Blue Cross HMO?

[debster913]

Hi, all--
I don't post often since I'm not a valve replacement patient (yet), but I know a lot of you have had issues with insurance, and maybe you can help me out.

I've had Blue Cross since I started working 5 years ago, and open enrollment at the school district I work for is coming up next week. The PPO option (called Blue Cross PCA--it replaces the POS service from last year) does not seem plausible. It would take a lot out of my paycheck every month, more than I'm willing to do, especially since my husband is in between careers. The HMO is a lot less, and I'm considering switching over.

If any of you have/were on an HMO plan through Blue Cross, what was your experience? Would you recommend it? Or should I just "bite the bullet" and choose the PCA?

BTW--I see my cardio twice a year. Had a TEE in April. Dr says I still have mild to moderate regurgitation in my mitral valve. Surgery to replace the valve may be a long way off. I see him again next month. Basically, I guess I'm concerned that should I suddenly need VRS, the HMO would cover it.

Thanks in advance for your replies.
Debbie

 

[geebee]

Debbie,

Switching to an HMO requires a bit of research. For example, are the doctors you see part of the HMO? Should you need surgery, would the hospital be in the HMO? What are the requirements for tests, surgical consults, etc.

I always advocate a PPO because it gives so much freedom. However, when money is an issue, if you find out all the care you need is covered by the HMO, then you should be OK.

Just be sure and do your homework before changing.

 

[Gail in Ca]

HMO experience

HMO experience

I now have Bl Cross HMO and have chosen the Palo Alto Medical Clinic, which, luckily for me, my cardiologist and GP belong to. I went to them when I had PPO, and when I needed surgery, I was recommended to Stanford Hospital, used a great surgeon there, and it was covered. Just about any specialty I have needed is covered at this HMO. If not, they refer outside and cover it.
My husband and daughter have chosen a different group and so they must be recommended to see specialists within that group, just like me with the PAMC. Sometimes, we have to drive about 40 miles to see a specialist or have a test done at the place the specialist uses.
So far, it has worked out well for us.
But, if the PAMC builds their own hospital and offers heart surgery, then I would consider paying more for PPO so I could use Stanford again.
Gail

 

[jax3172]

I have Blue Cross

I have Blue Cross

We have BC/BS POS (point of service). Most things are covered 100% but you really need to ensure you get all the proper prescriptions, referrals, and pre-cert (for some stuff). Hope that helps.

 

[KristaDeAnn]

Hi,
I have Blue Cross California Care HMO, they have paid 100 % of my mvr surgery that I had at Loma Linda University Medical Center on May 31, 2005.
I have not had one problem..with anything having to do with insurance. The most I have paid is the 5.00 copay for my regular doctor visits. I know my angiogram was 9000.00 and I have gotten a copy of the bill (just for my room at the hospital...not including the surgery,anthesiologist, etc) and they were billed 86,000.00. The contracted amount that they will actually end up paying will be 24,000.00. I am not responisible for any of the difference. Blue Cross has been wonderful....I have not had to deal with them at all. Once the surgery was approved..everything has been a breeze..I have yet to make a phone call to them. I am now going to try and get a home testing machine so I will be interested to see if they will cover any of the cost..especially the supplies..
Krista