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I would have thought the left would have been all over this - constantly promoting it. Not a peep.
**HHS PCIP Network -vs- State PCIP Networks**
- Thread starter AllenChicago
- Start date
Obummer told them not to say anything.
At least not until after the Nov elections . . .
In fact, they are not to talk about any of their passed legislation or even acknowledge they know PresBO. Even Prince Harry Reid is having misgivings about Obamacrap and has even written a letter to HHS Sebelius about his discoveries.
- 3,345
Just another day with Obama F'ing things up. Business as usual. By the way who in the hell is GEHA? How many billions in stimulous money did they skim off the top? Does GEHA employ Obama union workers?
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Sorry but I am not buying a quote engine to email PCIP quotes...
- Thread starter
- #15
- 8,448
Based on the detailed (76 pages) Outline of Coverage, I can understand how squeamish medical providers would be to enroll in this new network. There's a myriad of fraud warnings and threats not to pay providers if HHS thinks they're charging too much. Also, in some cases the government pays you, not the medical provider.
OOC Link: http://www.pciplan.com/forms/pdfs/brochure.pdf
There are things in this "brochure" that quite confusing. For instance, it qualifies as an HSA eligible plan, even though it has Co-Pays. I thought the government wanted to get rid of high deductible health plans because they "weren't fair" to consumers.
Also, GEHA = Government Employees Health Association. It's cute that they're touting no lifetime limits on coverage. You can only keep the policy until 2014! Our tax dollars at work, LOL. -AC
You're not using the search correctly. From the PCIP website:
At this time, this PCIP provider search is limited to participating providers within your state of residence for the states administered by GEHA. If you need to travel outside of your state of residence, please call (800) 220-7898.
At this time, this PCIP provider search is limited to participating providers within your state of residence for the states administered by GEHA. If you need to travel outside of your state of residence, please call (800) 220-7898.
Georgia IS an Obamapool state. I did a search using my Atlanta zip just for chuckles and grins.
FWIW, there are well over 300 docs within 10 miles of my home that are part of networks for Aetna, Blue, Cigna, Humana . . . and over 2 dozen hospitals.
The count for PCIP yielded this:
13 PCP GP's
65 psychiatrists
1 OB
4 hospitals, neither have a labor & delivery unit
Yeah, this is going to work real well.
And how about those benefits?
No benefits are payable until AFTER you have satisfied a $2500 deductible
Your annual physical exam is the exception and is not subject to the deductible
In network doctor visits are $25 (after the deductible)
Out of network doctor visits require you to pay 40% of the billed rate
Generic drugs are $4 after the $2500 deductible for the first 2 fills, afterward you pay 50%
Formulary brand drugs are $30 after the $2500 deductible for the first 2 fills, afterward you pay 50%
Non-formulary brand drugs are $50 after the $2500 deductible for the first 2 fills, afterward you pay 100%
FWIW, there are well over 300 docs within 10 miles of my home that are part of networks for Aetna, Blue, Cigna, Humana . . . and over 2 dozen hospitals.
The count for PCIP yielded this:
13 PCP GP's
65 psychiatrists
1 OB
4 hospitals, neither have a labor & delivery unit
Yeah, this is going to work real well.
And how about those benefits?
No benefits are payable until AFTER you have satisfied a $2500 deductible
Your annual physical exam is the exception and is not subject to the deductible
In network doctor visits are $25 (after the deductible)
Out of network doctor visits require you to pay 40% of the billed rate
Generic drugs are $4 after the $2500 deductible for the first 2 fills, afterward you pay 50%
Formulary brand drugs are $30 after the $2500 deductible for the first 2 fills, afterward you pay 50%
Non-formulary brand drugs are $50 after the $2500 deductible for the first 2 fills, afterward you pay 100%
- Thread starter
- #18
- 8,448
ParFour, did you call that number? I just did and it was an HHS recording giving an overview of the PCIP plan and instructing me to visit www.healthcare.gov to learn more about it. It/She then said, "Our office is closed. Try again tomorrow. Good-bye."
I hope that number is on the ID card along with wording advising people to call during the day if they're traveling out-of-state. Otherwise there will be a lot of angry PCIP insured voters after they get stung with out-of-network charges.
As I said near the top of this thread, HHS should never have allowed individual states to take on administering the PCIP plan at the local level. All 50 states should have been under the HHS/GEHA umbrella. The program would then be available in all 50 states by now and the potential for Out-Of-Network charges due to sickness/injury while traveling would be less likely.
Also, many states are flat broke. My state, Illinois, is deep in debt and behind on paying bills. Yet it has decided to administer the PCIP plan, instead of allowing HHS/GEHA to do it. I called the Illinois contact in Springfield who said that applications for the PCIP MIGHT be accepted from the public at the end of August. Since Illinois is broke, is it going to use part of the money that could pay for medical bills of insureds to administer the plan? If so, their MLR (Medical Loss Ratio) will be nowhere near 80%. I wonder what penalty the state will pay for running the program inefficiently??
-A.C.p.s. Somarco, the number of PPO medical providers could be low because the program reimburses doctors and hospitals at MEDICAID reimbursement rates? Could be.
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No doubt there are many reasons for the low number of par providers. They tap into several networks including First Health and PHCS but that does not mean all providers in that network are participating in THIS plan.
For those who cried foul over the lack of a public option, this is a good preview of what they could have expected.
For those who cried foul over the lack of a public option, this is a good preview of what they could have expected.
- Thread starter
- #20
- 8,448
Today I called the State of Illinois PCIP hotline to find out what network they're using, since it's not listed anywhere in their materials.
Found out that the Illinois PCIP (Administered by the state and re-named IPXP) uses Wellpoint's www.healthlink.com PPO. This network has a large footprint with most Chicago area physicians and hospitals participating.
QUESTION: If a doctor is a member of Health Link and the patient's card says "Health Link", doesn't the doctor have to grant the Network Price for services rendered?
-Allen
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