Who is Losing their PPO Health Plans?

[Mariner]

Well thankfully some of the Florida Blue EPO's offer some out-of-network coverage, albeit with a $12K deductible and OOP limit. That's a lot, but at least it's a cap.

 

My biggest concern as a single person is that if I had an extended illness like cancer, I'd want to be treated closer to family & friends in the northeast, assuming I was healthy enough to get there. What I realized is that I could change my residence and change my insurance to the new state if it would make a difference. Not perfect, but I can probably get care and avoid bankruptcy.

 

But it's stunning that no matter how much I pay, I can't get the same coverage I've always had in the past.

 

Please take this as economic observation rather than strictly political: Europe does not have a single payer system! Europe has 20+ systems, which compete with each other in subtle and often invisible ways. That's not my preferred structure, but in trying to avoid it, we've ended up with a monstrosity that's even more wasteful and anti-competitive. For those not bound to a hard ideological position, it's food for thought. I think we could have a better safety net and still respect market forces. But in Washington the debate is either-or, and the result is that we have neither.

 

 

Exactly Bob. The waste & incompetence just boggles the mind, and the result is that everyone loses in the long run.

[Blues]

We are one of those 360,000+, loosing [sic] our TX BCBS PPO.

 

Before all this actually came down, I think it was Jack Mayer had said he heard/thought that some non-exchange BCBS PPO plans in Texas would be grandfathered, and remain in effect. I can confirm that that did indeed happen, for someone with an Austin address who currently has a non-exchange BCBS PPO plan: BCBS sent a letter saying nothing needed to be done to keep the plan in force.

 

I haven't looked into it any further because on the other hand, I got a letter from BCBS saying I was losing my coverage, and that's a bigger issue right now.

[Blues]

As an RVer, the Scott & White PPO plans wouldn't work for us. Their network seems very limited and no docs or hospitals in our immediate home area (we'd have to travel at least 1/2 hour to reach any in-network providers, including a hospital).

 

 

Since you mentioned having a home area and didn't like the prospect of traveling half an hour to reach a network provider, I'm assuming that you're not fulltime RVing, roaming around. If I had a plan that would never require me to travel more than half an hour or even an hour to be in-network, I'd jump on it.

 

That's not available any more, but it's looking like Scott & White 's PPO may work best for me. I have an Austin address and Scott & White is the only on-exchange silver plan that provides any sort out-of-network coverage at all. The other five companies don't cover any out-of-network expenses at all, and presumably don't have nationwide networks that would make staying in-network even possible for traveling fulltimers.

 

Now, the out-of-network coverage has a separate deductible and the coinsurance is only 50%, but there IS an out-of-pocket limit. It doesn't include balance billing, but at least it's something standing between me and completely uncovered medical bills that drive me into bankruptcy. AND it will provide some protection in the situations where an out-of-network provider is used even when you think you're in-network. Someone upthread said that happened to them (pathology and anesthesia), and it happens more than you think, and there's absolutely nothing you can do to prevent it.

 

This article explains it (and has a link to the very interesting original series):

 

http://www.latimes.com/opinion/opinion-la/la-ol-out-of-network-doctor-bills-surprise-new-york-times-20140922-story.html

 

As bad as balance billing is, I'm thinking it can't be worse than having to pay the entire bill myself when an out-of-network service is provided, and it does provide me some coverage if I'm somewhere outside my network and it's not what my insurance company would consider a covered emergency-room situation.

 

Since I don't have a regular doctor and am much more likely to need care when I'm somewhere other than Austin, and I like the idea of having some sort of cap on at least part of my out-of-network costs, I'm thinking the availability of out-of-network coverage might be the deciding factor, and Scott & White is the only one offering that to me.

 

But I still have another month before I have to decide, and who knows what will change during that time.

[Daveh]

This article. Especially the graphic in Figure 2 explains why the two primary Escapee states are having so many insurer problems. http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/?utm_campaign=KFF:%20Health%20Reform&utm_content=24120579&utm_medium=social&utm_source=twitter

[richfaa]

This article. Especially the graphic in Figure 2 explains why the two primary Escapee states are having so many insurer problems. http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/?utm_campaign=KFF:%20Health%20Reform&utm_content=24120579&utm_medium=social&utm_source=twitter

Well that is interesting.

[sailwing2003]

 

Before all this actually came down, I think it was Jack Mayer had said he heard/thought that some non-exchange BCBS PPO plans in Texas would be grandfathered, and remain in effect. I can confirm that that did indeed happen, for someone with an Austin address who currently has a non-exchange BCBS PPO plan: BCBS sent a letter saying nothing needed to be done to keep the plan in force.

 

I haven't looked into it any further because on the other hand, I got a letter from BCBS saying I was losing my coverage, and that's a bigger issue right now.

