Saturday, March 19, 2016

So hard to keep track of who Edgepark hates

We have employer-sponsored commercial health insurance for our family, which is lovely. Cigna is a kind and benevolent group of control freaks who tell us exactly what sorts of medical care we are allowed to receive (benefits limitations, prior authorizations, medical reviews, etc.) and who we can use as providers (network limitations).

So when we need medical supplies or medical equipment, Cigna gives us a very short list of companies we are allowed to order from. One of those companies is Edgepark.

Edgepark refuses to sell to customers in a number of states when those customers have Medicaid as secondary insurance. Medicaid helps a lot of people with lower incomes, and Edgepark’s billing department was quite clear that they don’t want customers like that. “People like that are often on fixed incomes,” Edgepark’s billing department supervisor says, and expects me to understand that people like that are undesirable.

My son is 4. His fixed income is $0, as is the case for many 4-year-olds. Despite that, I don’t actually understand why he is undesirable. I think he’s quite cute. More importantly, he is insured.

There are a lot of levels of insanity and frustration here:

(1) We have already hit our son’s out-of-pocket maximum for the year with Cigna, so Cigna would pay Edgepark at 100%. Cigna can confirm this to Edgepark. There would not be any remainder to bill to any secondary insurance or to the customer. Yet Edgepark is very concerned about not being able to collect the $0 balance after Cigna pays them 100% of the contracted amount.

(2) We should be able to decline to use our secondary insurance, and I tried that. I offered to provide full payment for anything that Cigna does not cover. Edgepark says that’s not possible. Why exactly am I not allowed to decline a benefit? The offer of a handout from the state suddenly comes with handcuffs that are not removed even if I decline the handout.

(3) Medicaid as secondary insurance will only cover providers that are in network with our primary insurance, even if there are no such providers. They add no provider options. Instead they remove provider options, even when they are not involved in the financial transaction at all.

(4) Cigna offers no network adequacy exceptions for medical supplies. If there is no cardiologist within 50 miles who is in network, Cigna will let you see an out-of-network cardiologist. That isn’t true with medical supplies, for which Cigna does not recognize any obligation to have any providers in network. But even if they did, they say that Edgepark is technically an option for us to use even if Edgepark refuses to accept our orders.

(5) Edgepark will not bill our insurance and ship the order after they have been paid in full by our primary insurance, or even by us. It is so important to refuse to do business with people who have Medicaid as secondary insurance that even receiving full payment up front would not be enough to overcome Edgepark’s moral objections to poor people and disabled people.

(6) Medicaid is such a persistent stigma for Edgepark that if they get even a hint of Medicaid on a potential customer, they put a block on the account and refuse to remove the Medicaid information.

(7) Edgepark is so concerned about someone with secondary Medicaid possibly concealing that fact and paying on their own that Edgepark hides its own policy about this when signing up potential customers. Remember, it’s not about the money. It’s about not contaminating your customer pool with the wrong sort of people.

What would be different if Edgepark were refusing to do business with black people? It might help to know that 22% of people covered by Medicaid are black, while only 13% of the US population is black. But that’s ok with Cigna (the folks who decide what providers we have to choose from at all); black Medicaid customers can always shop at Byram instead of Edgepark. It doesn’t matter that Byram randomly cancels orders, is frequently back-ordered, doesn’t offer samples, and has fewer product choices. After all, the problem with “separate but equal” was probably the equal part, right?

I’m sure this is fixable. Edgepark could develop a corporate conscience. Cigna could decide to pressure their providers to accept all of their customers, even if they might be poor. We could change the law to say that providers who are willing to be “in network” for a plan must accept all customers who have that plan. We could change the law to say that providers who are willing to be “in network” for any plan must accept Medicare and Medicaid. We could improve societal attitudes towards poor people.

I don’t see any of that happening. Do you?

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