To martha...on "portability" of some bcbs plans.

[september]

Martha, I posted this last year, apparently before you were on the forum.
Since I read somewhere that you have a legal background, and you know relatively much about health insurance, i thought I"d ask you your opinion of this. For example, how legally binding do you think BCBS's contract "statement" is (below), and how comfortable would you be if you moved out of their service area given all of the info. below. I"m also wondering...if their "contract statement" is legally valid now, they can change it at each annual renewal, right?
(Last year's responses to my post weren't too informative...and "Kramer" has always insisted (in posts I've read by him, in the past year, after i posted this one) that none of the BCBS plans allow portability, despite what I wrote below last year.

**********************************************
I just discovered this forum, read most of the recent threads related to portability of individual hlth. insur....I found it very interesting because I just spent the past few weeks researching this issue (prior to reading this forum). The main point I want make, first, is: there is at least one (and I believe there's a few) BCBS individual PPO plans that will allow you to move anywhere in the US (permanently) without having to cancel the original policy (and get a "conversion"). But I would like to get your comments on this, and whether you actually believe what the plan is saying. (I'm still slightly skeptical, because it seems too good to be true). I don't remember the names of the expert posters off hand, but the agent/broker on the board says, I think, the none of the BCBS plans will let you do this...A woman (name) on the board said this also (but used the word "typically will not let you....". But one person on the board talked about moving from a particular state (i don't remember which) to Texas and not having to cancel over a very long period of time. Here's what I learned from my own BCBS plan on the east coast of USA, and i did ALOT of research on this (and I will tell you which plan it is, later on).. Here is a list of points of evidence, some of which I consider strong, and some weak....but they all point to the "good news".

(1) strong evidence: The contract states, in an amendment dated 10/02:
"Contract is amended to add the following: A members coverage will not be terminated based solely on the fact that the member no longer meets any residence requirements stated in the evidence of coverage. This amendment is issued to be attached to the evidence of coverage". (signed by the president of the bcbs plan/co.). (My comments: the earlier EOC says you must maintain a legal residence for at least 6 months in the service area".

(2) The website (available to the public), in the FAQ section of the plan says: "What to do if you move away from the service area: You can continue to use the blue card program anywhere.......".

(3) When you call customer service (after being a member): they say you can move anywhere and keep the plan.

(4) when you call "sales", about 70% say you can move anywhere, and about 30% says you have to cancel. (But the people who sound the "most on the ball" at the sales number are the ones who say you don't have to cancel".

(5) I called the BCBS national association, who typically will NEVER answer questions from the public. It was hard to reach anyone there who would talk, but I did reach someone in an adequately high-level position who said she talked the "legal dept." and was told there are "a few" bcbs plans that will let you move anywhere. Apparently the national association tells the plans they have to cancel you if you move, but it's superceded by fed/state laws.

(6) And now for the AMBIGUITY: Is this "contract" (in #1) valid? I called the STATE (health ins. examiners). They really were not totally sure, but said they did NOT think you could move out of the service area and keep the plan (but to tell you the truth, i didn't tell them exactly which BCBS plan/co. i was referring to, because at that time, i didn't want to "get the plan in trouble" or have them investigated (or make them change the rules, which may be silly on my part). The mentioned a state law (number) which i looked up, and it basically just said plans CAN cancel you if you move, but not that they HAVE TO. Anyway, the 2 people at the state where very sceptical about whether the contract is valid and one said "maybe it's unapproved". (??).

Comments welcome, and also on whether you would feel comfortable moving away, knowing that if they cancel you YOU ARE SCREWED (i would be).[/quote]

[Rich_by_the_Bay]

Quote:

Originally Posted by september Martha, I posted this last year, apparently before you were on the forum.

This is your first post under the user name September. Did you post under another name last year?

[september]

Quote:

Originally Posted by Rich_in_Tampa This is your first post under the user name September. Did you post under another name last year?

