Last edited:
HMO Plan - OON Doctor - what is Covered?
- Thread starter Yagents
- Start date
Interesting. So, apparently what's happening in TX actually happened years ago in other states. It's possible that some of these BCBS companies have shot themselves in the foot. I always thought that BCBS would be a carrier to survive when others exited or were bought & sold, but perhaps what happened to BCBSGA will happen to some of the others. I suppose it depends on the competing insurers in each state, and whether or not they offer larger networks and PPO designs.
- 8,448
Shooting themselves in the foot indeed. Unlike the other carriers, Blue Cross companies are (as far as I know) only health insurance. No Life, C.I., Disability, Medicaid, etc.. Wouldn't they want to have the BEST health plans in the industry?
All the BX plans are in it for the long haul. That is a given. Each one plays the game differently.
As Scott mentioned, in some regions (believe we have 16 in GA) they were/are the only carrier on the exchange. In some rural areas the closest par hospital might be 80 miles away, and you might drive past other hospitals while en route.
I don't know how much money BX made or lost in 2014. I do know their biggest competition was Humana with a national PPO (POS) and they lost their butts.
People in the south, and maybe other areas as well, buy BX because of the name. They are not as dominant in GA as they once were but they still write a lot of business in spite of their pricing.
On the Medigap side they have some of the highest rates in the state yet still are the #2 carrier with 23% of the market behind AARP/UHC (also high) with 38% of the market.
Both carriers dominate the market because of brand recognition, not competitiveness.
Just because a carrier lost $$ in 2014 running an HMO model is meaningless. They all lost money. Long run the HMO model does a better job of controlling claims than the PPO.
Narrow networks and limited Rx formularies are the way of the future.
AC, some Blues write group term life and group STD through subsidiaries. In GA it is Greater Georgia Life. In SC it is Companion Life.
As Scott mentioned, in some regions (believe we have 16 in GA) they were/are the only carrier on the exchange. In some rural areas the closest par hospital might be 80 miles away, and you might drive past other hospitals while en route.
I don't know how much money BX made or lost in 2014. I do know their biggest competition was Humana with a national PPO (POS) and they lost their butts.
People in the south, and maybe other areas as well, buy BX because of the name. They are not as dominant in GA as they once were but they still write a lot of business in spite of their pricing.
On the Medigap side they have some of the highest rates in the state yet still are the #2 carrier with 23% of the market behind AARP/UHC (also high) with 38% of the market.
Both carriers dominate the market because of brand recognition, not competitiveness.
Just because a carrier lost $$ in 2014 running an HMO model is meaningless. They all lost money. Long run the HMO model does a better job of controlling claims than the PPO.
Narrow networks and limited Rx formularies are the way of the future.
AC, some Blues write group term life and group STD through subsidiaries. In GA it is Greater Georgia Life. In SC it is Companion Life.
Young enough to have a kid who needs a pediatrician...
Whew!!!! I was beginning to think you were some teenager in her mom's basement.
----------
I wrote a couple in Baldwin county last year and the closest GYN was the next county over (not her GYN). There were as many chiropractors as PCP's (two) in the county (not their PCP). The local hospital, Oconee Regional Medical Center wasn't in the network. The only specialists in the county are one hematologist, 3 oncologists, 3 physical therapists and 11 psychiatrists/psychologists. As you can see, there are many other specialty practices missing. But their subsidy was so large (both retired and receiving Social Security and a small pension) that they couldn't pass up the savings.
I had a referral call me yesterday who has Cigna. He got the letter that he will be losing his coverage at the end of the year. He said his only requirement when it comes time to switch plans is that it can't be BCBS. His words were, "the level of incompetence at the company is just not worth dealing with even if I have to pay more for another carrier."
And I LOVE when I'm talking to someone and they say they have one of those two carriers. As long as they are healthy, it's an easy transition once the prospect has been educated. Just got a call on Monday from a referral who is turning 65. During our conversation she tells me her 67 year old husband has BCBS Plan F and a BCBS PDP. So he's paying a ton more on his Med Supp than he needs to and about twice as much on his PDP and prescription costs than he needs to. All because of a name he's familiar with.
Needless to say, we completed a new Med Supp app on him and will probably be changing his prescription plan during AEP. The savings on these two plans for him almost cover her Med Supp premium. That's when you feel great about what you do for a living.
- 2,121
We offer life through a BCBSFL owned company FCL and accident, ci and hospital indemnity through USable a company owned by 6 Blue Cross's. All through FB website.
If you're a woman, an existing client and you live in Athens, then yes.
- 514
Hopefully some of you will keep writing to hhs and your congress rep and gov officials. They need to be kept informed .
Similar threads
