does anyone have blue cross/blue shield insurance? feedback?

We have it thru work. Small company, so brutal on things like co-pays, etc. Since Obamacare, they removed any prescription coverage and dr. copays. We pay in full and get reimbursed later. I use my credit card at he doctor now, and my visits are just budgeted into our monthly bills. My deductible is 10k, and we likely won't hit it, even with blood work because they don't cover some of the tests.

That being said, I had several (4) major knee surgeries (micro-fracture and 2 AMZ/ACI procedures). I would estimate the total cost for those to be $500,000 or so. Just growing the cartilage was $75k (twice). I had to pay $3500 up front to the hospital for anesthesia and the surgeon/hospital space, but after that we paid $0 ... so BC/BS was a champion when it came to a major ticket item.

My plan so far has been great with them. Llmd visits are a copayment, most lab work is covered, and really low cost prescriptions. I am so thankful for good insurance (it's basically the reason I still work full time).

Oh my cd - This insurance 'stuff' sounds so very complicated...I do not envy you all in the U.S.

You need a degree in 'Insurance policies' to navigate through all that...goodness!

I have BC/BS and hate it. They no longer covered my thyroid meds (only synthroid is covered now) and my deductible is so high that I can't use the insurance - no matter what plan I choose.

I have had BC/BS for many years though, as it was the best plan when my hubby was working and they used to be really good at covering whatever I needed, even my LLMD even though he was out of state because he was still "in network".

If you have it and can afford to cover the cost of the deductible, I know that doctors like it because they pay pretty quickly.

I sourced what was called "independent plans" back in 2006. These are plans for people who don't get their insurance through their employment. I almost choked. There were hardly any plans to choose from, they offered very little coverage and cost double what I ultimately paid for a plan on the business group policy I already described.

That is why I continue working - plans available to businesses are much better than "independent" plans.

My BCBS plan covers Armour and generic desiccated thyroid.

We rarely deal with deductible because everything we've needed was fully covered or with a small co-pay ($30 for my primary, $50 for specialist...labs/imaging covered 100%)

I know there is 20% co-insurance for hospital/out-patient services but it has never been 20% of the provider's bill. It was 20% of what BCBS thought their bill should be.....which is MUCH lower.

There is a drug formulary. I pay $30 for a 90 days' mailorder supply of the generic meds I take. Hubby's meds are brand and it's $200 for 90 days' mailorder supply (the website shows the meds as "really" costing over $14K!!!!)

The ACA plans available to small businesses are something I avoid. Way too much out-of-pocket and truly only for catastrophic illness.

There has never been a time that BCBS denied reimbursement for hubby and me. Yes, there were times our doctors had to submit documentation and such. However, the end result was satisfactory to us.

While our insurance premiums increase 10-15% each year, it's been comforting knowing we're covered.

It all comes down to the type of plan and the reliability of the carrier.

Girlie - you are so right.

Navigating US health insurance is not for the fainthearted.

The independent agent I use taught me a LOT about the insurance world and that's why I stick with her.

Based upon what other people share about their cost/benefits, I've come to the conclusion that our plan is pretty good and not as expensive as what others might pay.

BCBS has renewed our plan for the past couple of years and we were able to maintain our benefits at "just" increased cost. The killer aspect of this is that BCBS is no longer offering our plan to new enrollees. As crazy as it sounds, we feel fortunate.

It should never be so expensive anyway, but you know how it is...the insurance companies are there to make money. I wish they go away and then we would directly pay the establishments, the professionals. It works like that for cosmetic surgeries that are not covered by insurance and if you compare the rates it is a gigantic difference.

Dashgirl-I handle the insurance for our company so I'm pretty well versed on health insurance. There is a difference between Blue Shield/Blue Cross of California and that of other States especially now with Obamacare.
I'm currently on Blue Shield of Cal. I have a Platinum PPO 90/10. No deductible. Very good coverage BUT PPO policies for 2017 are going to be EPO's which means no out of network coverage at all. You need to check that.

Almost all California plans follow the same format as the plans listed on the Covered Calif site. Platinum, Gold, Silver, Bronze etc. Pricing and options may vary.

My experience has been that most rx's are non formulary so they deny them which isn't really a denial it just means that it needs pre approval. If my policy wasn't purchased through a broker who called up and gave them heck at the first denial I would not have known that. I would have believed all non formulary was truly not covered. Just an FYI

I agree with others. BCBS coverage and policies will vary state by state, and weither you are part of a company plan or an individual. Some states like RI mandate that the insurance company covers Rx and labs within policy coverage for Lyme related dx for as long as the doctor prescribes it. How they get around it is they just stop listing certain Rx and tests in their approved list.

Two health care insurers in RI just dropped VSL#3 DS from their approved list at mid-year. United Health Care also will not continue to insure individuals through the state exchange in 2017. This leaves BC/BS with virtually no competition on rates.

PeteZa, your BC/BS is likely a very good insurance! I know that when my hubby was working (he was union as well) and we had BC/BS it was an amazing plan! That's what we were using when I went to the one LLMD that I saw and they covered everything I was prescribed at the time, plus excellent vision and dental coverage.

My LLMD takes BCBS, Aetna, and Medicare. He writes the lyme/bartonella diagnosis on the paperwork, etc. I pay my copay for the visit and a small fee for the prescriptions. Things like glutathione IVs are not covered, but at least the visits, meds, and labwork (with exception of Igenex) is all covered.

There are two LLMD's in my area that take insurance. I know that the receptionists at my current doctor make it very clear when they answer calls that he is NOT a "Lyme Doctor"...he is an integrative GP. Maybe that's the difference?

jrpsf said...

I'm currently on Blue Shield of Cal. I have a Platinum PPO 90/10. No deductible. Very good coverage BUT PPO policies for 2017 are going to be EPO's which means no out of network coverage at all. You need to check that.
=
XXXXXXXXXXXXXXXXXXXXXXXXXXXX

Thanks All!

jrpsf, our benefits spreadsheet shows we still have access to non networks drs and they pay 70%.

2017 renewal for a PPO. It's thru my husband's work, big company.

GREAT question, jrpsf. I'll ask tomorrow.