Blue Cross/Blue Shield lost $400 million last year on their PPO product, and have decided to no longer offer it in 2016.

http://www.expressnews.com/business/heal...408174.php

That wouldn't be that big of a deal, except they were they were the only company that offered a PPO in Texas.

Imagine you're a current BC/BS PPO policyholder that is undergoing cancer treatment at MD Anderson. Your new insurance options for 2016 are BC/BS's Advantage HMO, Aetna, Humana, and United Health Care. Great, it appears you have a lot of options. That is, until you look to see which plans MD Anderson accepts.

From MD Anderson's website:
http://www.mdanderson.org/patient-and-ca...plans.html

Quote:Note: MD Anderson is not a participating provider for the Aetna Texas Marketplace plans.

Note: MD Anderson is not a participating provider for the Blue Advantage HMO Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the Humana HMO X Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the UHC Texas Marketplace plans.

Quote:It's important to note the PPO is not going away for those with employer or group PPO plans.

Quote:Blue Cross Blue Shield of Texas recently announced they would be phasing out their individual PPO plans because it was no longer sustainable at the cost being offered.

Instead customers will be switched to an HMO or Health Maintenance Organization.

And what does this have to do with Obamacare?

Do you know the difference between a PPO and a HMO?

A PPO has a much wider network, and you can even go outside of the network, it just pays less. A HMO has a restricted network, and almost no hospitals (MD Anderson included) accept it. If you go outside of said restricted network, it pays nothing.

Answer the question I posed in the OP, what will those BC/BS policyholders (individual, not group or employer) currently receiving treatment at MD Anderson do on January 1, 2016?

(07-30-2015 01:58 PM)Kronke Wrote:  Do you know the difference between a PPO and a HMO?

A PPO has a much wider network, and you can even go outside of the network, it just pays less. A HMO has a restricted network, and almost no hospitals (MD Anderson included) accept it. If you go outside of said restricted network, it pays nothing.

Answer the question I posed in the OP, what will those BC/BS policyholders (individual, not group or employer) currently receiving treatment at MD Anderson do on January 1, 2016?

Again, what does this have to do with the ACA (aka Obamacare)?

Although it is nice to see that you're passionately concerned now about people without health insurance or care.

(07-30-2015 02:08 PM)Redwingtom Wrote:  

(07-30-2015 01:58 PM)Kronke Wrote:  Do you know the difference between a PPO and a HMO?

A PPO has a much wider network, and you can even go outside of the network, it just pays less. A HMO has a restricted network, and almost no hospitals (MD Anderson included) accept it. If you go outside of said restricted network, it pays nothing.

Answer the question I posed in the OP, what will those BC/BS policyholders (individual, not group or employer) currently receiving treatment at MD Anderson do on January 1, 2016?

Again, what does this have to do with the ACA (aka Obamacare)?

Quite literally everything. The ACA laid the tracks for these insurance companies to run on, and they are pulling out after just 2 years.

To address the MDAnderson question. That list is from 2/18/15. How do you know that they will not participate with the HMO come January 1st?

(07-30-2015 02:10 PM)Kronke Wrote:  

(07-30-2015 02:08 PM)Redwingtom Wrote:  

(07-30-2015 01:58 PM)Kronke Wrote:  Do you know the difference between a PPO and a HMO?

A PPO has a much wider network, and you can even go outside of the network, it just pays less. A HMO has a restricted network, and almost no hospitals (MD Anderson included) accept it. If you go outside of said restricted network, it pays nothing.

Answer the question I posed in the OP, what will those BC/BS policyholders (individual, not group or employer) currently receiving treatment at MD Anderson do on January 1, 2016?

Again, what does this have to do with the ACA (aka Obamacare)?

Quite literally everything. The ACA laid the tracks for these insurance companies to run on, and they are pulling out after just 2 years.

That's a nice opinion. Do you have facts to back that up?

(07-30-2015 02:16 PM)Redwingtom Wrote:  To address the MDAnderson question. That list is from 2/18/15. How do you know that they will not participate with the HMO come January 1st?

The list is up to date. Network agreements are year to year, so there is no reason to update it again since February. The Blue Advantage HMO network had existed long before the ACA came about, and they (MDA) have never previously accepted it. I "know" from my background and years of experience working with insurance companies, but you'll just says that's another opinion, so I'll be sure to bump this in 2016 if and when it's confirmed.

A more promising outcome than relying on an HMO to be widely accepted (two concepts that contradict one another), is for a new plan to be in the works that we are not yet aware of that MD Anderson will accept, or for MD Anderson (among other specialty hospitals) to reconsider accepting other company's PPOs. However, if that were to happen, it would only create the same problem BC/BS is facing. Let's say they decide to accept Aetna, all the cancer patients would jump to Aetna, Aetna would be bombarded with claims, and the plan would be shut down.