Yes, I tried logging on a bunch of times with that name today (taxmar1) and it always said "wrong username/password", but i know for sure i was using the right ones. Do usernames expire after a year? Apparently. I looked around in the forum rules/faqs, and didn't see anything about expirations though.

[W2R]

Quote:

Originally Posted by september Yes, I tried logging on a bunch of times with that name today (taxmar1) and it always said "wrong username/password", but i know for sure i was using the right ones. Do usernames expire after a year? Apparently. I looked around in the forum rules/faqs, and didn't see anything about expirations though.

Welcome to the Early Retirement forum.

I did a search on your previous name, and I see that you posted 5 times - - and I think they were all on your health insurance.

Maybe you would like to introduce yourself in the "Hi, I am..." forum and tell us a little about yourself, and what brings you to the Early Retirement forum.

[Rich_by_the_Bay]

Quote:

Originally Posted by september Yes, I tried logging on a bunch of times with that name today (taxmar1) and it always said "wrong username/password", but i know for sure i was using the right ones. Do usernames expire after a year? Apparently. I looked around in the forum rules/faqs, and didn't see anything about expirations though.

No problem. We encourage people to register only one name, so if your prior account was broken just stick with the September one and we'll close up the original.

I merged your two accounts and deleted the original one. Sorry to distract, probably should have done this by private message but was rushed.

Carry on...

[Martha]

Quote:

Originally Posted by september Martha, I posted this last year, apparently before you were on the forum. Since I read somewhere that you have a legal background, and you know relatively much about health insurance, i thought I"d ask you your opinion of this. For example, how legally binding do you think BCBS's contract "statement" is (below), and how comfortable would you be if you moved out of their service area given all of the info. below. I"m also wondering...if their "contract statement" is legally valid now, they can change it at each annual renewal, right? (Last year's responses to my post weren't too informative...and "Kramer" has always insisted (in posts I've read by him, in the past year, after i posted this one) that none of the BCBS plans allow portability, despite what I wrote below last year. ********************************************** I just discovered this forum, read most of the recent threads related to portability of individual hlth. insur....I found it very interesting because I just spent the past few weeks researching this issue (prior to reading this forum). The main point I want make, first, is: there is at least one (and I believe there's a few) BCBS individual PPO plans that will allow you to move anywhere in the US (permanently) without having to cancel the original policy (and get a "conversion"). But I would like to get your comments on this, and whether you actually believe what the plan is saying. (I'm still slightly skeptical, because it seems too good to be true). I don't remember the names of the expert posters off hand, but the agent/broker on the board says, I think, the none of the BCBS plans will let you do this...A woman (name) on the board said this also (but used the word "typically will not let you....". But one person on the board talked about moving from a particular state (i don't remember which) to Texas and not having to cancel over a very long period of time. Here's what I learned from my own BCBS plan on the east coast of USA, and i did ALOT of research on this (and I will tell you which plan it is, later on).. Here is a list of points of evidence, some of which I consider strong, and some weak....but they all point to the "good news". (1) strong evidence: The contract states, in an amendment dated 10/02: "Contract is amended to add the following: A members coverage will not be terminated based solely on the fact that the member no longer meets any residence requirements stated in the evidence of coverage. This amendment is issued to be attached to the evidence of coverage". (signed by the president of the bcbs plan/co.). (My comments: the earlier EOC says you must maintain a legal residence for at least 6 months in the service area". (2) The website (available to the public), in the FAQ section of the plan says: "What to do if you move away from the service area: You can continue to use the blue card program anywhere.......". (3) When you call customer service (after being a member): they say you can move anywhere and keep the plan. (4) when you call "sales", about 70% say you can move anywhere, and about 30% says you have to cancel. (But the people who sound the "most on the ball" at the sales number are the ones who say you don't have to cancel". (5) I called the BCBS national association, who typically will NEVER answer questions from the public. It was hard to reach anyone there who would talk, but I did reach someone in an adequately high-level position who said she talked the "legal dept." and was told there are "a few" bcbs plans that will let you move anywhere. Apparently the national association tells the plans they have to cancel you if you move, but it's superceded by fed/state laws. (6) And now for the AMBIGUITY: Is this "contract" (in #1) valid? I called the STATE (health ins. examiners). They really were not totally sure, but said they did NOT think you could move out of the service area and keep the plan (but to tell you the truth, i didn't tell them exactly which BCBS plan/co. i was referring to, because at that time, i didn't want to "get the plan in trouble" or have them investigated (or make them change the rules, which may be silly on my part). The mentioned a state law (number) which i looked up, and it basically just said plans CAN cancel you if you move, but not that they HAVE TO. Anyway, the 2 people at the state where very sceptical about whether the contract is valid and one said "maybe it's unapproved". (??). Comments welcome, and also on whether you would feel comfortable moving away, knowing that if they cancel you YOU ARE SCREWED (i would be).

