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Opinions Needed

L

ladybug

New member
I have a personal BC policy that I pay out of pocket for (I don't work). The premiums go up about $20 every year. My deductibles are now around $3000 each for both medical and meds ($6000.00 out of pocket deductibles yearly).

They have given me hassles in the past regarding silly things like whether a home health nurse can come do blood draws when I'm getting home IVs or whether they want me to drive to clinic to have them done. I've also had issues with them not covering a couple of my meds at more than about 50%. Probably cause things like xoepenex are brand name only and "non formulary".

I had a bit of a fight when switching from the super old and heavy vest to the newer model several years ago.

Otherwise, they do cover a lot, in my opinion. And, of the 3 CF centers I've gone to in the last 7 years alone they've always been providers. However that is deffinitely something I would check with your policy cause I have heard of hospitals that DON'T accept BCBS and if that's where you clinic is, I don't think there is any way around this.

Again, I agree with others that its probably very specific to your coverage, but that is my experience.
 
L

ladybug

New member
I have a personal BC policy that I pay out of pocket for (I don't work). The premiums go up about $20 every year. My deductibles are now around $3000 each for both medical and meds ($6000.00 out of pocket deductibles yearly).

They have given me hassles in the past regarding silly things like whether a home health nurse can come do blood draws when I'm getting home IVs or whether they want me to drive to clinic to have them done. I've also had issues with them not covering a couple of my meds at more than about 50%. Probably cause things like xoepenex are brand name only and "non formulary".

I had a bit of a fight when switching from the super old and heavy vest to the newer model several years ago.

Otherwise, they do cover a lot, in my opinion. And, of the 3 CF centers I've gone to in the last 7 years alone they've always been providers. However that is deffinitely something I would check with your policy cause I have heard of hospitals that DON'T accept BCBS and if that's where you clinic is, I don't think there is any way around this.

Again, I agree with others that its probably very specific to your coverage, but that is my experience.
 
L

ladybug

New member
I have a personal BC policy that I pay out of pocket for (I don't work). The premiums go up about $20 every year. My deductibles are now around $3000 each for both medical and meds ($6000.00 out of pocket deductibles yearly).

They have given me hassles in the past regarding silly things like whether a home health nurse can come do blood draws when I'm getting home IVs or whether they want me to drive to clinic to have them done. I've also had issues with them not covering a couple of my meds at more than about 50%. Probably cause things like xoepenex are brand name only and "non formulary".

I had a bit of a fight when switching from the super old and heavy vest to the newer model several years ago.

Otherwise, they do cover a lot, in my opinion. And, of the 3 CF centers I've gone to in the last 7 years alone they've always been providers. However that is deffinitely something I would check with your policy cause I have heard of hospitals that DON'T accept BCBS and if that's where you clinic is, I don't think there is any way around this.

Again, I agree with others that its probably very specific to your coverage, but that is my experience.
 
L

ladybug

New member
I have a personal BC policy that I pay out of pocket for (I don't work). The premiums go up about $20 every year. My deductibles are now around $3000 each for both medical and meds ($6000.00 out of pocket deductibles yearly).

They have given me hassles in the past regarding silly things like whether a home health nurse can come do blood draws when I'm getting home IVs or whether they want me to drive to clinic to have them done. I've also had issues with them not covering a couple of my meds at more than about 50%. Probably cause things like xoepenex are brand name only and "non formulary".

I had a bit of a fight when switching from the super old and heavy vest to the newer model several years ago.

Otherwise, they do cover a lot, in my opinion. And, of the 3 CF centers I've gone to in the last 7 years alone they've always been providers. However that is deffinitely something I would check with your policy cause I have heard of hospitals that DON'T accept BCBS and if that's where you clinic is, I don't think there is any way around this.

Again, I agree with others that its probably very specific to your coverage, but that is my experience.
 
