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Who is Losing their PPO Health Plans?


Zulu

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At last a good and open discussion on a subject that affects all of us, without straying too far into the political realm. Too bad this sort of discussion couldn't have happened years ago in D.C..

 

You just made it political again. At least you're consistent.

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Well for us it is better than insurance. We may have been part of the problem with the dropping of PPO. We dropped them so they lost that little bit of money. See I didn't disappoint you. lol

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We are probably going to go the route of Glenn and use Liberty Healthshare. We spoke with them and it is very feasible for us and a good alternative with no penalty as it is ACA compliant.

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Bigboomer liberty health is not ACA compliant but exempt. Very different things

 

Here is more bad news and some explanation regarding PPOs. 40% reduction in PPO's. http://www.cnbc.com/2015/10/29/fewer-plans-to-be-on-biggest-obamacare-exchange-in-2016.html

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

p

Dave and Lana Hasper

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Our FEHBP BC/BS did increase this year as it does most every year. It was higher than usual this year a increase of 19.83 per month or 237.96 per year . My out of pocket Monthly premium is now 217.06 per month or 2604.72 per year. That is BC/BS Standard self only. Since there will be no COLA this year my income will decrease by 237.96 per year. . That sounds like a increase in Cost of living to me...but what do I know.

 

The coverage is good and with Medicare which will not go up we pay little in medical expense.

FEHB= Federal Employee Health Benefits Program as we are a retired Federal Employee

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Dave,

 

My apologies as your correct. They are exempt and it must also be noted they are not an insurance company and although there is sharing of the medical costs within the entire group there is no guarantee of payment for the medical costs. But that being said in speaking with one of their advisers they noted that they have not had anyone's bills rejected or not paid unless it was an elected typed surgery or procedure (i.e., cosmetic, etc.)

 

They also noted that almost all healthcare providers welcome there card and use as they usually pay about 50% more than Medicare / Medicaid on average and always pay within 30 days of receiving bills.

 

Again, it is not for everyone but it is an option for us.

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

GOD Bless America!

GOD Bless Texas!

GOD Bless All of our Troops!

"CHARACTER is doing the right thing when no one is looking"

'09 International Durastar 4400 LP Customized by 2L Custom Trucks

'20 DRV Mobile Suites 40KSSB4, '10 H-D FLHRC Road King Classic, '09 Honda Rebel AmeriDeck M/C Loader in Truck Garage, Polaris RZR 570 EPS 10 - 320W Solar Panels, 4- Simpliphi 3.8 kWh 151A Lithium batteries, Victron Multiplus 3000W inverters, Victron 250/70 Charge Controllers, Progressive hardwired 50 AMP EMS, Class of 2012!

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If you read the website, you'll see that any pricing for "off exchange" shown is for the current 2015 plans. They won't have the 2016 plan options or pricing available until November 1:

 

 

NOTE: This pages is for ON Exchange quoting only! If you are looking for coverage OFF Exchange then please click below for those instant quotes (Available November 1 2015).

 

 

So we have to wait until Nov. 1 to know what "off exchange" plans might be offered for next year.

 

OK, I'm confused. Easy to do with ACA I guess.

 

If I look at Healthcare.gov for 77399 I see only BCBS products, and no PPOs. No surprise there. (If I look at the other Texas zip code I can use, in Travis County, there are PPOs offered by Scott & White, but their network is only in Texas, which doesn't help.)

 

If I skip healthcare.gov (and forego my subsidy), and go directly to BCBS or Humana or United, there might be (expensive, unsubsidized) PPO options?

 

That might be worth it, because when I see how limited the options are with the HMO offerings, I have nightmares about out-of-network and balance billing charges ...

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The TX BCBS website does not show any off exchange PPO plans for zip code 77399. All the plans listed are Blue Advantage HMO plans. On healthcare.gov indicating income above subsidy limits, I found 12 plans for 77399. All from BCBS and all were HMOs.

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If I skip healthcare.gov (and forego my subsidy), and go directly to BCBS or Humana or United, there might be (expensive, unsubsidized) PPO options?

 

 

 

Not for BCBS in Texas, since they've already announced that fact, but other companies *might* be offering non-HMO plans for 2016. We won't know for sure until Sunday (November 1) what will be offered off-exchange.

 

Kyle's RVerInsurance.com "Guide", linked in a couple of other threads and here https://www.rverinsurance.com/uncategorized/rver-guide-to-2016-aca-open-enrollment/

 

indicates there will be POS (Humana) and PPO (UnitedHealthcare) options off-exchange (scroll way down the Guide to Texas 2016 Plans). We just have to wait a couple of days until these off-exchange plans (and those for other zip codes and states) and their coverages/premiums are made public. I'm sure RVerInsurance will have even more details then to help us unravel which plans work best for RVers.

 

Michelle

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Our FEHBP BC/BS did increase this year as it does most every year.

