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Old 11-17-2015, 12:31 PM   #41
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That is interesting. I will probably have to change where I get my mammogram done next year. For 20 years I've gotten my mammograms at Memorial Hermann hospitals. Memorial Hermann will still be in network with the plan I think I will have next year.

But, they get their mammograms read by MD Anderson. And, that is out of network.

For my 2014 mammogram, I got this bill from MD Anderson for a doctor. It said pending insurance and nothing was do but I wondered why I was getting a bill from MD Anderson. I called and found out why. I also told them there was no pending insurance claim from them. They submitted it and it was denied as being too late. I am still getting monthly pending insurance statements on that. I'll be irritated if they try to bill me for it since it is their fault they didn't submit it timely.

Anyway, for 2016, I wouldn't be able to go to Memorial Hermann for my mammograms even though it is in network because MD Anderson is not in network. I'll have to try to find an in network place that reads its own mammograms.
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Old 11-17-2015, 09:27 PM   #42
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^ yeah went through the same thing this year. The rollout of switching the reading of the mammograms to MD Anderson was very poorly done. Once my exam was scheduled, Memorial Hermann sent me an email explaining MD Anderson's involvement & gave a phone # to call if I had questions. It was the wrong phone # - went to the collections department. About that time they bought a lot of radio ads touting the connection. Then after my exam I got bills for months from MD Anderson (luckily none of which I had to pay). Should've left well enough alone IMO.
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Old 11-17-2015, 10:19 PM   #43
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The Humana PPO seems to have a pretty good network and if I were still using an ACA policy and didn't qualify for a significant subsidy I'd probably go that way as well. Still not sure why it isn't available in the Houston or Austin areas, though.
Essentially the Humana PPO is offered outside of the Houston and Austin Tx metro and between them.

Just like if you live in a more remote town you need to check that your single choice local hospital is in network. (Or for even smaller towns find out where they send folks and check that as well). Since unless you need the services of a level 1 trauma center and helicopter transport you will go to the local hospital.
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Old 11-18-2015, 04:45 AM   #44
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Essentially the Humana PPO is offered outside of the Houston and Austin Tx metro and between them.

Just like if you live in a more remote town you need to check that your single choice local hospital is in network. (Or for even smaller towns find out where they send folks and check that as well). Since unless you need the services of a level 1 trauma center and helicopter transport you will go to the local hospital.
True, we rural folks are used to dealing with that. We basically have a three-tiered system here (and some other small towns in the boonies: The local hospital(s) for urgent care and relatively minor emergencies, or at least those that aren't obviously life-threatening; a regional hospital for more significant things (with a level 3 trauma center), and for more serious and/or specialized emergency needs, a trip to San Antonio, Austin or Houston is generally in order (including the level 1 trauma centers). Pretty much all of the hospitals are in our PPO network options (and *most* are in the BCBSTX HMOs offered on the Marketplace), though some have ER doctors, anesthesiologists or radiologists out of the network (though paid at in-network rates for emergencies apart from balance billing potential).

When we lived in the Hill Country we had a small, local hospital with an ER that wasn't really all that highly regarded; we lived about six blocks away from it. Very often we'd hear helicopters in town. Almost always, that was another patient going to the local ER, being stabilized as best as possible and then transported to (usually) Austin or San Antonio for further treatment.
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Old 11-23-2015, 04:11 PM   #45
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I guess we're going to go ahead and sign up for this Humana PPO, in spite of the stiff price tag. I'm really loathe to switch insurance companies, but I feel as if I have no choice.

Who knows what will be offered next year - we'll be taking it one year at a time!
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Old 11-23-2015, 04:16 PM   #46
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Who knows what will be offered next year - we'll be taking it one year at a time!
Your new sig line: "Health Insurance After FIRE - we have to redesign it every dang year!"
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Old 11-23-2015, 06:48 PM   #47
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Your new sig line: "Health Insurance After FIRE - we have to redesign it every dang year!"
You got that right, buddy! Until Medicare!
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Old 12-09-2015, 08:21 PM   #48
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The Humana PPO is now available in the Houston and Austin areas through brokers/agents. It is scheduled to appear on the Humana website December 18th.

Quote:
Hello agents,

Big news! If you have clients that want a true, broad network, national PPO plan, we’ve got one back in Austin and Houston now!

The Humana ChoiceCare PPO Bronze 6450 HSA style plan that has been available in most counties in Texas is now going to be available in the 26 counties where the NPOS network was recently discontinued. This includes AUSTIN and HOUSTON!

