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Insurance Issues
Coverage Wastes Money and Promotes MGM

Quotations on Insurance
   
   

The use of Medicaid tax money to pay for amputating an integral part of individual's normal body without his permission is a disgrace, and in North Dakota it is also insurance fraud because tax dollars are still spent on infant circumcisions despite regulations prohibiting its use. Using any health insurance money to pay for disfiguring operations on nonconsenting individuals is not only a waste, it is unethical, and likely a violation of the state charters under which insurance companies legally operate (see below, for example, BlueCrossBlueShield's Articles of Incorporation). The law proposed in 1995 (see below) must be passed to prevent such misuse of funds until boys are given the same protection from enforcement agencies as girls.

This page contains:
1992 Letter to Earl Pomeroy, State Insurance Commissioner.
BlueCrossBlueShield's Articles of Incorporation.
Blue CrossBlueShield's Mission Statement.
Open letter to BlueCrossBlueShield, November 1993.
Medicaid's policy statement and administrative interpretations.
1995 Proposal for new legislation to discontinue insurance coverage.


                                                                                             September 24, 1992

Earl Pomeroy
State Insurance Commissioner
State Capital Bldg.
Bismarck, ND
              
RE: Misuse of medical insurance money.

Dear Mr. Pomeroy: 

I saw Nightline last night and your campaign ad on the Blue Cross Hawaii board meetings. That is small stuff compared to what BlueCrossBlueShield plans across the country spend on unnecessary operations that mutilate infant genitals, namely, circumcision.

There is no medical reason for this operation which costs the country millions a year plus additional millions to repair "botched jobs." Then there is the cost to us in higher medical bills because doctors must pay higher insurance premiums to protect themselves from malpractice.

Estimates are as high as 200 people a year in the US die from circumcision complications; one in 500, according to the American Academy of Pediatrics (AAP), have major complications like loss of penis, and there is always the loss of the foreskin and its sensitivity. The operation is still generally done with no anesthesia and can cause life-long trauma [the AAP, in 1999, finally suggested that anesthesia be used, even though no safe and truly effective means is available, and even if there were, protecting the infant from immediate pain does not protect the cutters from ethical malfeasance].

Many like  Dr. Robert Wentz, Chief North Dakota Health Officer, and Gladys Cairns, Director Child Protection  Services, think this "routine" operation should not continue.

North Dakota may not have any laws on the books yet (some will be introduced next year), but ... your office could be proactive and ask for legislation to prevent wasting money on circumcisions and thereby the cost of their repairs.

A legislator has asked Attorney General Spaeth to rule on whether or not the ND Board of Medical Examiners and Commission on Medical Competency must consider circumcision as unnecessary surgery. Law suits claiming no one has the right to mutilate a healthy organ of another without his consent have been filed in other states and may be here. Some laws are being challenged because the laws are sexist in their enforcement, unless, of course, we allow parents and doctors to remove healthy genital tissue from females (common in Moslem countries, and U.S. and Canadian doctors have been asked to do it).

Sincerely,

Duane Voskuil, Ph.D.
Philosophy, BSC

[No response to this letter]

_______________________________________

The BlueCrossBlueShield of North Dakota's (BCBS) Articles of Incorporation which follow can be found in the archives of the North Dakota Secretary of State. Is BCBS legally in agreement with Article III in reimbursing for routine infant circumcision which BCBS itself, Medicaid and the American Academy of Pediatrics say is not a healthcare service? Italicized words are added emphasis to point out that BCBS is in the healthcare business, not a support for a social ritual that has no health justification.

***************************

EXHIBIT A

AMENDED ARTICLES OF INCORPORATION
OF
BLUE CROSS AND BLUE SHIELD OF NORTH DAKOTA

ARTICLE I.

The name of the Corporation shall be:

BLUE CROSS AND BLUE SHIELD OF NORTH DAKOTA

ARTICLE II.

The period of its duration is perpetual.

ARTICLE III.

The purpose for which this Corporation is organized shall be:

A. To establish, operate and maintain Health Service Plans whereby one or more kinds of health service is provided to Subscribers under a Prepaid Health Service Contract entitling each Subscriber to certain specified health services. In connection therewith, the Corporation shall have authority to:

1. Enter into contracts for the rendering of hospital service to any of its Subscribers with hospitals maintained and operated by the state or any of its political subdivisions, or by any corporation, association, or individual. The Hospital Service Plan operated by the Corporation may provide for hospital service and other related health services as advancements in health care and treatment warrant the extension and providing of such services and in case of emergency or expediency.

