Problems getting healthcare referrals
Oct 21st 2014, 9:22 pm
#31
Austin. TX.
Joined: Sep 2013
Posts: 5,930
Re: Problems getting healthcare referrals
I tell you Michael, next time I injure myself, I'm going straight to ER where they can do all the necessary xrays and scans without prior approval!
Despite not living in the UK for a looooong time I still have this very British attitude of not wanting to bother the docs unless it's really serious!
Other than this though, I'm pretty happy with our aetna coverage.
Despite not living in the UK for a looooong time I still have this very British attitude of not wanting to bother the docs unless it's really serious!
Other than this though, I'm pretty happy with our aetna coverage.
Oct 21st 2014, 10:20 pm
#32
Lost in BE Cyberspace
Joined: Jun 2008
Location: San Francisco Bay Area
Posts: 10,678
Re: Problems getting healthcare referrals
I tell you Michael, next time I injure myself, I'm going straight to ER where they can do all the necessary xrays and scans without prior approval!
Despite not living in the UK for a looooong time I still have this very British attitude of not wanting to bother the docs unless it's really serious!
Other than this though, I'm pretty happy with our aetna coverage.
Despite not living in the UK for a looooong time I still have this very British attitude of not wanting to bother the docs unless it's really serious!
Other than this though, I'm pretty happy with our aetna coverage.
Oct 23rd 2014, 2:57 am
#33
BE Forum Addict
Thread Starter
Joined: Feb 2010
Location: Temecula, CA
Posts: 4,759
Re: Problems getting healthcare referrals
Wife has received the 2015 benefits information in the mail today and I'm a bit pissed off. Though the fortnightly premium is only $107 for the four of us, it seems as though we can only choose the EPO (Tier 1) or a rather pricey Anthem Blue Cross PPO ("Value plan") at $152. By pricey I mean the following (EPO first / PPO second):
Annual Deductible None / $5000
Annual OOP $1500 / $6000
ER visit $25 copay / $300 copay then 30% after deductible
Dr visit $10 copay / $60 copay (3 per year) then 30% after deductible
Xray/lab No charge / 30% after deductible
Generic rx $10 copay / $25 copay
However, we already have Blue Cross on our ID cards so maybe that's the plan we're already on, and it's a sort of in-network / out-of-network kind of policy? There is no mention of out-of-network anywhere.
And can somebody explain this again for me please. Let's say on the above chart I'm super clumsy and visit ER 20 times in one year. I end up paying $5000ish for the first 16 visits and then pay... 30% of what... for the next 4 visits? 30% of whatever the bill ends up being, which could be thousands? But then overall capped by the $6000?
I suppose the policy isn't actually that bad in and of itself. It's the lack of specialists in this area that is the problem - including pediatricians, though that's not so much a problem any more since a new one started. So the insurers just find somebody cheap enough within a 100 mile radius or whatever.
They're offering interviews with benefits counselors - I think I need to go!
Annual Deductible None / $5000
Annual OOP $1500 / $6000
ER visit $25 copay / $300 copay then 30% after deductible
Dr visit $10 copay / $60 copay (3 per year) then 30% after deductible
Xray/lab No charge / 30% after deductible
Generic rx $10 copay / $25 copay
However, we already have Blue Cross on our ID cards so maybe that's the plan we're already on, and it's a sort of in-network / out-of-network kind of policy? There is no mention of out-of-network anywhere.
And can somebody explain this again for me please. Let's say on the above chart I'm super clumsy and visit ER 20 times in one year. I end up paying $5000ish for the first 16 visits and then pay... 30% of what... for the next 4 visits? 30% of whatever the bill ends up being, which could be thousands? But then overall capped by the $6000?
I suppose the policy isn't actually that bad in and of itself. It's the lack of specialists in this area that is the problem - including pediatricians, though that's not so much a problem any more since a new one started. So the insurers just find somebody cheap enough within a 100 mile radius or whatever.
They're offering interviews with benefits counselors - I think I need to go!
