, unlike PCs, can run both Mac OS X and Windows programs, including browsers, and including Internet Explorer for Windows.

    There is a version of Internet Explorer for the Mac, but it has always been buggy, and, recognizing that no one on the Mac platform used it, Microsoft no longer updates or supports it.

    The reason I couldn’t switch to Windows and view the site in IE for Windows? I’m using an older Mac laptop, released before Apple began releasing computers designed to run both Mac and Windows software with ease.

    Even with the older Mac’s (like mine), there’s precious little a PC can do that a Mac can’t … and, from personal experience, the Mac does the task faster, better, and more reliably.

    Newer Macs, of course, can run Windows programs natively.

    The assertion that owning a Mac limits one’s options or choices for software is a myth. Today especially, Macs (given the ease with which they run the Windows OS and Windows software) offer users more — not less — flexibility.

  • So if one is to switch, either get a new Mac or risk being unable to access certain poorly designed sites. Is that it?

  • Unless someone has an axe to grind, I can’t imagine that my encounter with one esoteric, badly programmed website over the course of eighteen months of Mac ownership would have any bearing on whether or not to switch to an Apple computer.

    The real point, though, is this: if Blue Cross really is dedicated to communicating with their clients — and especially since their website, in theory, is going to be visited by unhealthy people curious about their benefits — accessibility is paramount.

    Launching a site like this one — one they apparently failed to test across platforms on different browsers — doesn’t say much for their dedication to clear, efficient distribution of information to customers.

  • Yours was only the most recent of frequent comments I read from Mac users who cannot access some sites. It’s so disappointing that even after FEMA’s site failed so many when Katrina hit that others like Blue Cross still haven’t gotten the message. Thanks Mark.

Who Wrote This?

Mark McElroy

I'm a husband, mystic, writer, media producer, creative director, tinkerer, blogger, reader, gadget lover, and pizza fiend.

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