We’re trying to get info from our insurance company about an issue we’ve been having with some bills being billed as out of network when they were in network. I called my Blue Cross insurance to talk to them about my bills. Vince didn’t really believe me when I told him that my insurance coverages ends when I leave the state of Texas so I asked them again. Yep . . no doctor visits are covered. If I had a “real” emergency and had to go to the ER and it was submitted as a “life or death” type ER, that would be “considered” but would still be out of network. I understand the out of network but how on earth can “affordable” care insurance stop covering you when you leave your home state? Blue Cross is our only option in Texas.
I called one of the virtual doctor visit places and their charge for a virtual visit is $75. I can do that if I should get sick while in MO.
I’ve had this insurance since June 1 and I’ve been to MO . . what . . twice already? I didn’t worry about it so much then but it wasn’t cold, flu and allergy season. Not sure a virtual visit will do the trick if I slip on ice and break my neck so let’s just hope the worst that can happen is I need an antibiotic or cough medicine!
I really cannot get over that I pay ovr $1,000 per month for insurance and this is what I get. Since I’m going to be out of Texas for over 1/4 of the month, I wonder if I could ask for a refund for that portion of my bill!
OK . . rant over . . not really but I’ll be quiet about it for a while.
marcille irwin says
All I can say is, “Don’t get me started”. I just wish that they would outlaw health insurance companies – they are such a ripoff. I’ll stop there
Shirley Hobbs says
I agree with you 100%
tiptopquilts says
I agree! We are in our early 40s, pay over 1600 month to insure ourselves and 8 year old with outrageous deductibles. We are both self-employed, so could really work the system, but we chose not too.
Wendy P says
Hi, Judy
Not sure how your insurance works, but we get extra coverage for when we travel through CAA. Yours would be AAA. It’s called Travel Gold up here and we pay by the year. You have a few options for length of travel – 10 /15 / 30 days I think. Might be worth looking into.
Judy Laquidara says
It’s all so complicated. First, as far as I know, AAA only offers health coverage if you purchase a trip through them, and I am not. I’m driving and staying at my son’s house. Second, I think it only only affords coverage while traveling outside the U.S. But, since, in my opinion, the insurance situation in the U.S. is in such a horrible state, we just don’t have many (if any) options.
montanaclarks says
That’s so weird, I have BCBS of Montana and I’m covered no matter where I am.
Judy Laquidara says
I yours an HMO? We had BCBS of MN for years while Vince worked and we were covered anywhere too but that was a PPO.
Cheryl Lorence says
This whole “affordable healthcare act” is anything but. Most people I know feel just like you. They have less coverage and higher deductibles and premiums than before we had this forced upon us. So much for “if you like your insurance and your doctor you can keep them. I never thought I’d be looking forward to Medicare age but still have a couple years to go.
Sherry V. says
This isn’t about insurance…but I applied for Family Medical Leave since I ran out of sick time at work. My husband was having a surgical procedure and I was going to be with him.
Prudential, the carrier for my companies FMLA program denied my *unpaid* leave because the doctor did not specifically put done on the medical form that I had to be there.
I could not, can not, figure out for the life of me what they expected me to do….put him in a taxi to the surgery center and then back home?
Health care is a crock…..the only ones that are making out are the politicians that don’t have to deal with the mess they created.
Ok, my rant is over now too.
Linda in NE says
Health insurance is such a rip-off. Premiums are outrageous. If you have a claim the ins. companies do their best to deny it….or not even cover you if you go out of state. How crazy is that? Might as well go to the casino. Your chances of coming out ahead are about the same.
marcille irwin says
It’s funny that you said that about going to the Casino because I’ve long said having insurance is just like gambling in a Casino – and the insurance company is the house, and the house never loses because they are in absolute control
Nelle Coursey says
This is absolutely ridiculous! I can understand if you went out of the country, but to another state!! That is just not good!! Or even ethical as far as I am concerned!
Marla Willier says
Sounds complicated. I’m Canadian so I have public health care. When I travel out of province or country my private insurance through my employer kicks in.
dezertsuz says
If you haven’t gone to a doctor out of state, how are they billing it as out of network? They are truly messed up!
Judy Laquidara says
Two totally different issues. It was a provider here in town that was billing some of our bills as out of network, even though they were all in network. Still trying to get our money back from them.
Lani says
I agree with everyone. I call Insurance for anything, homeowners, health, car as necessary evils. I feel the same about cable companies and airlines.
Terri Schanz says
As a former insurance biller, I can tell you that you should dispute EVERY denied claim you get. Insurance companies deny a certain percentage of claims just to delay having to pay them or in hopes that you won’t know any better and just pay the bill yourself. Also, they make errors. Lots of them so you should always check and make sure your claim was determined correctly. In addition, billing staff at health care providers are often poorly trained and not very knowledgeable about how to submit complicated claims or question denied claims. As for your coverage outside of Texas,, you should always read he fine print when dealing with insurance companies to make sure you know exactly what is covered and what is not. Even though BCBS is your onlly option in Texas, they probably have other plans available that offer coverage outside your state. They probably cost more, though. When we were buying insurance from the Marketplace, we weighed what our needs were against what plans were available. We chose to pay a slightly higher premium to have doctor’s office visits and prescrptions covered before deductible since we both have chronic health conditions and take multiple meds. Now we have Medicare, but that’s not any better. I’ve had probably $5,000 worht of tests in the last couple of months for the sole purpose of getting Medicare authorization to pay for treatment for things I’ve been treating for years. It’s just now that I have Medicare, I have to jump through THEIR hoops because it’s not enough that i have the history. And I have to pay the 20% copay because they needed papaerwork. My treatment hasn’t changed. My conditino hasn’t changed.. Just my insurance.
It’s a racket for sure. The days of employer provided insurance where you could go to the doctor and not have to worry about what and if your insurance will pay are over. You have to become a knowledgeable consumer of health care and know what your plan coves, how to appeal a rejected claim and learn how to advocate for yourself so you dn’t get cheated out of coverage you pay for.
Judy Laquidara says
BCBS only offers HMO policies here. There are only four or five options and there isn’t much difference in any of them. I have the one down from the “best”. There’s no use disputing any denial – it’s right there in my policy that they don’t pay out of state. I knew that when I bought it but had no real choice.
As far as reading the policy, yesterday I called BCBS about a question. I was on hold 34 minutes while they researched the question (do you pay for virtual visits?), they had to call me back. They said “the language is unclear in the policy”. So … how am I supposed to figure it out if they can’t? Ridiculous!
Vince has been really happy with Medicare coverage/payments. After paying his $183 deductible, he hasn’t had to pay a dime otherwise.
I do have to say the BCBS web site is very easy to navigate and the people there are always friendly and helpful.