health insurance question (Pittsburgh, California, Penn: income, moving to, licenses)

[morefromcali]

Hi Everyone,

We will be moving to the Pittsburgh area in a few months, and since we are self-employed we will need individual health insurance. Unfortunately, our California coverage will not work there. It seems like UPMC is great but does not offer individual policies. I guess our second choice is Highmark Blue Shield. Are we missing anything? Will Highmark give us access to decent doctors etc? Is the CHIPS program ok for our kids? Thanks so much for your advice!

[guylocke]

CHIPS

You have to meet certain requirements to be eligible for CHIP including I believe income level.

UPMC is great but does not offer individual policies

UPMC is great at the hands-on part of providing health-care. Don't be sad about this, most UPMC insurance sucks and they are horrid to deal with.

I guess our second choice is Highmark Blue Shield

Give them a whirl. You might also want to check out Aetna, they are growing in this area.

[Hopes]

Originally Posted by boylocke

You have to meet certain requirements to be eligible for CHIP including I believe income level.

That's not true. Chip is available for all children under 19 who are uninsured regardless of their parent's income.

Originally Posted by morefromcali

Is the CHIPS program ok for our kids?

My sister used Chip for her daughter and it covered what she needed.

The problem you might have is that your children are technically insured right now. They might need to go a period of time without insurance to qualify. And you might have to meet a period of residency too.

Yep, I just checked. Here's where you're going to have difficulty getting Chip:

Originally Posted by http://www.chipcoverspakids.com/interior.php?subPage=AboutFAQ_Eligibility

Be a Pennsylvania resident
* All new applicants whose income falls in the low-cost and at-cost CHIP ranges must also show that the child(ren) has been uninsured for six months, unless the child is under the age of two, the child has lost health insurance because a parent lost their job or the child is moving from another public insurance program. At-cost CHIP families must also show that access to coverage is unavailable and affordable.

Your children don't meet the exceptions in bold unless they are under two years of age.

Also, you must be a resident for 30 days in order to qualify for Chip. You'll need to switch your driver's licences to Pennsylvania licenses ASAP to be able to show proof of residency once you do qualify.

Originally Posted by morefromcali

It seems like UPMC is great but does not offer individual policies. I guess our second choice is Highmark Blue Shield.

I hate UPMC insurance. UPMC period. If you have UPMC insurance, you're prisoner of the biggest monopoly in Pittsburgh. UPMC took over many of the hospitals and doctor's offices in Pittsburgh, then they started an insurance program. It's managed care to the extreme.

The good news is that both Highmark and UPMC don't require referrals anymore for special services, but UPMC still manages to oppress the system. The doctors are miserable trying to adhere to UPMC patient management protocol.

Out of the two, I prefer Highmark Blue Shield. You have access to whomever you want because you can go outside of the network and pay like an old fashioned major medical plan. All hospitals and doctors in Pittsburgh accept Highmark.

My family uses an out of state major medical insurance plan. I prefer to go wherever I want, whenever I want. I love old fashioned major medical insurance. I'm so glad to see it's coming back into vogue. Managed care simply does not work in my opinion.

Originally Posted by morefromcali

Are we missing anything?

There are numerous small insurance companies.

I found this in a google search: http://www.business.com/directory/financial_services/insurance/health_insurance/us_states/pennsylvania/ (broken link)

You'll have to research them to see what and who they pay. My insurance contracts reduced rates with 'intergroup' providers. In Pittsburgh, all hospitals and most doctors are intergroup members. Intergroup isn't insurance, it's a participating provider network that many insurance companies utilize; hence, many doctors participate in it.

[guylocke]

My mistake on CHIP! And we are in complete agreement about UPMC Hopes!

*SPIT*

[morefromcali]

Wow, I'm so glad I asked! Thanks for the input. Highmark it is for the entire family. You are right we don't meet that exceptions for CHIPS, and that is fine. We'll all share the same policy there like we do here. It'll just be a different insurance company.

Thanks much Hopes and Boylocke

[guylocke]

Don't forget Aetna, I know some people really like them!

[Lisa_from_Debary]

I have always preferred United to Blue Cross products. The cool thing with United is that its the same company across the US. Blue Cross is across the US but the companies are different and the ability to cooperate with other companies can sometimes be difficult. The different BC BS companies have different things they will and won't cover for instance.
One thing everyone should avoid if posible is the PCP driven HMO...its horrible to try and deal with. Meaning you have to have your primary care physician give you a referral for absolutely EVERYTHING...
I used to work in Medical and mental health insurance...

[Hopes]

Originally Posted by Lisa_from_Debary

One thing everyone should avoid if posible is the PCP driven HMO...its horrible to try and deal with. Meaning you have to have your primary care physician give you a referral for absolutely EVERYTHING...

The major health insurance companies in Pittsburgh have dropped that type of HMO. Referrals are no longer needed anymore.

[Lisa_from_Debary]

Originally Posted by Hopes

The major health insurance companies in Pittsburgh have dropped that type of HMO. Referrals are no longer needed anymore.

Thats awesome, we still had it here in Florida last I heard...it really makes it hard for people to navigate getting treatment.

[morefromcali]

Thanks again! I will definitley check Aetna, Boylocke. I guess I have a mental block because they aren't doing so well here in LA. But that has nothing to do with how well they are doing there. Good to know that people like them. Same with your suggestion to look into United, Lisa. I haven't even heard of them. So I'll do more homework And yea, no more referrals needed to access specialists! Now if only they would do away with lifetime caps . . .