<p>Busdriver11, employer plans are different than individual plans. By the Way, employer exchanges already exist, have existed for awhile and will continue to expand. </p>
<p>I can not force insurance companies to expand their coverage. Blue Cross and Blue Shield have networks in many states. If your insurance plan offers great coverage across state lines, that is great. Mine used too. It doesnt appear to do that now. It does have the lowest premiums and the best coverage in Cal so there are pluses and minuses. My son is going to turn 26 next year so this isnt going to be a long term issue.</p>
<p>I don’t know how different it would be, dstark. When we ask if people are preferred providers for BC/BS, they always say yes. They don’t ask if we have an employer plan, just what kind of insurance we have. Maybe I missed it, but have you asked for a list of providers in your sons area? It’s one of the largest insurance companies in the US, it is illogical they wouldn’t have plenty of options there. Then again, why would I think insurance companies are logical? Maybe you’re just getting bad info right now, as nobody seems to really have a clue.</p>
<p>Why would they change it now so you don’t have coverage over state lines? I probably missed the post where you addressed that.</p>
<p>Okay, I had BCBS for years and never through an employer. I went anywhere I wanted and the only question ever was what kind of insurance? BCBS. Good answer. Can you come in on Tuesday?</p>
<p>So, I’m wondering if the policies on the exchange are generally a little narrower?</p>
<p>I am guessing policies were changed to save a little bit of money. </p>
<p>I am not worried about my son’s network. He is in Manhattan. I think we can find coverage there. :)</p>
<p>The coverage can be different within insurance companies. My last plan at Anthem I had to pay more out of pocket than my previous plan. Deductibles were different. 90 percent of policies in the individual market had caps compared to less than 60 percent in the employer insurance market. (Cant remember if the caps were annual or lifetime). Preexisting conditions were prevalent in the individual insurance market.</p>
<p>You have to be careful in making assumptions about the Blues. There is no national BCBS insurance company. BCBS is an association of independent state insurers, and they operate more like a franchise than like a single insurance company. On some things they cooperate and on others they compete with each other in a very adversarial relationship. They share networks, at least to some degree, so frequently if you go to a hospital in the network of one of them in an emergency, you can get in-network charges. </p>
<p>The Blues each have their own business model. BCBS in your state may be a preferred insurer so that when Flossy says she says she’s with Blues and the doctor says, come right in. In my state, however, if you say you’re with BCBS, they are more likely to spit on the ground and in general act like an Irishman hearing Cromwell’s name. They are truly hated. They have smaller network of providers than Aetna or United, and refused to come to terms with many of the best hospitals in our state. We left BCBS last year when our best local hospital wouldn’t accept them.</p>
<p>NJ BCBS has only EPO plans for the new individual market, both off and on exchange. No PPO offered at all, at any price. No out of network coverage but they do include some hospitals in Philadelphia, but not as many as the PPO plans. If you are a large group or even a some small groups, you can still get the PPO and Blue Card. </p>
<p>Last night someone was talking about transplants, so out of curiosity I looked at BCBS transplant surgeons. Only 4 were in network for EPOs (2 in Philadelphia and 2 in north Jersey 2 hours away) and they were all liver transplant surgeons. I guess if you need a different part transplanted and you have an EPO, you’re either going to go bankrupt or die. What a choice.</p>
<p>Pretty sure this has been discussed already, but all plans cover out-of-network care if it is necessary. If you needed a kidney transplant and nobody in your EPO did kidney transplants, they’d have to pay for you to go out of network. That’s if your plan covers transplants, but I think under the ACA, it has to, at least in certain circumstances. (Maybe the insurance company wouldn’t have to pay for a transplanted organ if you’d take that organ to your grave in a year and a half, for example.)</p>
<p>CF, I would feel more comfortable if somewhere in writing it said all plans will cover out of network care if necessary, instead of out of network: not covered. Before, I wouldn’t be as concerned, but this is a new day in insurance.</p>
<p>I am still absolutely stunned that there is no guarantee of out of state coverage for college age offspring. Not even if they are 18 years old.</p>
<p>I mean, it’s really great that they’ve got all the middle age people who are sick covered at this higher expense, but if you send your kid out of state for college, you can’t even count on them being covered by your insurance.</p>
<p>It’s not even like kids come home all that often after the first year or so.</p>
<p>Plus, if you move states? </p>
<p>This whole thing seems to have been conceived with no consideration for people under 30 or so. How do we keep doing this to our kids?</p>
<p>Under the ACA, insurance plans are required to cover “essential health benefits.” What is essential is defined by the states. If the state deems a procedure “essential,” the insurance company has to cover it, even if they have to go out of network to do it.</p>
<p>It could be very costly to go out of network, even if the insurance pays for it. Paying 30 percent could be a lot of money compared to a $20 copay. </p>
<p>Interesting info about the BC/BS, Hayden. I had no idea they were like franchises, that is important to know. We actually have Anthem BC/BS. Dang this can be complicated!</p>
<p>LA Times is reporting that Blue Shield of California individual plan customers can ‘keep their plan, if they like their plan’ until March 31, 2014. </p>
<p>Maybe other states will follow since signing up on the new exchanges is very difficult.</p>
<p>My Blue Shield plan before 2010 had a $6 million lifetime cap for each person and no annual cap. College students were allowed to stay on the plan. According to the administration, this was a substandard plan. How many people spend more than $6 million on their care?</p>
<p>“LA Times is reporting that Blue Shield of California individual plan customers can ‘keep their plan, if they like their plan’ until March 31, 2014.”</p>
<p>Tatin, are they referring to customers who were told their plans were being cancelled on Jan 1. Is this in today’s paper?</p>
<p>busdriver, I’m reading the statute I posted in #3610 as saying that if a treatment counts as an essential health benefit, and if you are sent out of network because the in-network providers don’t treat that condition, you have to be charged for it just as if it was an in-network procedure.</p>
<p>So if you needed a kidney transplant, and you had to go out of network because your plan didn’t have any transplant surgeons, you would have to pay the same as you would have had to pay if it was in-network. Do you read the statute in a different way?</p>