When there's no options

[Crabcake Johnny]

Just took a call - referral. Man...I just hate conversations like this and when I'm asked to give bad advice.

Husband is 66, obviously on Medicare. Wife is 63 - myriad of health issues however has been on BX in PA for countless years - indie plan. She cannot work now.

Moving to MD in a week. MHIP (state pool) has a six mo. residency requirement - waived only if they're coming from another state pool or expiring Cobra.

PA BX is telling them they cannot continue their coverage once they move to MD. Actually, worse than that, they are getting conflicting stories from PA BX.

One rep is telling them they can move to MD, continue paying premiums and simply went over the out-of-network issues. They have no problem driving back to PA for treatment.

Yet another rep said no; once they change their address to MD they have no way of billing them and coverage must be canceled. Gotta love it when the BX reps don't know the story.

Now...their suggestion was to use their daughter's PA address - just tell PA BX they moved to that address and continue to drive up for care under that "how can we possibly get caught" theory.

Man...bad situation.

 

[Dave020]

I am literally out the door to England in about 10 mins but before I go....................................

If she has Bx in PA, she should be able to get at least a GI conversion plan in MD from MD Bx carrier. It's called an "Inter-Plan Transfer" and is a requirement of membership in the BCBS Association to provide this to existing BCBS members when they move to a new state. Bx PA wires Bx MD with contact information, Bx MD must accept her on an inter-plan transfer.

Cheers and wot-wot and all of that bloody rubbish!
(Just trying to get ready

Dave

 

[moonlightandmargaritas]

I am literally out the door to England in about 10 mins but before I go....................................

If she has Bx in PA, she should be able to get at least a GI conversion plan in MD from MD Bx carrier. It's called an "Inter-Plan Transfer" and is a requirement of membership in the BCBS Association to provide this to existing BCBS members when they move to a new state. Bx PA wires Bx MD with contact information, Bx MD must accept her on an inter-plan transfer.


Great idea, but be aware that the "inter-plan transfer policy" may be like the one that BCBSF offers here in FL.

Very limited coverage. Very high premiums.

 

[Crabcake Johnny]

She cannot get a straight answer out of BX - makes it tough.

 

[arnguy]

John, BX has an arrangement for members in PA that will cover them temporarily when they go on vacation, for example, the snowbirds that go to Florida for 4 to 6 months to aviod the occasional semi-raw winters. This is the case with Independence BX which serves residents of Philadelphia, Bucks, Montgomery, Delaware, and Chester Counties. I don't know about the other BX's in PA. I believe the subscriber must retain their permanent address in PA and then use a temporary address for their condo in Boca Raton (or similar places in FL) during their stay out of PA. Also, BX has a"Blue Card" for persons travelling on vacation to other states. This may be the Blue Transfer the other guys referred to in the above posts.

 

[Crabcake Johnny]

My issue is they are not my clients - I cannot coordinate this for them. She is adamant about talking to BX about moving. One rep has indeed told her she can move and keep BX for 6 months.

The last rep said she cannot and warned her that if she moved she must cancel. It was addressed whether or not there was any way she could move and the rep assured her there was not.

She is very distraught. If we have a PA expert here I'll be more than happy to put you in touch with her.

 

[moonlightandmargaritas]

The last rep said she cannot and warned her that if she moved she must cancel. It was addressed whether or not there was any way she could move and the rep assured her there was not.

Here's the real world.

We run into this all the time here in FL -- people move down and think they can "transfer" their Bx coverage. They believe it's all the same company.

To be a member of Independence Blue Cross, you have to be a Pennsylvania resident (probably for at least 181 days each year).

If she changes her address, it'll take 'em about six months to catch it and notify her.

Some may say use the daughter's PA address, but what happens if there's a major claim that leads to an investigation?

Her best bet, if she's not insurarable, is to take the inter-Bx transfer (even though it's limited) after six months.

She's not all that far away from Medicare anyway.

 

[moonlightandmargaritas]

Also, BX has a"Blue Card" for persons travelling on vacation to other states. This may be the Blue Transfer the other guys referred to in the above posts.

Arn, they are actually two different things.

Blue Card is a provider network that allows you to be in-network even when you're out of PA.

The "inter-Bx" transfer policy is an individual, GI, no pre-x policy. It is different with every Bx company, and is sometimes limited, and expensive.

 

[Crabcake Johnny]

Here's the real world.

We run into this all the time here in FL -- people move down and think they can "transfer" their Bx coverage. They believe it's all the same company.

To be a member of Independence Blue Cross, you have to be a Pennsylvania resident (probably for at least 181 days each year).

If she changes her address, it'll take 'em about six months to catch it and notify her.

Some may say use the daughter's PA address, but what happens if there's a major claim that leads to an investigation?

Her best bet, if she's not insurarable, is to take the inter-Bx transfer (even though it's limited) after six months.

She's not all that far away from Medicare anyway.

Solid advice.

I warned them about using the daughter's address. That's an intent to defraud and I told them if they got caught their policy could be rescinded.

They asked how in the world they could get caught? I used this scenario:

"You have a heart attack in MD, rushed to the hospital where they photo copy your ID. During the claims review they notice your MD license. Busted."

 

[moonlightandmargaritas]

Just like in poker, most people overestimate their hand.

BIG claims often get investigated.