ACA questions

[Thomas3857]

Hi - I understand there's a variety of ACA plans available and healthcare providers can vary by state but my admittedly incomplete research shows the vast majority of major cancer centers (MD Anderson, Mayo, Sloan-Kettering, etc.) don't accept ANY ACA plans. In fact, I haven't found one national cancer center that does. Just curious if this fact makes you hesitant to choose an ACA plan? Thanks

 

[MichaelB]

Hi - I understand there's a variety of ACA plans available and healthcare providers can vary by state but my admittedly incomplete research shows the vast majority of major cancer centers (MD Anderson, Mayo, Sloan-Kettering, etc.) don't accept ANY ACA plans. In fact, I haven't found one national cancer center that does. Just curious if this fact makes you hesitant to choose an ACA plan? Thanks

I had 4 different ACA plans over 9 years in Florida and they all covered the hospitals you mention. Most, or at least many, PPO plans cover those institutions.

 

[erkevin]

Our BCBS ACA plan has been accepted at several cancer centers in Arizona, Tennessee, Mississippi.

 

[gauss]

I had 4 different ACA plans over 9 years in Florida and they all covered the hospitals you mention. Most, or at least many, PPO plans cover those institutions.

In my state, most, but not all, of the plans listed on the ACA exchange are HMOs, perhaps this is similar nationwide and part of OP's issue.

-gauss

 

[FLSUnFIRE]

I had 4 different ACA plans over 9 years in Florida and they all covered the hospitals you mention. Most, or at least many, PPO plans cover those institutions.

For all the auto and property insurance issues, FL seems to do pretty well for HI on the Marketplace. I know I'm happy with the selections.

 

[retire48in2018]

Our ACA plan covers at least some of these (did not check all). We chose a BCBS PPO plan that works nationally. Most of the ACA plans were not national. Most were very small networks.

So, maybe many, maybe most ACA plans don’t cover nationally.

 

[Thomas3857]

ACA in-network provider participants must vary by state / city since in my state (TN) and city there's only 4 insurers and each one of them is an EPO with VERY limited provider choices and none are accepted at the national cancer centers or even our local cancer centers or major university cancer centers like Vanderbilt.

 

[MichaelB]

For all the auto and property insurance issues, FL seems to do pretty well for HI on the Marketplace. I know I'm happy with the selections.

I agree. Health insurance in Florida is pricey but has very good coverage options. My guess is the insurance commission worked with the insurers to gain this, as coverage options were generally good from the beginning of the ACA rollout.

 

[fisherman]

ACA in-network provider participants must vary by state / city since in my state (TN) and city there's only 4 insurers and each one of them is an EPO with VERY limited provider choices and none are accepted at the national cancer centers or even our local cancer centers or major university cancer centers like Vanderbilt.

Fellow TN resident here. We will be going back on the ACA soon. Is BCBS an option in your county and did you check BCBS for Vanderbilt? Thank you for the information.

 

[Thomas3857]

Fellow TN resident here. We will be going back on the ACA soon. Is BCBS an option in your county and did you check BCBS for Vanderbilt? Thank you for the information.

Yes, BCBS is an option but unless I’m missing something Vandy is not listed as an in-network provider. All the options in Shelby County appear to be EPOs and are very restrictive

 

[retire48in2018]

Check with BCBS directly. The online tools and searches are very poorly managed and barely work. Had to contact them ourselves to ensure Mayo Clinic was in network. The online said nothing appeared in that zip code - then through BCBS direct contact - they sent me a 21 page pdf of options in that zip code.

 

[fisherman]

Yes, BCBS is an option but unless I’m missing something Vandy is not listed as an in-network provider. All the options in Shelby County appear to be EPOs and are very restrictive

I’m in a county near Davidson and Vanderbilt university medical center acute care hospital is in network for our BCBS of TN EPO policy. None of the out of state are listed as in network but I have not called to ask.

 

[MBSC]

Yes, BCBS is an option but unless I’m missing something Vandy is not listed as an in-network provider. All the options in Shelby County appear to be EPOs and are very restrictive.

I’m in a county near Davidson and Vanderbilt university medical center acute care hospital is in network for our BCBS of TN EPO policy. None of the out of state are listed as in network but I have not called to ask.

The Memphis area has BCBS-TN ACA plans named Bronze 07E, 10E, 11E, etc. The 'E' on the end identifies the smaller provider network that excludes Vanderbilt. The more expensive plans named Bronze 14S, 15S, etc. use the larger 'S' provider network that includes Vanderbilt.

