<p>Yes… I havent seen anything else about eliminating blue card. I dont like that. I will call one more time before I pull the trigger to make sure the elimnation is true. The elimination of blue card, if true, changes what I am going to do going forward.</p>
<p>So all hospitals in the state have to charge the same? Johns Hopkins charges the same as Nice Community Hospital for an uncomplicated birth?</p>
<p>Yes Bclintonk, I received one of those letters. I am not buying the plan suggested. :)</p>
<p>I did not like the blue card answer. I thought kids were supposed to be covered even if they live out of state. I called back Anthem. I was told there is a 2 hour wait in Calif. December is going to be ugly. How long is the wait going to be in Dec.? I want to wrap this up soon so I dont have to find out. </p>
<p>Anthem said they will call me which is nice.</p>
<p>** Moderator’s Note</p>
<p>Please stop posting Reports by Politically Leaning Organizations. There are too many dueling reports on both sides and people can read them wherever they are posted. **</p>
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Wait for what? To get through on the phone? With the insurance company or Covered California? I had no wait time at all when I called Covered Cal. on Saturday. I also found the web site to be very responsive. I realize that Kaiser has some very nice plans that are not on the exchange (like an HSA with only $1500 deductible). But if you are going to buy off-exchange, then you don’t need to wait at all: you can simply get an insurance agent to do all of that work for you. (It’s easier than ever for the agents, as they don’t have to guide clients through the maze of filling out lengthy medical forms – they can just collect basic info and sign you up to earn their commissions). </p>
<p>I would very definitely use an agent if I didn’t want to keep that tax credit door open. In fact, even though I did my own signup via Covered Cal, I designated an agent – partly to throw a little money toward someone who has been nice enough to spend time with me on the phone, but also because I think its simply a good idea to have an agent on your side if any sort of issues crop up.</p>
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<p>No, I oversimplified. Different hospitals have different rates. However, within that hospital, each insurance company will get the same payment for the same procedure.</p>
<p>Can I ask a very specific question? Young married couple, each with health insurance provided by their respective employers. Way below the 400% poverty level. Baby on the way. Mom will lose her employer provided insurance when she drops to part-time after the baby is born (or go on COBRA, likely expensive.) Mom and baby could be covered on Dad’s insurance but would have to pay the entire premium, no subsidy for dependents by Dad’s employer. Also likely to be very expensive. But, as I understand it, Mom and baby cannot get a subsidy on the exchange because Dad’s insurance costs him less than 9.5% of his AGI.</p>
<p>Is that correct? No subsidy for Mom and baby as long as Dad has employer provided insurance? Although they could probably find something off the exchange that would be less expensive than COBRA or Dad’s.</p>
<p>As I understand what you’re saying, cartera, Snooty Hospital has one rate for an uncomplicated birth, and any insured person is charged that same rate. But Snooty Hospital’s rate might be larger than Nice Community Hospital’s rate.</p>
<p>So now I have two more questions. What if Snooty charges $100,000 for a hangnail, and Nice Community Hospital charges $100 for a hangnail. Can FangCo say, Snooty costs too much, even though the charges accurately reflect the costs of the solid gold nail clippers and the dancing girls that the patient watches while having their nails trimmed, and therefore Snooty is not in our network?</p>
<p>Also, if every insurance company has to pay the same amount at a given hospital for a given procedure, is that rate also given to an uninsured person who gets that procedure at that hospital? How about Medicare?</p>
<p>Wellspring - the answer to your question is yes as to the Mom - if she is eligible to be covered via the father’s employer, she doesn’t qualify for an exchange subsidy. (That was one of those parts of the law that was unclear as written, and has been interpreted in an adverse way under the regulations… it’s possible that there’s a lawsuit in there somewhere, as it is a little easier to challenge a regulation than the underlying statute … but for now that is how it stands). For the baby, it’s a little more complex, depending on how far down “way below” 400% of FPL is – with SCHIP, the baby may qualify for medicaid – I think in California the eligibility line for Medi-Cal for children is 250% of the FPL, but the children’s limits vary from state to state.</p>
<p>Thanks Calmom. This was for a friend of my daughter who, in fact, works in AR in a physician’s office and was having trouble figuring it out. Or maybe believing it.</p>
<p>I’ve called Blue Shield & verified from a supervisor-agent the Blue Card IS still honored under the ACA plans. (First phone agent was nice but clueless, so I had to ask for a supervisor. I’ll cut the insurance company a little slack here, as it’s possible that they’ve had to hire new people to staff the phone lines. But it’s clear that you have to move up the line just to get someone who is even familiar with basic terminology)</p>
<p>I had posted before that the web site seemed to indicate a “yes” on the Blue Card question, but I wanted to verify that - so now I have.</p>