Jack was talking about an old BCBS policy, and he and I might have had the same type of policy. He reported and I had the same issues, but that great policy doubled in cost in the three years before the ACA when into effect. If either of us had continued to pay the increases that policy would be been "grandfathered", and would still be providing us great coverage. I did not at the time see the value in paying the ever increasing premiums, and switched to a less expensive family plan PPO, as we also dropped my wife off the TX risk pool plan.

[BasicRV]

Got a renewal letter saying nothing changed but to check out the new rate. Rate went up 500%

[NH2]

 

 

Exactly Bob. The waste & incompetence just boggles the mind, and the result is that everyone loses in the long run.

Mariner, I'm not disagreeing with your views or feelings. Let's face it, things are a mess.

I do think it's important to recognize that prior to the ACA, the insurance industry was perfectly happy with the way things were. Profits were high, regulations limited and they had members of Congress (on both sides of the aisle) watching out for their industry's interests. The last thing they wanted were bumps placed on their smooth road to profit and are now doing whatever they can to make sure the ACA does NOT succeed. They want us—all of us—to hate the changes. I'm not preaching the praises of the ACA but believe I understand why it's not going well.

Mark

[richfaa]

Do we understand this. We have had a national debt almost from the beginning of our nation it is nothing new. "

 

Main article: History of the United States public debt

Except for about a year during 1835–1836, the United States has continuously had a fluctuating public debt since the US Constitution legally went into effect on March 4, 1789. Historically, the United States public debt as a share of GDP has increased during wars and recessions, and subsequently declined. Public debt as a percentage of GDP reached its highest level during Harry Truman's first presidential term, during and after World War II, but fell rapidly in the post-World War II period, and reached a low in 1973. Debt as a percentage of GDP has consistently increased since then, except during the presidencies of Jimmy Carter and Bill Clinton.

[Daveh]

This could change things for the better in South Dakota but the soonest we would see impact is 2017. http://www.argusleader.com/story/news/2015/11/17/daugaard-weighing-medicaid-expansion/75941658/

[Blues]

Got a renewal letter saying nothing changed but to check out the new rate. Rate went up 500%

 

 

Jack was talking about an old BCBS policy, and he and I might have had the same type of policy. He reported and I had the same issues, but that great policy doubled in cost in the three years before the ACA when into effect. If either of us had continued to pay the increases that policy would be been "grandfathered", and would still be providing us great coverage.

 

I haven't looked into it lately, but I remember wondering if the Texas Blue Cross PPO with a national provider network plan that I know is being grandfathered complied with ACA, but BCBS keeps offering it, so it must be okay.

 

As for premium increases, I ran the numbers and got the following percentage increases for this particular policy's premiums:

 

From 2010 to 2011: 13%

From 2011 to 2012: 13%

From 2012 to 2013: 5%

From 2013 to 2014: 22% (anticipating beginning of ACA)

From 2014 to 2015: 7% (one year after ACA was implemented)

From 2015 to 2016: 11% (increase when plan grandfathered and all other PPO plans in Texas eliminated)

 

Note that the policyholder has never filed a claim under this policy, and is 17 years younger than Jack Mayer (don't know how old you are, Dave, or BasicRV). Maybe one or both of those factors makes a difference. But it definitely doesn't have the astronomical premium increases that other people have reported. I wish I knew why, but no way am I going to rock the boat, and besides, that would mean I actually understood something about how the health insurance companies operate, and I know that's out of the question.

 

I'll just wait for the policy to be cancelled next November.

[Blues]

This could change things for the better in South Dakota but the soonest we would see impact is 2017. http://www.argusleader.com/story/news/2015/11/17/daugaard-weighing-medicaid-expansion/75941658/

 

Medicaid coverage for out out-of-state health care is problematic, at best, because Medicaid is administered by the individual states, with doctors contracting with that state. So even if a state does expand Medicaid, you still have the original problem of not having a national network of health care providers.

[Mariner]

Mariner, I'm not disagreeing with your views or feelings. Let's face it, things are a mess.

I do think it's important to recognize that prior to the ACA, the insurance industry was perfectly happy with the way things were. Profits were high, regulations limited and they had members of Congress (on both sides of the aisle) watching out for their industry's interests. The last thing they wanted were bumps placed on their smooth road to profit and are now doing whatever they can to make sure the ACA does NOT succeed. They want us—all of us—to hate the changes. I'm not preaching the praises of the ACA but believe I understand why it's not going well.

