Can I Change From a Family Plan to a Single Person Planbluecross Blue Shield
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| i am being offered a pick of either aetna or blueish cantankerous/blue shield for our piece of work wellness program - both are pos. anyone out at that place accept a preference for 1 over the other?? thanks! |
10-27-2009, 01:ten PM 
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| Provider-wise, it is probable pretty difficult to beat BSBS of MA. I believe I had Aetna from a prior employer and have found we now take many more choices with BCBS. I'm going to assume in that location may be a departure that is important to you in your item situation: perhaps one is more expensive but has lower co-pays or improve perscription costs? Most recently we went from my wife's plan at Tuft's to BCBS. The most noticable thing is that co-pays went up another $5 to like $20/visit, but nosotros happen to at present have a dental plan that has human more providers than earlier. The skilful news is that you have both a job and health insurance! |
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| For the record - to paraphrase the belatedly Sy Spurling - I'm not but an Aetna employee, I'g also a customer. Only when people are "shopping around" I give them the full rundown on whatever specific criteria they're looking to meet. In that location'southward no point in omitting or sugar-coating anything in order to gain a policyholder who might end upwardly unpleasantly surprised. What'southward oft not fully appreciated is that health insurance is a major purchase that should be treated every bit such. I'm pleased that the TO is making this enquiry for that reason. Folks who spend months deliberating over all the pocket-size details earlier buying a business firm, car, or computer will nuance caput-on into selecting coverage which could stop up not serving them likewise as that from some other policy. Due to this, the commencement question I'd put to each company would regard what sort of "escape clause" they offer - is there flexibility in terms of cancelling, or are you "locked in" for a period of time? Scrutinize deductibles, the sums of money which have to be accounted for before benefit payments brainstorm. While it'due south tempting to pay a lower premium upward front in exchange for college deductibles, someone who's by and large in practiced health may end up with a poor return on their investment if they go with a high-deductible plan. But if the deductible is waived for certain medical services (emergency-room visit, routine physical) it'd testify to be a smarter investment. Detect out whether there are separate deductibles (i.e. for prescriptions) and also whether there are different ones to meet when providers both "in" and "out" of network are utilized. Whatever health care provider should exist able to tell you lot whether or not they're considered participants with any given insurer and policy type. Aetna offers to the public, through the aetna.com Website, the nationwide "Doc Detect" directory; whatever person or facility listed there should be "in network" and therefore payable accordingly. BC/BS and other insurers probably offering a like resource. Realize also that for the protection of policyholders on any programme with any company, in that location are provisions which allow for benefits to be paid at the higher in-network rate (subject to "out of network" limitations) under sure circumstances: an ER visit at a participating hospital where the md on duty isn't a programme participant, anesthesia during childbirth given past an out-of-network provider, etc. These provisions fall under what's chosen RAPS (Radiology/Anesthesia/Pathology/Surgery.) Then information technology could be the case that a certain hospital, for instance, is on lath with both potential plans but has a surgical staff which doesn't participate with 1 or either. RAPS could conceivably make this beside the point. "Pre-existing condition" has become function of the national vocabulary. Expect into whether each policy has limitations along those lines. They could be stringent (no benefits for a year, fifty-fifty none whatsoever) or non-real. And if a "Pre X clause" does exist, it could even so not be an consequence if in that location was previous coverage. The suggested federal guideline for an commanded lapse betwixt the end of one plan and the get-go of another is 63 days, but inquire of each insurer (or consult their sites) because this tin can and does vary. Co-pays (set fees per service) shouldn't be used in and of themselves as a ways of comparing benefits. There could be a college co-pay on i policy, only better coverage one time the co-pay is deemed for. "In-network" payments are fabricated based on an agreed-upon contract rate. So one plan may offer an 80% benefit afterward a $xx co-pay, while another allows for ninety% coverage after a co-pay of $50. Simply the contract rates may differ plenty betwixt plans to go far so that the actual out-of-pocket expense could exist lower for either case. "Big local network" is an easy trap to fall into. If the same family practitioner has been used for 37 years, and s/he participates with both potential plans, what does that matter? Look into how far the network internet is bandage. It's part of Murphy's Law that people become sick or injured while out of town for business organisation or pleasure. Are both policies linked in with nationwide networks, and if and then how extensive are they? This just seems similar a minor consideration until someone wakes upwardly in Vegas not with a new wedding band but with appendicitis, or trips over Minnie Mouse during the Main Street parade at Disney World and earns a chemical compound ankle fracture as a souvenir. Notice out also whether the respective plans extend their benefits around the world. It'southward a hassle to file medical statements and pay for services upwards front, but even an "out of network" benefit check from the insurer is amend than zero. One may never leave the US according to plans, but life doesn't work that way - deep discounts on air fare could make a trip to New Zealand or Romania suddenly possible, whereupon Potato's Law might go into effect. If at that place are dependent children in the family, ask specifically equally to whether and when there'due south a cut-off age. I regularly assist folks who never let that thought cross their minds until a letter from their insurance company arrived to let them know Tyrone Jr's policy will expire at the end of next month because he reached his 23rd birthday. One last matter to consider is that BC/BS' status as "non-profit" tends to be misleading. They have acquirement targets and contract limitations exactly as private insurers practise. That'due south why I take the opinions about unmarried-payor systems and public options that I do, despite potential implications to how I make a living. Treat this every bit a free customer-service phone call or time off from Web surfing |
Status as a full-time higher pupil also has an effect on how long offspring can stay on a parent's plan. Why face the bedevilment of getting Ty 2 onto another policy if you don't take to?
But think that Aetna, BC/BS, and every insurance carrier accept trained and defended staff to help with any questions. Cheers again for looking before y'all leap.| | |||
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| Give thanks you goyguy. My wife recently went in for surgery at Falmouth Ma hospital. The surgeon and infirmary were in network. The anesthesia and pathology lab were treated as out of network providers. Consequently nosotros received a bill for $2500. I have appealed this to United Health Care and hope that RAPS volition exist what saves me from having to pay this beak. |
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| I've used both providers. I similar my BCBS program MUCH better. Of course, both companies offering a variety of plans and so you lot have to read upwardly on what's existence offered... |
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| Thanks goyguy for a very structured mail. |
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