Those who know, know. The *other* story behind the recent ball dropping of Magellan from Blue Cross Blue Shield. Goodbye, 2005. Goodbye, Magellan.

story here

and here

The year 2006 starts off with what I can only describe as the ultimate justice and redemption for all the hard work this family has done to resolve an issue that began as a personal family crisis and, in late 2004, became extremely political. The justice and redemption came in an envelope. From Blue Cross Blue Shield.

I knew, vaguely, of the way politics and health services are intertwined, I just had none of the details. I had no idea how BADLY political things were, and how devastating and incompetent they were... most have witnessed similar with FEMA news coverage of how things are 'handled' with any crisis. We weren't just television witnesses... we had to experience it for ourselves, as a whole family unit. On numerous levels.

Had we recognized sooner the flags along the way warning us of what would take place in 2004-2005, perhaps a lot, if not all, of the struggles for our family and other families could have been avoided. Ah, hindsight, where you kick yourself in the ass for not confronting, more strongly and legally, things you knew were absolutely wrong.

In 1996, I easily could have embarked on a financially and legally rewarding journey, I just opted not to, as I'd rather just move on after any crisis. I'm also the type of person who believes suing hospitals or agencies isn't necessary, when written and verbal apologies will suffice. Now I see, quite clearly, that the written and verbal apologies did not stop the cycle of corruption and incompetence from continuing along, merrily, almost a decade after our first encounter with how hospitals, insurance companies and government agencies handle their mistakes, littered with hints of what was to come.

So, those who know, know. And our family is just ONE of many families in Massachusetts who know the *other* reason Magellan was dropped the pink slip. On the last day mail was delivered in 2005, a letter from Blue Cross Blue Shield, alerting us to a change in the management of Behavioral Health services. Magellan, the former controller of the behavioral Service section of Blue Cross Blue Shield, stands to lose quite a few million dollars. Blue Cross Blue Shield of Massachusetts (and Georgia) is taking back over the management of behavioral health services. What this means is that Magellan got canned. To that I say: GOOD CHOICE, BLUE CROSS BLUE SHIELD!

I'd warned Magellan, from September of 2004 until January of 2005, that the decisions they were making with people's coverage was reflecting poorly on Magellan itself, as well as Blue Cross Blue Shield, and if even just half of the people wrongly shafted by Magellan were to sue, Blue Cross Blue Shield could stand to lose billions of dollars in lawsuits, as well as negative press/media, which could easily lose the company a few more million in potential subscribers who would shy away from a company going through questionable proceedings.

I guess Blue Cross Blue Shield heard me, and at least dozens of others from Massachusetts, loud and clear with my bi-weekly phonecalls, alerting them to how seriously illogical, potentially life-risking decisions were being made over at Magellan headquarters. The news items on this are saying it was solely a business decision; I won't argue that. I wouldn't want Magellan staff managing my cactus collection, never mind a part of a billion dollar business. Because that is what heath insurance is... a business. I have no problem with that. I know they don't cover everything. That was never my issue with Magellan. Here's what was...

It started with a choice by Magellan not to allow coverage for a family member's stay at a hospital because (and I'm quoting a Magellan staffer here) "we aren't sure if they are licensed." Not sure? I asked the guy I was talking to if he made a lot of decisions like that for a multi-billion dollar company, based on 'not sures'. That got his feathers all bent.

I told him he may want to reconsider making life-risking decisions on coverage for a hospital stay without finding out, for sure, if the place in question was licensed or not. I then pointed out to him the numerous other insurance policies that must have information he personally did not have or know, as each insurance policy covered the stays at the hospital in question.

I asked him exactly what steps would have to be taken to determine if the hospital were licensed or not, told him I'd do it for him if it was too complicated for him, and asked him exactly what was stopping him or any one else over at Magellan headquarters from making sure the choice they were making was one made on fact and not 'not sure'. Yes, I was being hard-core obnoxious at this point, and I know I was making him angry. I WAS ANGRIER. This wasn't my job on the line, this was a family member's wellbeing. Finding out a family member's wellbeing was being put at risk based on a 'not sure' pretty much put me in warrior mode.

He said they had tried but couldn't find out for sure. Again, just a 'not sure' was the sole reason for making this choice; it should be noted that in the past they HAD covered stays for subscribers to this same hospital. Then, abruptly, based on a 'not sure', they stopped. I asked how long ago the 'not sure' popped up for them and why it hadn't been resolved. I got hung up on (I had a lot of folks hanging up on me in late 2004- early 2005, when they couldn't answer questions honestly or when they knew I'd caught them in an outright lie. More on that in the near future.)

Making decisions on 'not sure'. Does this sound like the work of a competent business agency that is 'handling' a section of medical coverage for a company as big as Blue Cross Blue Shield?

