letter to blue cross

RE: your letter to me of March 15, 2023

Dear Mary Beth Erwin,

It was so great to hear from you that you want to help with my prescription coverage! I love when my health insurance is eager to pay for the medication my doctor has thoughtfully prescribed.

I have to admit however that I was confused as I read further in your letter that in fact you were not writing to help me with my prescription coverage, but rather to take it away from me! How counterintuitive!

As of course you’re aware, since you have access to all my prescription history over the last several years, I’ve been taking ZOLMOTRIPTAN TAB 2.5 MG for a few years as my doctor prescribed it after finding that sumatriptan was not doing the job on my migraines. Blue Cross Blue Shield of  MA had in fact been covering this medication since it was prescribed, so if it is no longer covered under my plan, again, I think the first sentence of your letter is a bit misleading. If it is now subject to “step therapy”, well, you can see as well as I do that in fact I was prescribed a different medication first, which I believe is what “step therapy” means for health insurers.

As an aside, do you know that my primary care doctor, who prescribed this medication, is so overworked and stressed out that last year he told all his patients he could no longer answer their emails? In fact, there is a massive and increasing shortage of primary care physicians in this country, which I would think would be bad news for health insurers, since we all know how access to primary care reduces overall healthcare costs! A big reason primary care docs are leaving the field, it turns out, is because health insurers pull moves like this all the time and make them do busywork to affirm that actually when they prescribed a drug to a patient, they MEANT to do it, because they think it’s the best option for treating that patient! 

Anyhoo, I’m sure you’re pretty busy helping other people with their prescription coverage too. But, I would like to share with you this very interesting piece of investigative journalism from ProPublica about a different health insurance company, Cigna, and how it is rejecting claims without a single human ever reading them: https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims. 

I am sure Blue Cross Blue Shield of MA is not doing that. I’m sure you spent at least a few minutes looking at my medical history in your files before denying this particular claim! But wouldn’t it be embarassing for you if not! 

Thanks for caring so much about my health! I know that now that you have the full information about my zolmotriptan prescription you will make sure I can fill it the next time I need to, without bothering my doctor and driving him to early retirement. 

All the best!

Amy