Anthem Blue Cross - Billing & Deductibles

[4walnut90]

I am interested in Anthem Blue Cross's "Tonik 5000" insurance plan (Southern California). I understand that it has a $5,000 deductible and that I am responsible for the first $5k of expenses before insurance kicks in.

This may be a silly question, but I assume that medical expenses that I do incur will be billed at the negotiated Blue Cross rate, correct?

So, if I have blood work and the lab charges $100 but the BC rate is $40, I pay $40 and this $40 is applied to my $5k deductible for the year, correct?

Thank you.

 

[somarco]

medical expenses that I do incur will be billed at the negotiated Blue Cross rate, correct?

Yes, if you use a par provider and the procedure(s) are a covered expense under the policy.

 

[4walnut90]

Thanks. Anyone familiar with the Tonik programs or Anthem Blue Cross vs. others... I'm considering this or Kaiser. Kaiser has higher rates but no deductible.

 

[GreenSky]

I am interested in Anthem Blue Cross's "Tonik 5000" insurance plan (Southern California).

You are okay with the generic only prescription benefit?

Don't answer now. Wait until you need $500/mo for life saving brand name medication.

Rick

 

[somarco]

Gee Rick. You jump in and assume he has even thought about Rx. Don't know what your Tonik plans are like in CA but in GA they gave them silly names.

Fire-breather, Cat Hater and Dragon Slayer.

 

[Dave020]

There is only one left in CA these days, the 5000 with generic Rx. It does come with a little dental plan and vision plan as well, which makes it kind of cool for healthy younger people. I don't think it has a name anymore since it is the only one standing. I think they used to be called Soothsayer, Anti-Christ and Devil Worshipper or something like that in California

When comparing to KP, remember KP offers only HMO plans to individuals which is why they have a richer benefit. Also, with KP you cannot use private doctors or providers and must obtain all of your care at a KP provider facility.

Tonik has a network in CA of over 80,000 private doctors (Prudent Buyer PPO) and participates in the national BlueCard PPO program so you can get services in any of the 50 states in-network just like you received them in CA (routine and emergency).

One other plan you should look at is the Blue Shield Vital Shield Plus 400 and 900 PPO plans. They come in generic only Rx and combo generic and brand. These are a mature kind of Tonik plan with lower out of pocket costs (400 has an out of pocket of $2900 including the 400 deductible and 900 has an out of pocket of $3900 including the 900 deductible).

You can run quotes and compare them to your heart's content on the links below (no information on who you are is required to run quotes).

Anthem Blue Cross Quotes

Blue Shield CA Quotes

Blue Shield also participates in the BlueCard PPO program, however they normally limit it to urgent/emergency services whereas Anthem Blue Cross allows use for pretty much any service.

If you want to run quotes for multiple carriers/plans to compare more than one carrier side-by-side, here is my link for that (quotes Anthem, Blue Shield, Health Net, KP, Aetna, etc)

Online Quotes

 

[Sales71]

Hi Dave I have a client that pregnant about 4 month no ins do u have a provider for her. I can send her to u if u can get her ins.

 

[Dave020]

Hi Dave I have a client that pregnant about 4 month no ins do u have a provider for her. I can send her to u if u can get her ins.

Yes, either MRMIP if she has been insured in the last six months or PCIP if she has been uninsured for six months or longer. PCIP would be a better option for her is she qualifies as there is no pre-ex waiting period for her. MRMIP is more expensive and imposes a waiting period which can be waived if she had last coverage as employer coverage less than 180 days prior to MRMIP enrollment (group to group rule in CA).

Send her to my link and number is on there.

 

[Sales71]

Dave what foes pcip stand for?? They will taker her if is pregnant and never had health ins before??

 

[somarco]

PCIP - Pre-existing Condition Insurance Plan - Home