- 2,024
Would be amusing if someone bought the plan then went right back at the carrier saying they wanted free preventive because the law says they're entitled to it and they can't give their "rights" up.
World -- Health Care Reform Commission Calculations
- Thread starter YouGotMyMoney
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- health care reform
Would be amusing if someone bought the plan then went right back at the carrier saying they wanted free preventive because the law says they're entitled to it and they can't give their "rights" up.
- 14,809
Option 3 seems to include in-network also. The difference is with option 1 and 2 you need to see a BlueChoice doctor. With option 3 you can choose from their PPO network. So back to the same issue - I thought it was illegal to not offer free preventative. Carefirst's option 3 allows people to see Carefirst doctors with no preventative coverage.
https://carefirst.inshealth.com/ehealthinsurance/benefits/ifp/MD/MDCareFirst-HealthyBlue.pdf
Option 2 – Higher costs with more flexibility
You must use CareFirst BlueChoice doctors and
facilities. Referrals are not required to see a specialist.
Receive greater flexibility while still maintaining an
opportunity to save money, when you receive care
through any doctor in the CareFirst BlueChoice network.
Option 3 – Highest costs with greatest flexibility
Visit any CareFirst PPO doctor or any out‑of‑network
doctor.
Option 3 allows you to receive care from any doctor or
facility within the larger CareFirst BlueCross BlueShield
PPO network, or to receive care from a doctor who
doesn’t participate in a CareFirst provider network.
Select any doctor for care within the CareFirst
Preferred Provider Organization (PPO) network of
more than 33,000 doctors, or any out-of-network
doctor with Option 3.
You’re not required to get your care or referrals from your personal PCP. You’ll pay the highest out-of-pocket costs.
n You’ll pay the highest annual deductible.
n Adult preventive care, well-child care visits, and
cancer screenings are not covered. Other services
are covered once the deductible is met. Once the
deductible is met, then a copay will apply.
Their website says it is a POS plan, not a PPO plan. My half-educated guess would be that anything from the BlueChoice HMO network is considered "in-network" and anything out of the BlueChoice is considered out of network, even though you're within the BCBS network. At least you know you won't be balance billed if you see a BCBS provider that isn't part of BlueChoice.
- 14,809
Not to be a smart a**, but nothing in the legislation says "no cost sharing for preventative, unless it's not a PPO plan."
I believe all plans, POS, PPO, HMO, etc...must follow the law regarding free preventative. IMHO, Carefirst is trying to sneak one by.
I believe all plans, POS, PPO, HMO, etc...must follow the law regarding free preventative. IMHO, Carefirst is trying to sneak one by.
None of the POS group plans I just quoted for a client last week had preventative for out of network either. HMO doesn't cover anything out of network so that one is kind of a moot point. I would be surprised if CF went through the trouble of coming out with a PPACA-compliant plan that is not PPACA-compliant.
I don't have a dog in this fight, but it appears they are playing semantics.
Georgia requires carriers to offer DAMN coverage as any illness. Most simply offer it as a rider. Until recently, Aetna was all or nothing. No DAMN coverage or buy up to "as any illness".
Humana is still offering DAMN standard with a 12 month wait and an option to buy up to any illness.
I am speculating that Carefirst is claiming they OFFER a "free" preventive care benefit but only if you want to pay for it.
I like it.
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I like it as well, total Fing chaos in the market. Love it.
- 14,809
I can see Carefirst's side of this. If you sign up for a HMO you need to see your specialist. If you choose to wander into any doctor's office, even if said doctor is in the Carefirst network, that's a violation of the terms and conditions.
So Carefirst is trying to say that go ahead and buy the Healthyblue Triple Option BUT you're going to use our preferred (ie: the docs we pay the least) if you want free preventative. You can go ahead and use the full Carefirst network but if you choose option 3 then no soup for you.
Will it fly? Time will tell. It'll be the first "confused" Carefirst client who chose option 3 to save money then gets whacked with a $300 preventative bill and starts to scream to anyone willing to listen.
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John: you forget Obama is so smart, that maybe he will have Michelle fix this mess....
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What a clusterfrack...
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