Rising medical prices is only one part of the annual increase for the majority of us here. A major factor for most of us is that we keep having birthdays! Because the typical medical needs of people tend to increase with age, once we reach the age to qualify for Medicare we are also getting into higher risk categories and so our birthdays tend to bring larger premiums for any supplemental coverage that we may carry. While I have found that getting old has some major negative aspects, it still beats the alternative! :P

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

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

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As a Canadian, this all sounds really confusing. We can all travel within our own country and our universal helath care which is provincially controlled, pretty much covers you in other provinces. Where is gets pricey for us is traveling in the US and we pay a lot to cover that. Our provincial plans will only cover up to what it would cost in Canada, which is way way less than the US. Our doctors get paid the same, we have to purchase the same equipment, etc etc. Seems to me you guys should be questioning why the base cost of medical care is so high in the US, compared to other developed countries, rather than the costs to insure you. Somebody is making a lot of money over the misfortunes of others. Or maybe you simply have just way too many middlemen in the equation, all taking their cut.

 

All that being said, the baby boom demographic bubble is going to put a strain on any medical system

Paul Beddows

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We are probably going to go the route of Glenn and use Liberty Healthshare. We spoke with them and it is very feasible for us and a good alternative with no penalty as it is ACA compliant.

My god how do you get that rig into forestry sites?

Paul Beddows

Summer-Abbotsford BC, Winter Jalisco Mexico

Co-Founder of NATCOA

Wagon Master for Caravanas de Mexico RV Caravans

2010 Majestic Class C

 

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Not to get into the politics of single payer systems vs yours, of course you pay for it one way or another, but the cost of the services to start with in the US are way out of line compared to all other western countries, and there is only one logical explaination for that. Too many hands in the pie.

Paul Beddows

Summer-Abbotsford BC, Winter Jalisco Mexico

Co-Founder of NATCOA

Wagon Master for Caravanas de Mexico RV Caravans

2010 Majestic Class C

 

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Not to get into the politics of single payer systems vs yours,

You state my point. It is difficult enough to discuss the issues of this thread and avoid getting into the political side of things, but you introducing international political views isn't helpful. Let's not make this a debate between our countries over who has the best system.

 

I am deleting my previous response, for the same reason. Neither of our remarks are applicable or appropriate to the subject of this tread. :)

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

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

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I've been fortunate to get an affordable nationwide PPO plan thru my domicile in Illinois (Chicago area) the past 2 years, but like the other Blues owned by HCSC-owned Blue Cross insurers, Illinois BCBS decided to cancel their individual PPO plans in 2016. Now, every on-exchange plan in Illinois, even if still technically called a PPO with nationwide coverage, offers just a shadow of what they once did for the same or higher cost. Even more alarmingly, Illinois (and many other states) have allowed insurers to offer plans with UNCAPPED out-of-network costs-- meaning, if the insurer decides to reduce their network providers suddenly, and no longer offer any in-network provider, you're on the hook for the provider's full fees, no matter how many thousands or millions they might turn out to be.

 

Don't think it can happen to you? Think that Ministry co-op cost sharing plan will always have your back no matter what? Think again!

 

I tried out a lower cost ACA PPO plan earlier this year after 30 years of healthy claim-free living. 5 months later was diagnosed with cancer and needed surgery. To my horror, my low-cost plan offered me ZERO in-network provider options for anesthesiologists, even though they had already pre-approved the hospital and surgeon.

 

The devil is in the details of these new ACA plans. Networks are shrinking and insurers are looking for any legal loophole to minimize their cost exposure. All we, as full-time under-65 RVers can do is search for domiciles that continue to offer nationwide coverage and provide the true safety net of both capped in-network and out-of-network costs.

 

At this moment, it's looking like Florida Blue out of Bushnell will be my solution for 2016, but I won't start the domicile move process until I can confidently confirm nationwide PPO will stay in-network on these plans. Kyle's document seems to believe they will, but I know better than to assume ANY coverage without carefully checking each insurer and confirming these kinds of details.

 

Whatever your political bend on the ACA, know that we ALL pay for this broken mess of a healthcare system with unreigned costs spiraling out of control. Until our system controls costs that the insured and uninsured incur, we will all continue to pay one way or another.

 

At a minimum we should demand that every insurer's network offer at least 1 in-network provider of all specialties and facility types, and that out-of-network out-of-pocket costs be capped to a level that is fair but still affordable. If private insurers refuse to do this, allow Medicare to come in and compete for the under-65 business!

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Don't think it can happen to you? Think that Ministry co-op cost sharing plan will always have your back no matter what? Think again!

 

I tried out a lower cost ACA PPO plan earlier this year after 30 years of healthy claim-free living. 5 months later was diagnosed with cancer and needed surgery. To my horror, my low-cost plan offered me ZERO in-network provider options for anesthesiologists, even though they had already pre-approved the hospital and surgeon.

Tell us more about this issue, please. Was your plan part of the Affordable Care Act program or was it one of the health sharing programs? And what was the name of the plan that you had?

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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my low-cost plan offered me ZERO in-network provider options for anesthesiologists, even though they had already pre-approved the hospital and surgeon.