Starting immediately, we will have the ability to quote plans in Texas for 26 counties (Austin, Bastrop, Bosque, Brazoria, Burnet, Caldwell, Chambers, Colorado, Falls, Fayette, Ft. Bend, Galveston, Grimes, Hays, Hamilton, Harris, Lee, Liberty, Limestone, Milam, Montgomery, Travis, Waller, Washington, Wharton, Williamson) that were previously unavailable for 2016. Since that time, a new Humana plan, TX Bronze 6450 ChoiceCare PPO, has been added for 2016 coverage and is now available to clients.

Thank you!
Kristen Rohde
Humana Accounts
Quote:
Humana is now selling a PPO in Harris County and any other county in which they previously had not been. It appears to be a very comprehensive plan with MDA IN NETWORK. The network is Choice Care. The plan will also be sold in every county in Texas. Starting immediately, they will have the ability to quote plans in Texas for 26 counties that were previously unavailable for 2016.

This plan will be available on their quoting and enrollment tools on December 18th. If you need to obtain a quote prior to the 18th, please contact them at 1-800-833-2572 to obtain a quote for a January 1st effective date. If you are looking to obtain coverage for a January 1st effective date, you will need to enroll once the plans are active in the quoting and enrollment tools, and contact Humana to request their January effective date.
Reference: Breaking News Houston - We Have a Humana PPO - J-Vibe

Quote:
This week, Humana announced they will offer their PPO plan to the missing counties for 2016. Only the Bronze plan will be available as a PPO to go along with Humana’s HMO offerings. If you purchase this plan you’re paying a premium for the network, but sometimes the flexibility is worth it and this will be the only plan that has MD Anderson and others in network.

This plan won’t show on the Humana site until December 18th. Humana will not be able to confirm your plan until after December 18th, which is after the December 15th deadline for most other plans. However, if you live in one of the counties where this plan was not being offered, you will still be able to get a January 1st 2016 effective date if you enroll through (an agent or Humana 800 number), it just may not be confirmed until after the 18th.

If you sign up before Dec 15th, we can get you a Jan 1st start date and you can cancel your other plan before you even use it. If you miss the Dec 15th deadline, open enrollment goes through Jan 31st. Jan 15th is the deadline for Feb 1st start dates and Jan 31st is the deadline for Mar 1st start dates. You could use your current plan for a month or two, and then use the Humana PPO effective February or March 1st 2016.
Reference: Take Command Health - Humana PPO now available in Houston Metro-Area!
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Old 12-09-2015, 08:30 PM   #49
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Wow! That's an amazing change!
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Old 12-09-2015, 08:43 PM   #50
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Wow.

So this is off-exchange only, right?

To see plan details -- since it isn't available in Austin yet -- is the best bet to put in the zipcode of another county? Would the plan details be the same?

And I suppose the only way to get a rate quoted is through a broker or the Humana 800 number.

I was going to pull the trigger on the limited Scott and White PPO tomorrow, but now I will have to rethink.

Wow.
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Old 12-09-2015, 09:03 PM   #51
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Thanks for the update!
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Old 12-10-2015, 05:33 AM   #52
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Wow.

So this is off-exchange only, right?

To see plan details -- since it isn't available in Austin yet -- is the best bet to put in the zipcode of another county? Would the plan
The plan should be the same, if I understand the announcement correctly, but the pricing may vary a little by county.
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Old 12-10-2015, 01:18 PM   #53
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Help! I am having no luck finding the list of Austin-area hospitals that are in-network for the Humana PPO.

Does anyone have a link?


Sigh. I have now spent more time working on this than I do compiling two tax returns!

Scott and White's PPO has zero in-network hospitals in Austin -- the nearest one is 20 miles away. Aetna has the Seton hospitals in network but notes that there are no ER docs under contract. UHC has the St. David's hospitals, but requires a specialist referral for their EPO. The Humana PPO is $225 more a month but might be worth it for one year if the hospital list is decent.
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Old 12-10-2015, 02:31 PM   #54
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Help! I am having no luck finding the list of Austin-area hospitals that are in-network for the Humana PPO. Does anyone have a link?
Start here: https://www.humana.com/insurance-pla...l-us-about-you

Enter Dallas zip code 75207 and other required info.
On next screen, click on words "Humana Bronze 6450 ChoicePlus PPO".
Click "Physician Finder"
On next screen, choose "Individuals and Families" and enter Austin zip code.
For Network, choose "Humana ChoiceCare Network PPO" (Don't choose the one with +)
For Search, choose "Specialty" and type hospitals (plural). Click "Hospitals" and search button.
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Old 12-10-2015, 02:46 PM   #55
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Thanks! Both of the major Austin hospital groups are in-network.

