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BCBS Texas to stop offering PPO Plans in 2016


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Thanks to modern medical advances we are living longer and facing new medical challenges. The average life span is increasing. If health insurance premiums are $500 a month and RX's, dr visits, labs etc exceed that how can insurance companies stay in business

 

They stay in business because they don't pay the providers what they charge. A level 3 office visit may be billed at $75 - $100 or more. The actual reimbursement is around $18. The majority of office visits are level 3. There is no way anrovider can stay in business at $18 per visit. It costs much more than that just to pay the staff. Any tests done in office, such as a UA are reimbursed very low. A UA is reimbursed around $3 if you can get it. The HMO's would routinely deny coverage for a group of tests and my wife would have to wait on hold from 30 min to 1 hr to talk to someone. Is it cost effective to pay someone to sit on hold for a $3 reimbursement. Insurance hopes you won't think it is. I was glad when I closed my clinic and didn't have to play their games. I was very happy when my surgeon put me on disability and I didn't have to play with Obamacare.

Ron C.

2013 Dynamax Trilogy 3850 D3

2000 Kenworth T2000 Optimus Prime

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If you already have a BCBS of TX PPO plan will it be grandfathered?

I'm told that it will not be. But we will see.....

Jack & Danielle Mayer #60376 Lifetime Member
Living on the road since 2000

PLEASE no PM's. Email me. jackdanmayer AT gmail
2016 DRV Houston 44' 5er (we still have it)
2022 New Horizons 43' 5er
2016 Itasca 27N 28' motorhome 
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No truck at the moment - we use one of our demo units
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See our website for info on New Horizons 5th wheels, HDTs as tow vehicles, communications on the road, and use of solar power
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If you already have a BCBS of TX PPO plan will it be grandfathered?

 

http://www.bcbstx.com/company-info/alerts-announcements/alerts-announcements?lid=icadpkzd

 

If individually purchased (as opposed to employer group coverage) and non-grandfathered (begin after March 23, 2010), as of July 23, 2015 BCBSTX currently says "no".

 

We'll know in October when the 2016 plans are unveiled what the final answer is.

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Looks like FL has Cigna PPO in the marketplace. Giving up my grandfathered plan and getting a subsidy to offset high insurance costs rubs me the wrong way. Might have a few options for keeping a Wisconsin address. This is one thread I'm going to follow closely.

Barbara Jones, missing my furry travel companions Reggie and M.E.C.O. (RIP)
2005 Montana 3295RK
2006 Dodge Ram 3500 Diesel Dually Crew Cab LB
http://www.spacetonature.blogspot.com

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Really? First the stock market and now insurance. Ugh. Anybody want to hire an aerospace engineer who likes to travel, eat and have insurance that allows me to travel and have money left for food and fuel? :rolleyes:

Barbara Jones, missing my furry travel companions Reggie and M.E.C.O. (RIP)
2005 Montana 3295RK
2006 Dodge Ram 3500 Diesel Dually Crew Cab LB
http://www.spacetonature.blogspot.com

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While this isn't an insurance plan it does provide good access to care and a good place to have some customer service oriented medical care that is close by. I do hope that those who live at Rainbow's End will participate as it will need a customer base to keep the clinic operating successfully as well as use by those who travel through. And it will certainly make things better for the residents of CARE!

Good travelin !...............Kirk

Full-time 11+ years...... Now seasonal travelers.
Kirk & Pam's Great RV Adventure

            images?q=tbn:ANd9GcQqFswi_bvvojaMvanTWAI

 

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Really? First the stock market and now insurance. Ugh. Anybody want to hire an aerospace engineer who likes to travel, eat and have insurance that allows me to travel and have money left for food and fuel? :rolleyes:

 

 

Hang in their BPJ....The media always sensationalizes stories for ratings.

 

No. 1: Keep your perspective. After a crazy ride, the Dow trimmed its losses Monday to 588 points, or 3.6%. On Black Monday in October 1987, the Dow fell more than 22% in a single day. The takeaway: The recent stock declines are big but not crashes, when viewed on a percentage basis. for the complete article click here: http://www.usatoday.com/story/money/markets/2015/08/24/tips-investors-stock-market/32261825/

 

Here are some historical charts on various stock market indices that may provide some reassurance:

http://stockcharts.com/freecharts/historical/marketindexes.html

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  • 4 weeks later...

My wife just received a letter from AZ BCBS that said her PPO plan won't be available next year.

 

A visit to the AZ BCBS web site yielded this:

 

In 2016, no individual PPO plans will be available for sale. These PPO plans will terminate no later than December 31, 2015.

