Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I'll try to make this short, but my hopes are slim.
My husband and I are self employed, so we pay for every penny of our healthcare coverage out of our own pockets. We do not qualify for any subsidies. Three years ago we had a BCBS HMO that cost $575 per month with a $3000 each deductible, copays, etc. My husband started working more out of state, so we switched to a BCBS PPO. That went up to $1100 and then nearly $1400 a month, with ever increasing deductibles and fewer benefits each year.
This past December, BCBS cancelled this PPO and our only option with them was an HMO. We weren't happy with that so we went to an insurance brokerage who looked high and low for another viable alternative for us. Simply put, there is none - I mean there was if we wanted to pay $1800 a month but otherwise we were screwed. Wait - we're still screwed.
So anyway, we settled (and I do mean settled) on a BCBS HMO for $1000 a month, $4500 deductible each, and 30 percent out of our pocket after that deductible is met. Basically we pay for everything up front till we reach $4500 and then pay 30 percent afterwards. Oh, and no going to specialists without a referral from our PCP.
Which BCBS changed for us since our former doctor, who we loved, in the healthcare system we loved, was suddenly dropped from BCBS as a provider. The whole healthcare system - which we had chosen because they specialize in heart and pulmonary stuff and that's what runs in my husband's family - this whole major healthcare system was dropped by BCBS. No coverage at all.
Now - we live in the healthcare hub of northeast Texas. There are three major hospitals here. One of them is 45 minutes from our house. The other two (which are larger and more established) are 15 minutes from our house and have clinics 3 minutes from our house. Of the other two, the one we used for thirty years has been dropped from BCBS approved providers. So we have to change.
BCBS assigned us to a doctor at the hospital 45 minutes away. Friday we went there - to establish care and as luck would have it, my husband happened to be sick as a dog that day. Great - kill two birds with one stone, right?
We got there and my husband's BP was 213/119. FREAK OUT. So they gave him something to lower that BP, did an EKG, and a chest X ray. His BP got down to 177/96. They sent us home and told us that they would call in a slew of prescriptions and they also gave us a list of over the counter stuff to buy. They said they would call with lab results.
They forgot to call in all the prescriptions and the only one that was called in was a cough suppressant - which didn't even work because it actually revved my husband up more, gave him anxiety attacks, and caused his BP to shoot way up again - back to about 215/115. So off we go to the ER on Sunday. I'm scared to death that he's about to stroke out.
So we went to the other major hospital ER and we got their attention, that's for sure. This particular doctor was very alarmed and said, "Wow, your husband needs to get in with a GOOD PCP right away. Like immediately." He put him on an IV with stuff for BP as well as a heavy duty antibiotic and gave us the name of a doctor that should be in network and said, "Try to get in to see him immediately."
Good news - with much finagling and arguing with BCBS, we were able to get the PCP changed to a local doctor three minutes from our house. More good news - we are going in today to establish care and when I spoke with that office, they were very concerned and I feel like we will get the attention my husband needs today.
The bad news? Meanwhile, the other doc (from Friday) calls and my husband apparently has some kidney involvement, an enlarged and overstressed heart, conduction issues on his EKG - WHY DID THEY EVEN LET HIM GO HOME FRIDAY? Or yesterday from the ER for that matter? His BP is sky high again this morning. He's sick as a dog. WHAT THE HECK.
More bad news - the woman at the local clinic said, "I have to warn you - your husband likely needs a couple of specialists. Unfortunately, most of the specialists around here will not accept that coverage. So - you will probably end up driving to Dallas." Now - this isn't because Dallas specialists are BETTER. We will pass hundreds of local specialists just driving to Dallas. It's simply an insurance issue.
Sorry your husband is not doing well and sorry you are having to deal with all of the insurance crap on top of that. It is sad that you will have to drive so far just to get him the help he needs when you have so many others close by who could help, if the insurance was good enough for them to take. It's a shame to spend so much and get so little back. I hope you can get to the root cause and that he is better soon.
So sorry to hear about hubby's issues. My son has had similar - high bp, enlarged heart, congestive heart failure - for several years, although now under control. We are very near hospital/docs and his insurance does pay his providers.
Quote:
Originally Posted by KathrynAragon
Which BCBS changed for us since our former doctor, who we loved, in the healthcare system we loved, was suddenly dropped from BCBS as a provider. The whole healthcare system - which we had chosen because they specialize in heart and pulmonary stuff and that's what runs in my husband's family - this whole major healthcare system was dropped by BCBS. No coverage at all.
Now - we live in the healthcare hub of northeast Texas. There are three major hospitals here. One of them is 45 minutes from our house. The other two (which are larger and more established) are 15 minutes from our house and have clinics 3 minutes from our house. Of the other two, the one we used for thirty years has been dropped from BCBS approved providers. So we have to change.
In what plans do these providers now participate if not BCBS?
So sorry to hear about hubby's issues. My son has had similar - high bp, enlarged heart, congestive heart failure - for several years, although now under control. We are very near hospital/docs and his insurance does pay his providers.
In what plans do these providers now participate if not BCBS?
Medicare and Medicaid, baby!
I'm not sure what else. Actually I don't know what the woman was talking about because the doctor we saw today got us an appt with a cardiologist tomorrow morning, right here in town. So at least that's working out.
BCBS - it's always been extremely comprehensive as far as providers go. I don't know what the problem is now.
I can't find the link but I will keep trying (link found)
I read a few months ago that BCBS TX Health Insurance Marketplace HMO plans pay healthcare providers around 10% less than Medicaid. Assuming that's correct I can understand why many providers don't want anything to do with such BCBS TX plans.
I read a few months ago that BCBS TX Health Insurance Marketplace HMO plans pay healthcare providers around 13% less than Medicaid. Assuming that's correct I can understand why many providers don't want anything to do with such BCBS TX plans.
I need to find a link.
I'd like to see that link.
If this is the case, it's a significant change over the past couple of years. Just a year or two ago, BCBS of Texas was THE health insurance provider that everyone took and that got you the most access and best benefits.
Note - we did compare plans and providers and BCBSTX did seem like the best plan for the money when we were forced to choose another plan in December of this past year.
Dr. Bruce Meyer, UT Southwestern’s executive vice president for Health System Affairs, says the academic medical center’s two hospitals were offered rates that were less than what Medicaid pays.
In Dallas, Texas Blue Cross, in its Exchange plan, is paying 10 percent less than what Medicaid pays. So these are low rates. They take all the doctors who accept that fee—and that typically doesn’t include the best doctors, by the way—and that’s how they get their premiums down. They’re convinced that healthy people buy on price. The only thing a healthy person is going to do is look at the premium. The only people who look at networks are people who are sick. So, if I’m an insurer and you’re asking about my network, I know automatically I probably don’t want you in my pool. So we’re getting a race to the bottom. We have insurers with terribly perverse incentives and that is not going to change until we change the way Exchanges operate.
Both those articles are scary. Froedtert in our area is getting into the health insurance business - has a half interest in NetworkHealth through which I have a Medicare Medical Savings Account (MSA) Advantage plan (no networks) this year. Perhaps these hospitals/facilities which have been excluded from BCBS should consider setting up their own HMO's - similar to Kaiser. I'll bet they'd have no shortage of people waiting to buy in, including KofA. There's a lot of comfort in having a local (not national) medical facility offer its own insurance.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
