Blue Cross Truly Nationwide Coverage?

[HealthGuy]

Does the "Nationwide Blue Network" truly offer 'nationwide' coverage? I know that a true emergency is always considered covered as in network - but can anybody give me horror stories of clients thinking that once they moved with Blue Cross that they would be offered coverage out of state, but it never ended up happening? Is UnitedHealthOne truly the only 'national' carrier - but even United from what I know doesn't operate in markets like Minnesota...Assurant also seems like a nationally based carrier, but there are many markets where they are virtually non existent as well...

 

[TXINSURANCE]

There are a few things I learned over the years:

-Everyone is #1
-Everyone has the largest network
-Everyone pays claims the best

Essentially everyone is full of $#@@!

Yes there is a BCBS or BC and BS in all 50 states. Yes you will get negotiated rates in most cases for covered services under your contract. Will you get your $20 co pay of your home state? Probably not.

 

[Dave020]

Seems there are two things being discussed here so I will address them both.

BlueCard PPO is the national BCBS network for in-network services outside of the local area. Client has to call BlueCard (and be on a Blue PPO plan) and get the information on in-network services in other states (BlueCard® - When Traveling Inside of the U.S.)

TX is essentiall correct, they don't authorize preventative care on the BlueCard Program as there really is no need to get a physical in another state. It is intended to provide in-network services for non-routine urgent and emergency care. Local Blue obtains any necessary pre-authorizations through the local association member and notifies home state Blue of authorized service. As long as the client stays in-network, it works pretty smoothly. Out of network all bets are off.

As far a insurance reciprocation goes (obtaining a plan in new state), the general BCBS Association rule is mandatory GI coverage through conversion plans at a minimum in all 50 states. Every Blue must, by Association rule, provide a GI product to any Blue member moving to that state. Most states use the individual conversion plan, although there are exceptions. Anyone in good health would simply apply for a plan with the new Blue. GI is mainly reserved for those who are uninsurable. The process, in a nutshell, local old Blue sends out (at client request) a J-4 or T-4 wire to the new Blue who, in turn, sends enrollment information to the client.

Notable exception, Anthem offers reciprocation with 13 of their states at this time. The list is on the Anthem site somewhere. Anyone on an underwritten plan will be offered closest match new plan in the new state. I can't remember all of them but I know a few include CA, CO, WI, NV.

 

[taterpeeler]

one note about bc paying claims in another state:

while i was commuting back and forth from manhattan ny 3 years ago to see my future wife at the time i would always get drug claims paid from a nyc pharmacy. the pharmacy was only located i think in ny... no locations in texas. also, i had 2 claims for lab and dr visit paid as in network and no questions asked

 

[moonlightandmargaritas]

As far a insurance reciprocation goes (obtaining a plan in new state), the general BCBS Association rule is mandatory GI coverage through conversion plans at a minimum in all 50 states. Every Blue must, by Association rule, provide a GI product to any Blue member moving to that state.

While this is true, there is no uniform standard of what type of plan must be offered.

Here in Florida, Blue offers lousy coverage ($100,000 LT max) as their "guaranteed issue" cover.

 

[Dave020]

Yup. Most states use the conversion plans or special GI plans in the program. CA both Blues use conversion plans, not the HIPAA plans. Most conversion plans have limitations somewhere in the system.

 

[TXINSURANCE]

I had a client a long time ago who was offered a $4000/mo or something ridiculous "intra network transfer" from Blue A to Blue B since they were uninsurable.

They declined and applied for the TX health pool instead.

TX health pool declined them as well since they were offered coverage, but they declined to accept it.

 

[Guest]

Yup. Most states use the conversion plans or special GI plans in the program. CA both Blues use conversion plans, not the HIPAA plans. Most conversion plans have limitations somewhere in the system.

Just another reason why we need a national health care system... or at least standards... perhaps something like how Med Sups are done. We can have Plan 1, 2, 3, etc.

If left to the whim of private enterprise as the carriers would have it, greed will rule... as it does now... but who cares if "they" can't get health coverage... as long as "I" can! I hate this system... my role as an agent is not to sell it to people but to mitigate the damages from it.

If we end the Middle East wars (which we will lose anyway if history is any guide) and end agricultural subsidies, and cut ALL pork "bridge to nowhere" payouts, and cut the defense budget by 50% (let Europe defend themselves) we'll have plenty of money for a fair and balanced national health plan.

It makes no difference to anyone if they get it from a private company or a government agency. No one in this country should lose their home, their life savings, their retirement account, or the kids college funds because they get sick or have an accident.

Of course I don't expect ANY of the greedy agents (on this board or elsewhere), NAHU members, carrier reps, as well as over-paid providers, who are making a hell of a living on (off of) the present system to agree, but that's my story and I'm sticking with it.

Al

 

[Dave020]

Below are links to the Blue Shield CA (not for profit, btw) individual conversion and interplan transfer plan, The Spectrum Conversion PPO 2000.

Look at it carefully and find where it is lacking in any way compared to the Spectrum PPO 2000 underwritten plan. Same benefits, same lifetime max (6M), it is exactly the same plan on a GI basis.

http://pdf.blueshieldca.com/bsc/findaplan/download/A16251.pdf

Now rates. These come in almost identical to the corresponding HIPAA Spectrum PPO 2000 (rates which are set by the government, btw (MRMIB)). Actually, the conversion rates are slightly less than the HIPAA rates on this plan. Here is a link to the conversion plan rates, you can find the 2009 HIPAA rates on my site on the HIPAA page.

http://pdf.blueshieldca.com/bsc/findaplan/download/A11710_ICP.pdf

So it's slightly cheaper than a HIPAA plan, has the same exact benefits as the equivalent underwritten plan, what exactly is this greedy carrier thinking?

Anthem BC conversion is similar in every way. So,for that matter is Health Net.

 

[TXINSURANCE]

Of course I don't expect ANY of the greedy agents (on this board or elsewhere), NAHU members, carrier reps, as well as over-paid providers, who are making a hell of a living on (off of) the present system to agree, but that's my story and I'm sticking with it.

I am not a NAHU member, never have been.

I do agree individual plans should be standardized benefit levels A through Z and tighten up on recision and the process of blocking. It is amazing how many agents sell individual insurance and do not know the business of blocking.

I would rather see a national risk pool than GI for all 50 states. GI implemented to the current system would be a huge failure.

GI with a national risk pool (subsidized however) could work hand and hand with private enterprise - however Mr. Obama will never go for such a thing, and neither will his colleagues.

So I wouldn't say everyone disagrees with you by any means I just think adding certain variables (compromise) to an already broke system is making matters even worse.