 

I'm on Medicare (thank god!), but she has another year to go.

SKP #79313 / Full-Timing / 2001 National RV Sea View / 2008 Jeep Wrangler Rubicon
www.rvSeniorMoments.com
DISH TV for RVs

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My wife just received a letter from AZ BCBS that said her PPO plan won't be available next year.

 

A visit to the AZ BCBS web site yielded this:

 

In 2016, no individual PPO plans will be available for sale. These PPO plans will terminate no later than December 31, 2015.

 

I'm on Medicare (thank god!), but she has another year to go.

AZ Blue will be offering an option that includes a nationwide network. If you enrolled through an agent contact them for an update.

 

Coleen M. Elkins

Escapee Since August 2008

Full-time 2004 Holiday Rambler Scepter

with one retired husband and two very sweet Border Collies

Wintering in Arizona 

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My agent said my Texas PPO plan was in force BEFORE ACA was enacted (March 23rd, 2010) and will continue unless I cancel or don't pay my premium and in either case then it would not be reinstated.

I think that is true of non-exchange plans. In my case, I had a non-exchange BCBS of TX plan, but when ACA came in I went to the Exchange plans. One reason was that BCBS encouraged that change by raising the rate on the non-exchange plan significantly. About 40%. Also, I qualified for a subsidy on the exchange at that time. I no longer qualify for a subsidy. Thus, I'm basically out of luck. They are dropping the Exchange PPO and I am not grandfathered into my "previous" plan so it is not available...... I have to go HMO as far as I can tell. In my case only for 6 months until medicare kicks in. So I'm lucky in that regard.

Jack & Danielle Mayer #60376 Lifetime Member
Living on the road since 2000

PLEASE no PM's. Email me. jackdanmayer AT gmail
2016 DRV Houston 44' 5er (we still have it)
2022 New Horizons 43' 5er
2016 Itasca 27N 28' motorhome 
2019 Volvo 860, D13 455/1850, 236" wb, I-Shift, battery-based APU
No truck at the moment - we use one of our demo units
2016 smart Passion, piggyback on the truck
-------------------------------------------------------------------------
See our website for info on New Horizons 5th wheels, HDTs as tow vehicles, communications on the road, and use of solar power
www.jackdanmayer.com
Principal in RVH Lifestyles. RVH-Lifestyles.com

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Not sure how ACA is to blame for non-coverage since the states discussed either decided not to participate in ACA or did not expand health coverage under that plan. Cannot blame something that is not in affect. We are 75 and have Medicare and GEHA. Medicare takes care of serious ailments and GEHA takes up the slack, and prescriptions.

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AZ has expanded health coverage although they were late to the party and went kicking and screaming the whole way. Will be interesting to see whether other companies still offer PPO in that state. Otherwise, I agree Reed, this looks like a natural consequence to non-participatory states. I am eagerly awaiting Michigan's plans for next year. I have received no notice from MBCBS that ppo's will not be offered.

Dave and Lana Hasper

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Not sure how ACA is to blame for non-coverage since the states discussed either decided not to participate in ACA or did not expand health coverage under that plan. Cannot blame something that is not in affect. We are 75 and have Medicare and GEHA. Medicare takes care of serious ailments and GEHA takes up the slack, and prescriptions.

 

I didn't think that participation in ACA was optional to the States. The only option was whether States wanted to create their own exchange or have their citizens participate in the Federal exchange.

 

I may be wrong, but I believe that even non-exchange (employer or private non-subsidized) plans have to adhere to the exchange minimum standards. That was the reason my non-exchange plan gave for an increase in premium costs.

Everybody wanna hear the truth, but everybody tell a lie.  Everybody wanna go to Heaven, but nobody want to die.  Albert King

 

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The participation part relates to whether they accepted funds to expand Medicaid within the state utilizing federal funds. Some states refused the federal funds for the stated reason that if federal dollars went away the state would be left with a program they could not avoid. There are many counter arguments to this rationale and opponents accuse these states of putting thousands of lives at risk by refusing funds only for political purposes in the hopes of sinking the ACA before it got off the ground. Setting aside the politics there are now states with very different systems. Having a large number of uninsured in a state places a large burden on the medical system in those states since the uninsured delay care, develop chronic diseases in advanced states, and typically only get care after going to an emergency room with life threatening conditions. These patients generally then enter a phase of rotating in and out of emergency admissions to hospitals until they ultimately die. Hospitals then are forced to eat the costs of the care for these people and, to the extent they can. the costs are ultimately charged to those who do have insurance. This creates cost inefficiencies in these states which may be causing the strain on the insurance companies.

