Find EOC for BCBS Plan

[yorkriver1]

I am searching for a tool to look up EOC's as well as SoB's. I recall there may be a web link for both. A BCBS rep just told me and my client that although a plan's full MOOP may have been met in network, this plan has an additional full deductible for out of network. It's a 2014 Marketplace plan.

The SoB for the plan does not mention anything about a second deductible, only that the disallowed portions of the bill don't count toward MOOP. So, by my reading, if the plan pays 60% of their allowable amount (still using UCR in some form, I imagine) for OON, then the client is out the 40% + excess over "allowable" charges. In network, of course, they would pay 100% after MOOP.

 

[AllenChicago]

I am searching for a tool to look up EOC's as well as SoB's. I recall there may be a web link for both..

1.) EOC= ????

2.) You mean a Web Link for looking up SOB's and ?EOC?'s for all carriers?

 

[Ann H]

Evidence Of Coverage (i.e. the contract)

Don't ask what SOB stands for!

Yorkriver, you want it for BCBS for which state?

 

[yorkriver1]

Virginia. Thanks Ann and Allen. I may be remembering this wrong, but I recall a link to find Summary of Benefits. Maybe i am imagining that you could also look up Evidence of Coverage.

 

[AllenChicago]

Evidence Of Coverage (i.e. the contract)

Don't ask what SOB stands for!

Yorkriver, you want it for BCBS for which state?

Wow..that would be nice if you could see each health insurance contract online.

 

[yorkriver1]

Yes, it would, Allen. I am probably confusing it with the SoB lookup link, at least for BCBS. Tomorrow I will contact the carrier's broker service and find out what they can do to get me the Evidence of Coverage, also talk to a manager if I get the same dual deductible answer about the POS out of network coverage.
May not be too much help to current client, but I need to know how to get the information I need, even if the staff can't explain it. Just a reality sometimes.

 

[bluediamond]

Wow..that would be nice if you could see each health insurance contract online.

FB did just that last week, we can now see each plan policy through the agent portal.

 

[kgmom219]

Wow..that would be nice if you could see each health insurance contract online.

Allen...I can see both for Texas. Its convoluted if I look at the agent portal, but if I run a quote, I can get both the SoB or policy docs.

Never heard it called a SoB before. I always called it the BS.....

 

[AllenChicago]

YorkRiver and KGMom,

I can see the actual BCBS plan document (aka "The Policy") if I click on a link to the document while viewing a client's data in the Blue Access for Producer's portal. But seeing inforce plan documents is all we can do, I think. The agent's section of BCBSIL.com is a maze of links that reminds me of most states' DOI websites. (There are 2 ways to access it and 2 different Login UserNames.)


Before the SOB's (Summary of Benefits) were mandated by the ACA, we used the OOC (Outline of Coverage) to show exactly how much the company/patient paid for Inpatient, Outpatient, Rx, etc.. I'm starting to gravitate away from showing the SOB, and going back to the OOC when an applicant needs more information. The OOC is simple straight-forward. The BCBSIL SOB creates more questions than it answers. Great concept but poorly written. (That's changing with the 2015 SOB's however.)
ac

 

[TxOnline]

Allen,

Here's your Illinois Summary-of-Benefits screen for ON-Exchange Plans:
On-Exchange | Blue Cross and Blue Shield of Illinois

I stumbled on this page (for Texas) last year when I clicked on More Details at HC.gov plans. I just changed Tx to Il (and it works for you).