When I select Blue Network E on the BCBS-TN site and search for hospitals using Nashville zip code 37205, Ascension St. Thomas is in-network. If I search Oncology, the oncologists at St. Thomas are in-network. No mention of Vanderbilt unless I select 'all networks' where they are listed under networks P & S.

Vanderbilt University Medical Center (VUMC) and Monroe Carell, Jr. Children's Hospital at Vanderbilt are in-network participants in the local and national health insurance plans listed below.

BlueCross BlueShield of Tennessee - Networks P, S (Includes individual exchange plans) Note: Vanderbilt is excluded from Network L & E.

BlueCross BlueShield - BlueCard (for out-of-state plans with “suitcase”)

Source: https://www.vanderbilthealth.com/insurance/insurance-plans

[pages 10-11]Blue Network S - The Blue Network S provider network is based on a variety of credentialed practitioners, hospitals and other health care providers as well as all participating pharmacies. It’s available for plans purchased on and off the Health Insurance Marketplace.

Blue Network E - The Blue Network E provider network focuses on providing the most affordable care by limiting the number of participating providers in the network. This network will include fewer providers than Blue Network S and is available only in Memphis, Nashville.

Plans on the Marketplace are offered in all eight regions across the state on Blue Network S. These regions include:

Region 1 - East
Region 2 - Knoxville
Region 3 - Greater Chattanooga
Region 4 - Greater Nashville
Region 5 - West
Region 6 - Greater Memphis
Region 7 - East Central
Region 8 - West Central

Select plans are available on Blue Network E in Region 4, Greater Nashville and Region 6, Greater Memphis.

Reference: https://www.bcbst.com/providers/manuals/bcbstPAM.pdf

 

[fisherman]

The Memphis area has BCBS-TN ACA plans named Bronze 07E, 10E, 11E, etc. The 'E' on the end identifies the smaller provider network that excludes Vanderbilt. The more expensive plans named Bronze 14S, 15S, etc. use the larger 'S' provider network that includes Vanderbilt.

When I select Blue Network E on the BCBS-TN site and search for hospitals using Nashville zip code 37205, Ascension St. Thomas is in-network. If I search Oncology, the oncologists at St. Thomas are in-network. No mention of Vanderbilt unless I select 'all networks' where they are listed under networks P & S.

Good to know. I’m not in those two regions so only see S networks.

 

[Thomas3857]

Our BCBS ACA plan has been accepted at several cancer centers in Arizona, Tennessee, Mississippi.

E Network is very limited. In Memphis, it’s basically restricted to Baptist. There’s only one urology group, one orthopedic group, etc. Do not recommend!

 

[Alex The Great]

Hi - I understand there's a variety of ACA plans available and healthcare providers can vary by state but my admittedly incomplete research shows the vast majority of major cancer centers (MD Anderson, Mayo, Sloan-Kettering, etc.) don't accept ANY ACA plans. In fact, I haven't found one national cancer center that does. Just curious if this fact makes you hesitant to choose an ACA plan? Thanks

Indeed the only marketplace PPO plan we have (Blue Shield of California) is not accepted by any hospital you mentioned. But this is because it has coverage within the state of California only. There is no way to sign up for nationwide PPO plan on our marketplace if I understand it correctly: the only way is to apply directly which won't include any subsidy.
Fortunately there are some great hospitals in California with focus on cancer research anyway.

 

[qwerty3656]

There is no way to sign up for nationwide PPO plan on our marketplace if I understand it correctly: the only way is to apply directly which won't include any subsidy.

I'm in the same boat in Michigan. I don't understand why in some states you can get a national plan from BCBS, but in other states you can only get a statewide plan. In addition to the out of state cancer hospitals, my problem is I live on the border between Michigan and Ohio with the nearby big city (and all the nearby medical facilities) being in Ohio.

 

[FloridaJim57]

Moffit does

Hi - I understand there's a variety of ACA plans available and healthcare providers can vary by state but my admittedly incomplete research shows the vast majority of major cancer centers (MD Anderson, Mayo, Sloan-Kettering, etc.) don't accept ANY ACA plans. In fact, I haven't found one national cancer center that does. Just curious if this fact makes you hesitant to choose an ACA plan? Thanks

I believe Moffit in Tampa accepts Florida Blue.