When no one knows what they're talking aboutGo to Top
I have a current client who's been with me almost three years - just got pregnant, unplanned, and doesn't have maternity. No biggie - right into MHIP and she's covered.
She calls me back and it turns out she's living part of the time in Reston VA with her "on again off again" boyfriend.
So she throws this scenario about me: "John, what happens if I'm in Reston and go into early labor? Will I still be covered if I have to go to the local hospital?"
Well, that's out of the Carefirst Blue Cross network that only covers MD, DC and northern VA. So now we're into the Anthem network.
I called MHIP and they had no clue. They cover "emergencies" out of network as if they're in network. Duh - I knew that. But is early labor considered a medical emergency? They don't know - call Carefirst.
I called Carefirst - 1st rep told me as long as she's at a Blue Cross hospital in VA she's covered but she'd check and call back. She never called back. I called again - different answer. If she's out of the Carefirst network she's subject to balance billing since Carefirst has no contact with Anthem. Oh, but medical emergencies are ok.
I said "I thought with Blue Cross you could see any Blue Cross doctor or go to any Blue Cross hospital. His reply? "Where'd you hear that?" I said, "actually, when I called you over 2 years ago and asked." Great.
So is early labor a medical emergency? He couldn't tell me and his gut instinct is yes since she'd "have" to seek medical treatment.
So I called my client back and she wasn't thrilled. Now she wants something in writing stating if she goes into early labor in VA she'd be covered. I told her such a letter would never be written by Carefirst.
So where are we? No where.
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Re: When no one knows what they're talking aboutGo to Top
John.... does she really have any options... no, she is prego, not your fault.... so it's kinda the old... she's up against a brick wall with no way out.
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I can't spell, I can't write..... and I can't be bothered if you dont like it... got it???
Re: When no one knows what they're talking aboutGo to Top
I thought that any Blue Cross Blue Shield licensee had to participate in this "Network Blue", or "Blue Card PPO" which gives par coverage when you're out of your area...
Re: When no one knows what they're talking aboutGo to Top
I thought that any Blue Cross Blue Shield licensee had to participate in this "Network Blue", or "Blue Card PPO" which gives par coverage when you're out of your area...
Nope.
You catch a break if you are covered under a group plan and part of their national network, otherwise you are limited to your "home state" network. Buy in GA and go to Disney World. Covered for emergency situations, otherwise . . .
Each Blue plan operates mostly independent of the others, even among "sister" plans like the Anthem/Wellpoint conglomerate.
Re: When no one knows what they're talking aboutGo to Top
Originally Posted by somarco
Nope.
You catch a break if you are covered under a group plan and part of their national network, otherwise you are limited to your "home state" network. Buy in GA and go to Disney World. Covered for emergency situations, otherwise . . .
Each Blue plan operates mostly independent of the others, even among "sister" plans like the Anthem/Wellpoint conglomerate.
I'm not sure about this, in California you get access to Blue Card PPO as long as you are enrolled in a Blue Cross CA or Blue Shield CA individual PPO plan.
If she is in an HMO, then yes there is no Blue Card, however PPO is a different animal.
Re: When no one knows what they're talking aboutGo to Top
Also, we can go back to the "interplan transfer" rules that do require all Association members to provider a GI plan for transferees coming off another state's Blue Plan.
Blue Card is the Association PPO arrangement and applies to all association members. They can operate as independent as they want, however they must obey specific rules set in order to be a member of the BCBS Association. That includes PPO Blue Card and Interplan Transfer. No exceptions.
Re: When no one knows what they're talking aboutGo to Top
Originally Posted by Dave020
Also, we can go back to the "interplan transfer" rules that do require all Association members to provider a GI plan for transferees coming off another state's Blue Plan.
The one they offer here in Florida is very limited in the amount of benefits it provides.
Re: When no one knows what they're talking aboutGo to Top
Call this number, they can tell you if she's covered.
1-800-810-BLUE (Blue Card)
"BlueCard® is a national program that enables members of one Blue company to obtain healthcare services while traveling or living in another Blue company's service area. The program links participating healthcare providers with the independent Blue companies across the country and in more than 200 countries and territories worldwide, through a single electronic network for claims processing and reimbursement." BlueCard®
Re: When no one knows what they're talking aboutGo to Top
Originally Posted by moonlightandmargaritas
Can you get me a good deal on some garlic?
All you can smell, no charge!!!
Now, if you've ever driven through Gilroy on a hot day, you understand a little garlic smells good, a LOT of garlic, well, let's just say that's another story.
Re: When no one knows what they're talking aboutGo to Top
Now here is where worlds collide LOL
Gilroy processes a lot of garlic and in the summer there is a plant near my house that kicks off about 4 PM - makes me hungry every time.
Annual Garlic Festival last full weekend in July every year - draws almost 150,000 currently. Used to draw 250k bu they were having problems and cut it back.
Now the collision - DJS, I graduated from USF, used to live off 42nd street up towards the end in a complex called Vestavia (probably still there) and worked at the Eckerd photo lab on Nebraska Ave. We called it Camp Nebraska.
Re: When no one knows what they're talking aboutGo to Top
Moonlight you probably know that area a least a little, it's up on the north side of USF off Fletcher. Used to hit the Circle K on 42nd and then Cooper Hall at USF for classes.
Jeff Garcia, hometown hero boy for sure. His dad used to coach him in high school and at Gavilan College here in Gilroy. Also used to own the health club around the corner here. He gets a ton of press in the local fish wrap (which just went from 5 days a week to 2). Jeff is in town often and you usually run into him somewhere around town.
Another comer from Gilroy boxer Robert "The Ghost" Guerrero has an incredible record. Not sure what weight class, I think light or middle weight. Used to pass him running in the park while walking my dogs.
Re: When no one knows what they're talking aboutGo to Top
The national Blue Card is only available to BCBSGA plan participants in groups of 51+. This option is not available to small group or individual plans.
Re: When no one knows what they're talking aboutGo to Top
From making a few more calls it seems the last person I spoke with at Carefirst is correct - she cannot just plop into any doctor's office who accepts BX.
The way is was explained to me was Carefirst has contracted rates with their doctors. Those contracted rates do not apply to other BX doctors/hospitals so if she seeks treatment out of the Carefirst network she's subject to balance billing.
One more reason not to sell BX and more reasons to sell plans with true national networks like Aetna, UHC and Assurant with PHCS for anyone who travels or lives out of state a portion of the year.
When no one knows what they're talking about
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