I had my Pain Management doctor send me a note that they will no longer use the insurance I have, my insurance is Blue Shield Platinum PPO, I called her, she said that my plan was not a full PPO, I told her I am paying $1,800 a month for it, it better be. She went on to say the in California, they made a plan for the Obamacare, and Blue Shield copied that plan and called it a PPO. I have not contacted Blue shield yet. Does anyone know about these different levels of PPO? Is she thinking it is a EPO? I think the EPO just has to do with doctors out of your area? I cannot get it through the exchange because I am with a non-profit church, so I bought a individual plan, I understand it is the most expensive plan you can getā¦
I would think this would be illegal to falsely represent something to the consumer.
I mainly got it for the Remicade infusions, they are billed out at $10,000 now that I got my extra viel, insurance is paying $5,000 every 6 weeks.
Plans sold on the exchange are not necessarily the same as whatās available privately. Thatās why the name is not just bcbs.
I listen to Doctor Radio on Sirius xm. Thereās a show called health care connect and you can email them questions like this at http://rubinhealth.com
It seems insurances companies can do pretty much whatever they wantā¦ My brother is always battling with Cigna over his Part D coverage. Every year before he selects a Part D provider he will get in writing that they will cover drugs like his Lyrica, which is expensive. Every year about March they will stop covering some med they put in writing they would cover. When he confronts them about their answer is āSo sue us.ā
He calls the state insurance board and they just tell him he can file a complaint, but nothing will happen. Now he has to go without drugs like Lyrica for his chronic pain because it is over $400 a month. I don;t look forward to the day I retire or end up on disabilityā¦
The answer isnāt so sue us. The answer is for your brother to file a complaint with the insurance commissioner in his state. He needs to send in copies of any documentation on what they claimed they would cover.
This year he needs to look into Part D medicare coverage and choose the best fit for him. He has until December 7th so he needs to get on this
Not quite following you Stoney, I am not on the exchange, but started my group of one. Are you saying the exchange has a better plan? I bought the plan thinking it was a full PPO, but I guess it isnātā¦
I misunderstood. My apologies. Definitely check with the insurance company and I would still encourage you to email that Rubin health. They can help explain things to you.
Called Blue Shield today, they said I do infact have the full PPO insurance. It should be at that price! Maybe the doctors office was mixed up also, I told her that I had a āExclusiveā Group of oneā¦ I di call the Doctoās but wasnāt able to talk to the insurance lady, just relayed the message āYou are wrongā (in a nice voice)ā¦
Latest latest update, got a email from the Pain Doctorās insurance lady, my plan Platinum 90 PPO, this is a Individual Family Plan not a full PPO, I continue to get BS from BS. (Blue Shield) So paying $1,810 ro a bunch of Snake Oil salesman.
Is there any honest insurance companies in California?
I work in health insurance ā Jon I would say you need to call BC/BS and get your exact plan design. Do not trust the doctorās office to know what your plan design is, all they did was have someone in the office call your insurance and ask random questions (trust me, I take those calls all day long, at least 50% of the time the person calling me has no idea how insurance works in general, let alone the specific plan theyāre calling about).
And I agree with you that Blue Shield is not always the best, especially for indiv plans and particularly in CA. California is basically a hot mess in general. You may want to look at other providers. The link below give you overviews of companies in CA that may be available in 2019. Youāll have to check actual availability on your own based on your circumstances, tho:
Iām not sure what you mean by āfull PPOā ā all a PPO is a perferred providerer plan, which means you have a network of providers that are perferred by the plan and considered to be in-network. Iām not sure how the term āfullā is coming into play, can you provide more details? You should have been sent plan design documents when you enrolled that advise all the details of your specific plan, it might be worth digging it out, although weāre almost to 2019 so you might want to focus your attention on the new benefit year thatās rapidly approaching.
Hi,
Thanks for the info.
So I am on hold with BS at the moment, they are calling my doctor about a possible waiver so I can continue to be covered.
The plan I have is actually a IFP not āfull PPOā appearantly only buisness plans can get that.
So BS is sending me a waiver, to continue to get the ābenifits form them for this doctor. I doubt that would work, as they are not getting paid enough from BS with the IFP plans to stay in business. He is a single doctor, with his own equipment, for doing ablasions and epidurals.
Still trying to figure out what to do, I could open a business and get a group plan that wayā¦ this is a very big mess, I hope the Congress can come together and come up with a solution to healthcare, but first they have to kick out the lobbyists that represent Big Pharma and the Insurance companies, donāt think that will happen without a āConvention of Statesā stepping in a changing the Constitution. Opening up the insurance market so you can buy out of state would help bring down the cost by free market competition, but the new House will never do that, as they are sold out.
I guess I will either have to pay cash for pain treatment, or find another Pain doctor that will take this bastardized California PPO.
Ah, unfortuntely this makes perfect sense to me. Those so-called mirror plans in CA are just awful! Itās literally like looking through a mirror darklyā¦ the benefits appear to be there for the patient but the plan pay to the doctor is so low no doctor will actually work for that amount.
In the end it looks like you have insurance but in reality no one will take your insurance because they insurance wonāt pay out enough for the doctor to keep the doors open. BC/BS exploited this horribly, especially in CA. Iām not even sure how they got away with it.
Right now is open enrollment, though. You have until December 7 to make a change, I would start researching new plans if I were you and get away from BC/BS ā having worked in the health insurance industry for 25 years Iām willing to tell you my personal opinion of BC/BS is very low. Iām in Ohio, though, so Iām not a very good resource for whatās in CAā¦
Hereās a thought ā some states offer indiv health insurance via the stateā¦ that is that state allows indivs to purchase insurance through them and they actually take all the indivs and create a small group health plan out of all the indivs buying the plan. (I think CT did it out east, or maybe MD). Some health insurances offer this same general plan design, they allow indivs to buy into a small group health plan in which the actual group is made up of indiv.
You may want to check around for something like that, I have no idea if itās available in CA, I can only recall it out East.
Thanks, I will keep looking. Since I am part of a non-profit organization we canāt do the covered California or ACA sites, have not heard of a state run pool for insurance in California. The lady at the doctorās office suggested Healthnet as a good insurance company, but they have the same āsmoke and mirrorā plan.
Since it is only one doctor, for now that is refusing the IFP insurance, I will probably just pay cash for that doctor, since the insurance does not pay for the SIJ radiofrequency ablation procedure anyway. Should get a cash dis ount on the office visits. The last RFA he did, we combined it with a cervical epidural, he just charged me $350.
@tamac ā¦not looking forward to retirementā¦same here. I could retire now but IDK what will happen if I do. Iām pretty sure Medicare and the supplements donāt cover Enbrel.
