Anthem MAPD PPO Deductible

[Franz Kafka]

I'm trying to help someone with MAPD (can't afford Supp) and couldn't find anything from the forum search. I'm looking at Anthem PPO (Freedom Blue) with $500 deductible. I'm trying to figure out which services trigger the annual deductible because most services show set copay amounts.
Anyone familiar with this plan (in so ca)? Anything good or bad to say about it? The network looks pretty large with many specialist providers in where the client lives.

 

[Dave020]

They got rid of that $500 lower deductible FB Plan I last year. They kept the FB higher deductible plan which is always slightly above the Part A annual deductible (around $1150 last year I think). Unless they added a new one back in, they only offer FB Plan II with the higher deductible.

 

[Franz Kafka]

They got rid of that $500 lower deductible FB Plan I last year. They kept the FB higher deductible plan which is always slightly above the Part A annual deductible (around $1150 last year I think). Unless they added a new one back in, they only offer FB Plan II with the higher deductible.

Ritter quote is showing both FB Plan1 and FB Plus (premium plan for more dental, vision and hearing benefits) being available 2010 for my client's area (unless they're wrong).

Copay for Inpatient Care is $850 for each stay. I'm trying to figure out for which service she would have to pay $500 deductible.

Edit: Got the answer from the 2nd rep I called (and he had to ask around). The deductible applies to any services besides doctor visits, preventive service and labs/x-rays. So the initial inpatient care would require $1,350 ($850+$500) deductible and copay.

 

[Dave020]

I just ran a quote and it looks like for this year they have added new FB plans (Classic, Plan I and Plus). Hmmmm, interesting, all three now $500 deductible, Classic has no drugs and Plus costs actual premium.

Deductible on these FB plans applies to Inpatient/Outpatient, Home Health, Chiro, Accupuncture and other major services.

They way they do it is say for inpatient is subtract it off of the total bill for the first stay. So as long as the first NFR billing exceeds $1350, they get credit for the $850 and the $500 deductible. If the bill is less, the difference from the $850 is credited towards the deductible.

 

[DS4]

For 2010, Anthem BC in Ca has 3 regional PPO's.
1)Freedom Blue I MAPD
2)Freedom Blue Plus MAPD, and,
3)Freedom Blue Classic MA This plan CAN"T be sold with a PDP.
The $500 deductible applies to Inpatient Hospital(Acute/Mental), Skilled Nursing, Home Health and Chiro

 

[Franz Kafka]

Thanks guys. Anything good or bad to say about this plan in comparison to other HMO plans?

 

[DS4]

Thanks guys. Anything good or bad to say about this plan in comparison to other HMO plans?

Big difference when comparing a Regional PPO to a HMO.
One advantage to the Regional PPO is no gatekeeper.