BCBSTX Discontinue U65 PPO Network

[AllenChicago]

what did they think was going to happen..... anyone with half a brain, hopped up on crank and drunk off their rear would have known that......

Parent company Health Care Service Corporation (HCSC) directed BCBS of Texas, Illinois, Oklahoma and New Mexico to find and enroll as many medically needy people as possible for 2014. They felt that the ACA's Risk Corridors program would offset the high claims, but something went awry. Too many moving parts and unknowns. HCSC got screwed and is now swinging the pendulum extremely in the opposite direction..particularly so in Texas it seems.

 

[somarco]

Health Care Service Corporation (HCSC) directed BCBS of Texas, Illinois, Oklahoma and New Mexico to find and enroll as many medically needy people as possible for 2014. They felt that the ACA's Risk Corridors program would offset the high claims,

Incredibly stupid decision. The only sane carrier was UHC that decided to sit out 2014.

However, given their timid entry in 2015, they would have done as well to avoid 2015 as well.

 

[wehotex]

Incredibly stupid decision. The only sane carrier was UHC that decided to sit out 2014. However, given their timid entry in 2015, they would have done as well to avoid 2015 as well.

Doesn't the ACA's risk corridor mitigate the financial risks, ie overpayment of claims? It does create some disruption for patients and healthcare professionals and pisses off many agents, but BCBS is the ONLY option in many Texas counties (judging by healthcare.gov website). Maybe there's some method to their madness?

Google can be a friend. Apparently, BCBS is 100% on the hook for up to 3% of losses beyond a set target, then 50% from 3-8% of the target (Govt makes up the other 50%). Then govt pays 80% of losses that go beyond 8% of target (BCBS would pay 20%). Bottom line- It STILL lost $$.

 

[AllenChicago]

BCBS is the ONLY option in many Texas counties. Maybe there's some method to their madness?

Imagine all the vodka, pills, snortees and smokees being consumed by the Obama departments that oversee implementation of the ACA at this point.

HHS put out a rule earlier this year which requires every state Marketplace health insurer to have a variety of physicians and medical facilities in a given geographical radius. This was done in response to so many people getting burned by narrow-networks in 2014.

It will be interesting to see who wins this escalating tug-of-war event between Insurers and Health and Human Services.

 

[taterpeeler]

Because of what allen is thinking that is why I am getting more and more into thinking they may offer a limited network PPO..... I just have no clue at this point..... side note, BCBS HMO is also in EVERY county in Texas(I think)

 

[STIBROKER]

I just have no clue at this point..... side note, BCBS HMO is also in EVERY county in Texas(I think)

please let the record show that peeler has no clue at this point.....just to keep confusion out of future posts....

 

[somarco]

Doesn't the ACA's risk corridor mitigate the financial risks, ie overpayment of claims? It does create some disruption for patients and healthcare professionals and pisses off many agents, but BCBS is the ONLY option in many Texas counties (judging by healthcare.gov website). Maybe there's some method to their madness?

Google can be a friend. Apparently, BCBS is 100% on the hook for up to 3% of losses beyond a set target, then 50% from 3-8% of the target (Govt makes up the other 50%). Then govt pays 80% of losses that go beyond 8% of target (BCBS would pay 20%). Bottom line- It STILL lost $$.

What kind of business model plans on losses that will be absorbed by a disappearing reinsurance program?

If anything has come from this administration it is that you should never believe a damn thing they say.

BX and other carriers don't care what agents think.

The govt doesn't have any money, except what they take from us by force.

let the record show that peeler has no clue at this point.

Be very careful when you start your truck in the AM

 

[cornelius322]

Aren't all the Multi-State plans BCBS? (pasting, I don't think I've posted enough to include a URL yet)

"A Multi-State Plan is a private health insurance plan sold through the Marketplace under a contract between the U.S. Office of Personnel Management (OPM) and an insurance company. OPM is the federal agency that administers health insurance plans for federal employees, retirees, and their families."

 

[russelltw]

multi state plans are design so that they are identical from state to state. So client will not lose the plan design they have when they move.

 

[STIBROKER]

multi state plans are design so that they are identical from state to state. So client will not lose the plan design they have when they move.

beg to differ.....it is for family's that live say in Texas and has a child on the plan going to school out of state.......