Could you get me a copy of the separate types of products law. Our largest Cartel member, Excellus BC/BS (really WellPoint!!!) here uses the all products crap on us all the time. They bundle HRA's and HSA's into standard PPO when we can't even know whether or not to collect allowable at time of service. A four thousand dollar deductable that I can't even know whether it has been met or not is not the same as collect a simple $20 copay and the rest of the claim shall be covered, there is a carrier behind this claim. Oh, just let 'em walk out the door and try to collect from the patient weeks if not months later.... Suuurrreee, right......
They have bundled all products other than traditional indemnity or state SCHIP like products and the new road to riches Medicare ones, under one entire bucket! So POS, PPO, EPO, HMO and all the rest are take it or leave it, no pick and choose what so ever. They call all of them now, "Managed Care" products. It seems they are even trying to package the traditional plans into the bundle soon.
But to me is the killer for all PCP's is just because someone may need a referal or prior auth later on, they are effectively barred from seeing any PCP who is not in network for fear of not being able to get their stupid paperwork thru the system sometime in the future if and when they may need it, be the referal to the specialist, drug approvals, tests and all the rest. Yes now we need to get all imaging other than x-rays or ultrasounds prior auth'ed before proceeding to "go". And we can't turf that to the specialist, because they are going to want to know what we already found out as to why we are sending them on.
I'm straining to remember which carrier right now, but just the other day, we looked up a patient's plan which was called "Whatever PPO". Now we all know what PPO means, "preferred provider", but that there should still be some method for patients to pay a modest amount more and still go out of network; RIGHT??? Well this plan clearly stated in the computer that there were NO out of network benefits at all!!! So how the hell are they getting away with calling it or charging for PPO type coverage while not providing PPO type coverage? Simply amazing.
