BCBS of Texas to drop individual PPO plans in 2016

westernrvparkowner wrote:
The fact they are stopping PPOs for individuals and not employer groups would indicate that BCBS got severe "adverse selection" in their enrollment. Many people predicted this. To me, it was obvious the most likely people to buy insurance under the ACA were those people who had pre-existing conditions, were older, those who could only afford a policy with the financial supplements (and you can easily document that poverty is linked to poorer health) and those people who already were paying for a policy and had to make the jump to an ACA approved policy.
The entire financial structure of the ACA was to force younger, healthier, and hence profitable, people into the system to offset the costs of those other people. This obviously has not happened. Employer group policies do not have this adverse selection. Businesses tend to hire younger, healthy people.
And finally, I would guess that BCBS of Texas has determined that out of Texas claims cost them more than claims from in state. Somewhat logical, since there is more paperwork, and less local control. Logic again would suggest that employees based in Texas are more likely to seek treatment in Texas than members of Escapees.
Now for my political comment: If the government tells you they are going to help you, it is most likely they mean they are going to help you empty your wallet.

Whoa! :E

I'm glad that you stated that your post was "just a guess," because it's packed with misinformation as well.

Your claim of; "severe" "adverse selection" above, needs some factual links to back-up your allegation(s) as just one example of your non-fact based claims.......

I am based out-of-Texas for nearly 40 years straight.

I subscribe to, and am a member of BCBSTX for at least a couple of decades+, and much of what you wrote is not only preposterous, but just plain wrong (as in incorrect.....) wrver.

I'd suggest you do some homework on the FACTUAL specifics of BCBSTX healthcare and insurance, and get back to us with your newly found, factual information regards BCBSTX going forward in Texas.

GMandJM wrote:
Looks like BCBS-TX wants to move all the individual plan subscribers to HMOs or offload them into the Affordable Care/Obamacare pool. Good grief.

Bad news for independent contractors. I hope that doesn't turn into a national trend.

The last bit says it will still cover anyone whose plan predates 2010.

Thanks for the info.

:h Huh?

Please clarify, define and differentiate between; "individual plan subscribers," and, "the Affordable Care/Obamacare pool???"

BTW.....and FYI...there is no such plan as; "the Affordable Care/Obamacare pool."

Your post doesn't begin to make sense. Is why I ask?

I'm not sure I can agree with everything you're saying, westernrvparkowner, but it does give us something to think about.

Yes, the overly-optimistic scenario of the ACA mandate was that it would push younger, healthier people into the insurance "pool". It seems, as many suspected, they chose less expensive HMO's. No shocker.

Totally agree with you there. But I'm seeing something else:

Health insurance companies use statistics to figure out which insureds are cost-effective and which aren't and they can cut up the "pools" any way they want. In this instance they've divided it between employed/employer-based PPO insureds vs self-employed/not-employed PPO insureds.

What would their cost analysis have been had they considered ALL PPO insureds as one pool? Or self-employed vs. non-employed? (We'll never know.)

And it makes me wonder who might be next? Cut the pool smaller and say "We're not going to offer PPOs to businesses with less than 10 employees"? 50 employees?

I realize that an BCBS-TX is a for-profit entity and not a charity....I just don't like the trend they're setting. A very valuable insurance option for self-employed/not-employed people is gone and that's upsetting (to me, anyway).

(And I won't even mention that someone, somewhere PROMISED we'd be able to keep whatever insurance coverage we already have.)

And as for the wallet thing, I might agree with you except if I did DianneOK would yell at us for talking politics. So let's don't go there. ;)

Seems one of the biggest problems is the legal requirement for insurance companies to spread their cost increases on any one plan over all other plans they offer. Because of that they may choose to eliminate a high cost plan in an effort to hold down prices to subscribers on other plans they offer. I think I read that this was exactly the reasoning Blue Cross gave for their decision.

We can argue the pros and cons of ACA, single payer systems, greed on the part of Doctors, hospitals, insurance companies or whatever, but in the end it probably doesn't matter as prices will go up ahead of costs, or services will decline to match what can be charged. We need a critical mass of people and politicians to develop a real understanding the the relationship of cost-to-price and recognize that shifting costs doesn't diminish them in any way. It may lower prices to one privileged group but it will increase prices to others to compensate.

No doubt the BCBS of Texas decision will prompt a lot of full timers to relocate to other States which currently offer better insurance plans at lower prices, but these changes will come to those States in time as well. We are like lemmings marching to the edge of the cliff - some of use see the edge and object to the path we're on, other's see it as a great mass migration journey and drag us along with them.

Food for thought (no pun intended) Click link for complete article...

"Chronic diseases and conditions—such as heart disease, stroke, cancer, diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems"

Chronic diseases and conditions—such as heart disease, stroke, cancer, diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems

GMandJM wrote:

wannavolunteerFT wrote:
GMandJM, like you, I am excited to see the Self plus One option coming out...Maybe this January my check will go up instead of down, due to insurance increases outweighing any increase in pay.

