Blue Cross Changing Product Network for 2017
With a new year comes new insurance plans for some people.
Blue Cross of Idaho is changing its network product. They are have removed the preferred provider organization plan.
We spoke with the individual market leader of Blue Cross of Idaho, Peter Sorensen, who told KIFI/KIDK they will no longer have a preferred provider organization (PPO) available product.
That plan allowed on individual plans to seek care whenever and where ever they wanted. That is going away.
Now, clients with Blue Cross of Idaho will be on a geographic network plan instead. The insurance company feels it will be better for Idaho.
In each region of the state, Blue Cross will offer a plan with a narrow network of providers. In a narrow network, the cost to the person is lower if they see a provider or goes to a hospital in network and much more expensive if the provider or hospital is out of network.
“We want to keep that money in Idaho, and when we keep that money in Idaho then the Idaho provider system are able to provide systems at a little lower cost for this population, and that will help keep premiums down,” Peter Sorensen said.
They reviewed where they could provide a network in rural areas of the state, he said.
This is because they do not have hospital based networks everywhere.
They made this map, which shows all of the different networks where Blue Cross is available. The benefits are all identical; they are just associated with different networks, he said.
“There’s a lot of counties that didn’t have a network, so Blue Cross of Idaho has put together a network for those counties and we created two products; one’s called Hometown East and one’s called Hometown North, where we didn’t have an entity that was able to pull a network together,” Sorensen said.
Now, for the confusing part of the plan. This how it was explained to KIFI/KIDK.
If a member in one county needs to go to another county because that is where they are used to going to, or if there is some type of treatment the state does not offer, Sorensen said they ask that each member have a relationship with a doctor or primary care physician in the network and have that person write a referral for another Blue Cross network.
If you do not get the referral, then visiting an out-of-network or an out-of-state doctor could cost you more.
“I’ve give you an example of solid organ transplant. There’s not any place in Idaho to receive a solid organ transplant, so we would be working with that primary care physician and the specialist on the most appropriate care. And that will all be paid in network. That won’t cost an individual any additional dollars,” Sorensen said.
If you are looking to send a referral within the network, it will automatically be approved.In the case someone does need to go out-of-state for health care, the written referral needs to be sent to Blue Cross of Idaho’s headquarters.
The best advice is to speak with your insurance agent or locate one on Your Health Idaho. They can help you understand this new narrow network product.