L

ladybug

New member
I have a personal BC policy that I pay out of pocket for (I don't work). The premiums go up about $20 every year. My deductibles are now around $3000 each for both medical and meds ($6000.00 out of pocket deductibles yearly).
<br />
<br />They have given me hassles in the past regarding silly things like whether a home health nurse can come do blood draws when I'm getting home IVs or whether they want me to drive to clinic to have them done. I've also had issues with them not covering a couple of my meds at more than about 50%. Probably cause things like xoepenex are brand name only and "non formulary".
<br />
<br />I had a bit of a fight when switching from the super old and heavy vest to the newer model several years ago.
<br />
<br />Otherwise, they do cover a lot, in my opinion. And, of the 3 CF centers I've gone to in the last 7 years alone they've always been providers. However that is deffinitely something I would check with your policy cause I have heard of hospitals that DON'T accept BCBS and if that's where you clinic is, I don't think there is any way around this.
<br />
<br />Again, I agree with others that its probably very specific to your coverage, but that is my experience.
<br />
<br />
 
R

Ratatosk

Administrator
Staff member
We have BCBS Selectchoice, which means we have to chose a local provider (clinic) and either get a referral from them to go elsewhere (near impossibility) or pay higher percentage out of pocket for care. We go out of network for DS' CF care because we don't feel the local accreditted CF clinic is proactive enough.

I don't remember the maximum allowable for durable medical equipment, but we were able to get the vest thru them even though we more than maxed out on that.

Our prescriptions are $15 copay plus 20%, maximum out of pocket of $1,000. $30 for a 3 months supply of meds...
 
R

Ratatosk

Administrator
Staff member
We have BCBS Selectchoice, which means we have to chose a local provider (clinic) and either get a referral from them to go elsewhere (near impossibility) or pay higher percentage out of pocket for care. We go out of network for DS' CF care because we don't feel the local accreditted CF clinic is proactive enough.

I don't remember the maximum allowable for durable medical equipment, but we were able to get the vest thru them even though we more than maxed out on that.

Our prescriptions are $15 copay plus 20%, maximum out of pocket of $1,000. $30 for a 3 months supply of meds...
 
R

Ratatosk

Administrator
Staff member
We have BCBS Selectchoice, which means we have to chose a local provider (clinic) and either get a referral from them to go elsewhere (near impossibility) or pay higher percentage out of pocket for care. We go out of network for DS' CF care because we don't feel the local accreditted CF clinic is proactive enough.

I don't remember the maximum allowable for durable medical equipment, but we were able to get the vest thru them even though we more than maxed out on that.

Our prescriptions are $15 copay plus 20%, maximum out of pocket of $1,000. $30 for a 3 months supply of meds...
 
R

Ratatosk

Administrator
Staff member
We have BCBS Selectchoice, which means we have to chose a local provider (clinic) and either get a referral from them to go elsewhere (near impossibility) or pay higher percentage out of pocket for care. We go out of network for DS' CF care because we don't feel the local accreditted CF clinic is proactive enough.

I don't remember the maximum allowable for durable medical equipment, but we were able to get the vest thru them even though we more than maxed out on that.

Our prescriptions are $15 copay plus 20%, maximum out of pocket of $1,000. $30 for a 3 months supply of meds...
 
R

Ratatosk

Administrator
Staff member
We have BCBS Selectchoice, which means we have to chose a local provider (clinic) and either get a referral from them to go elsewhere (near impossibility) or pay higher percentage out of pocket for care. We go out of network for DS' CF care because we don't feel the local accreditted CF clinic is proactive enough.
<br />
<br />I don't remember the maximum allowable for durable medical equipment, but we were able to get the vest thru them even though we more than maxed out on that.
<br />
<br />Our prescriptions are $15 copay plus 20%, maximum out of pocket of $1,000. $30 for a 3 months supply of meds...
 
A

Aspiemom

Guest
It does depend on the contract and Network. We have Network S - as in sucks. I have a hard time finding a dr. that will work with them, a few of the better hospitals in our area won't access our Network. I would like to change a couple of my drs. but can't. Prescriptions have been running a lot $35, $50 & $70.

