Blue Cross and Blue Shield Standard Vs Basic
| Michael | #1 Posted : Wednesday, November 2, 2011 12:14:35 AM(UTC) | ||
| Rank: Newbie Groups: Registered | Thinking about switching from Blue Cross Standard Option to Basic Option. I've viewed the chart available at the OPM web site to compare the plans and am seeking the pros and cons of each option compared with the other from those who have previously made the switch. I am retired, over 60 (but not yet eligible for Medicare), and am on several prescribed medications that are regularly refilled; some generic and a couple that are not. Any sharing of your personal experience with BCBS Basic Option, especially in comparison with Standard Option would be greatly appreciated. | ||
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| emkute | #2 Posted : Wednesday, November 2, 2011 5:19:36 AM(UTC) | ||
| Rank: Groupie Groups: Registered | I switched from Standard to Basic a few years ago. To get a handle on the drug cost impacts, I went through the previous year's prescriptions (quite a few, both generic and not) and estimated costs assuming I was with Basic instead of Standard. Assessing other costs is more difficult to do but a major factor is using preferred providers. In my case, Basic is to my advantage due to premium cost. | ||
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| upandup | #3 Posted : Wednesday, November 2, 2011 1:34:01 PM(UTC) | ||
| Rank: Senior Member Groups: Registered Was thanked: 17 time(s) in 16 post(s) | BCBS Basic in many ways has lower cost-sharing (copays/coinsurance) than Standard. In addition, it has lower premiums. There are some services not covered under Basic but covered under Stanard, and Standard allows you to go out of network, while Basic has zero coverage at domestic non-PPO providers except for emergency care. | ||
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| shelter1 | #4 Posted : Wednesday, November 2, 2011 9:40:40 PM(UTC) | ||
| Rank: Advisor Groups: Registered Was thanked: 1 time(s) in 1 post(s) | I also made the switch from Standard to Basic a few years ago and never regretted it. However, you must stay in network or they won't pay anything. I do NOT take any medications, so this was the best choice for me. I did have to take an antibotic drug during the year, and dr. prescribed the generic. It was very cheap, BUT I did use a preferred pharmacy which was not a problem. There are so many to choose from. | ||
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| John | #5 Posted : Wednesday, November 2, 2011 11:17:14 PM(UTC) | ||
| Rank: Senior Member Groups: Registered | I've had Basic for 3 years and been mostly pleased (3 people on plan). I live in an area where many providers are preferred and Caremark network is stong. You sometimes have to watch what they classify things as. I had an minor biopsy done, in a doctors office, and they classified it as outpatient surgery with a $100 co-pay. But for premium costs vs out of pocket costs, I like it. I check every year, but have no expectations of switching | ||
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| mikedelta | #6 Posted : Tuesday, November 15, 2011 9:08:37 AM(UTC) | ||
| Rank: Rookie Groups: Registered | I have been with Basic for 3 years. I am 66, my wife three years younger. No complaints..except the volumes of statements from BCBS. As long as I review and file them immediately all is well. have not taken Medicare Part B yet. | ||
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| John | #7 Posted : Tuesday, November 15, 2011 9:26:40 PM(UTC) | ||
| Rank: Senior Member Groups: Registered | I agree..BCBS does spend a lot of money on 'paper' information. (yet they are going 'green' in 2012 and not sending out booklets unless requested) You get a payment statement for each doctor, procedure, test, Lab. If you go to a doctor and have Lab/tests done you may get 4 or 5 statements for the one visit. Last year I probably got over 150 of them. | ||
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| Dot | #8 Posted : Thursday, April 12, 2012 9:26:02 PM(UTC) | ||
| Rank: Senior Member Groups: Registered | Since I have been in hospital a few times the past few years = how does Basic handle those non-participant Doctors when the main Doctor and hospital are both participating members | ||
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| shelter1 | #9 Posted : Thursday, April 12, 2012 9:54:00 PM(UTC) | ||
