Costco Aetna Health Insurance now available in CA

[bearishgurl]

[quote=Hatfield]Glad to hear folks are healthy. Let’s keep it that way, OK? 🙂

So it’s open enrollment season again. Quick recap: I was with Costco Pacificare since 2006, and good booted about a year ago when Pacificare pulled out of the individual marker in California. Went on the exchange and picked HealthNet which was one of several PPO options available. Was informed a few months ago that HealthNet was pulling their PPO plans out of the exchange.

it looks like (at least for my demographic) Blue Shield is the only company currently offering a PPO through Covered California. There’s probably 20+ other plans available to me, but they’re all HMO or EPO.[/quote]

For 2015, BSOC offers a PPO in all regions except for 1, 2, 6 and 9, I believe (where Anthem Blue Cross offers a PPO). BSOC is also is a member of the BCBS nationwide provider network (not sure about Anthem). Therefore, nationwide coverage is available to BSOC’s PPO members, not only for emergencies, but for everything. For this reason, it is the only carrier I’ll sign up for on the exchange and I am keeping my current plan for 2015, which will rise by $82.88 month beginning January.

[CA renter]

[quote=bearishgurl][quote=FlyerInHi][quote=CA renter]Great to hear it’s not cancer in both of your cases. 🙂

Yeah, it takes a while for the biopsy site to heal, but it’s always a good idea to get anything unusual checked out.[/quote]

FYI, insurance was charged $1198 for biopsy. I think you estimated $500.

I hate going to the doctor’s and using up resources for nothing, when I gain nothing.

I don’t see why people are so uptight about discussing medical costs. They should not be so opaque.[/quote]

Ironic that you posted this, FIH, and my Blue Shield file is sitting right here on my desk!

My ins was actually charged $578 for two visits plus a biopsy. But the EOB’s and bills indicate that $144.40 was pd by my ins co (per contract) and I paid $88.38 in copays/coinsurance for a total of $232.78.

Medical providers always charge a lot when they code procedures/visits for billing purposes but end up settling for the contracted amount from the carrier, whatever that may be. The rest is the responsibility of the patient.[/quote]

Brian, that is pure insanity! My family has a very high melanoma risk, so I am on a six-month exam schedule and often have at least one biopsy a year. You are being robbed.

I’m looking at my dermatologist bill right now, and the office visit was *billed* at $114; first biopsy at $168.00; and second biopsy at $51.00. The Blue Cross adjustment was ~$178.88, and they paid $113.97 with a $20 co-pay and $20.15 co-insurance payment from me.

Summary: $40.15 paid by me, and $113.97 paid by Blue Cross for the exam and two biopsies. Total of $154.12.

The dermatologist billed $306.00 for the pathology exam for these two specimens. Blue Cross adjustment of $113.30 and payment of $154.16. Co-insurance paid by me was $38.54.

Summary: $192.70 for pathology for *two* specimens

Total cost for full-body exam, and biopsy/pathology exam for TWO sites was $346.82.

——————

And, yes, I could not agree more about the need for **fully transparent** pricing for medical care. What they do now is totally unjustifiable from a business perspective, not to mention completely unethical and immoral.

[CA renter]

And you didn’t “gain nothing,” brian. You gained the knowledge (not to mention the peace of mind) that you didn’t have melanoma. Trust me on this…you do NOT want to blow something off because of some jacked-up belief about medical care only to find out later that it was melanoma. I cannot begin to tell you how very regrettable that decision was for so many people.

[CA renter]

[quote=Hatfield][quote=bearishgurl]Medical providers always charge a lot when they code procedures/visits for billing purposes but end up settling for the contracted amount from the carrier, whatever that may be.[/quote]

I have a theory about this. I think what might happen is that the provider initially sends a bill for “Rack Rate” which is sometimes ten or 20 times their contracted reimbursement rate. My gut feeling is that they do this so that if the patient is uninsured or the insurer denies coverage, they can go after the patient. If the patient can’t pay, they then sell the debt to a collection agency for the usual pennies on the dollar. Pretty shifty but that’s my theory.[/quote]

That’s an interesting theory, Hatfield. Probably pretty close to the truth. “Rack rate” medical billing has always bothered the hell out of me. That alone (and the opaque pricing issues that goes along with it) is a good reason to nationalize healthcare, IMO.

Good luck with your insurance choice. As you can see from my above post, we have a Blue Cross PPO plan, and have had no problems with it.

[Author]

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