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Does anyone have Blue Cross Blue Shield HMO?

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manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
Originally posted by: senseamp
I have BCBS PPO, not HMO, and it sucks. It's much much worse than United Healthcare I had before. They have doctors who never see you overruling your doctor's decisions as to what is necessary. Plus they drag their feet on the payments, I was getting letters that they didn't receive this or that so they won't pay, pretty much nitpicking. One time they were complaining that the hospital sent them the medical records electronically instead of in paper form, so they were refusing to pay for a test. Yep, this is in 21st century.
I have United Health Care right now. Its really nice. I love it.
 

Legendary

Diamond Member
Jan 22, 2002
7,020
1
0
You'll have to pay more for your HMO? That seems a bit backwards.
I'm new to the health insurance game, but my company provided me with either HMO or PPO, PPO seemed much more expensive and I'm young so I don't think I'll be making too many trips to the doctor so I took the HMO.
 

senseamp

Lifer
Feb 5, 2006
34,859
4,801
126
Originally posted by: mjuszczak
Originally posted by: senseamp
I have BCBS PPO, not HMO, and it sucks. It's much much worse than United Healthcare I had before. They have doctors who never see you overruling your doctor's decisions as to what is necessary. Plus they drag their feet on the payments, I was getting letters that they didn't receive this or that so they won't pay, pretty much nitpicking. One time they were complaining that the hospital sent them the medical records electronically instead of in paper form, so they were refusing to pay for a test. Yep, this is in 21st century.
I have United Health Care right now. Its really nice. I love it.
Never had any issues with UHC. BCBS is like this from the beginning. I go to doctor, he orders a test, then the receptionist looks up BCBS procedures and says "Ya know what? You gotta wait for a BCBS doctor to approve it first" :roll: I don't understand why in our country, doctors who have not seen you in person and have a vested interest in rejecting treatment, are allowed to overrule the treating doctor's orders. It's absolutely nuts. I don't think a doctor can prescribe you painkillers if he's never seen you, but he can stop you from getting care ordered by your treating physician.
 

Zugzwang152

Lifer
Oct 30, 2001
12,134
1
0
Originally posted by: senseamp
Originally posted by: mjuszczak
Originally posted by: senseamp
I have BCBS PPO, not HMO, and it sucks. It's much much worse than United Healthcare I had before. They have doctors who never see you overruling your doctor's decisions as to what is necessary. Plus they drag their feet on the payments, I was getting letters that they didn't receive this or that so they won't pay, pretty much nitpicking. One time they were complaining that the hospital sent them the medical records electronically instead of in paper form, so they were refusing to pay for a test. Yep, this is in 21st century.
I have United Health Care right now. Its really nice. I love it.
Never had any issues with UHC. BCBS is like this from the beginning. I go to doctor, he orders a test, then the receptionist looks up BCBS procedures and says "Ya know what? You gotta wait for a BCBS doctor to approve it first" :roll: I don't understand why in our country, doctors who have not seen you in person and have a vested interest in rejecting treatment, are allowed to overrule the treating doctor's orders. It's absolutely nuts. I don't think a doctor can prescribe you painkillers if he's never seen you, but he can stop you from getting care ordered by your treating physician.
If all doctors were honest in their dealings with heal insurers, the system wouldn't need to be like this. The purpose of the BCBS doctors is to detect and prevent overbilling by your doctor, who is probably bitter that he makes $150k when he think he could be making $200k. So he does a little coding magic and gives himself a raise.

The BCBS doctors are preventing the health plan's costs from going up, yes, but only to keep the rise in premiums down. For standard procedures, there is rarely a reason that deviation is necessary from the established treatment methods.
 

Capt Caveman

Lifer
Jan 30, 2005
34,549
650
126
Personally, I don't believe you should let this issue stop you from taking the job. I assume you currently have a number of doctors that you regularly see and they are probably all part of the BCBS HMO network currently. Making one of them your primary physician, when you have to see another doctor, just explain to your pp why you need to see another one and have them refer you.

Congrats and Good Luck!!!

edit - ask for a higher salary to cover the additional costs of their woeful health care copayments.
 

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