Virginia Client Wants Individual PPO Next Year

yorkriver1

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Virginia
Now that Humana PPO is going away in 2017, my client is asking me to find an individual PPO. I don't know if any carrier will be offering a plan that would pay on out of state care as in network like a group PPO would do.

Other than starting a (legitimate) business, any suggestions for PPO that would pay out of state care as "in network"? I am not sure if these are going to be available on the individual market.
 
The only PPO I am aware of (Northen VA) is Aetna/Innovation Health. Also, you might want to look at UHC, they did file in VA for 2017 (hopefully they will pay commission) or Aetna, since these are national networks.
 
Must check fine print, thanks for heads up about UHC/Aetna, but if I recall correctly, Humana was the only carrier with national network providers being paid on PPO benefit level in or out of state. HMO's won't (maybe Kaiser, in their other locations nationally--they are NoVa also). We aren't in Northern VA, also thanks for info about Innovation, will review, I have some clients there.
As an example of the limitations on individual plans--Anthem individual policies will do the following thing:
If the insured gets treatment out of state they will apply the out of network payment reductions, but *if* the provider is in the national Blue Card network, the providers can't balance bill over their negotiated rates. They only do this on their POS plans. They offer a few of those, mostly HMO's.
I had to discuss this POS out of state feature with our area reps to be sure I could explain it to clients who saw the mention in the sales literature about getting treated out of the area with Blue Card providers. Older PPO's and group have given folks the idea that if there is a national network, their plan will pay the same as in state if they have voluntary treatment elsewhere.
 
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Now that Humana PPO is going away in 2017, my client is asking me to find an individual PPO. I don't know if any carrier will be offering a plan that would pay on out of state care as in network like a group PPO would do.

Other than starting a (legitimate) business, any suggestions for PPO that would pay out of state care as "in network"? I am not sure if these are going to be available on the individual market.
I'd love to help out if I could! Shoot me an email at mpickner20 at gmail.
 
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