An Open Letter To Blue Cross/Blue Shield of Texas

Dear BCBS-TX Federal Employees Insurance Program,

You suck.

You suck like my vacuum cleaner sucks after I put a new bag into it. You suck like Austin traffic on a hot July afternoon with a thunderstorm on the way. You suck so much that nothing, not even light, can escape the event horizon of your awful fucking suckitude.

You told Rosie up at the Magic Prosthetist Elf's that you wouldn't cover but about a grand of the cost of my oral prosthetic. That's less, BCBS-TX, than Medicare covers on the same sort of prosthetic. You are actually reimbursing *less than Medicare* for something that allows me to eat, talk, and breathe properly.

Oh, but I'm getting ahead of myself. Let me explain what an oral prosthetic is, why I need it, and thus, why you suck so much.

See, I had cancer. I had a weird rare form of cancer that necessitated removal of half my hard palate and all of my soft palate. Open your mouth, BCBS-TX, and look at the back of your throat. That, on me? Is gone. It was that or lose half my face when the cancer that I had came back again and again because it hadn't been cleared out properly the first time.

Without a soft palate, I cannot speak intelligibly. I can't swallow very well, and spit tends to drip out of my nose if I bend over. Of the three problems, speech is the biggest one, and the one that the prosthetic I use helps most with. Basically, without the prosthetic, I would be unable to work, unable to function in public, and unable to communicate using devices like a telephone. I would be as handicapped as a person with only one leg or one arm. My disability would be huge.

There are two prosthodontists in the state who would take me on. Two. Both of them are non-contract (ie, out of network) with you. The guy I'm seeing now is the only guy around who's willing to do what it takes to get me speaking well. Yet you, BCBS-TX, think that I should drive four hours to some dude at MD Anderson in Houston who, by his own admission, is not as competent at this sort of extreme prosthodonty as my Happy Elf Doc. There is a reason that my surgeon sent me to Happy Elf Doc rather than somebody who also works for the University of Texas system, guys: it's because Happy Elf Doc is much, much better.

Anyway, I've got my first prosthetic from this guy, and because you only reimbursed a grand of its cost, he took only cost from me. The thing cost six grand for him to make, and I paid him five grand yesterday. He gave it to me for cost. He did not charge me for the fourteen hours of office visits I've already racked up with him. That's fourteen hours of face-to-face time with a specialist--time that he could've used to see two less complex patients.

BCBS-TX, I will need two more prosthetics before things are done here. I'll also need various adjustments and remoldings throughout the life of the prosthetic. If something goes terribly wrong and I break the thing or run over it with the above-mentioned ultra-strong vacuum, I'll need a replacement. Each of the two prosthetics I know I'll need will cost me six grand, just as this one cost six grand.

Simply put, BCBS-TX, my prosthetics will cost more than the total out-of-pocket-cost of my surgery, hospitalization, and preliminary MRI/CT/PET scan. And you want me to bear that cost without whining.

Well, guys, you're in for a very, very long year. See, it seems to me that if somebody had a limb amputation and the only folks who could deal with the prosthetic for that amputation were in Outer Backobeyondistan, you'd allow for that prosthetist and his minions to be in-network, just that once. You would reimburse fair market value for that prosthetist's labor, especially if it were considered a really unusual case. You'd be, in other words, something other than the black-hearted, asinine, no-explanation-of-denial dipwads you're currently being.

My mouth is bigger than it was before surgery, y'all. You may be BCBS-TX, but I am a pissed off woman who has already had the shit scared out of her. I'm gonna bug you until you pay up.

In fact, I'll bug you so much that you'll pile cash on the table in front of me until I smile, then give me more just to go away. You've thrown down this gauntlet, BCBS, and I am *pissed*.