| Rank: Advisor Groups: Registered Was thanked: 1 time(s) in 1 post(s) | Angel - BCBS won't pay anything if you go out of network under the BASIC plan. Even if the primary doctor and hospital ARE in the network, they won't pay for any other service provided by someone not in their network. I went for a routine bone density test at a participating hospital. I received the test at the Radiology Dept. at the participating hospital as I have done in the past without problems since BOTH the hospital AND Radiology Dept. were listed as participating facilities in the BCBS booklet. I was shocked to get a bill for $172.00 from the hospital's radiology dept. I called BCBS and was told that on that particular day that I received the test the Radiology Dept. of that hospital was not a participant. I found the BCBS booklet and quoted the page number where they could find the Radiology Dept listed. I was informed that these facilities can go in and out of network on any given day! Even though someone is in the book, they said I should have called the facility on the day of my x-ray to ask if they were still in network. This is ridiculous. I then called the hospital's radiology dept. and explained what happened. They reduced my bill to $86.00 and apologized saying that it was BCBS who kicked them out of the plan for a week and then reinstated them. Can you believe it? So from then on I have made it a point to call on the day of any test to be sure I am staying in network as I still have the BASIC Plan. Bottom line - You can't trust the book since it is printed only once a year and things can change throughout the year. | ||
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| Kathi52 | #10 Posted : Thursday, April 12, 2012 10:25:50 PM(UTC) | ||
| Rank: Senior Member Groups: Registered Was thanked: 1 time(s) in 1 post(s) | Wow, when I read these posts it is unbelievable! And, no, not being snarky. It is just astounding! I have had BC/BS Standard for 34+ years and have NEVER had these problems. I realize you don't always know if the docs, techs, etc. are participating. And I used to go to the ER all the time before any fusions (long story); had all kinds of tests, surgeries, procedures through the years. So, the only thing I can think of is that the staff at my own hospitals are all network providers. The same thing must hold true for the Imaging Centers as well. I don't know, must be the locale or something and/or the Basic plan itself. Anyway, with Standard, I just don't worry about it, the staff does the pre-cert and that sort of thing. And since 2005, having Part B is even better. Bottom line is...I have absolutely no complaints thus far. And of course, Tricare does their part. | ||
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| Dot | #11 Posted : Friday, April 13, 2012 7:55:17 AM(UTC) | ||
| Rank: Senior Member Groups: Registered | Ah Tricare as tp BC/BS standard | ||
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| Steve Johnson | #12 Posted : Friday, September 21, 2012 10:22:53 PM(UTC) | ||
| Rank: Newbie Groups: Registered | I am going to do a separate post on the subject, but it is relevant to the differences between basic and standard at least in those plans administered by Anthem (Wellpoint). A major justification for the premium differential is that standard provides for reimbursements when out-of-network providers are used. Using out-of-network providers is not always elective; for many specialties and specific procedures there are no participating or preferred providers, and frequently these are very complex and expensive services. Under the plan brochure the plan allowance will be based on 100% of the usual, customary and reasonable amounts (UCR) subject to 35% coinsurance (but see later). UCR is a term of art in the insurance industry and is an amount based on actual billed charges and market rates. Anthem does not adhere to industry practices with respect to UCRs, and purports to not be subject to industry standards because FEHB is a federal program. Anthem does not utilize any actual billed charges or market rates, and relies solely on preferred provider and Medicare schedules in determining plan allowances. I am reasonably certain that their methodology will always result in the Medicare fee schedule amount being the plan allowance. The difference can be huge, and the member is liable for the full amount charged by the provider. Thanks to a major industry-wide investigation by the NY Attorney General in 2009, consumers can now gain access to true UCR amounts at no charge through the auspices of fairhealthconsumer.org. If you are curious, go there and do a search for CPT code 21196 and the first 3 digits of your zip code followed by 01. For a real eye opener, do the same for New York City's superzip, 10001. I'll mention that for discrete services that exceed $5,000 there is an alternative calculation of the reimbursement that is somewhat more generous (page 130 of 2011 brochure). However, the calculation is based on the plan allowance and is watered down considerably when it is set at the Medicare rate as Anthem does. chinnboy2012-09-22 09:06:06 | ||
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| OUtside | #13 Posted : Saturday, September 22, 2012 7:02:30 AM(UTC) | ||