Dave and Lana Hasper

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  • 3 weeks later...

is it even feasible to change plans at each new volunteer location? I'd be changing my insurance every 2-3 months.

I assume each time you move and change insurance, your deductible starts over again.

 

A couple of other points related to choosing insurance...some RVers think they're safe using an HMO, or even a PPO with a limited network, because ACA requires your insurer to cover out-of-network care in case of an emergency. But it doesn't require them to pay the full amount. The insurer decides how much they'll pay (what it would cost them if you were in network, for example) and you are liable for the rest. It's called "balance billing" and it's a huge problem, because if the regular charge for a test is $1,000 and your insurer usually pays a negotiated in-network rate of $100, you owe the $900 difference...and it doesn't even count toward your deductible OR your "Maximum Out of Pocket."

 

Lucky enough to end up in an emergency room in your network? Chances are the ER doctor is out of network, and can charge whatever he wants. In my case it was the equivalent of $5,700 per hour, and my PPO insurance only covered half. I was liable for the rest, and it didn't count toward my deductible. Same with the charge for the pathologist who read my CT scan. Assurant decided it wasn't medically necessary.

 

I've spent hundreds of hours on the phone (not an exaggeration) and still have an outstanding $10,000 bill from February that Assurant claims I have to pay. It was in-network provider AND a life-threatening emergency, but Assurant keeps processing it as out-of-network and no one can tell me why. It's all these delays, paperwork and red tape that make healthcare so expensive. I had the exact same emergency last year, when I was still at home with HMO coverage, and the total cost was $2,000 - of which I paid $50.

 

Now we make $1,500 too much to qualify for a Marketplace subsidy. So it costs two of us over $13,000/year in premiums, with an in-network deductible of $6,000 each, an out-of-network deductible of $18,000 each, plus all the stuff they don't cover. We've been healthy except for that one ER visit, and still spent well over 25% of our income on healthcare (not even counting the $10k we supposedly owe). And that's not the worst part. Next year we can't even get this crappy insurance because Assurant is getting out of the business.

 

And what if they DO offer Blue Cross PPO coverage in your state? Did you know that just because an out-of-state doctor/facility accepts BCBS PPO, it doesn't mean they accept YOUR insurance? Each plan and state is different. We spent two weeks trying to find out the extent of the BCBS network outside Florida, and no one could tell us. We tried multiple agents and several calls to various BCBS departments. No one knew. Yeah, I want to spend a quarter of my income on that insurance.

 

And while I'm on a rant...does anyone else find it ironic that some posters bash ACA and the government's involvement in healthcare, and in the next sentence thank God they qualify for Medicare? Or complain about paying for coverage that includes Well Baby Care at our age, but are happy to benefit from reduced premiums that come from having young people in the insured mix? Young people who, if the tables were turned, would rather not subsidize our prostate surgeries, hip replacements and other "senior" medical costs that, statistically, comprise half a person's lifetime medical expenses.

 

We're all in this together, folks. And we're all going to pay for it, one way or another, so let's make it as cost effective as possible. I'd love to see the Medicare model expanded to include anyone who needs or wants to buy it. Then all of us pre-65 fulltimers could enjoy the same portability and coverage our elders do.


There's more to see than can ever be seen

More to do than can ever be done

 

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I too am one of those full timers who are not yet eligible for Medicare. I have BCBS of TX Multi State Plan. I called Member Services yesterday and was told by the salesman (yes the Customer Services Rep had to transfer me to a salesman) that all PPO plans will end on 12/31/2015. Not sure if he meant only individual PPO plans or all PPO plans. He said that TX has not yet approved any new plans but they (Blue Cross) have been told that a decision regarding approval by TX legislature is expected 10/18/2015. Once the options are available to the public we will have till 01/31/2016 to choose a new plan. All new plans proposed are HMO plans. Guess my only option will be to get a high deductible catistrophic plan since that will be the only time I will be able to make a claim.

2015 Itasca Ellipse 42QD

2017 Jeep Wrangler Unlimited Rubicon Hard Rock Edition

2021 Harley Street Glide Special 

Fulltimer

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TXTiger,

 

We are in the same sinking boat and are going to go with Liberty Healthshare. We spoke with them today and they are a very viable option for those of us under 65 and are fulltimers with nothing but a PMB address.

 

Check them out at libertyhealthshare.org

http://ramblingrvrat.blogspot.com/?m=1

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