Blue Cross Blue Shield of Texas will begin phasing out its PPO coverage
Blue Cross Blue Shield of Texas has announced that it will be phasing out its PPO coverage for individuals. The health insurance providers is doing so because it believes that offering this coverage is no longer financial sustainable. Those with PPO coverage from the insurer will have to switch to HMO plans as a result. Notably, the company’s PPO plans will continue to be offered to employers and group PPO plans will still be available.
Cost of claims is going up for many health insurance providers
For many insurers, the cost of medical claims has become a major financial burden. The number of claims has grown significantly since consumers began using health insurance exchanges to purchase coverage. The cost of medical care has also been on the rise. This combined with the growing number of claims has lead some insurers to make difficult decisions. For some, these decisions come in the form of discontinuing certain health insurance products.
Consumers may have to find new policies if they want to keep their doctors
For those in Texas with Blue Cross Blue Shield coverage, they will have to decide whether or not they would like to choose a new doctor once they switch insurance plans. Because the insurer is discontinuing its PPO offering to individuals, many will have to find new doctors or new insurance providers. They may be able to keep their doctors if they switch to one of the insurer’s HMO plans, but they will have to do some research into these plans to ensure that this is the case.
Change from Blue Cross Blue Shield of Texas is expected to affect 400,000 consumers in the state
The changes that the health insurance company is making will not go into effect until January 1, 2016. As such, there is still time for customers to ask questions concerning how the changes will affect them and what they can do to keep their preferred doctor. The change is expected to affect some 400,000 consumers in Texas.
I did some checking tonight at the Texas Blue Cross website. When Blue Cross cancels the 400,000 PPO Plans on 12/31/2015 and moves all these families over to the HMO network the next day, here’s what they’ll have to endure…
The PPO Network includes virtually every primary care physician in the state of Texas..17,385 of them. On the other hand, the HMO Network only has 6,740. That’s a whopping 62% reduction in available primary care physicians.
In addition, with an HMO, your medical plan provides NO (Zero..Zilch) coverage for medical care received outside of that network. See a doctor outside of the HMO network in Texas, or any doctor outside of Texas (like when you’re on vacation) and you have no insurance. There is emergency coverage, but it had better be an honest-to-goodness emergency. And Blue Cross will make that determination…not the attending physician, or some government oversight person.
Alan in Chicago
Oh…I forgot to mention this: If you check the SERFF Insurer Filing System for Illinois ( filingaccess.serff.com/sfa/home/il ), you’ll see that Blue Cross of Illinois is doing something similar for 2016. It’s expected to affect 367,000 customers, but won’t be as drastic as what BCBS of Texas is preparing to unleash. The Blue Cross of Illinois PPO Network is staying, but the participating doctors are being reduced by approximately 30%. However, the BCBS-IL premiums are going up by an average of 34% effective 1/1/2016. Not a pretty picture, no matter how it’s framed.