Blue Cross and Blue Shield SUCKS!
So, imagine you've been on a medication for a number of years, and you change jobs. Your new insurance company decides that your medication is "experimental" and therefore they will not pay for it. Now imagine the medications costs between one and two THOUSAND dollars per month!
Blue Cross/Blue Shield's Anthem plan has decided that my husband's medication is "experimental" even though it is approved for Rheumatoid Arthritis. Since it isn't specifically approved for Psoriatic Arthritis, it is therefore "experimental" and they won't pay, DESPITE the fact that the only drug approved for Psoriatic Arthritis gave him fibromyalgia and his doctor says he can't use it any longer.
Psoriatic arthritis is a degenerative and nasty disease that eats the bones of victims. Without the medication, his condition will deteriorate and he will lose functionality. He goes to one of the best arthritis doctors in the country, but will Blue Cross listen? Of COURSE not. They don't want to have to pay, despite the fact that my husband's employer pays them significant amounts of money for their insurance.
If you are an employer who is making a decision on health insurance for your employees, or have a choice in your coverage, think VERY HARD before choosing Blue Cross/Blue Shield. If there's any possibility that you will get a catastrophic disease whose only workable treatment happens to be classified by BC/BS to be "experimental" then you can likely forget that treatment, regardless of what it does to your life.
We have appealed the decision, taken it to peer review, and the claim is still denied. Are we having fun yet?