Mark

 

 

Mark,

I agree completely. But before the ACA I don't remember ever reading about millions of Americans losing the healthcare they chose, or losing their doctor, or for that matter anyone having astronomical deductibles they had to satisfy before they saw any benefit from an insurance co. Or for that matter small businesses making sure they stay under the 50 employee threshold so they don't get hammered with all the fees and bureaucratic hoops they have to jump through to offer their employees healthcare. It's stifling small business owners from expanding which helps the overall economy. And then you have the American people subsidizing the healthcare of others who are questionable of even being eligible. There has to be a better way other than forcing something down the throats of Americans, who to this day the majority doesn't want. I'm certainly not smart enough to come up with all the answers, but I resent it when we hear from someone like Gruber, one of the architects of the ACA, who said Americans were too stupid to understand what was coming. The sad thing is...he was right. OK flame away.

[DuffMan]

 

 

Mark,

I agree completely. But before the ACA I don't remember ever reading about millions of Americans losing the healthcare they chose, or losing their doctor, or for that matter anyone having astronomical deductibles they had to satisfy before they saw any benefit from an insurance co. Or for that matter small businesses making sure they stay under the 50 employee threshold so they don't get hammered with all the fees and bureaucratic hoops they have to jump through to offer their employees healthcare. It's stifling small business owners from expanding which helps the overall economy. And then you have the American people subsidizing the healthcare of others who are questionable of even being eligible. There has to be a better way other than forcing something down the throats of Americans, who to this day the majority doesn't want. I'm certainly not smart enough to come up with all the answers, but I resent it when we hear from someone like Gruber, one of the architects of the ACA, who said Americans were too stupid to understand what was coming. The sad thing is...he was right. OK flame away.

 

X2

[NJTroy]

In our area on our insurance from a Fortune 50 company, we saw significant erosion of coverage before the ACA. High deductibles, higher price for our portion of the coverage, lots more fighting for coverage. Our doctor list eroded significantly. Two years before the ACA, I needed to see an orthopedist. Closest one who could treat a common shoulder issue was 30 miles from my home, 45 miles from my office and none of the doctors had admitting privileges at our local hospitals if I needed surgery. As far back as 20 years ago, the hospital That's before the ACA.

 

Looking at other aspects of the ACA, I have a history of brain aneurysms in my family. My two sons should have been tested for them as I have a cousin who died very young for one. Before the ACA, we chose not to have them tested because once they needed insurance on their own they would have been uninsurable if diagnosed and the aneurysm was untreatable.

 

The ACA definitely has significant problems. But when implemented with the Medicaid expansion as originally planned I still think it's better than before.

[Daveh]

I am not going to flame away mariner because I am going to go out and enjoy nature on a beautiful Alabama day and it would take me hours to respond to every falsehood you just spouted. You are over 65 so you are not looking for help anyone here but to bombard us with negativity and list garbage talking points that were debunked years ago. ALL of your posts on this topic are simply political and I wish Escapees would enforce their own policy. Misinformation hurts people especially in the health care area We have had people in the hospital who avoided care due to misinformation or in a state of panic because more interested in making political points told them they would be left to die. I have not been responding to some of your posts because it can take hours to fully respond with documentation and all you have to do is spew more nonsense. You are not here to discuss either the truth or solutions so go share your anger elsewhere.

[Daveh]

Blues, sorry for the confusion, I was referring back to an earlier discussion with my reference to South Dakota medicaid expansion. I was not suggesting Escapees get on medicaid but expressing the hope that by expanding medicaid the insurers in that state would see a decrease in costs due to the uninsured population and be able to offer a broader array of plans offered. The ACA was intended to operate with both a public option and expanded medicaid. Political opponents cripple the plan and then scream it doesn't function as intended. The states with expanded medicaid seem to be doing better under the ACA and I hope we see the same in South Dakota. It will take time though.

[Blues]

Why can't people just discuss the OPTIONS AVAILABLE TO PEOPLE WHOSE HEALTH INSURANCE HAS BEEN CANCELLED? You know, like HELP them instead of wasting their time keeping up with a thread that is 95% NOT about what options are available to people who are in a sticky spot.

 

I appreciate everyone who exhibits the ability to control their impulses and not engage in general discussions at all, especially political discussions. This thread is about people who have lost their PPO insurance policies, and presumably, what they can do about it. Especially in Texas and South Dakota, the two states that have a big representation among fulltimers.

 

If you're over 65, then shut up. UNLESS you have a lot of time on your hands and have chosen to use it navigating the health insurance options available for someone under 65 who wants a PPO health plan with a good nationwide network. It's easy--just put 60 and a zip code in the search fields, and then comes the more difficult part: get a list of plans, and then start drilling down to see which ones are PPO, what the national network looks like, what the out-of-network coverage is like, and what the premiums are.

 

Then please share your results and bask in the glow of appreciation you'll receive from people who are trying to find a solution to an immediate problem, and who resent wasting their time reading through dozens of posts that have nothing to do with this, but they can't completely ignore the thread because somebody might put up something that actually discusses losing PPO coverage, who all is in that boat, and what to do about it.