2. Make and enter into mutual agreements with hospitals or groups of hospitals, nursing homes, and other vendors and furnishers of health care services and other related facilities.

3. Make and enter into mutual agreements with state, federal, or other governmental agencies to provide hospital services, nursing home care, and other related health services, including health care services for the needy and other persons.

4. Make and enter into mutual agreements with any other health care corporation or with any state or local government or agency thereof to provide health care administrative services, to act as administrator of any other health care service plan, or to act as a marketing agency or as a fiscal intermediary of any health care plan or of any other health care organization or of any federal, state or local government or agency thereof.

5. Enter into contracts with other corporations or other entities in this state or in other states or possessions of the United States, or of the Dominion of Canada or other foreign countries so that:

a. Reciprocity of benefits may be provided to Subscribers.

b. Transfer of Subscribers from one entity to another may be effected to conform to the Subscriber's place of residence.

c. Uniform benefits may be provided for all employees and dependents of such employees of entities and other organizations transacting business in this state and elsewhere and a rate representing the composite experience of the areas involved may be charged for such employees and their dependents.

d. Health services may be provided for Subscribers of this or other corporations or entities for the purpose of ceding or accepting reinsurance of of [sic] jointly providing benefits, underwriting, pooling, mutualization, equalization, and other joint undertakings which the governing board may from time to time approve.

6. Enter into contracts with physicians for the rendering of medical service to Subscribers in accordance with the terms of the Subscriber Contract.

7. Enter into contracts with laboratories and vendors of health appliances and prostheses to provide material and services pursuant to contracts with Subscribers.

8. To do everything necessary and proper for accomplishing any of the purposes or attaining any one or more or the objects herein enumerated or which, at any time, appear to be convenient, conducive to, or expedient for the protection or benefit of this Corporation or any of the Subscribers and Health Care Providers.

_____________

BlueCross BlueShield of North Dakota Mission Statement
>http://www.noridian.com/about/about_mission.html

[link may be dead]

Mission Statement

It is the mission of Blue Cross Blue Shield of North Dakota to provide the best value in health insurance to our customers. [Yet BCBS pays for contra-indicated surgeries]

Vision Statement

We apply our corporate values to exceed our customers' expectations in providing health insurance, government program administration, and related employee benefits by:

  • Responding to our customers in all interactions.
  • Offering products and services that provide financial security to our customers.
  • Maintaining effective and professional employees.
  • Collaborating with our health care providers for cost-effective, healthy outcomes.
  • Operating the company efficiently and effectively while maintaining financial stability.
  • Empowering our customers to make informed health care decisions by providing them with informational opportunities and resources. [Requests that they help educate the public on the circumcision issue are dismissed.]
  • Supporting and contributing to economic development within North Dakota.

Our Shared Business Values

Our Customers
We are committed to understand our customers' needs and proactively deliver products and services to meet those needs.

A Dynamic Workplace
Working together, we encourage an environment where every employee can pursue and be recognized for outstanding individual and team performance with diverse opportunities for personal growth.

Excellence
Excellence is an expectation. We continually improve and remain open to being compared to the best.

Integrity
We are trustworthy, ethical, honest, and accountable for our actions.
[Is it honest and ethical to pay people to amputate valuable, normal, healthy tissue from those who have no say in the procedure?]

_________________________________

Open letter to BlueCrossBlueShield of N.D.
November 17, 1993

RE: One Unnecessary Surgery Covered by most ND Blue Cross plans (except state employees).

Routine infant circumcision has no medical justification. It is a surgery looking for a medical rationalization. In 1891 James Hutchinson of the Royal College of Surgeons in England proposed it as a "treatment" for masturbation which supposedly caused insanity. He went so far as to say that "if public opinion permitted their adoption—measures more radical than circumcision would be a true kindness." Today we are told it helps prevent urinary tract infections, cervical and penile cancer and even HIV infections.

Even if any of these claims were true (and none are to any statistically significant degree and others are actually the opposite of the claim), still the actual known risks to the surgery far outweigh the purported advantages, namely, infection, significant pain, penises with physical distortions (in addition to their loss of the natural foreskin,) total loss of the penis, and death (not to mention some possible long-range psychological problems and loss of significant sexual nerve tissue). Robert Wentz, MD, former State Health Officer agrees "that the purported medical indications are outweighed by risks and disadvantages and that circumcisions represent an unnecessary health care cost" (Letter to Voskuil 10/1/92).