I would love nothing more than to end up being wrong and you be able to shove this in my face, because as it stands, this is a nightmare situation for those who will be affected.

(07-30-2015 02:56 PM)Kronke Wrote:  

(07-30-2015 02:16 PM)Redwingtom Wrote:  To address the MDAnderson question. That list is from 2/18/15. How do you know that they will not participate with the HMO come January 1st?

The list is up to date. Network agreements are year to year, so there is no reason to update it again since February. The Blue Advantage HMO network had existed long before the ACA came about, and they (MDA) have never previously accepted it. I "know" from my background and years of experience working with insurance companies, but you'll just says that's another opinion, so I'll be sure to bump this in 2016 whenever it's confirmed.

A more promising outcome than relying on an HMO to be widely accepted (two concepts that contradict one another), is for a new plan to be in the works that we are not yet aware of, or for MD Anderson (among other specialty hospitals) to reconsider accepting other company's PPOs. However, if that were to happen, it would only create the same problem BC/BS is facing. Let's say they decide to accept Aetna, all the cancer patients would jump to Aetna, Aetna would be bombarded with claims, and the plan would be shut down.

I would love nothing more than to end up being wrong and you be able to shove this in my face, because as it stands, this is a nightmare situation for those who will be affected.

Yes, I understand that it's only a once a year thing...but the change does not take effect until 2016 so it would never be reflected in that list. Not saying that it will or won't, just stating that fact.

And nope...I'm not going to shove anything in anyones face. I'm well aware that there are issues with the ACA that cause problems for people. No legislation is ever going to be perfect.

I'm just asking if there is direct evidence of the ACA being the direct cause of this. I'm sure you're aware that it gets blamed all the time for things that existed before and after it for which it had nothing to do with really.

That's all I was trying to ascertain.

Thanks.

The Blue Choice PPO network (the one shutting down) also existed long before the ACA came about (I'll do my best to find you an exact date), but is now inexplicably (right?) shutting down 2 years after the ACA was enacted, citing losses of $400,000,000 this past year alone.

I will allow you to ascertain what you wish, but the answer is staring you in the face.

(07-30-2015 01:29 PM)Kronke Wrote:  Blue Cross/Blue Shield lost $400 million last year on their PPO product, and have decided to no longer offer it in 2016.

http://www.expressnews.com/business/heal...408174.php

That wouldn't be that big of a deal, except they were they were the only company that offered a PPO in Texas.

Imagine you're a current BC/BS PPO policyholder that is undergoing cancer treatment at MD Anderson. Your new insurance options for 2016 are BC/BS's Advantage HMO, Aetna, Humana, and United Health Care. Great, it appears you have a lot of options. That is, until you look to see which plans MD Anderson accepts.

From MD Anderson's website:
http://www.mdanderson.org/patient-and-ca...plans.html

Quote:Note: MD Anderson is not a participating provider for the Aetna Texas Marketplace plans.

Note: MD Anderson is not a participating provider for the Blue Advantage HMO Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the Humana HMO X Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the UHC Texas Marketplace plans.

What those people will do, I have no idea, but I imagine MD Anderson won't have any other choice but to kick them out come January 1, 2016.

Even MD Anderson will have trouble doing business without any Texas customers.

I suppose Texas can provide Diabetics like me with an affordable full coverage product. Or simply we just move to a system where every doctor gets a huge payment haircut because no one will pay them.

(07-30-2015 04:04 PM)Tom in Lazybrook Wrote:  

(07-30-2015 01:29 PM)Kronke Wrote:  Blue Cross/Blue Shield lost $400 million last year on their PPO product, and have decided to no longer offer it in 2016.

http://www.expressnews.com/business/heal...408174.php

That wouldn't be that big of a deal, except they were they were the only company that offered a PPO in Texas.

Imagine you're a current BC/BS PPO policyholder that is undergoing cancer treatment at MD Anderson. Your new insurance options for 2016 are BC/BS's Advantage HMO, Aetna, Humana, and United Health Care. Great, it appears you have a lot of options. That is, until you look to see which plans MD Anderson accepts.

From MD Anderson's website:
http://www.mdanderson.org/patient-and-ca...plans.html

Quote:Note: MD Anderson is not a participating provider for the Aetna Texas Marketplace plans.

Note: MD Anderson is not a participating provider for the Blue Advantage HMO Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the Humana HMO X Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the UHC Texas Marketplace plans.

What those people will do, I have no idea, but I imagine MD Anderson won't have any other choice but to kick them out come January 1, 2016.

Even MD Anderson will have trouble doing business without any Texas customers.

They accept most employers plans, group plans, Medicare and Medicaid. It appears they just want nothing to do with the individual market.

