BCBS FL Plan 700 (What's the Catch?)

One more paragraph from the contract, there is nothing that says it has to be related to a surgical event or hosptalization. Maybe you will actually research the facts next time before making an assumption:

*except for the fact that it is called a "Hospital / Surgical" plan.
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since most of you obviously have never read the contract for the Plan 700 you are just blowing smoke up everyone's asses and sell the higher priced plans just to pad your commissions. I'm ot going to do your homework, but here is just one part of the contract relating to Inpatient confinement:

Hospital Services
Inpatient:
[FONT=Arial,Arial][FONT=Arial,Arial]The following may be Covered Services when rendered in an Inpatient Hospital setting:
1. room and board in a semi-private room when confined as an Inpatient, unless the patient must be isolated from others for documented clinical reasons;
2. intensive care units, including cardiac, progressive and neonatal care;
3. use of operating and recovery rooms;
4. use of emergency rooms;
5. respiratory, pulmonary, or inhalation therapy (e.g., oxygen);
6. drugs and medicines administered by the Hospital (except for take-home drugs);
7. intravenous solutions;
8. administration and cost of whole blood or blood products (except as outlined in the Drugs exclusion of the "What Is Excluded?" section);
9. dressings, including ordinary casts;
10. anesthetics and their administration;
11. transfusion supplies and equipment;
12. diagnostic Services, including radiology, ultrasound, laboratory, pathology and approved machine testing (e.g., EKG);
13. chemotherapy and radiation treatment for proven malignant disease;
14. Physical, Speech, Occupational, Cardiac Therapies; and
15. transplants as described in the Transplant Services category in this section.
Exclusion:
Expenses for any Services rendered in an Inpatient Hospital setting are excluded when such Services could have been provided without admitting you to the Hospital.
In addition, expenses for the following and similar items are also excluded:
1. gowns and slippers;
2. shampoo, toothpaste, body lotions and hygiene packets;
3. take-home drugs;
4. telephone and television;
5. guest meals or gourmet menus; and
6. admission kits.
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[/FONT]Note: [FONT=Arial,Arial][FONT=Arial,Arial]This Contract does not provide coverage or benefits for maternity/obstetrical care, except for complications of pregnancy, unless the Contractholder purchased such coverage under an Optional Maternity/Obstetrical Care Benefits Endorsement, if available.
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That's assuring ...?
 
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One more paragraph from the contract, there is nothing that says it has to be related to a surgical event or hosptalization. Maybe you will actually research the facts next time before making an assumption:

*except for the fact that it is called a "Hospital / Surgical" plan.
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That's assuring ...?

Don't worry, you can still save up to 15% on your car insurance. It might be 0%, it might be 15%, but it will definitely be between 0 and 100%. If I was a marketer I'd make every sale "up to" 100% off.
 
brah, where do u get a copy of the contract?

under hospital/surgical, for anything outpatient it says "related to surgery only"......most chemo is outpatient, mind posting the entire contract or emailing it to me or mm or ins.dave?

I called BCBSFL Agency Services and got a contract emailed to me. Once I read it I switched my coverage to the plan and have a hard copy of the contract, it is the same as the one that was emailed to me. 'May be covered' is Universal language used by BCBSFL in all of their contracts. Just because you aren't covered for a non-surgical or illness requiring inpatient hospitalization diagnostic test in a hospital or ambulatory center doesn't mean you aren't covered, you just need to use a free standing diagnostic center, what is so difficult about that? Is eductating clients on how to use a plan not worth saving them thousands a year in premium and possibly thousand in out of pocket cost? If you are hospitalized you are covered for everything in the hospital, period.

I'm not going to do everyone's homework, that makes it too easy for you. I'll just continue to sell the plan and educate my clients into using it properly, it saves them enormous amounts of money on both premiums and healthcare services. I will tell you that I have shown this to more than one physician's office and a skeptical office manager enrolled her family two days later after reviewing the benefits, it cut her premium in half and lowered the plan deductible from $2,500 to $250.