The financial cost to Blue Cross and the public is high. Estimates range from $300,000 to half a million dollars for the operation and follow-up care for North Dakotans alone. This does not even cover the cost of paying for the multimillion dollar law suits that follow when one ends up with a badly damaged or lost penis. Just what these costs are no one seems to know since no one is keeping records and making this information public. We are aware of at least one case of a Glendive, MT, who has lost his penis and several other cases reported by James Snyder, MD, former chairman of the Virginia Urological society.

Circumcision, the only male surgery done by those specializing in female care (gynecologists), is the only surgery still permitted to remove healthy tissue from a non-consenting individual (though some argue that abortion falls into this category). Much is made of the so-called parental right to decide whether to cut off a infant’s foreskin, but few consider what the child might want. Since this is an irreversible operation, and one that is not medically indicated and one that can be done at anytime with no more, and probably fewer, problems than when it is done as an infant, reason should dictate that the decision to cut this sexually sensitive tissue away be left to the one who must live with it.

The legal aspects of circumcision are just beginning to be explored as they are with the female genital operations of circumcision, clitoridectomy and infibulation, common in many parts of the world and re-occurring in the US and Canada because of new African immigrations. Even as late as 1977 some Blue Cross plans covered clitoridectomies according to Constance A. Bean, coordinator of health education at MIT and author of Methods of Childbirth (p.227).

Over and above the discussion of circumcision as unnecessary surgery, there is an increasing awareness that circumcision is abusive. Since it has been a common social practice for 100 years (in the US but not in Europe where the incidence is less than 1% compared to our 60% nationally and probably 90% in many North Dakota hospitals), to say circumcisers and parents who put their sons through the operation are legally culpable of child abuse is still an unsettled legal and moral issue. Most who do not want to call it child abuse do not, however, hesitate to call female genital mutilations what they are, namely, "mutilations" and the ones who do it culpable of criminal behavior.

Psychologists, especially those who specialize in the effects of neonatal experiences on adult thinking and behavior, stress that the placing of pain in the region of the brain/mind that is designed for pleasure produces neurotic people. Also, the distrust the infant comes to feel towards the world ("mother" who betrayed him) can never be completely erased.

Summary: There are no health reasons to circumcise. There are reasons not to. Stop paying for it.

Duane Voskuil, Ph.D.
Jody McLaughlin
P.O. Box 209
Minot, ND 58702

Addendum: North Dakota BCBS did stopped paying for routine circumcisions for a while in the '80s upon the urging of Ron Miller, MD, but reinstated payments because they thought they might be losing subscribers. This would not be a concern if all policies were the same, this is why we need a prohibition on any insurance coverage such as the following bill suggested in 1995:

 ___________________________

1995 Proposal for an Amendment
to the N.D. Century Code

An Amendment to create and enact a new section to chapter 26.1­36 of the North Dakota Century Code, relating to a restriction on health insurance coverage of infant circumcision procedures.

 

A new section to chapter 26.1-36 of the North Dakota Century Code is [to be] created and enacted as follows:

 

Circumcision coverage. No health insurance policy, health service contract, or evidence of coverage may be issued, delivered, executed, or renewed unless the policy, contracts or evidence of coverage restricts coverage for infant circumcision to cases in which the patient has a life-threatening or health-threatening condition requiring immediate care.

 

   In support of this amendment we would have the legislators consider the following quotations:

 

Medicaid’s present policy statement: “Effective for services provided on or after November 1, 1986, the North Dakota Medical Assistance Program will provide payment for circumcisions only when there is documented evidence that the circumcision was performed due to medical necessity. Routine circumcisions that are not medically indicated will no longer be reimbursable through the Medical Assistance Program.”

 

ND Public Employees Retirement System Group Health Plan (PERS), July 1, 1993, underwritten and administered by BlueCross BlueShield of North Dakota: “You [North Dakota Public Employees] are not covered for: nonmedically necessary circumcision for newborns.” PERS handbook.

 

“Regarding circumcisions–We [the Contract Administration Committee of BlueCross BlueShield of ND] consulted with other Plans and The American Academy of Pediatrics. The majority of these entities do not have an established policy regarding circumcision.... There is recognition by these parties that this [i.e., routine infant prepuce amputation] is an elective service." Letter to Jody McLaughlin from BCBS, 11/23/92.

 

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