I'm with you on that, but with no COLA next year (for me, anyway) I'm thinking it's gonna pretty much a wash. That could be just wishful thinking on my part though. ;)

It will be interesting when the actual numbers come out, but I've been looking some of the "hypotheticals" and they're all over the place price wise.

With FEBH it's really going to be a smaller, defined pool of people: Retirees plus one "dependent" (spouse, presumably) who are not age-eligible for Medicare.

And I guess that's what bothers me so much about the BCBS TX thing. That was also a smaller, defined pool of people they're shuttling into HMOs or offloading to other insurers. (Or "shedding", for those who might disagree with the term "offloading".)

BCBS TX is still offering PPO plans to people who have insurance through their employer.

They're just not going to offer PPO plans to people who self-pay for private policies. Self-payers will be offered only HMO's (which most people would not prefer.)

Apparently that unemployed/self-employed, pool of people in TX who pay for health insurance out of pocket, on its own, was too expensive to BCBS.

And it makes me wonder what "pool of people" BCBS (or any other insurer" is going to target next.

The fact they are stopping PPOs for individuals and not employer groups would indicate that BCBS got severe "adverse selection" in their enrollment. Many people predicted this. To me, it was obvious the most likely people to buy insurance under the ACA were those people who had pre-existing conditions, were older, those who could only afford a policy with the financial supplements (and you can easily document that poverty is linked to poorer health) and those people who already were paying for a policy and had to make the jump to an ACA approved policy.
The entire financial structure of the ACA was to force younger, healthier, and hence profitable, people into the system to offset the costs of those other people. This obviously has not happened. Employer group policies do not have this adverse selection. Businesses tend to hire younger, healthy people.
And finally, I would guess that BCBS of Texas has determined that out of Texas claims cost them more than claims from in state. Somewhat logical, since there is more paperwork, and less local control. Logic again would suggest that employees based in Texas are more likely to seek treatment in Texas than members of Escapees.
Now for my political comment: If the government tells you they are going to help you, it is most likely they mean they are going to help you empty your wallet.

I've read the same thing about people using ERs because they can't legally be turned away. I wonder if the new requirement that everyone must have insurance or pay a fine will change that.

Half price for cash sounds like a win-win-win:
You pay less (presumably)
Your insurance pays nothing
Your doctor gets paid without having to hassle with the insurance co and wait for payment

The only downside I can think of is that it's not applied to your yearly deductible that way.

There was an opthalmologist's (sp) office in our area that had a sign saying they accepted payment in gold. Never tried it though. Seemed odd to me.

Our ER experience in Arizona we were told by locals that because there were so many uninsured coming to the ER and since by law the hospitals could not turn them away they hiked the bills of those with insurance to defray the costs.

Our insurance paid for our visit then we get a bill from the Hospital?? Our adjustor told us it is common practice and if you pay by mistake you will never get it refunded. He told us to write a letter saying the "usual and customary fee" was paid any questions contact him.

Another trend Hospitals Eliminate 1 in 4 U.S. Emergency Rooms in Past 20 Years

New Urgent Care centers have become quite a new booming business and provided relief in the flow of non-emergency situations into ER's. Some are more reasonable in price for office visits and walk in or next day appointments are an option in some areas.

Many times if you offer to pay cash instead of using insurance doctors will give you a substantial break in the prices. In Florida we receive 1/2 off our bill when we paid cash instead of using our insurance.

carl2591 wrote:
problem i see is medical cost are too high for the amount of service provided. Too many doctors living in million dollar homes, driving expensize cars, having million dollar yachts with million suffering higher and higher insurance cost do to this and other facts.

I'm not sure it's the doctors, Carl. My latest BCBS EOB for a follow-up office visit reads:

Medical care:
Submitted charges $244.00
Plan allowance $140.01

Doesn't seem all that outrageous, but I'm not sure.

After opening a half-dozen EOB's this morning relating to an emergency room visit, though, it would seem hospital charges can be a bit over the top.

ML wrote:
….

A couple years ago a friend was in the hospital curiosity prompted my DH to go the accounting office to ask how much a particular outpatient procedure would cost? They asked if he had insurance? He asked for both prices $800 for cash and $2000 for insurance. If we got rid of the middleman healthcare costs might go down? I have met a couple of people on the road that have paid their own medical bills by making arrangements directly with the hospital or doctor's office instead of an insurance company. …

Please note that while they may bill the insurance company $2000 for your example above, they probably settle with them at $1000 or less. The rest is written off as a lost so that they always remain non-profit. The difference between what you might pay with cash versus what the insurance company pays also goes to covering those people with no insurance who get treated at the hospital. We still have millions of people who are the working poor - they make to much for Medicaid and make to little for ACA and their states didn't go with the expanded Medicaid.

Barb