Hello everyone,
Very interesting topic. Thanks to the OP and everyone who commented.
Uh? I thought a BCBS PPO plan would pay for medical expenses even for out-of-network providers?!
I believe I'm making some serious mistake here, and will be grateful if someone can set me straight.
Thanks in advance,
--
Vall.
A PPO plan is ONLY the ability to choose your own doctor or hospital within a preferred provider network or organization.
Provider "organization" is the key wording.
Contrast this with a HMO......you choose upfront, a doctor from a list of insurer provided practitioners and that doctor is stamped directly on the insurance ID card. This is the only PRIMARY doctor you can see and be assured of full plan premium coverage.
The insurance provider also dictates which hospital you can go to in order to stay within the plan's provisions and not pay any "non-preferred" up charges.
If you go outside that HMO or a PPO, to get treatment, say from Clark county (Las Vegas, Pahrump) to Washoe (Reno area) one is not within that "network" or "organization" that insurers have negotiated with a block of medical providers.
Note how every plan wants you to state upfront, and before any quotes are offered....enter a zip code.
What one block of medical providers have negotiated in the Las Vegas zips, other providers in a Reno zip MAY have not.
I believe doing due diligence and making a phone call to the plan providers and asking this specific question would be prudent.
"If I have Clark county as my home address, can I get plan coverage in Washoe county, or any locality I am in at the time, at the same cost or are there "out of network" up charges"?
Personally, I have resigned myself to just "plan" on routine doctor visits and be in my "network" at that time or take out a Medigap policy and ditch the Medicare Advantage plan.
Medigap policies do not have the "network" restrictions.
One thing I have found out during research of all this is......United Health Care has what they call a "passport" plan which allows a person to get medical care out of network, without the up charges.
This passport plan delineates what counties and in what states participate, and at this time, those counties are very limited.
There are a few hoops to jump, a person has to call UHC and tell them when and where you plan to be out of "network" and for what duration of time.
Costs for this passport plan necessitates a phone call also......premiums don't just jump out on the screen.
I had a lengthy (75 minute) phone call to a UHC representative who was beyond belief helpful.....she even dug up the list of states and their counties which participate in the passport program.
I have that list if anyone might be interested.
It all boils down to how much are you willing to pony up for monthly premiums. A HMO is the least costly and often no additional premiums are due, and if you want the freedom to see any doctor you want, within a delineated network, a PPO is going to make you pay for that freedom.
Caveat:....don't take an anonymous internet poster, on an internet forum as the gospel.