Got a client, U65. He is undergoing an aggressive cancer treatment at MD Anderson and has 20+ doctors there that he sees. MD Anderson sent him a notice that on 11/1 they will no longer accept the Flex plan. The plan is exactly the same in network as out of network. 0 cost share for anything. What I am trying to make sense of is if MD Anderson will bill as out of network, or flat out refuse to see him. Asking here because even MD Anderson says something different every time. They have implied that they will bill as out of network, which is fine, he won't pay anything. I seem to recall seeing someone ask about this plan, and iirc MD Anderson prior. Trying to figure out what came of it. Techinically he is still in his OEP, but being U65 in texas it is just a plan A which is like $700ish. Trying to figure out correct course of action. Can he continue to see his doctors and pay the out of network cost share ($0) or are they just going to flat out refuse him and he is out of pocket 100%?
BCBS Flex and MD Anderson
- Thread starter Cdevin
- Start date
InsuranceGuy29
Guru
- 595
They can flat out refuse to see him and that's probably what they will do. Hospitals love to claim they're the second coming of Christ, but sadly, they will use your client as cannon fodder, to prove a point and try to make top dollar, because they are in a war against Medicare Advantage.
Even though the plan is essentially the same as a Plan F (and even better, because it includes prescriptions and a few extras), since it's technically Medicare Advantage, they likely won't accept it.
Doctors/hospitals flat out refusing to accept a PPO is extremely rare, because they can bill their full amount, but it technically can happen, and it likely will here, because they're a bunch of pricks. Pretty crappy thing to do to someone that's suffering. The Flex plan is a phenomenal plan. I have a good amount of clients on it. Literally 0 copays on everything.
MdAnderson and Mayo Clinic are the only two places I have ever heard of that will simply refuse to bill a PPO at all and will just flat out refuse to see people. If I was a patient, that alone would be enough of a turnoff for me to go to other places. They're good hospitals, but nowadays, there are a lot of good cancer hospitals.
Even though the plan is essentially the same as a Plan F (and even better, because it includes prescriptions and a few extras), since it's technically Medicare Advantage, they likely won't accept it.
Doctors/hospitals flat out refusing to accept a PPO is extremely rare, because they can bill their full amount, but it technically can happen, and it likely will here, because they're a bunch of pricks. Pretty crappy thing to do to someone that's suffering. The Flex plan is a phenomenal plan. I have a good amount of clients on it. Literally 0 copays on everything.
MdAnderson and Mayo Clinic are the only two places I have ever heard of that will simply refuse to bill a PPO at all and will just flat out refuse to see people. If I was a patient, that alone would be enough of a turnoff for me to go to other places. They're good hospitals, but nowadays, there are a lot of good cancer hospitals.
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