**HHS PCIP Network -vs- State PCIP Networks**

[YouGotMyMoney]

This reminds me of discount cards and ppo networks.

Just because they says "Multiplan/PHCS" doesn't mean they accept patients using the discount plan or the discount card using a sub network only for discount cards & it's not the same network reserved for "real insurance".

 

[AllenChicago]

Mark, I understand what you're saying. But the PCIP/IPXP plan IS real insurance. It would seem therefore that medical providers in the Health Link network would honor the PPO network discount for this coverage. No?

-Allen

 

[YouGotMyMoney]

Mark, I understand what you're saying. But the PCIP/IPXP plan IS real insurance. It would seem therefore that medical providers in the Health Link network would honor the PPO network discount for this coverage. No?

-Allen

Agreed, but let's say you had an Assurant plan that used PHCS and a discount card that uses PHCS:

1. PHCS had 2 networks: 1. insurance 2. discount

2. Just because a doctor is in a networks provider directory, that doesn't tell you if they accept you're plan.

I've heard of doctors saying they don't accept discount card even if they are on the list. So it's either outdated or they can choose which plans they will accept within the network.

 

[somarco]

If a doctor is a member of Health Link and the patient's card says "Health Link", doesn't the doctor have to grant the Network Price for services rendered?

The short answer to your direct question is yes. Docs do have to honor their contract and agree to pricing set under PCIP.

But the bigger question is, are all docs in the network required to accept PCIP policyholders as patients.

The answer to that is no.

 

[HealthGuy]

So should we caution folks we refer into the fedaral high risk pool to enroll at their own risk as many Docs may not take the shitty reimbursement? Is this a safe assumption?

 

[YouGotMyMoney]

So should we caution folks we refer into the fedaral high risk pool to enroll at their own risk as many Docs may not take the shitty reimbursement? Is this a safe assumption?

Does it even matter?

To get on the crapola plan, you must of been uninsured for 6 months and uninsurable, so it's not like we are losing $$ by them enrolling and it's not like they have any other options unless your in a state like MD, which has(had?) a great high risk pool plan already.

 

[AllenChicago]

Thanks for the replies gents. As "YouGotMoney" stated, this client I'm working with has NOTHING now. The PCIP is better for her than what she has, even if her physician is not in the network. Since she's been seeing this provider for many years and skimping on her treatments, (Stomach/Intestinal issues) it's unlikely that he will turn away her PCIP insurance with the HealthLink PPO. -Allen

Edit to Add: I just got off the phone with the Doctor's office. The billing lady said that if the Doctor is listed in a network, she honors the network price for major medical plans which have that network's logo on the ID Card. Therefore, the PCIP high-risk pool patient would be billed like any other Health Link PPO patient.