Insurance Agent Forum

[healthagent]

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.

[Peelerinsurance.com]

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.

[moonlightandmargaritas]

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...

Provider directory at Blue Cross Blue Shield Association - Better knowledge for healthier lives

[healthagent]

That's what I was told once - by a Carefirst rep; that as long as they're in the Blue network clients are fine.

[salpro22]

HaHa, leave it to Carefirst to not be informed about their own plans....

[somarco]

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.

[TXINSURANCE]

Why didn't she look all of this up before getting pregnant?

I hate to state the obvious.

Its like looking up your flood coverage after the hurricane.

[moonlightandmargaritas]

Originally Posted by somarco

Buy in GA and go to Disney World.

What about Universal? Or Busch Gardens here in Tampa?

Thanks Bob, I learned something.

[moonlightandmargaritas]

Originally Posted by TXINSURANCE

Why didn't she look all of this up before getting pregnant?

Throes of passion perhaps?

[Dave020]

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.

[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.

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.

[moonlightandmargaritas]

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.

[Dave020]

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®

[Dave020]

Originally Posted by moonlightandmargaritas

The one they offer here in Florida is very limited in the amount of benefits it provides.

Yup, same in California, Individual Conversion Plan, not great but it is GI.

Anthem/Wellpoint currently have full reciprocation (same plan or most similar) with CA, NV and CO.

Much better deal but not an Association arrangement.

[moonlightandmargaritas]

Originally Posted by Dave020

Yup, same in California, Individual Conversion Plan, not great but it is GI.

Anthem/Wellpoint currently have full reciprocation (same plan or most similar) with CA, NV and CO.

Much better deal but not an Association arrangement.

Dave, On an unrelated note...

Gilroy CA huh? Hometown of Jeff Garcia.

Can you get me a good deal on some garlic?

[djs]

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.

Dan