Well, I was hearing rumblings a week or so back and now that “rumor” has become reality; Blue Cross Blue Shield of Texas will STOP offering coverage to children under 19 on a stand alone basis. They will still offer kiddie coverage if a parent or guardian comes along for coverage, but no longer will they offer any of their widely popular Major Medical insurance in Texas.

Blue Cross Blue Shield of Texas is simply following the lead of other companies that have pulled this stunt, United HealthCare comes to mind as they exited the child only market about a month ago. One interesting point is BCBS will introduce new plans for the child only market sometime in the future known as “Blue Pathway”, the plan was just filed with the state department of insurance.

Two things about the filling with the insurance department. First, these fillings take time, lots of time, in my 18 years in this business I have seen it sometimes takes months and months to get approval from TDI all because of legal wording in the insurance contract. Lawyers go back and forth over minor details until one side gives in and this process could take up to a year, don’t know so no one should think the new Blue Pathways will be on “store shelves” any time soon. I have also seen new policies just flat die at compliance, never to be seen again.  Also, Blue Cross Blue Shield of Texas has made a decision to ONLY market this product direct, meaning your local, helpful and knowledge broker has been cut out of the loop. Why? Simple, BCBS has said in the past their major distribution channel is the broker community and by eliminating us from the picture drastically cuts down on the number of applications they will receive. Thats the goal folks. In my opinion they just flat-out don’t want the business, who would? Its guaranteed issue without a coverage mandate.

Don’t have a clue what Blue Pathways will look like but I can only guess it will not be as rich in benefits as some of their current offerings, if it was why not just use their current portfolio to offer guaranteed coverage on kids? Makes no sence unless the benefits will be reduced… or the monthly premium is jacked up to federal deficit levels, you just wait and see, that is if there is anything to see, may never get out of TDI compliance.

Should we be mad at Blue Cross Blue Shield of Texas, or any other Texas Health Insurance company for doing this? No, I don’t think so, it’s not their fault. Insurance companies are not in the business of selling policies to consumers as they sit in the emergency room and that’s how this provision of health care reform is written. There is no mandate that kids must be covered AND there is no pre-existing condition waiting period so in theory a family could wait till little Johnny needs that heart transplant and call up their local broker or insurance company and under law they must sell him a policy, that is if they offer child only coverage AND he would get the policy the insurance company offers to kids.

So, what do I feel will happen? Parents looking for child only coverage will find only one or two options, and those options will NOT be affordable. Rates that today are $75, $150 a month for one child could be $500 to $1000 a month, who knows. I do know how insurance companies work and that leads me to believe the rates will be large.

Ok, who should we blame for this? What caused this mess.. Simple, next time you get mad about the next rate increase, or the fact you can’t afford little Johnny’s coverage call Obama and his gang, this has his name written all over it. Why? Insurance companies are not in the business of providing charity, they are a business and must remain profitable, if not they go belly up, jobs are lost and the economy dwindles even more. Forcing Texas health Insurance companies to cover sick kids as they are on the way to the hospital is just flat dumb. Offering them coverage is an automatic massive claim with little premium dollars in return. Remember, Mr. Obama required no federal mandate requiring coverage, so any child can get a policy at any time, even on the way to treatment for a major health condition.

As we sit today there are still companies offering child only coverage so don’t panic… yet. if you are looking for coverage for you kids, call us, there are still options.

Blue Cross Blue Shield entities from Texas, Illinois, New Mexico and Oklahoma (hereinafter “BCBS”) have filed a lawsuit against Pfizer over its marketing of three drugs. The allegations in the lawsuit state that the company pushed off-label uses of the drugs and used “kickbacks” to persuade doctors to prescribe them. The allegations made in the Complaints resemble those in the $2.3 billion settlement between Pfizer and the United States Department of Justice. Also named in the lawsuit are four Pfizer managers and ex-managers in their individual capacities. Those Pfizer employees and former employees are not company higher-ups. One was a district sales manager who allegedly prepared misleading sales materials to present to doctors.

According to the lawsuit, Pfizer not only handed out those misleading materials for off-label uses, but sent doctors on Caribbean junkets and paid them $2,000 in honoraria in return for them listening to lectures about Bextra. More than 5,000 healthcare professionals were entertained in meetings in the Bahamas, Virgin Islands and across the U.S., according to the lawsuit. Pfizer has responded stating:

This is a case of an insurance company seeking its money back for medicines that physicians prescribed appropriately using their best medical judgment.

Back in 2009, a former Pfizer sales manager was sentenced for off-label promotion of Bextra. The sales manager told Massachusetts officials that the company not only knew about her off-label activities, but actually encouraged them. It appears that off-label promotion of Bextra was “part of the Pfizer culture.” It should be noted that Pfizer settled with the federal government for $2.3 billion for off-label marketing regarding Bextra and Neurontin, among other drugs.

Source: Fierce Pharma