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Sure, I'd rather choose a doctor who takes my insurance, especially while I have this fairly good plan. I would have liked to see Boachie, though, or at least been sure, I was really ineligible. (From this thread, it's seeming to be uncertain). I certainly don't want to fear later, that something went wrong because I had to compromise on my surgeon!
There is a serious problem in determining benefits, though. As I said, the payout is basically only figured out at processing! That's done according to a complicated series of "translations" . My plan's benefits (one of a subset of other Blue Cross PPO plans) have to be priced in the framework of acceptable charges in THAT facility's Blue Cross plans (the one the surgeon, anesthesologist and hospital work with - hoping they're the same)
Some states have at least a dozen Blue Cross companies (New York City alone has three primary ones), each of which has upwards of a dozen plans - they designed them individually for various companies and markets. Those many plans are further broken down by levels of benefits too - Bronze silver, gold, acrylic (JK! Wanted to see if you were listening). All pay and charge premiums by zip code - a fast and sloppy way of approximating level of usage and cost of care.
Blue Cross - a PPO plan like mine, anyhow - is, in many ways, the best. I can go ANYWHERE and to ANYONE, where Blue Cross is taken.
What is NOT ideal, is it's virtually impossible to know what it will cost you in advance because of all the translations. My plan benefits have to be translated into what the new area's U & C reimbursements are.
And there is always the risk some acceptable MD may send me to a lab or radiology facility which doesn't take my insurance. It already looks like that's happened at least once, and I'm afraid I have a mass of fights in front of me - about the legitimacy of what charges I' m supposed to have incurred!
One "EOB" (Explanation of benefits) envelope I opened yesterday had a key indicating what whatever some doctor was charging me, was for a service not even recognized as medically necessary by my plan for my diagnosis!
I can't imagine how that happened, or what it means. I'll bet some busy surgeon will be forced to write a letter justifying it, though - why it wasn't a routine bone density scan (just a guess at the problem).
There are too many damned things to think of in advance, and I'm afraid once I'm hospitalized it may be even more complicated as various charges are incurred without regard for my coverage...
No one could go grocery shopping without price tags, much less car -shopping and this is equal to about ten+ nice new cars!
Furthermore, the amounts are so vast, Surely there has to be some way to learn in advance what to expect. Sometimes I suspect they just wing it on the day they get every pile of out of state claims, having no real standard to go by. It's NOT just a matter of choosing a doctor who takes BC!
There is a serious problem in determining benefits, though. As I said, the payout is basically only figured out at processing! That's done according to a complicated series of "translations" . My plan's benefits (one of a subset of other Blue Cross PPO plans) have to be priced in the framework of acceptable charges in THAT facility's Blue Cross plans (the one the surgeon, anesthesologist and hospital work with - hoping they're the same)
Some states have at least a dozen Blue Cross companies (New York City alone has three primary ones), each of which has upwards of a dozen plans - they designed them individually for various companies and markets. Those many plans are further broken down by levels of benefits too - Bronze silver, gold, acrylic (JK! Wanted to see if you were listening). All pay and charge premiums by zip code - a fast and sloppy way of approximating level of usage and cost of care.
Blue Cross - a PPO plan like mine, anyhow - is, in many ways, the best. I can go ANYWHERE and to ANYONE, where Blue Cross is taken.
What is NOT ideal, is it's virtually impossible to know what it will cost you in advance because of all the translations. My plan benefits have to be translated into what the new area's U & C reimbursements are.
And there is always the risk some acceptable MD may send me to a lab or radiology facility which doesn't take my insurance. It already looks like that's happened at least once, and I'm afraid I have a mass of fights in front of me - about the legitimacy of what charges I' m supposed to have incurred!
One "EOB" (Explanation of benefits) envelope I opened yesterday had a key indicating what whatever some doctor was charging me, was for a service not even recognized as medically necessary by my plan for my diagnosis!
I can't imagine how that happened, or what it means. I'll bet some busy surgeon will be forced to write a letter justifying it, though - why it wasn't a routine bone density scan (just a guess at the problem).
There are too many damned things to think of in advance, and I'm afraid once I'm hospitalized it may be even more complicated as various charges are incurred without regard for my coverage...
No one could go grocery shopping without price tags, much less car -shopping and this is equal to about ten+ nice new cars!
Furthermore, the amounts are so vast, Surely there has to be some way to learn in advance what to expect. Sometimes I suspect they just wing it on the day they get every pile of out of state claims, having no real standard to go by. It's NOT just a matter of choosing a doctor who takes BC!
Cervical stenosis op'd 3-07, minimally invasive
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