FreshFluff

Payroll firm (big national one) won’t each plan’s legal documents. “You get those after you sign on.” Is that even legal?

Each insurance plan has its own set of in network providers, who agree to accept the compensation that the insurance company offers. The plans with OON coverage run about $1000-1300 in NY for an individual and 2-3x that for a family. Plans offered on the state exchange cost the same but with much smaller networks, no non-emergency coverage out if state, and no OON coverage.

That’s precisely wha put me off too, @blondeq. They even require preauth in network. (“We don’t approve X before age 50.”) Plus it’s the priciest plan! That’s why Oxford is out, and it’s between thetwo BCBS plans. Thank you again; your posts are very helpful. @RealAvalon $3000 is the amount I need to spend out of pocket before they start covering services with out of network doctors. Even afterwar that, they only pay a portion of what they consider the usual and customary rate, which is often very low. There is also an in network deductible, though that middle plan allows you to mostly circumvent it.

Here are the 3 plans, from cheapest to most expensive. If you remove dental/vision, thmost expensive, the Oxford, is about $147 more than the cheapest. Oxford has the best coinsurance, but I keep hearing that they’re stingier. FWIW, I’ll meet the $3000 OON deductible in a few months particularly if dental expenses count. I may use diagnostic imaging (likely OON) and labs and some minor outpatient procedures. I want to hedge against the possibility that I’ll need outpatient surgery and even have my first hospital admission. Thanks again for all your help.

This is really important. Thanks for letting me know. Nearly all providers take both but one regional hospital and a few private practice providers who take Anthem aren’t turning up in the Empire Blue provider directory. I’m calling them, but most are clueless. They just give you their tax ID and tell you you to call BC. So it’s tough to figure this out.

Furry

The issue is that this is an NY based Empire BCBS plan. Some CA hospitals say they take our of state BCBS but their doctors aren’t listed on the directory. You’re right. The premiums are high for all but lower than the near worthless exchange HMOs. As for the large copay, maybe they saw your tiara and thought you could pay.

Thanks, @nycman , @blondeq , and @sniper. Oh, I’ve already been screwed plenty by my $$$ exchange UHC HMO. They.denied an out of state urgent care claim for an x-ray when I tripped. (ERs only!) That’s why I’m so eager to switch to the best PPO coverage I can find. Even decent nationwide EPO would be great, but if a PPO is available, I’m going for it. The current consensus from my own docs and my own experrience with HMOs agrees with both of you: I’m leaning towards Aerna/BCBS. As @blondeq said, UHC/Oxford demands more preauth. The plan details says their PPO requires preauth for outpatient hospital fees while BCBS does not. That alone is a big deal. @sniper , so the UCR is a cap for OON compensation? I suspected as much, yet there see. But what I’m seeing, there are big differences in compensation across insurance providers even with similar counsurance %.

For medical personnel and others who’ve tied out different insurance recently: Who compensates better for OON care, Oxford/United Healthcare Choice Plus PPO or Empire BCBS PPO? I am asking my current doctors, but it’s very possible that new conditions will pop up and require new doctors. I use a lot of out of network care so OON coverage is important. Which one has been more generous out of network rates that use when multiplying by coinsurance. Does that make sense? I keep hearing that Oxford/UHC is especially stingy. Is that right in your experience?

Deleted my video. I hadn’t read @MikeBiDude ’s reply.

All kidding aside, I wish OP well and hope he gets support that will help him work through this.

Your friendly neighborhood kitten posted a thread about this. https://www.companyofmen.org/threads/switzerland-is-reopening-check-out-what-theyre-permitting-see-the-third-row.157837/#post-1922358

Got any good stories?

If anyone’s interested, my younger self’s ad is back up. It’s 2 AM, and he’s horny.

Yes, but she’s available for worship only.

Happy birthday, William! May you have a great year.

Coffee, tea, or me?

Welcome, @snowstalker02 . What brought you to the forum?

There are members in their 20s. Someone told me that there are straight women too.

Sorry to hear that. I’ve had great care overall from physicians, partly due to luck but also because I seek out good care. Unfortunately, a good derm misdiagnosed a BCC in a prominent spot—which turned out to be infiltrative. Even the Mohs surgeons hesitate to pull out the dermatascope, which has been shown to improve diagnosis of BCCs over visual inspection alone. Diagnosis in this area needs some work IMO. (FWIW I've been careful about sun protection since my teens and haven’t sunbathed since I was a small child. Unfortunately, heredity has a big hand in this area.)

Hugh Grant

Sounds like one or two top transplant surgeons can. The A-listers always seem to get names of the top doctors, regardless of specialty? Wonder how they do it.

From where was this hair transplanted? Also, either he’s dyed both hair and beard, or the after is digitally manipulated.