September, I am not comfortable giving you an opinion online about your contract. That would be practicing law and not only would that be practicing law, I couldn't do it without reading your contract and being licensed in your state.

I can give you a few issues to think about. One point is that insurance is largely a matter of state law and most if not all states regulate the health insurance market and require insurers to have their insurance product approved before it is offered in the state. So, you need to know if the policy is approved in the state where you are moving to. If not approved, the insurance could be canceled because cancellation would not be "solely" because you changed your residence.

Another point is the ability of insurers to change agreements when they are renewed, and in some circumstances, before they are renewed. The language may be removed at a later date. Or the plan for that matter may be terminated at a later date.

There may be other issues, depending on the language of your entire policy and state law.

So, what are you trying to do? Are you looking at buying this policy? Or do you have it already and are thinking of moving? If moving is in the near future, I would ask for a formal opinion from the insurance company, telling them where you are thinking of moving and requesting that they confirm you policy will still be in effect. Or ask a lawyer.

Please note my signature line.

[september]

[quote=Martha;712203]September, I am not comfortable giving you an opinion online about your contract. That would be practicing law and not only would that be practicing law, I couldn't do it without reading your contract and being licensed in your state.

I'LL WRITE IN CAPS TO DISTINGUISH MY WORDS FROM YOURS. I SHOULDN'T HAVE ASKED YOU TO DO ANYTHING THAT WOULD SEEM TO BE PRACTICING LAW. I SHOULD HAVE ASKED YOU TO RESPOND AS AN EDUCATED LAYMAN (I MEAN LAYLADY). ANYWAY, I ALREADY GAVE YOU EVERY BIT OF DETAIL THAT THE CONTRACTS CONTAINS (AND IT'S NOT MUCH, OBVIOUSLY).

I can give you a few issues to think about. One point is that insurance is largely a matter of state law and most if not all states regulate the health insurance market and require insurers to have their insurance product approved before it is offered in the state. So, you need to know if the policy is approved in the state where you are moving to. If not approved, the insurance could be canceled because cancellation would not be "solely" because you changed your residence.

THIS IS BCBS!!! YOU CAN GET CARE ANYWHERE IN THE US VIA THE 'BLUE CARD PROGRAM'. THAT'S A NATIONWIDE NETWORK OF PPO DOCS AND FACILITIES IN EVERY STATE. (YOU'RE NOT FAMILIAR WITH THAT?). SO, BCBS IS EITHER APPROVED IN EVERY STATE RIGHT NOW, OR THEY DON'T HAVE TO BE.

Another point is the ability of insurers to change agreements when they are renewed, and in some circumstances, before they are renewed. The language may be removed at a later date. Or the plan for that matter may be terminated at a later date. I DID MENTION THAT BCBS PLANS ARE ANNUAL CONTRACTS (THOUGH I MIGHT ADD THAT I'VE NEVER GOTTEN AN AMENDMENT TO MY CONTRACT IN THE PAST 5 YEARS). SO, I GUESS THAT'S ONE POSSIBLE PROBLEM.

There may be other issues, depending on the language of your entire policy and state law.
I ALREADY GAVE THE CONRACT DETAILS, AND I GAVE THE STATE LAW INFO. IN MY POST.