Covered Facility Benefits
[FONT=Arial,Arial][FONT=Arial,Arial]This subsection describes your benefits for Covered Services received in a Hospital or Ambulatory Surgical Center. In order to qualify as a Covered Service, these Services [/FONT][/FONT]must [FONT=Arial,Arial][FONT=Arial,Arial]be proximately related to a covered Inpatient confinement or Outpatient Surgical Service rendered in a Hospital or Ambulatory Surgical Center. [/FONT]
[/FONT]Ambulatory Surgical Centers
[FONT=Arial,Arial][FONT=Arial,Arial]The following Services may be Covered Services when they are proximately related to a Surgical Service: [/FONT]
[FONT=Arial,Arial]1. use of operating and recovery rooms; [/FONT]
[FONT=Arial,Arial]2. respiratory, or inhalation therapy (e.g., oxygen); [/FONT]
[FONT=Arial,Arial]3. drugs and medicines administered at an Ambulatory Surgical Center (except for take-home drugs); [/FONT]
[FONT=Arial,Arial]4. intravenous solutions; [/FONT]
[FONT=Arial,Arial]5. dressings, including ordinary casts; [/FONT]
[FONT=Arial,Arial]6. anesthetics and their administration; [/FONT]
[FONT=Arial,Arial]7. administration and cost of whole blood or blood products (except as outlined in the Drugs exclusion of the "What Is Excluded?" section); [/FONT]
[FONT=Arial,Arial]8. transfusion supplies and equipment; [/FONT]
[FONT=Arial,Arial]9. diagnostic Services, including radiology, ultrasound, laboratory, pathology and approved machine testing (e.g., EKG). [/FONT]
[/FONT]Note: [FONT=Arial,Arial][FONT=Arial,Arial]Chemotherapy treatment for proven malignant disease may also be covered regardless of whether Surgery is rendered in connection therewith. [/FONT]
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What happens when you need a prescription not related to a surgery or given in the hospital?

$800 deductible, $10/$60/$100 for the standard BCBSFL pharmacy formulary for outpatient, all other drugs are covered, here is just one paragraph:

Self-Administered Prescription Drugs
[FONT=Arial,Arial][FONT=Arial,Arial]Unless otherwise covered under a BCBSF Pharmacy Program Endorsement to this Contract (see above), only Self-Administered Prescription Drugs used in the treatment of diabetes, cancer, Conditions requiring immediate stabilization (e.g. anaphylaxis), or in the administration of dialysis are covered. [/FONT]
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That's much better than the UHC1 Copay Select plan with 25% coinsurance for Tier 4, that could means thousands a year in drug costs for the really expensive prescription meds.
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Exclusions-Drugs
[FONT=Arial,Arial][FONT=Arial,Arial]1. Prescribed for uses other than the Food and Drug Administration (FDA) approved label indications. This exclusion does not apply to any drug that has been proven safe, effective and accepted for the treatment of the specific medical Condition for which the drug has been prescribed, as evidenced by the results of good quality controlled clinical studies published in at least two or more peer-reviewed full length articles in respected national professional medical journals. This exclusion also does not apply to any drug prescribed for the treatment of cancer that has been approved by the FDA for at least one indication, provided the drug is recognized for treatment of your particular cancer in a Standard Reference [/FONT]
[FONT=Arial,Arial]Compendium or recommended for treatment of your particular cancer in Medical Literature. Drugs prescribed for the treatment of cancer that have not been approved for any indication are excluded. [/FONT]
[FONT=Arial,Arial]2. All drugs dispensed to, or purchased by, you from a pharmacy, unless covered under a Pharmacy Program Endorsement to this Contract, if any. This exclusion does not apply to drugs dispensed to you when: [/FONT]
[FONT=Arial,Arial]a. you are an inpatient in a Hospital, Ambulatory Surgical Center, Skilled Nursing Facility, Psychiatric Facility or a Hospice facility; [/FONT]
[FONT=Arial,Arial]b. you are in the outpatient department of a Hospital; [/FONT]
[FONT=Arial,Arial]c. dispensed to your Physician for administration to you in the Physician‟s office and prior coverage authorization has been obtained (if required); [/FONT]
[FONT=Arial,Arial]d. you are receiving Home Health Care according to a plan of treatment and the Home Health Care Agency bills us for such drugs [/FONT]
[FONT=Arial,Arial]3. Any non-Prescription medicine, remedy, vaccine, biological product (except insulin), pharmaceuticals or chemical compounds, vitamins, mineral supplements, fluoride products, over the counter drugs, products, or health foods, except as described in the Preventive Adult Wellness Services and Preventive Child Health Supervision Services categories of the "What Is Covered?" section. [/FONT]
[FONT=Arial,Arial]4. Any drug which is indicated or used for sexual dysfunction (e.g., Cialis, Levitra, Viagra, Caverject). The exception described in exclusion number one does not apply to sexual dysfunction drugs excluded under this paragraph. [/FONT]
[/FONT][FONT=Arial,Arial][FONT=Arial,Arial]What Is Excluded? 3-3 [/FONT]
[/FONT][FONT=Arial,Arial][FONT=Arial,Arial]5. Any Self-Administered Prescription Drug, which is otherwise covered under a BCBSF Pharmacy Program Endorsement to this Contract except for a Self-Administered Prescription Drug, indicated as covered in the "What Is Covered?" section of this Contract. [/FONT]
[FONT=Arial,Arial]6. Blood or blood products used to treat hemophilia, except when provided to you for: [/FONT]
[FONT=Arial,Arial]a. emergency stabilization; [/FONT]
[FONT=Arial,Arial]b. during a covered inpatient stay, or [/FONT]
[FONT=Arial,Arial]c. when proximately related to a surgical procedure. [/FONT]
[FONT=Arial,Arial]The exceptions to the exclusion for drugs purchased or dispensed by a pharmacy described in exclusion number two do not apply to hemophilia drugs excluded under this subparagraph. [/FONT]
[FONT=Arial,Arial]7. Drugs, which require prior coverage authorization when prior coverage authorization is not obtained. [/FONT]
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That's much better than the UHC1 Copay Select plan with 25% coinsurance for Tier 4, that could means thousands a year in drug costs for the really expensive prescription meds.