 

 

This issue is unfortunately common and existed well before ACA. I've run into it with both anesthesiologists and radiologists as far back as 15 years ago. It's something we don't think about when signing in at pre-admissions, but there is a statement in the consent paperwork that does state just because the hospital facility might be on your network, the providers themselves may not be and it's up to you to do your own checking on their in-network status. Trouble is, you usually can't find out exactly who the anesthesiologist will be or which radiologist will be reading any films (the latter got me on an annual screening mammogram).

 

Michelle

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This issue is unfortunately common and existed well before ACA. I've run into it with both anesthesiologists and radiologists as far back as 15 years ago. It's something we don't think about when signing in at pre-admissions, but there is a statement in the consent paperwork that does state just because the hospital facility might be on your network, the providers themselves may not be and it's up to you to do your own checking on their in-network status. Trouble is, you usually can't find out exactly who the anesthesiologist will be or which radiologist will be reading any films (the latter got me on an annual screening mammogram).

 

Michelle

 

Anesthesiologists and radiologists seem to have a monopoly on NOT participating in any networks. Problem at the hospitals is you almost NEVER have a choice due to their contracts with these two professions. Also if your admitted you don't have the time to investigate your choices (if there are any)

I blame it on the hospitals to insist that any contracted profession (anesthesiologists, radiologists, ER) belong to or accept the same network as the hospital.

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Insurance companies won't always have your back either. Dear friend of mine recently found this out. He has lung cancer. He wants to go to a major cancer center in another state. His insurance said no coverage. Local doctors have basically wrote him off. Sad. Please do let us know what you were referrring to.

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OK, I'm confused. Easy to do with ACA I guess.

 

If I look at Healthcare.gov for 77399 I see only BCBS products, and no PPOs. No surprise there. (If I look at the other Texas zip code I can use, in Travis County, there are PPOs offered by Scott & White, but their network is only in Texas, which doesn't help.)

 

If I skip healthcare.gov (and forego my subsidy), and go directly to BCBS or Humana or United, there might be (expensive, unsubsidized) PPO options?

 

That might be worth it, because when I see how limited the options are with the HMO offerings, I have nightmares about out-of-network and balance billing charges ...

 

But even if you can get a PPO, that does very little for peace of mind when it comes to out-of-network care because my understanding is that even if you have out-of-network coverage, you're still subject to balance billing charges, which are what the doctor charges over and above what the insurance company will pay for the out-of-network care. If the insurance company doesn't pay anything (like with an EPO or HMO), then it's the same as balance billing only the starting point is $0 instead of whatever the insurance company pays to an out-of-network provider.

 

And I don't know if you saw this in Kyle's Guide, but people in Texas who buy insurance on the exchange will have their ID cards branded with that fact. Very nice. I don't know if that alone would send you to an off-exchange policy, but if your subsidy isn't very big, it might be with it not to have that scarlet letter on your card. (And I don't know what your subsidy is, but remember that that's only part of the equation--even more important are the cost-sharing reductions that come with lower incomes, where what would normally be a $6,000 deductible might be a $500 deductible instead.)

 

I've experimented with the coverage finder at Kyle's site, not healthcare.gov, but I assume the results should be the same.

 

I entered 77399 for on-exchange policies and saw the same you did, and the same that Kyle mentions in his Guide--HMO only in Polk County, and only through Blue Cross.

 

However, I entered a zip code for Travis County, and got several on-exchange PPO or EPO silver plan choices. (Silver plan because they qualify for a subsidy.)

 

They were with the following companies:

 

Ambetter from Superior Health Plan (EPO) - 6 plans

 

United HealthCare (EPO) - 5 plans

 

Aetna (EPO) - 1 plan

 

Scott & White (PPO) - 3 plans (but I get a 404 error when I click on SUMMARY OF BENEFITS; maybe Kyle has bad links, but since there IS some out-of-network coverage, I'd like some information about it)

 

 

I looked at Kyle's discussion of what is available OFF-exchange in Florida. He mentioned United HealthCare EPO Choice as possibly a good choice. That particular one isn't available in Travis County, but some United HealthCare EPOs are; maybe what makes the Florida one okay also applies to the ones in Travis County.

 

He also mentioned Ambetter, but didn't have it underlined, which means he doesn't think it's a good choice. But we don't know why--is it a terrible company, which means it'll suck in Texas, too? Or is there some Florida-specific something going on?

 

I didn't look into HMOs in Travis County, but I'm wondering if I should. They can be a lot cheaper than an EPO or PPO, and if there's no national network for any plan, I'm probably not going to be using my insurance anyway unless something terrible happens, and at that point I will have a lot more to worry about than having a primary care physician as a gate keeper.

 

This is really annoying because not long ago, I was thinking that as a fulltimer, it's annoying to get routine health care because I'm always somewhere new, but figured it was mitigated by thinking I was perfectly situated to get the finest health care available because "moving" wouldn't be an issue at all--if the best care for me was at the Mayo Clinic, and if they were in-network (or if I was willing to expose myself to balance billing in order to save my life), all I had to do was move to Rochester, Minnesota. Now, not only do I not have access to the best health care, I don't have access to any at all unless I'm in Texas, and maybe only a small part of Texas. That's a HUGE change.

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