There are so many things they deny coverage or "out of network".

We really hate it, but since my husband is forced to find other work we are hoping for a better plan.
 
A

Aspiemom

Guest
It does depend on the contract and Network. We have Network S - as in sucks. I have a hard time finding a dr. that will work with them, a few of the better hospitals in our area won't access our Network. I would like to change a couple of my drs. but can't. Prescriptions have been running a lot $35, $50 & $70.

There are so many things they deny coverage or "out of network".

We really hate it, but since my husband is forced to find other work we are hoping for a better plan.
 
A

Aspiemom

Guest
It does depend on the contract and Network. We have Network S - as in sucks. I have a hard time finding a dr. that will work with them, a few of the better hospitals in our area won't access our Network. I would like to change a couple of my drs. but can't. Prescriptions have been running a lot $35, $50 & $70.

There are so many things they deny coverage or "out of network".

We really hate it, but since my husband is forced to find other work we are hoping for a better plan.
 
A

Aspiemom

Guest
It does depend on the contract and Network. We have Network S - as in sucks. I have a hard time finding a dr. that will work with them, a few of the better hospitals in our area won't access our Network. I would like to change a couple of my drs. but can't. Prescriptions have been running a lot $35, $50 & $70.

There are so many things they deny coverage or "out of network".

We really hate it, but since my husband is forced to find other work we are hoping for a better plan.
 
A

Aspiemom

Guest
It does depend on the contract and Network. We have Network S - as in sucks. I have a hard time finding a dr. that will work with them, a few of the better hospitals in our area won't access our Network. I would like to change a couple of my drs. but can't. Prescriptions have been running a lot $35, $50 & $70.
<br />
<br />There are so many things they deny coverage or "out of network".
<br />
<br />We really hate it, but since my husband is forced to find other work we are hoping for a better plan.
 
J

Jenica

Guest
Our claim for the Respirtech vest was denied, but after an appeal, they covered it in full, even waiving the $5000 durable medical equipment cap. We had Harvard Pilgrim before, and they were super hands-on (in a good way) and assigned us to a nurse care manager who took care of most issues before I even realized we had them. I miss her! But that said, I don't have any complaints about BCBS.

Hopefully your plan is just as accommodating!
 
J

Jenica

Guest
Our claim for the Respirtech vest was denied, but after an appeal, they covered it in full, even waiving the $5000 durable medical equipment cap. We had Harvard Pilgrim before, and they were super hands-on (in a good way) and assigned us to a nurse care manager who took care of most issues before I even realized we had them. I miss her! But that said, I don't have any complaints about BCBS.

Hopefully your plan is just as accommodating!
 
J

Jenica

Guest
Our claim for the Respirtech vest was denied, but after an appeal, they covered it in full, even waiving the $5000 durable medical equipment cap. We had Harvard Pilgrim before, and they were super hands-on (in a good way) and assigned us to a nurse care manager who took care of most issues before I even realized we had them. I miss her! But that said, I don't have any complaints about BCBS.

Hopefully your plan is just as accommodating!
 
J

Jenica

Guest
Our claim for the Respirtech vest was denied, but after an appeal, they covered it in full, even waiving the $5000 durable medical equipment cap. We had Harvard Pilgrim before, and they were super hands-on (in a good way) and assigned us to a nurse care manager who took care of most issues before I even realized we had them. I miss her! But that said, I don't have any complaints about BCBS.

Hopefully your plan is just as accommodating!
 
J

Jenica

Guest
Our claim for the Respirtech vest was denied, but after an appeal, they covered it in full, even waiving the $5000 durable medical equipment cap. We had Harvard Pilgrim before, and they were super hands-on (in a good way) and assigned us to a nurse care manager who took care of most issues before I even realized we had them. I miss her! But that said, I don't have any complaints about BCBS.
<br />
<br />Hopefully your plan is just as accommodating!
 
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