Tell that to someone with MS who needs a $2500/mo drug that would be a $65 tier 3 co-pay with United. There are hundreds of drugs that wouldn't fall under the categories you just mentioned that can still be incredibly expensive, especially when you're taking 3, 4, 5, 6, 10 of them at the same time. An 80MG dose of Oxycontin is about $1000/month, lots of people with chronic pain from car accidents or whatever else who take that drug. You get the idea. I wouldn't want to be the one answering why the drugs the person thought were covered aren't actually covered. Unless I'm reading what you just posted wrong, that's how it reads to me.

I also just checked out the benefit summary and it isn't really clear whether the $2500 OOP max is per incident or per year....can you clarify on that? I'm just curious, I don't sell in FL.
 
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Tell that to someone with MS who needs a $2500/mo drug that would be a $65 tier 3 co-pay with United. There are hundreds of drugs that wouldn't fall under the categories you just mentioned that can still be incredibly expensive, especially when you're taking 3, 4, 5, 6, 10 of them at the same time. An 80MG dose of Oxycontin is about $1000/month, lots of people with chronic pain from car accidents or whatever else who take that drug. You get the idea. I wouldn't want to be the one answering why the drugs the person thought were covered aren't actually covered.

this is really getting tiring. This plan uses the STANDARD Blue Cross Blue Shield medication guide, the same guide used by the Blue Options Plan 504, under which the drug you mention, Oxycontin, is a TIER 2 drug and would cost $60.

I don't really give a crap if any of you sell the plan or not, it's just intriguing how you can criticize without actually having any facts to support your criticisms, it's no wonder insurance agents are held in such low esteem by so many.
 
this is really getting tiring. This plan uses the STANDARD Blue Cross Blue Shield medication guide, the same guide used by the Blue Options Plan 504, under which the drug you mention, Oxycontin, is a TIER 2 drug and would cost $60.

I don't really give a crap if any of you sell the plan or not, it's just intriguing how you can criticize without actually having any facts to support your criticisms, it's no wonder insurance agents are held in such low esteem by so many.

I don't know what Plan 504 is and I don't sell in FL. My question is whether Oxycontin (or any other drug) is covered when it's not inpatient or related to surgery. What you posted makes it sound like it's not covered unless specifically related to cancer/diabetes/inpatient/etc.
 
One more paragraph from the contract, there is nothing that says it has to be related to a surgical event or hosptalization. Maybe you will actually research the facts next time before making an assumption:

Diagnostic Services


[FONT=Arial,Arial][FONT=Arial,Arial]Diagnostic Services rendered in a Physician‟s office or an Independent Diagnostic Testing Center may be covered. In order to be covered the diagnostic Services must be ordered or rendered by a Physician and are limited to the following: [/FONT]
[FONT=Arial,Arial]1. radiology, ultrasound and nuclear medicine, Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiogram (MRA), Positron Emission Tomography (PET), Computed Tomography (CT) ; [/FONT]
[FONT=Arial,Arial]2. laboratory and pathology Services; [/FONT]
[FONT=Arial,Arial]3. Services involving bones or joints of the jaw (e.g., Services to treat temporomandibular joint [TMJ] dysfunction) or facial region if, under accepted medical standards, such diagnostic Services are necessary to treat Conditions caused by congenital or developmental deformity, disease, or injury; [/FONT]
[FONT=Arial,Arial]4. approved machine testing (e.g., electrocardiogram [EKG], electroencephalograph [EEG], and other electronic diagnostic medical procedures). [/FONT]
[FONT=Arial,Arial]Exclusion: [/FONT]
[FONT=Arial,Arial]1. Diagnostic Services that are not ordered by a Physician; and [/FONT]
[FONT=Arial,Arial]2. Oversight of a medical laboratory by a Physician or other health care Provider, as described in the "What Is Excluded?" section. [/FONT]
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Now show us the exlusions.

Says those diagnosic services may be covered. My understanding is those diagnostic services have to be related to a surgery.
 
According to FLM there are no holes whatsoever in the plan. They just offer this plan and we are greedy if we sell plans that are worse with the "same" carrier but are double the price. I guess I wonder why BCBS even offers different plans if this is the best plan and it's the cheapest.

Now show us the exlusions.

Says those diagnosic services may be covered. My understanding is those diagnostic services have to be related to a surgery.
 
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