(07-30-2015 04:05 PM)Kronke Wrote:  

(07-30-2015 04:04 PM)Tom in Lazybrook Wrote:  

(07-30-2015 01:29 PM)Kronke Wrote:  Blue Cross/Blue Shield lost $400 million last year on their PPO product, and have decided to no longer offer it in 2016.

http://www.expressnews.com/business/heal...408174.php

That wouldn't be that big of a deal, except they were they were the only company that offered a PPO in Texas.

Imagine you're a current BC/BS PPO policyholder that is undergoing cancer treatment at MD Anderson. Your new insurance options for 2016 are BC/BS's Advantage HMO, Aetna, Humana, and United Health Care. Great, it appears you have a lot of options. That is, until you look to see which plans MD Anderson accepts.

From MD Anderson's website:
http://www.mdanderson.org/patient-and-ca...plans.html

Quote:Note: MD Anderson is not a participating provider for the Aetna Texas Marketplace plans.

Note: MD Anderson is not a participating provider for the Blue Advantage HMO Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the Humana HMO X Texas Marketplace plan.

Note: MD Anderson is not a participating provider for the UHC Texas Marketplace plans.

What those people will do, I have no idea, but I imagine MD Anderson won't have any other choice but to kick them out come January 1, 2016.

Even MD Anderson will have trouble doing business without any Texas customers.

They accept most employers plans, group plans, Medicare and Medicaid. It appears they just want nothing to do with the individual market.

They're going to face litigation on that.

(07-30-2015 03:54 PM)Kronke Wrote:  The Blue Choice PPO network (the one shutting down) also existed long before the ACA came about (I'll do my best to find you an exact date), but is now inexplicably (right?) shutting down 2 years after the ACA was enacted, citing losses of $400,000,000 this past year alone.

I will allow you to ascertain what you wish, but the answer is staring you in the face.

For what that is worth... I had it from at least 92 - 2002.... I remember it because of issues with my kids.

The far grander issue is that there is virtually no way for insurance to 'lose' in an unmanipulated market. They estimate their expenses and charge premiums accordingly, plus a profit margin. I guess they suddenly just got 'bad' at estimating things.

To those who don't believe, no proof will suffice.

(07-30-2015 04:11 PM)Tom in Lazybrook Wrote:  They're going to face litigation on that.

Why? There is no requirement that a hospital or provider be in 'every' HMO. They have to treat you to save your life, but they don't have to accept your insurance. Even HMOs have 'out of network' benefits for emergencies so don't say they won't get paid... They'll simply bill your HMO $5,000 for something they would have taken $1,000 for from a contracted vendor... collect $700 from your HMO and bill you for the remaining $4300.

We do it every day.

This is actually a very common issue with those policies. The mandated premiums don't cover the expenses in part because they are predicated on people being healthier in the future... but that requires providing even more care today. That math doesn't work.

I'd ask you Tom... as I recall, you have DM1, meaning it isn't a function of bad habits and there is treatment and management of symptoms, but no 'cure'. Not trying to 'out' you, as I believe you've used this as an example yourself... While I understand that you personally were probably fine either way, someone with fewer resources who now has increased access to care may avoid being forced into poor choices... you really aren't going to be any healthier until they find a cure, am I right? My point being that for many diseases, we are improving the quality of life for people which absolutely has merit, but it doesn't necessarily result in any long-term savings as programmed into the ACA. Heck, we will arguably be spending more by prolonging the lives of people who would have died early from things like untreated Hep c. Too much of the ACA relies on projections that increasingly seem overly optimistic (like most government programs). It's fine to ask the government to pay for 'quality of life' improvements for our citizens, but we are essentially asking insurers to do so... and that isn't going to work. This is why some argue that it's designed to force us to single payer.

For someone where their health issues are a result of poor decisions, how are they now encouraged to make better ones if we are treating their symptoms for free?

(07-30-2015 04:29 PM)Hambone10 Wrote:  

(07-30-2015 03:54 PM)Kronke Wrote:  The Blue Choice PPO network (the one shutting down) also existed long before the ACA came about (I'll do my best to find you an exact date), but is now inexplicably (right?) shutting down 2 years after the ACA was enacted, citing losses of $400,000,000 this past year alone.

I will allow you to ascertain what you wish, but the answer is staring you in the face.

For what that is worth... I had it from at least 92 - 2002.... I remember it because of issues with my kids.

The far grander issue is that there is virtually no way for insurance to 'lose' in an unmanipulated market. They estimate their expenses and charge premiums accordingly, plus a profit margin. I guess they suddenly just got 'bad' at estimating things.

To those who don't believe, no proof will suffice.

(07-30-2015 04:11 PM)Tom in Lazybrook Wrote:  They're going to face litigation on that.

Why? There is no requirement that a hospital or provider be in 'every' HMO. They have to treat you to save your life, but they don't have to accept your insurance. Even HMOs have 'out of network' benefits for emergencies so don't say they won't get paid... They'll simply bill your HMO $5,000 for something they would have taken $1,000 for from a contracted vendor... collect $700 from your HMO and bill you for the remaining $4300.