After that Magellan staffer hung up on me, I called back, and asked to speak to his supervisor. I went right up the ladder, too. Not one of those I spoke with had a valid reason why the business decision was being made, and all agreed it needed to be looked into further. This didn't do JACK SQUAT to help us in our current situation, but a good friend of mine around this time had me reading hitchhiker Guide to the Galaxy, so I just took to the motto "Don't panic." That motto helped. I figured the best thing to do was to deal with things as they were, without trying to force things to change 'right now', even though they technically could be changed 'right now' by any logical person over at Magellan (that was obviously one aspect of the problem... there WERE NO LOGICAL PEOPLE over at Magellan, at least none that I spoke with) and even though these things were so very wrong.

I then began alerting Blue Cross Blue Shield to this incredibly awful business decision made by the folks over at Magellan. Instead of looking at it as an emotional situation, which it was at the time, I knew the best way to get through to those in any business is to take the personal, emotional aspect right out of it and focus on how it will impact the business itself. Here's the ironic part; Blue Cross Blue Cross staff got compassionate and emotional about it. They agreed it was not a good way to make a decision. They were sympathetic to my frustrations with the whole experience.

Blue Cross Blue Shield staff were extremely concerned, more concerned than the folks over at Magellan were. BCBS also obviously recognized it as a failure of making sound business choices. It could potentially lead to lawsuits, which isn't in any company's best interest. Magellan, on the other hand, viewed it as something they 'probably should look into.' I have names and I have quotes, verbatim, written down. As I was skimming my notes before writing this post to my blog, notes written so long ago, it's funny how I look back on it now, today, and feel so vindicated for all Magellan put us through with this particular situation. It also relieves me to know I won't have to sue them to make a difference, as the difference has already been made: they got fired. I had planned to take them to court over their decision, probably in a civil suit, now I won't have to... happy 2006! That's one less entire agency or company and/or individual on my list of 'things to do' this year.

There were many other 'situations' to come, but this incident with Magellan was the starting gate to a very long and complicated race to do all we could to keep things safe and hope alive.

In the meantime, though, the hospital stay was not covered. This led to a chain of events that can only be described as bureaucracy lunacy. As we soon discovered, we weren't alone. Many families were going through the same, some with even harsher circumstances and rougher, longer roads than we were on. And in a lot of the cases, the roots of origin for the start of the worst possible course of direction started right at the point Magellan made a business decision based on 'not sure'.

When you get paid to do a job by a company that makes billions of dollars, a 'not sure' should immediately be investigated, all day if it has to be, for two days, a week, if it has to be, until that 'not sure' is a conclusive yes or no. Am I wrong for suggesting that? Am I being 'unreasonable' in suggesting that? Sure, I can be confrontational and pretty edgy when I'm up against the one thing in life that bothers me: illogical behavior in places of power. I don't mind illogical behavior when its effect isn't life-threatening. But when you work for and run management for a billion dollar company that literally oversees the wellbeing of PAYING SUBSCRIBERS for your services, you better make every decision by the book. You put the business at risk if you don't.

I had no problem with other things not covered, as long as I read, in black and white, that it was not covered. But a company should not be making any choices on the flimsy 'gee, I am not sure.' If you aren't sure, you bust your ass to get sure. It is not good business, and it could cost somebody their life. THAT is what bothered me. That is why I took the time and energy to make all my complaints by the book. That is why I confronted and investigated everything (and then some) until my eyes went dry. People's lives were at stake... I am both dismayed and overwhelmed by all I learned throughout my investigation. Inspired, but dismayed and overwhelmed. Having spent the past few months recouping, I am now ready to embark upon this year's journey and I can't think of a better way to start than with the news Magellan got a definite response to every 'not sure' they ever tossed out there.

Any decisions made based on 'not sure' should not be considered 'good business'. But apparently Magellan staff in Massachusetts have the audacity to have done just that to numerous clients. Now, they lose millions with losing some contracts with BCBS. And as BCBS will find next year, when they go over the statistics/costs of managing their own Behavioral Health care clients, in both Massachusetts and Georgia, perhaps Magellan will lose millions more in the states and areas they still have contracts with BCBS to manage. Because my guess is that BCBS will find that managing Behavioral Health services in conjunction with physical health services will lead to a more competent, safer, and beneficial outcome for BCBS as well as for subscribers (and doctors/agencies as well, who most likely will find it easier to deal with one company instead of two different ones.) Everyone stands to gain something positive from this impressive and strategic business move by Blue Cross Blue Shield.

Kudos to Blue Cross Blue Shield of Massachusetts and Georgia for making this long overdue business change.

To the staff of Magellan, I've only this to say: the decisions made based solely on 'not sures' perhaps led to you losing close to 100 million dollars. Make sure your business choices are more logical, from here on out. Don't let other families pay for your bad business choices, as your company now pays the price financially. Like I told you back in 2004, bad business choices would eventually cost you much more than you saved, and potentially could cost somebody their life.

I'm glad it was your financial profits rather than somebody's life. You were taking risks and making bad business choices. Let's hope you learned something from all of this. I know I did.