 

If that means this thread has only 3 posts in it...great! That will provide a quick answer to: What can I do about this?

[R. Walter]

In today's news, United HealthCare, this country's largest insurer in health care, is contemplating dropping out of the ACA's health exchanges because of the impact on profitability. If United is having financial problems writing health care insurance under the ACA, one can reasonably suppose that other health care insurers are having similar, if not worse, financial problems.

[sailwing2003]

We are still looking at options to replace the PPO plan BCBS is not going to offer in 2016. The options are still a moving target, as we are seeing some Beta versions thru United Health Care of checking for Drs. in their plans.

 

Since July of last year, my wife has gotten and seen 19 new Drs, at UTSW in Dallas. She wants to remain in the Late Effects Program she entered, that has served her better in the 17 months than any Drs. have in the years since she was first treated in 1978-79. As of this morning, she has 1 Humana EPO HSA plan option available to her that include her Drs. We are waiting to see if Cigna is going to change what we see vs what the agents see and is being reported. A mess, yes. Since my wife has always had a pre-exsiting condition, we have always paid a huge premium for her coverage. The TX Risk Pool, was an expensive option, but accepted her, and we had nationwide coverages, and out of network coverage, with caps. Those options are gone.

 

This link to CNBC from 2013, says that medical costs are the leading factor above, credit card and mortgages bankrupties. http://www.cnbc.com/id/100840148

 

As I will go on medicare in June as several others in this thread, I have only to find something to get me thru 5 months. But the frustration is huge when we see the lack of options, and the few plans for our zip code, the deductables that were once only $3,000 that are now $ 6,450, along with the zero out of network coverage, and the inability to risk leaving the state of TX to travel. This year we have been fortunate to be working suddenly on our bucket list. To that end we have seen over 60 friends and family, driven some 7,000 miles, and been in 28 states. With the loss of a network of providers outside of TX, we might be done with the most wonderful life stytle we started when her treatments ended last April.

 

Having medical insurance coverage does not mean much if you have to stay home to access a Dr. in your home town. Maybe we need to start parking in their lots outside their offices or the hospitals, as we do love our coach.

[Jack Mayer]

Dave I have the same issues as you.....what to choose to replace a perfectly workable BCBS PPO. Right now it looks like there is only one choice in the plans off Exchange. I'm also waiting to see how it shakes out, but I'll have to do something at one point.

 

I'm reticent to just let my BCBS former PPO plan roll over to an HMO, if only for 5 months. If an accident happened to me outside of my home area it could easily bankrupt us. VERY easily. Because if you look at the fine print on these policies I read it as virtually nothing is covered as "Emergency" and it all depends on coding and other arcane elements of the health care system. Not something I'm willing to risk.

[sailwing2003]

Blues commented on the rate increases. He had shown his increases, which is about a 91% increase.

 

My comments were from perhapes a faulty memory, of almost 3 years ago. Plus rates are age and zip code rated. The yearly increases were of course going to be on going, and the new family plan was a logical option at the time.

 

My broker warned me, we were going to be living in interesting times.

 

As a side note, we just received a message from a friend. She reports that MD Anderson has just told her they will be taking no, individual insurance plans for 2016. The friend has been a patient there since 1978, perhaps no longer, unless she can pay for the out of network costs.

 

Yes we could have kept that plan, if we could afford it, and if it was offered. Things change.

[Jack Mayer]

 

As a side note, we just received a message from a friend. She reports that MD Anderson has just told her they will be taking no, individual insurance plans for 2016. The friend has been a patient there since 1978, perhaps no longer, unless she can pay for the out of network costs.

I'm not sure what that means - "no individual insurance plans"??? Does that mean no plans that are not company plans? Meaning my personal BCBS PPO? Or any other PPO?

[sailwing2003]

Jack mentions coding of services.

 

This link says that the new version 10, increases the codes from 14,000 to 69,000.

 

http://www.njspotlight.com/stories/15/09/28/new-medical-diagnoses-codes-increase-accuracy-and-room-for-error/

 

This is good to know:

Sites have sprung up that ridicule the precision of actual ICD-10 diagnoses, such as code W59.22XA -- “struck by a turtle, initial encounter” -- which is part of the broader category, “contact with nonvenomous reptiles.”

[sailwing2003]

I'm not sure what that means - "no individual insurance plans"??? Does that mean no plans that are not company plans? Meaning my personal BCBS PPO? Or any other PPO?

Yes, that what she was told. So unless you have an employer plan, you are on your own next year. We are seeing the same thing at UTSW, with one maybe exception, and "things are still be worked on" per the latest we have been told.