We do it every day.

This is actually a very common issue with those policies.

Correct, in case of emergencies.

However, for a planned hospital stay or outpatient surgery, if a hospital or clinic isn't in your HMO's network, your plan isn't going to pay anything.

(07-30-2015 04:29 PM)Hambone10 Wrote:  

(07-30-2015 03:54 PM)Kronke Wrote:  The Blue Choice PPO network (the one shutting down) also existed long before the ACA came about (I'll do my best to find you an exact date), but is now inexplicably (right?) shutting down 2 years after the ACA was enacted, citing losses of $400,000,000 this past year alone.

I will allow you to ascertain what you wish, but the answer is staring you in the face.

For what that is worth... I had it from at least 92 - 2002.... I remember it because of issues with my kids.

The far grander issue is that there is virtually no way for insurance to 'lose' in an unmanipulated market. They estimate their expenses and charge premiums accordingly, plus a profit margin. I guess they suddenly just got 'bad' at estimating things.

To those who don't believe, no proof will suffice.

(07-30-2015 04:11 PM)Tom in Lazybrook Wrote:  They're going to face litigation on that.

Why? There is no requirement that a hospital or provider be in 'every' HMO. They have to treat you to save your life, but they don't have to accept your insurance. Even HMOs have 'out of network' benefits for emergencies so don't say they won't get paid... They'll simply bill your HMO $5,000 for something they would have taken $1,000 for from a contracted vendor... collect $700 from your HMO and bill you for the remaining $4300.

We do it every day.

This is actually a very common issue with those policies. The mandated premiums don't cover the expenses in part because they are predicated on people being healthier in the future... but that requires providing even more care today. That math doesn't work.

Dont complain when you get socialized medicine

HB, don't blame us for not believing or being cynical every time we hear about the evil ACA without seeing the concrete proof.

The blatant lies and distortions the opponents have been telling for years and years...the countless stories that were continually debunked when looked into...the bogus kill grandma claims...the job killing lies...and on and on.

It's the same thing with Obama. The haters refused to stick to the issues and actual problems and went after everything under the sun from pastors, to birth certificates, to SSN's, to religion, to birth places, to book authors, to racism, to patriotism, to his wife, to her patriotism...I could go on for days.

(07-30-2015 04:42 PM)Tom in Lazybrook Wrote:  

(07-30-2015 04:29 PM)Hambone10 Wrote:  

(07-30-2015 03:54 PM)Kronke Wrote:  The Blue Choice PPO network (the one shutting down) also existed long before the ACA came about (I'll do my best to find you an exact date), but is now inexplicably (right?) shutting down 2 years after the ACA was enacted, citing losses of $400,000,000 this past year alone.

I will allow you to ascertain what you wish, but the answer is staring you in the face.

For what that is worth... I had it from at least 92 - 2002.... I remember it because of issues with my kids.

The far grander issue is that there is virtually no way for insurance to 'lose' in an unmanipulated market. They estimate their expenses and charge premiums accordingly, plus a profit margin. I guess they suddenly just got 'bad' at estimating things.

To those who don't believe, no proof will suffice.

(07-30-2015 04:11 PM)Tom in Lazybrook Wrote:  They're going to face litigation on that.

Why? There is no requirement that a hospital or provider be in 'every' HMO. They have to treat you to save your life, but they don't have to accept your insurance. Even HMOs have 'out of network' benefits for emergencies so don't say they won't get paid... They'll simply bill your HMO $5,000 for something they would have taken $1,000 for from a contracted vendor... collect $700 from your HMO and bill you for the remaining $4300.

We do it every day.

This is actually a very common issue with those policies. The mandated premiums don't cover the expenses in part because they are predicated on people being healthier in the future... but that requires providing even more care today. That math doesn't work.

Dont complain when you get socialized medicine

Feel the Bern!

(07-30-2015 04:46 PM)Redwingtom Wrote:  HB, don't blame us for not believing or being cynical every time we hear about the evil ACA without seeing the concrete proof.

The blatant lies and distortions the opponents have been telling for years and years...the countless stories that were continually debunked when looked into...the bogus kill grandma claims...the job killing lies...and on and on.

It's the same thing with Obama. The haters refused to stick to the issues and actual problems and went after everything under the sun from pastors, to birth certificates, to SSN's, to religion, to birth places, to book authors, to racism, to patriotism, to his wife, to her patriotism...I could go on for days.

How much does BCBS pay its executives? How much do the hospitals pay their executives...

While they charge different prices for the same service?

Cr*p like this drives support for regulation and taxes and fines.

I suppose that's a cute way for BCBS to drop Cancer coverage in Houston...just stop covering the hometown facility that provides cancer coverage.