Insurance Conundrum

BCBS (Blue Cross Blue Shield) has canceled all their PPO plans in Texas and are only offering HMO plans through the federal website, Healthcare.gov. In addition, other insurers are canceling their PPO products. This will leave patients with more restrictions on the doctors that they are able to see. From our standpoint, HMO’s are less desirable because they require us to obtain authorizations or referrals for our patients to see any other physician. If many of our patients choose HMO’s we will have to hire someone to just take care of the paperwork. It is like having an unfunded mandate from Congress. It increases the hassle factor of obtaining needed care. If you are having difficulty obtaining insurance, I think it makes sense to use an agent. There are a number of independent insurance agencies which have agents who can assist in sorting through all the options. Wortham, Catto and Catto and Sanger and Altgelt all have agents who can assist in this. The key points are: 1) to look at a plan’s website and see if we are on it. It seems logical that we would know every plan that we are on, but that’s not the case given the turmoil in this industry. 2) Look for something that contains the phrase “Open Access”. This generous access to specialists than a traditional HMO.