So, what are you trying to do? Are you looking at buying this policy? Or do you have it already and are thinking of moving? If moving is in the near future, I would ask for a formal opinion from the insurance company, telling them where you are thinking of moving and requesting that they confirm you policy will still be in effect. Or ask a lawyer. I ALREADY OWN THE POLICY. I'M NOT ABOUT TO CALL CUSTOMER SERVICE WITH MY ACCT NUMBER AND TELL THEM I'M THINKING OF MOVING, BECAUSE WHATEVER THEY SAY IS NOT BINDING. HEALTH INS. COMPANIES DO NOT GIVE "FORMAL OPINIONS". PROBABLY THE MOST UNLIKELY EVENT IMAGINABLE ON THE FACE OF THE EARTH WOULD BE TO HAVE BCBS SEND ME A FORMAL NOTE TELLING ME THAT I CAN OR CANNOT MOVE....... SO, WHAT MATTERS IS WHATs IN THE CONTRACT. I ALREADY WROTE WHAT THEY SAY ON THE TELEPHONE. AND WHAT THEY SAY IS THAT YOU CAN MOVE ANYWHERE IN THE US AND KEEP THE POLICY (WITH NO ADDITIONAL UNDERWRITING, AND NO CHANGES). BUT I THOUGHT I'D ASK HERE, BECAUSE SO MANY PEOPLE THINK THAT ITS IMPOSSIBLE TO MOVE TO ANOTHER STATE AND KEEP THE SAME BCBS POLICY. ALTHOUGH THAT'S TRUE IN MOST CASES, APPARENTLY NOT IN ALL (SUCH AS MINE). THANKS FOR YOUR EFFORT.

P.S. THE OTHER REASON WHY I WOULDN'T CALL OR WRITE TO THEM ABOUT WHERE I PLAN TO MOVE, ETC., IS THAT....WHO KNOWS WHAT THEY'D REALLY DO. IF I DO ACTUALLY MOVE (AND I HAVEN'T YET), I MIGHT JUST KEEP MY OLD ADDRESS WITHIN THEIR SERVICE AREA (USING THE SAME MAILBOX I CURRENTLY USE) AND JUST GET HEALTH SERVICES WHEREVER I MOVE TO VIA THE BLUE CARD PROGRAM....SO ON PAPER IT JUST LOOKS LIKE I'M TRAVELLING (FOR A LONG TIME) . BUT THATS BEING ULTRA CONSERVATIVE/SAVE. FROM WHAT I WROTE IN MY OP, I'M PROBABLY SAVE TO JUST CHANGE MY ADDRESS TO THE NEW STATE OF RESIDENCE WITH NO PROBLEM, ACCORDING TO THE CONTRACT (WHICH I QUOTED).

[Martha]

BCBS is a national trade association of locally owned plans. So, you have BCBS of Florida, of Minnesota, etc.

Here is a thread on an insurance forum that talks about changing state residence with a BCBS plan and possible problems with "interplan transfers". I don't think it is as simple as changing your address. http://www.insurance-forums.net/foru...hread2346.html

[Westernskies]

Laylady? I'm not exactly sure what that means but I kinda like the sound of it...

[harley]

Quote:

Originally Posted by bigwonderfulwyoming Laylady? I'm not exactly sure what that means but I kinda like the sound of it...

Bob Dylan song..."lay across my big brass bed"

[september]

My post had nothing to do with interplan transfers. Those things ARE a problem, and I wouldn't go near it. (for example, once you leave one bcbs plan, the other plan does NOT have to convert you to their plan. And if they do convert you, they can charge a huge amount). So, i won't be reading that thread.

