Narrow networks... that's an understatement!
We self-pay for our insurance because my husband is self-employed. I have pre-existing conditions, so prior to Obamacare was paying a HUGE amount
every month for my insurance, which was offered through our state for people with pre-existing conditions.
When Obamacare came along, I was told I was losing my insurance because the program would no longer exist. So, like many others I was one of those
who didn't have the option of keeping previous insurance.
It was really expensive, but the coverage was excellent.
So I sign up our family to all be under a new plan with the affordable care act in place. I won't even go into all the drama with that. Website
never worked, no one knew anything on the phone, it was an absolute disaster. I knew we wouldn't qualify for any subsidies so I was told I could
apply directly to an insurance company rather than using the official government website.
So I applied for covered for our family through Blue Cross/Blue Shield. They had been our insurer before, so I was somewhat familiar with them.
The problem was, at this time they didn't have any of their networks online - meaning you couldn't look up and see if a particular doctor was
in-network or not. I ended up getting a PPO Gold Basic plan. It wasn't the cheapest, so I thought it should be OK. I had no concept of the
networks being "narrow"... I stupidly thought a BC/BS PPO network (a "gold" one at that) would be widely accepted.
Finally, we had our new coverage - just in time as my old coverage was disappearing. Well, it turns out that PPO Gold Basic was HORRIBLE. Our
kids pediatrician was NOT in network. My primary care doctor - NOT in network. Husband's doctor - NOT in network. My specialist - NOT in network.
My OB/GYN (did I mention I had just become pregnant - eek!) - NOT in network. In fact, the entire hospital that is literally 5 minutes from our house
was NOT In network. The keyword was "basic"... doctor after doctor told me they didn't accept the basic plans.
So they weren't covering anything. We were paying $1200 per month for health insurance that covered NOTHING. Once during this period, I had to take
a child in for an ear infection, and a 5 minute office visit cost $200. Her medicine cost more on top that.
There was only one hospital in-network in our area, and it was 1 1/2 hours away, and pretty rinky-dink.
No doctors, no hospitals were taking the BC/BS basic plans.
What on earth is the point of insurance if no one accepts it?
I called BC/BS and explained the situation. (Mind you, it took several days to get to speak to a human being... their system seemed to always be down
during this time.) I told them how when I purchased insurance I wasn't able to see the networks, because they weren't online at the time. I begged
them to let me switch plans. (Something they said they don't normally allow until one policy had expired, but apparently I lucked out and they were
still in an open enrollment period.)
I was very very very fortunate to get to switch to a different insurance plan. We are also extremely blessed to be able to afford these ridiculous
premiums, but they are a huge chunk of our budget. We now have BC/BS PPO Gold (just standard Gold... not the "basic" Gold that no one wants to
accept). It costs a few hundred dollars more a month, but at least doctors will take it.
I can't even imagine how expensive this pregnancy and delivery would be if we weren't able to get the insurance switched.
So... that is my long-winded experience. The network was SO NARROW that it was completely useless. We were shelling out a TON of money for ZERO
So people can pay a lot of money to just be within the law of having insurance coverage...but the reality is that if they have a health crisis and
need assistance with huge medical bills, it isn't necessarily going to pay off at all.
edit on 5-8-2014 by VegHead because: (no reason given)