<p>Wellspring, I think that is one of the glitches in the law that really wasn’t intended. It makes no sense at all – I think the law was structured in a way to try to preserve the employer system. In this setting, I think the wife would be better off if the husband worked for one of those companies that did NOT offer coverage for a spouse – then she would be eligible for a subsidized policy on the exchange --though I think that she’d probably have to report full household income and the subsidy might not be all that much for a policy covering only one young person. In fact, she probably should check the prices for insurance both on and off the exchange – she could find she does better paying the full price than she would with COBRA or the husband’s policy. (I mean, she’s not looking at old-people prices like I am – I’m guessing that she is probably 20-something so insurance shouldn’t be cost-prohibitive in any case). Maybe her best bet is to keep the employer coverage until after the baby is born, and then after that look at various options, including separate policies for her and the baby, perhaps opting for a lower deductible for the baby once she has fully recovered from childbirth (assuming no complications that impact her own health). That’s what I always did in the pre-ACA years – I’d buy a high deductible plan for myself, low deductible for the kids, as kids seem to have much more frequent doctor visits, especially when they are small. Of course that was before the preventive stuff (well baby visits and vaccinations) were provided free no matter what the deductible. </p>
<p>I know it seems unfair, but she is still better off than she would be without Obamacare. That is, without ACA she’d have the same $$ choice: husband’s plan or COBRA. But she probably would NOT have the third option of buying insurers policies direct from the insurers, because her recent pregnancy would probably be enough of a pre-existing condition to delay her eligibility to buy on the private market.</p>
<p>According to this brochure (see page 4), Anthem will keep the Blue card, however it might be narrowing it only for emergency and urgent care. I wonder if they can use the Blue Card program for this purpose only. I also wonder if BS is doing the same thing. I agree with dstark that this stinks. Calmom, did BS supervisor say what Blue Card could be used for? </p>
<p><a href=“http://file.anthem.com/OFF_HIX_CA_KIT5.pdf[/url]”>http://file.anthem.com/OFF_HIX_CA_KIT5.pdf</a></p>
<p>Although the wait times might get longer in the future, I would not pull the trigger yet. There is too much we don’t know and too much uncertainty to select a plan now.</p>
<p>Apparently no limits on the Blue Card. There also seems to be a huge difference between what DStark was told by Anthem about maximum out of pocket for out-of-network, and what I see in my documentation. I am trying to nail that down a little more – the supervisor promised to send me an email with the documentation she had, and she did indeed send an email - but I couldn’t open the attachment. So I’ve sent an email back and hopefully will have that at some later point. </p>
<p>I read the Anthem brochure the same way as you do-- that the BlueCard will be for urgent and emergency care only – but that could be simply because you’ve linked to a general brochure, and there is a difference between EPO’s and PPO’s. So they could be using wording which applies to both. </p>
<p>I’d add that insurances often can and do pay for things that go outside the basic coverage if you make arrangements in advance. That is, you can’t assume that they won’t pay just because it isn’t a listed benefit. That’s not something you can count on – but on the out-of-area issues it might be as simple as working with the insurance benefits coordinator to explain the circumstance. (Example: “I will be staying in Arizona for 3 months starting in June.”) So it may turn out that for extended travel or stays in different states, all you would need would be to submit a form which confirms that you are maintaining your California residency, but living temporarily somewhere else.</p>
<p>I was just talking with a friend whose son needs a liver transplant. The disease came on rather suddenly from what I’m told and it’s not related to alcohol abuse. This middle aged man had no idea he would ever need a transplant. Apparently the waiting list to get a transplant at Stanford (or elsewhere in California) is long. He’d likely die first. So he’s going to a large midwestern state to get a new liver. Fortunately, his insurance will cover it. Fortunately, he does not have one of those EPO plans that require a person to stay in their counties or state.</p>
<p>I don’t see how you can make a law that says a kid “has to” stay on the parents insurance or receive no subsidy and pay full price and then allow insurers to only insure in the state the parents live in.</p>
<p>I think they have to give you guys the ability to insure your adult children in different states on all levels of coverage. I canNOT see how the other is even a legal possibility.</p>
<p>That’s exactly the type of situation where a person COULD likely talk to the plan administrator and get permission for treatment out of state. It’s a clear cut situation of availability of treatment. An EPO doesn’t require a person to stay in their county or state - it just might set the bar somewhat higher for getting approval for the treatment.</p>
<p>That makes no sense, poetgrl. BC/BS said they’d cover our son wherever he was, and that they had a large number of preferred providers in NYC (across the country from us) to refer him to. Why would this be different?</p>
<p>I have never heard of an EPO until people started mentioning in yesterday. How does it differ from a PPO and is it prevalent outside of CA?</p>