<p>I’d probably want to go out of state and stand in more than one liver transplant line for myself. I’d certainly do anything I could under current law to get a liver for my son if he needed one. But this is a crappy system that ought to be changed, and I don’t see why insurance companies should aid and abet it by paying for their insureds to shop around and stand in several lines at once.</p>
<p>“To my mind, health insurance is for when catastrophes happen, like the gall bladder cancer case in the WSJ or the need for a transplant. If the exchanges are trying to save money by limiting treatment for those conditions in order to cover minor things, that’s nuts.”</p>
<p>All plans on the exchanges cover serious illnesses.</p>
<p>
You would if your specialist was in-network for that EPO, but not included in another PPO. Just because the network is broader doesn’t mean that it includes the doctors or facilities you want. For example, in SF it looks like UCSF will be included within the Anthem EPO, but not the Blue Shield PPO.</p>
<p>calmom is right that if you were already being treated by a specialist, you’d sign up for the plan that included the specialist that was treating you, whether that plan was an EPO or a PPO.</p>
<p>But more generally, you’d sign up for an EPO for the same reason you’d sign up for an HMO: it was convenient and it seemed to be able to handle any condition you’d have in the future. People who have chronic diseases sign up for HMOs, after all. In fact, if I had some chronic disease with various manifestations, like diabetes, I might be more likely to sign up for Kaiser, an HMO, because I might think they were better at coordinating all my care, whereas various specialists would each treat a part of me without much reference to the rest of me. And I might feel the same way about an EPO.</p>
<p>My wife 's primary doctor was not on Anthem’s list of approved doctors and my wife asked why?</p>
<p>The doctor thought she was signed up. She has Anthem insurance herself. So the is going to take care of this. My wife thinks her ob-gyn is also going to take Anthem and doesnt know why he isnt on the list.</p>
<p>So … The list of providers taking Anthem is not complete…</p>
<p>“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.”</p>
<p>Calmom or dstark, could you elaborate on this? Didn’t see anything in this thread about what dstark was told about maximum out-of-pocket.</p>
<p>“I think this is a california thing, but since most of this thread is about california? who knows. I chalk it up to they are further along because they have a better working website and so can discuss their plans.” </p>
<p>I am going to refrain from getting political, but this is not the reason!</p>
<p>BTW, I would never purchase a plan with an EPO network.</p>
<p>The max out of pocket I mentioned was for out of network plans. In network is 12700 for a family or whatever it is…</p>
<p>Ok… I see calmom’s post.</p>
<p>“So … The list of providers taking Anthem is not complete…”</p>
<p>Which is why I wouldn’t do anything right now.</p>
<p>What did they tell you about the maximum out-of-pocket for out of network?</p>
<p>$33,300.</p>
<p>I dont know what calmom has seen.</p>
<p>I am fine with the list of providers now… It can only get better…</p>
<p>Okay, but the $33,000 is deceiving because it doesn’t include the charges in excess of the amounts that are allowable to their in-network doctors and hospitals.</p>
<p>That sounds like catastrophic plans. Those are high maxes.</p>
<p>Regarding going to hospitals in EPO regions with a PPO plan, did the agent sound like she knew what she was talking about?</p>
<p>GP, I am not plannng on using over 33,300 of out of network care. I dont see the point with Stanford, UCSF and Marin General in network.</p>
<p>GP… I dont know. She didnt hesitate. :)</p>
<p>You should call yourself when you are ready to pull the trigger. </p>
<p>I asked her if I was covered at UCSD because UCSD was covered by EPO and Anita said yes.</p>
<p>Anthem’s PPO plans cover everything in network in California…PPO or EPO.</p>
<p>The agent told you that you could go to UCSF. You’re in a region with a PPO network. SanFrancisco only has an EPO network. I am wondering if you are from a region with a PPO network can you use a hospital in a region that only has an EPO network?</p>
<p>Okay, just saw your last post.</p>
<p>I plan on calling but I dread the thought of it.</p>
<p>Put the phone on speaker so you can do something else while you wait. :)</p>
<p>“I am not plannng on using over 33,300 of out of network care.”</p>
<p>No one ever does!</p>