Quote:

Originally Posted by Martha BCBS is a national trade association of locally owned plans. So, you have BCBS of Florida, of Minnesota, etc. Here is a thread on an insurance forum that talks about changing state residence with a BCBS plan and possible problems with "interplan transfers". I don't think it is as simple as changing your address. Portability of individual BC/BS plans

[Martha]

Quote:

Originally Posted by september My post had nothing to do with interplan transfers. Those things ARE a problem, and I wouldn't go near it. (for example, once you leave one bcbs plan, the other plan does NOT have to convert you to their plan. And if they do convert you, they can charge a huge amount). So, i won't be reading that thread.

Well, pardon me.

If you had read the link you would have discovered one poster who does support your position, at least for SC BCBS.

[Gotadimple]

Quote:

Originally Posted by september My post had nothing to do with interplan transfers. Those things ARE a problem, and I wouldn't go near it. (for example, once you leave one bcbs plan, the other plan does NOT have to convert you to their plan. And if they do convert you, they can charge a huge amount). So, i won't be reading that thread.

September,

BCBS is a franchise arrangement, just like McDonald's. Each company is indepentantly owned (some by their policyholders and others by shareholders). When you buy a health plan from BCBS you get interplan health coverage eliminating the need for you to file a claim should you get health care while outside of your own state. You are correct that it doesn't necessarily mean that you can transfer your coverage between states.

To confirm your assumptions and ask other questions it would be better if you contacted customer service directly. As to questions of portability, your insurance commissioner's office can probably get you the information you need.

-- Rita
(recently retired from Regence BlueShield, Seattle)

[september]

.....I mean the one martha mentioned (another forum, related to "conversion policies").....I couldn't help myself...I did go look at it after all. Interesting. I knew all about those general issues, but learned alot of anecdotes and details. Anyway, one poster said this (and so his plan appears very similar to mine, with regard to the issue I first posted about):
************************************************** ***
09-05-2007, 10:20 AM #39 schealthagent
Super Genius

Join Date: Feb 2007
Location: South Carolina
Posts:85



Re: Portability of individual BC/BS plans Go to Top
With BCBS of South Carolina, you are able to move to any other state and maintain your coverage - the only thing that changes is the doctors that you see (as long as they are in the BC and or BS network.) I have been told this by everyone from member services, marketing reps & the president of on of the largest GA's in the state. Several of my clients have moved, filed change of address and had no problems. It might be due to the higher rates that members seem to pay here versus other states.

Marc
************************************************** *********************

So, there seem to be AT LEAST 2 state plans BCBS plans that allow the member to move away (without having to deal with "conversion" plans, or "re-applying", etc.

[Bestwifeever]

Just want to say I'm always interested in reading Martha's posts--they have taught me a lot over the years and I appreciate her always thoughtful analysis. Yay Martha.

[Martha]

Quote:

Originally Posted by Gotadimple September, BCBS is a franchise arrangement, just like McDonald's. Each company is indepentantly owned (some by their policyholders and others by shareholders). When you buy a health plan from BCBS you get interplan health coverage eliminating the need for you to file a claim should you get health care while outside of your own state. You are correct that it doesn't necessarily mean that you can transfer your coverage between states. To confirm your assumptions and ask other questions it would be better if you contacted customer service directly. As to questions of portability, your insurance commissioner's office can probably get you the information you need. -- Rita (recently retired from Regence BlueShield, Seattle)

Thanks Rita for reinforcing and adding to what I said.

[REWahoo]

Quote:

Originally Posted by september I'LL WRITE IN CAPS TO DISTINGUISH MY WORDS FROM YOURS.

Next time try writing in a different color rather than shouting. Please.

[september]

Quote:

Originally Posted by Martha Thanks Rita for reinforcing and adding to what I said.

Rita obviiously didn't read my post at all (where I discussed what 'customer service" says, and what the "state insurance office" says.

[september]

Quote:

Originally Posted by REWahoo Next time try writing in a different color rather than shouting. Please.

Why do you think it's "shouting". I obviously wasn't shouting (and i gave the reason for the caps), so therefore it's not "shouting".

[REWahoo]

Quote:

Originally Posted by september Why do you think it's "shouting".

Common courtesy:

" Online TYPING IN ALL CAPS is considered shouting...."