Insurance questions

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I am through with active treatment, but stage III so will never be without worry.  I had wanted to go to MDA for a second opinion back during treatment, but my insurance wouldn't cover it and there was no way we could afford it.   Now I'm working again, and it's our open season.  I work for the government.  I want all my ducks in a row in case I developed any further problems.  

My ONLY complaint with my current health insurance, which is a plan local to my isolated city, is that it does not cover out of this state.  There is absolutely no point going anywhere in this state for medical care other than the city I'm in, so really I'm limited to my city.    

My options are BC/BS, GEHA (Government Employees Heatlh Assoc), and a whole bunch that are through postal workers or special agents groups that we can join for about $40.  Does anybody have any experience with any of these?  Any experience with what to look for in an insurance plan, or where I might find reliable ratings?

Edited to include:  I can't believe I left this out!  The problem with BC/BS is that they had a snit with the hospital where I've been treated and no longer pay any hospital charges there.  I could sort of continue with my oncology group with BC/BS, they'd just have to admit me to a lesser hospital, one that has had some problems. What a pain. 

 

Comments

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2011

    For $40, I would take it and run like a thief in the night...

    I had BC/BS many years ago and had no problems with it. 

  • scuttlers
    scuttlers Member Posts: 1,658
    edited December 2011

    You can also contact the breast center billing department at MDA and ask them which would be the best choice. They have been helpful guiding my upcoming Medicare choices.

  • LindaLou53
    LindaLou53 Member Posts: 929
    edited December 2011

    I have been on a BC/BS PPO plan through my husband's employer's group insurance for the last 11 years of my 2 separate BC diagnoses.  My experience with BC/BS has been great and I am very happy to have the coverage.  It is much better to have a national insurance that will provide coverage in many states versus the local type that you currently have.  The thing to remember is that an employer provided group plan will be "customized" to what the employer chooses to cover.  My BC/BS plan will be different from other BC/BS plans.  There is the basic difference between HMO and PPO plans plus the differences an employer defines in their group coverage.

    During your open enrollment period is the time to ask all the detailed questions regarding exactly what is covered by each plan.  Make sure you understand the "In Network"  and "Out of Network"  differences.  Remember that if one plan has better coverage for the types of services you will most likely need, it is worth paying a little more in co-pays or deductables. You don't want to find out too late that you have a plan that won't cover your trusted physicians or prescription meds or scheduled scans and tests.  So....make sure your HR department at work can tell you in detailed specifics what coverage you can expect for your personal medical needs.

    Just as an example...I have Lymphedema following BC treatments.  I had to call my husband's HR reps to verify exactly how much the insurance would cover for my lymphedema sleeves, gloves and night time garments that must be replaced every 4-6 months for the rest of my life.  Some insurances won't cover garments at all....some will only pay for one set at a time and limit the patient to 2 sets a year.  My BC/BS plan allows me to order 2 sets at a time and up to 6 sets of garments total each year.  It is the employer who picks and chooses which services they will make available to their employees...this is how they determine how much premium they will charge their employees.  Typically HMO plans will be cheaper than PPO plans, but that is because the degree of options and services available are fewer in HMO plans.

    So if there are certain diagnostic tests or supplies you know you will need each year you should verify now exactly what the coverage situation is from the various insurance companies you can choose from.  It is your employer's HR reps who will know those details or can find out the answers for you.

  • scuttlers
    scuttlers Member Posts: 1,658
    edited December 2011

    All that Linda said. Also, since you specifically want to go to MDA, contact them to make sure they take the insurance you are considering. My dear BIL had a very well know AARP plan with his Medicare, and was not able to even make an appointment for a consult there. So EVEN if it is a national plan there could be a problem.



    With my insurance (public employee benefit); MDA is covered as if they were in network. It has been really AWESOME.

  • Outfield
    Outfield Member Posts: 1,109
    edited December 2011

    I say MDA because here in New Mexico I'm not really closer to anything else.  Most of the time I've heard of someone from here going out of state for care, it's been to MDA, but I guess it's about the same distance to the west coast.  

  • MLizA
    MLizA Member Posts: 33
    edited December 2011

      I was a govt employee when I was diagnosed and my husband still is, so I go through the govt insurance review every year.... OPM's website (link below) is the best place I have found to see all the plans available to you based on your location and status/office and then you can select several to compare and they give direct links to each plan's benefits booklet.  I am in Colorado and use Aetna Consumer Driven Health Plan. It has never denied any treatment but it takes some time to understand how it works.  It is my experience that the Nationwide FeeForService and PPO's offer more flexibility.  GEHA as a FFS is a pretty good plan with less penalty when out of "network". 

     http://www.opm.gov/insure/health/search/plansearch.aspx

    Hope this helps,

    LindaP 

  • Wabbit
    Wabbit Member Posts: 1,592
    edited December 2011

    I'm a retired federal employee.  We switched to NALC a few years ago and have been very happy with it.  Even factoring in the yearly membership fee you pay their premiums are among the most reasonable.  I haven't had much in the way of claims since we switched but my husband has and they have paid everything quickly and with no hassle.  Every provider we have been in contact with has also accepted the insurance with no problem in that respect either.

    I think the website LindaP gave you above will have a Plan Comparison Chart available on it also. 

    Good luck with finding something that works better for you. 

    Edited to add ... we left BC/BS for the same reason.  They were playing a game of 'chicken' with our local hospital group threatening to not cover anything and then extending for just a couple of weeks ... rinse and repeat.  You never knew from one day to the next what the status was.  So when Open Season came we decided to bail out and let them play their games without us stuck in the middle.  Have been glad we did make the change since it turned out I like the new plan better.

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