They sure don't make it easy to find, do they? Thanks so much for the detailed instructions.

At this point -- without any major medical issues, and being a small user of medical services other than quarterly checks by my opthamologist -- I am nonetheless inclining to go the most expensive route with the Humana PPO because it has the most downside protection (a max on out-of-network) if you disregard balance billing. And I travel a lot.

Only 7 years to go until Medicare.
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Old 12-10-2015, 02:48 PM   #56
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You can get a look at the Texas networks including hospitals from this page: https://www.humana.com/finder/Provider%20Directories - choose Texas and No on the Medicare Policy questions (if not already selected)

For example - there is a downloadable PDF directory just for the
Austin - Humana/ChoiceCare Network PPO - TX-69000-BO (10.8 MB): http://apps.humana.com/marketing/doc...asp?file=52845
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Old 12-10-2015, 07:24 PM   #57
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Humana is now selling a PPO in Harris County and any other county in which they previously had not been. It appears to be a very comprehensive plan with MDA IN NETWORK. The network is Choice Care. The plan will also be sold in every county in Texas. Starting immediately, they will have the ability to quote plans in Texas for 26 counties that were previously unavailable for 2016.

This plan will be available on their quoting and enrollment tools on December 18th. If you need to obtain a quote prior to the 18th, please contact them at 1-800-833-2572 to obtain a quote for a January 1st effective date. If you are looking to obtain coverage for a January 1st effective date, you will need to enroll once the plans are active in the quoting and enrollment tools, and contact Humana to request their January effective date.

My wife tried calling this number today and got the runaround from Humana. They had no idea what they were doing and said to call an agent. They sent her to processors, claims, etc. and even got dumped and had to call back. They don't seem to have any idea what they are doing.We may stick with the HMO Humana has for our daughter's coverage since it appears to have enough local docs, but who knows who will really accept it after the first of the year.

On another note, a health insurance agent that had been quoting us a plan with United Health Care said that they had pulled the plan, so another one bites the dust.
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Old 12-10-2015, 07:58 PM   #58
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The broker with whom I had been dealing had no clue about this. And then a colleague of hers picked up off J-Vibe (quoted above) the announcement saying that Humana won't be live on the quoting software until Dec 18. So she told me to book a short term plan for January and then after Dec 18 sign up for a Feb 1 start.

Not likely. Too much potential there for catastrophe. And I've expended enough cycles worrying about medical insurance this month. I want it settled.

Called Humana and spoke with a CSR who said one of their agents would need to call me and would do so within 48 hours. So by 4:00pm Saturday. Hmmm.

The TakeControlHealth website linked in the original announcement IS showing the Humana PPO for Austin, so I may have to jump over to them to purchase.

QUESTION: if I do not purchase a 2016 plan by Dec 15, but wait until Dec 18 to purchase with Humana and ask for a Jan 1 start, is that a problem in the eyes of HealthCare.gov? I'll need to cancel the 2016 BCBS plan that they have assigned me (I purchased on exchange in 2015).

Oy, vey.
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Old 12-11-2015, 07:50 AM   #59
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My wife tried calling this number today and got the runaround from Humana. They had no idea what they were doing and said to call an agent.
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Originally Posted by BarbWire View Post
The broker with whom I had been dealing had no clue about this. And then a colleague of hers picked up off J-Vibe (quoted above) the announcement saying that Humana won't be live on the quoting software until Dec 18. So she told me to book a short term plan for January and then after Dec 18 sign up for a Feb 1 start.

Not likely. Too much potential there for catastrophe. And I've expended enough cycles worrying about medical insurance this month. I want it settled.

Called Humana and spoke with a CSR who said one of their agents would need to call me and would do so within 48 hours. So by 4:00pm Saturday. Hmmm.

The TakeControlHealth website linked in the original announcement IS showing the Humana PPO for Austin, so I may have to jump over to them to purchase.
You may want to try the local Humana Sales Office at the website below. Independent agents have been running quotes for people in the new area so I think it depends on the Quote Engine they have access to.
Local Humana Office: https://www.humana.com/about/guidanc...ch-blvd-austin

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QUESTION: if I do not purchase a 2016 plan by Dec 15, but wait until Dec 18 to purchase with Humana and ask for a Jan 1 start, is that a problem in the eyes of HealthCare.gov? I'll need to cancel the 2016 BCBS plan that they have assigned me (I purchased on exchange in 2015).
I have seen posts saying Humana will work with you to get the Jan. 1 start. The 12/15 deadline is for on-exchange plans. This plan is off-exchange. You can keep the BCBS plan for Jan if Humana cannot give you clear direction.
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