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Author Topic: Urgent question about choosing insurance- deadline tomorrow!!!  (Read 2164 times)

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Offline kuttakamina

  • Member
  • Posts: 47
Urgent question about choosing insurance- deadline tomorrow!!!
« on: November 22, 2010, 09:19:33 PM »
I need to choose between two health plans by tomorrow afternoon and I'm struggling with it, because I don't know how the health system works and what plan would be best from the viewpoint of getting treatment for hiv.

There is Blue Cross PPO where the premium is higher by about 20$/month and then there is Blue Cross Plus. Does anybody know a hiv doctor in SoCal who is also an MD (internal Medicine)?

Because with PPO I don't have to choose a doctor, but I have to with Plus. I'm new to the area and don't know any doctors. How do I do that?

Do I just pick any doctor and hope he's an Infection Specialist or do I go through some hiv/aids organisation in picking one? The, do I call the doctor and ask if he's accepting new patients?

Or do I simply go through any AIDS organisation in SoCal and expect that they would accept BC plus?

It's very confusing and any information would be helpful. I understand that you are under no obligation or liability to provide me any information to help me make a decision SOON.

Thanks a lot!

Offline Grants Committee

  • Member
  • Posts: 138
Re: Urgent question about choosing insurance- deadline tomorrow!!!
« Reply #1 on: November 22, 2010, 09:26:50 PM »
Hi kuttakamina:

Your insurance plan should have provided you with a directory of health care providers and you should be able to pick one from there. 

Many times they only list General Practice doctors - or at least that is all they let you select as a PCP (Primary Care Physician).

Do you know if your plan is "Open Access?"  Open access means that you can see a specialist (which ID docs are classified as) without a referral. 

My current plan and my last one were both HMOs - but both were open access - so even though a picked a PCP with my old plan - I only saw her one time - as I am more comfortable with my ID doc and the plans were open access - allowing me to see a specialist without a referral.

Most PPO plans have a larger network of providers - or even let you go out of network sometimes - but they typically have higher out of pocket expenses.

With our PPO and HMO plans they both offer similar benefits - except the PPO requires a payroll deduction every pay period - where the HMO is 100% employer covered (so, that is the one I went with). 

You might also check the website for your insurance plan as it probably allows you to search for docs - then compare that with docs listed on local ASO - or do a google search about local docs who specialize in HIV.

Hope this helps.

Offline phildinftlaudy

  • Member
  • Posts: 2,985
  • sweet Ann what you think babe...
Re: Urgent question about choosing insurance- deadline tomorrow!!!
« Reply #2 on: November 22, 2010, 09:30:07 PM »
OOPS - posted under wrong screenname -
My apologees ----

Same advice kuttakamina - but put it under my screenname (phildinftlaudy) and not "Grants Committee."

(who just fell on his sword)
September 13, 2008 - diagnosed +
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline AaronbytheC

  • Member
  • Posts: 124
Re: Urgent question about choosing insurance- deadline tomorrow!!!
« Reply #3 on: November 22, 2010, 10:01:41 PM »
I have a BC PPO and have had no issues with my doc and coverage. 
True a PPO usually cost a little more, but there are usually more freedoms with it and as sad as it is to say, in the US you get what you pay for.   :'( 

Another thing to look at is drug coverage and copay...  BC is good at not covering name brand drugs!   :-\

I'm up in the Monterey area not down in SoCal, but I'm sure there are plenty of good ID docs down there who will take a BC PPO.  If you're new to the area I'd find the local ASO and ask for a list of doctors, maybe talk to a few of them before choosing one.  We all know a good doctor relationship is important!
04/2012 CD4 721 / 29% / VL UD
12/2010 CD4 587 / 24% / VL 210
11/2010 Started Atripla
10/2010 CD4 420 / 18% / VL 13,500
09/2010 CD4 541 / 17% / VL 10,500
08/2010 CD4 498 / 18% / VL Not Taken
07/2010 CD4 307 / 18% / VL 9,500
06/2010 Confirmed Poz
03/2010 Infected
06/2009 Neg

Offline kuttakamina

  • Member
  • Posts: 47
Re: Urgent question about choosing insurance- deadline tomorrow!!!
« Reply #4 on: November 23, 2010, 02:03:51 AM »
Thank you all for your responses. Aaron, I wish I had more time to call doctors and find out what is covered or what is not, but I'm low on time.

I think I also read just in the last hour something about with new insurance they will not treat a pre-existing condition for at least six months. In that sense, I suppose it's a moot point which provider I go with as I probably can't see a doctor for six months anyway. I did not have any insurance in the last six months let alone one for hiv.

So, I guess I will do a toss and go with the PPO or the Plus, the difference in premium is no more than $20, but I think with PPO there's a lot of 20% payment out of my pocket but Plus seems to not have so many charges. So, in the end, is it possible I'm short-changing myself by saving the $20 dollars a month? It is possible, but I guess I'll take my chances and bear the consequences.


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