| Rank: Senior Member Groups: Registered Was thanked: 54 time(s) in 51 post(s) | I think a discussion of this topic should go into the details of 2012 plan brochure page 132 where non participating providers are discussed. Paraphrasing the paragraph re: doctors says they use the greater of the Medicare rate (or 60% of the billed charge if there is no Medicare rate) or 100% of the UCR for the geographic area (local plans determine UCR in different ways). Offhand I would not see a problem with this. I have noticed other fehb plans quoting different methods for setting rates, but in the past, I have not read any publications recommending concern along these lines and I have not been concerned about it when making plan selection. Should I be concerned about it? Your posts says they may use PPO rates but I am not sure why this would be a problem assuming PPO rates are reasonable; also, why would anyone expect a plan to pay using higher rates than it uses for its own network?. There are two ways to look at this: the plan provides the coverage as if the provider were in network; or it pays higher than if in network. What is justification for thinking the latter? For subscribers age 65+ with and without Medicare Part B, let’s remind ourselves the plan must use the Medicare rate for the doctor’s charge if doctor accepts assignment; and if doctor does not accept assignment, doctor cannot charge more than 115% of the Medicare rate where subscriber, without or without Part B, pays the additional 15% out of pocket. As the Medicare rate is usually a low rate, 115% of Medicare rate should usually protect retiree age 65+ from a sky high rate. | ||
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| Steve Johnson | #14 Posted : Saturday, September 22, 2012 11:30:48 PM(UTC) | ||
| Rank: Newbie Groups: Registered | As for your last point, the 15% Medicare override limitation is a significant protection and probably adequate for Medicare-covered members. The analog for non-Medicare enrollees is at page 133 p.3 of the 2012 brochure, and is far weaker. For them, the issue should be of major concern. It is not a safe assumption that preferred provider rates are "reasonable". In my case, Anthem refused to disclose the preferred rates for the procedures in question, and I was told that the only way I could ascertain them was to have the service performed and review my EOB. I tried to ascertain from my preferred primary provider how the Anthem preferred provider schedule was structured They were either unwilling or unable to answer in writing, but one person who has years of experience in this area stated that nearly all PPO base their preferred schedules on the Medicare fee schedules, either at parity or at some multiple, i.e. 120% of the Medicare rate. I did extensive research and it that it is a commonplace weakness with PPO plans that many specialists will not participate because of this. In my area, there are at least 16 providers who perform the procedure, and none of the are either Anthem or Medicare participating. I looked at the FEHB PPO plans in my area, and Anthem is the only one that prescribes the use of UCRs for out-of-network providers without describing in detail how they derive UCRs. Anthem provides no description, and in my sojourn was given 3 totally different and conflicting explanations. It is because of their obfuscation that I can't say for a fact certain that out-of-network allowances are the Medicare fee schedule rates, but I am nearly certain that is the case. What I can state for a fact certain is that in my case the plan allowance was equal to the Medicare fee schedule amounts for each of the 4 services involved, and each was far below the true UCR amounts. This is not a new issue. It was the focus of major investigations by the NY Attorney General and a U.S.Senate subcommittee. I'm not sure if I can post links here, but a search for "Senate Underpayments to Consumers by the Health Insurance Industry" and "NY Attorney General Code Blue" should lead you to their reports. The Senate report findings strongly suggests that as a result Wellpoint/Anthem has changed their methodology, from using doctored actual billing data to the (much lower) Medicare fee schedule. chinnboy2012-09-23 07:40:19 | ||
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| #15 Posted : Sunday, September 23, 2012 12:43:49 PM(UTC) | |||
| Rank: Guest Groups: Guests Was thanked: 15 time(s) in 15 post(s) | SO FOLKS - I just signed up for Medicare B as it was about the amount I will be receiving on my own social security = very important, at least for me - although I had 42 years CSRS I made sure that I had enough quarters working part time believe me it does ad up I just had my second cataract surgery and surgeon does not accept anyone that has any co-pays etc. People like me have to have Medicare B or some supplemental to cover everything - must admit tho = do enjoy not paying anything - | ||
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| FSUGuy | #16 Posted : Sunday, October 7, 2012 10:56:57 AM(UTC) | ||
| Rank: Senior Member Groups: Registered | I'm also thinking about making the switch. I would save just under $700 a year. I do like the freedom to see any doctor without worrying about in network/out of network. Is that worth $700 more? Additionally, I'll be greatly increasing my FSA contributions. I'm healthy, but there is elective stuff I can use it on for before the deadline. | ||
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