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BCBS Texas to stop offering PPO Plans in 2016


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

 

I don't think so . . .

However, Health Net and UnitedHealthcare's All Savers Insurance have filed paperwork to sell PPO plans in 2016.

 

We'll find out soon.

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

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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.

 

 

 

If you have a BCBS nationwide PPO plan they will. We never had any problems with drs who accept BCBS in their respective state accepting our TX BCBS PPO policy and paying in-network. We never needed hospital services, but it would be the same. Assurant has their own network and I guarantee you it's not the size of the nationwide BCBS network.

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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Each state that offers BCBS is a franchise from the Blue Cross Association, the parent organization, so it is not consistent across all states. Each state BCBS plan offers it's own policies 'tailored' for the residents of each state. There is a program that ties all of the BCBS claims for payment, example if you have a NY BCBS plan and utilize services in another state, the provider in that state files their claim, that state's BCBS plan processes it by sending the claim to your state BCBS plan for payment. So the coverage is dependent on the terms of coverage of your BCBS plan. Check carefully for your 'Out Of Network' coverage.

Jim & Nancy

Newmar Mountain Air

Love to travel

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Each state that offers BCBS is a franchise from the Blue Cross Association, the parent organization, so it is not consistent across all states. Each state BCBS plan offers it's own policies 'tailored' for the residents of each state. There is a program that ties all of the BCBS claims for payment, example if you have a NY BCBS plan and utilize services in another state, the provider in that state files their claim, that state's BCBS plan processes it by sending the claim to your state BCBS plan for payment. So the coverage is dependent on the terms of coverage of your BCBS plan. Check carefully for your 'Out Of Network' coverage.

The program is called the BlueCard program. For more information see:

 

http://www.bcbs.com/already-a-member/coverage-home-and-away.html

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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If the BCBS agents don't know about the BlueCard program, which I find rather shocking, then all the more reason why you should be talking to Kyle.

2008 Newmar KGDB with dual desk setup and 55" HDTV - for sale soon
2020 Advanced-RV Mercedes Sprinter van - on order
past full-timer for 8 yrs, now-seasonal

 

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It is not the Blue Card program. The state knows about that. It is a program that allows students and travelers with a Blue Cross HMO to elect another state while they are traveling The link explains that. The program was mentioned on the Wheeling It website discussions that I believe Kyle is aware of since they reference him often.

 

I was just looking to see if others have info if they are in a state that is a Blue Cross HMO.

http://www.bcbs.com/...e-and-away.html

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Unfortunately, The Blue Card Program (generally for PPO/EPO plans only) and the Away From Home Program (designed for traveling HMO members and students) are not available to BCBS of TX Blue Advantage HMO members in 2016.

 

Read the print at the bottom of this link. It states the following:

 

* The BlueCard Program is not available for Medicaid, Medicare Advantage or Medicare Part D plan members. HMO plan members can use the BlueCard Program only for emergency or urgent care when traveling or away from home for less than 90 days. Also, the Away From Home Care Program is not available for Medicaid plan members or for HMO plan members on the Blue Advantage network.

All BCBSTX plans in 2016 will use the Blue Advantage network.

Kyle Henson, Fulltime RVer since 2011

Founder/Former Owner of  RVer Insurance Exchange

 

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