medical coverage while fulltiming

I am covered by Blue Cross/Blue Shield Florida and last summer while in Maryland, I had bloodwork at my doctor's request in order to get my Rx refilled.  He had provided me with the lab order prior to my leaving.  Just got a bill from BCBS for $345.  They say that Quest Diagnostics in Maryland is out of network, but Quest Diagnostics Florida is not!!!  Any similar experiences out there?  What do you Florida domicilers do when you full time and need ongoing meds?  Thanks for the input.

From past experience, I know the East coast has some strange insurance coverage.  It is always best to check with your insurance co to see if any procedure will be covered at the office you are planning to have the work done at first.  You may have to check with a couple of different places before you get one that your insurance covers.  Emergency treatment is usually handled differently, however.

Is  Blue Cross/Blue Shield Florida a Medicare HMO type plan?
We went with "old" fashion Medicare with an AARP supplement so we would always have nationwide coverage. More money than a local Medicare HMO type plan, but for us it works.
Before we retired, I chose a plan at work that covered out or area medical expenses while traveling, again a little extra cost.

Scratch that answer - not relevant to original question.

ArdraF

ArdraF said:

Scratch that answer - not relevant to original question.

ArdraF

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ArdraF, Huh? ???

We're meeting with a Medicare insurance "specialist" tomorrow.  This is a timely topic for us.

Sorry for the confusion, Max.  I was in a hurry and wrote something that simply was not relevant to the question so it was a hurried attempt at retraction.  That's all!

ArdraF

You need to carefully read the in/out of network coverage rules for whatever policy you have or are considering. Most plans have network stipulations, whether HMO or PPO type plans. But often they will have exceptions for temporary travel and will always allow for emergencies as well. Sometimes they also allow out of network providers if they will accept in-network rates.

if Medicare or a Medicare Advantage (Medicare C) plan, usually any Medicare-qualified provider can be used on an exception basis but HMO-type plans will require a referral from your primary care doctor.

In your BCBS case, the ultimate question will probably be whether the test could have been deferred until you got back in the coverage area. If the care was "necessary" while you were traveling, they will probably agree to cover it (at in-network rates), but if you went out-of-network merely for convenience they probably will not. Call BCBS and discuss why you needed to have the test done at that time & place. You can appeal their decision if you have just cause.

Gary, what you say is true.  My daughter lives in Washington DC and if her physician wants lab work done, an order is given.  My daughter then has to contact different labs to see if they will accept her insurance and call the insurance to see what labs are covered.
If she just goes to any lab, she may find none of the tests are covered.

This is quite different than the way insurance and the medical community works in Minnesota, where virtually everything is covered without the hassles of checking first, and a lot of lab work is done right in the MD's office.  Labs in DC are independent of physicians offices and insurance companies pay completely different.

My daughter lives in Washington DC and if her physician wants lab work done, an order is given.  My daughter then has to contact different labs to see if they will accept her insurance and call the insurance to see what labs are covered.
If she just goes to any lab, she may find none of the tests are covered.

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I just can't even imagine having to do all that when you have a serious illness. When you are sick or in pain, that stuff is the last thing you want or need to do.

I have HealthPartners in Minnesota and I love them because they are all about prevention. Lab visits are free and are almost always done in the doctors office or at least at the same clinic. You can even go to any other clinic in their system and have tests done if its more convenient. I like that.

Im not sure how thats going to work for us once we are on the road. My DH can get medicare and VA both but I will need something else.

Having just gotten health insurance for Tara, we're familiar with the choices. In BCBS (Texas) we had to select a plan that specifically covered the full United States. Cost per month was about $200 more than an equivalent plan covering in state only. We used the Federal government's site and found it to work smoothly both for '14 and'15.

Ernie

cadee2c said:

I just can't even imagine having to do all that when you have a serious illness. When you are sick or in pain, that stuff is the last thing you want or need to do.

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It took them 3 mos to diagnose my daughter with C. Diff.  One month to get a doctors appt.  One month to get into a lab and then one more month for the lab to get the results back to the doctor.  The doctor then made my daughter make an appt to go over the lab work.  My neighbor is a physician and she said to have your daughter fly home next time and she would take care of the whole thing in 2 days-and for this particular thing my neighbor said she would have done it for free. Airfare would have been cheaper too.

What makes it worse is that it took 2 visits to the MD before she would order tests.  As I told my neighbor what was happening she said.  "Oh she has C. Diff."  I called my daughter and that's when her physician ordered lab tests.  Ok, enough of my rant.

At the risk of adding to the confusion, I actually work for Blue Cross South Carolina, am a fulltimer, have a PPO plan, and have lived in 17 states in the last five years. I have yet to be refused payment at any stop for any procedure or lab order. And I bet I have filed in almost all those states. Here's the caveat - that's how my plan works!

All the Blues cover differently, so one size does not fit all. The Blue Cross and Blue Shield System consists of 37 independently operated Blue Cross and Blue Shield member companies, a Federal Employee Program and an Association.

In these days and times, it is more critical than ever that you CLEARLY understand your policy, ask specific questions, and understand that the policy premiums AND coverage are subject to change each enrollment period, typically annually. Do NOT listen to how others get coverage, even in the same system, unless you clearly understand YOUR policy.

Medicare is secondary coverage for me, so I can get into some interesting claim conversations, but all in all, it has worked, pretty flawlessly.

My plan also includes drug coverage and I use Walgreen's across the country with very little effort. Online ordering and the prescription is filled at the location of my choice or mailed to me. No issues with state to state refills except for some controlled substances.

Nobody wants to become a claim expert, because it is complicated and frustrating, but to adequately maneuver the new waters, you are going to have own your health care and how it is reimbursed.

It is the new normal.

Kim