Revisiting the "portability" issue with BCBS plans

Sep 11, 2008

  1. ConsumerOfHlthIns
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    ConsumerOfHlthIns New Member

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    Hello, i recently discovered this forum, as an interested consumer of private hlth. ins. I think this might be an interesting topic to bring up again (at least for SOME people!). I came across the following post, written last year--here it is (below, by "super genius"...are you still around?...i hope so). Following that, I'll post my own (long) comment. After reading all of that, please comment on how "comfortable" you would feel moving out of your bcbs plans area, given the info. i've written (or, if your an agent,
    put yourself in a consumers place)....and any other comments welcome. By the way, I'm "thinking" of moving, but health ins. is one of the main determinants on whether i actually do (because i probably would not be able to get another policy if i lost my current one). I don't really want to name the state or bcbs plan at this point, other than to say it's on the east coast, and not SC.

    09-05-2007, 10:20 AM #39 schealthagent
    Super Genius

    Join Date: Feb 2007
    Location: South Carolina
    Posts:85



    Re: Portability of individual BC/BS plans Go to Top
    With BCBS of South Carolina, you are able to move to any other state and maintain your coverage - the only thing that changes is the doctors that you see (as long as they are in the BC and or BS network.) I have been told this by everyone from member services, marketing reps & the president of on of the largest GA's in the state. Several of my clients have moved, filed change of address and had no problems. It might be due to the higher rates that members seem to pay here versus other states.

    NOW, FOR MY COMMENTS: There seem to be at least two BCBS individual PPO plans that will allow you to move anywhere in the US (permanently) without having to cancel the original policy (and get a "conversion")...the SC plan mentioned above, and the (different) one i'm in. But I would like to get your comments on this, and whether you actually believe what the plan is saying. (I'm still slightly skeptical, because it seems too good to be true). Here's what I learned from my own BCBS plan on the east coast of USA, and i did ALOT of research on this (and I will tell you which plan it is, later on).. Here is a list of points of evidence, some of which I consider strong, and some weak....but they all point to the "good news".

    (1) strong evidence: The contract states, in an amendment dated 10/02:
    "Contract is amended to add the following: A members coverage will not be terminated based solely on the fact that the member no longer meets any residence requirements stated in the evidence of coverage. This amendment is issued to be attached to the evidence of coverage". (signed by the president of the bcbs plan/co.). (My comments: the earlier EOC says you must maintain a legal residence for at least 6 months in the service area".

    (2) The website (available to the public), in the FAQ section of the plan says: "What to do if you move away from the service area: You can continue to use the blue card program anywhere.......".

    (3) When you call customer service (after being a member): they say you can move anywhere and keep the plan.

    (4) when you call "sales", about 70% say you can move anywhere, and about 30% says you have to cancel. (But the people who sound the "most on the ball" at the sales number are the ones who say you don't have to cancel".

    (5) I called the BCBS national association, who typically will NEVER answer questions from the public. It was hard to reach anyone there who would talk, but I did reach someone in an adequately high-level position who said she talked the "legal dept." and was told there are "a few" bcbs plans that will let you move anywhere. Apparently the national association tells the plans they have to cancel you if you move, but it's superceded by fed/state laws.

    (6) And now for the AMBIGUITY: Is this "contract" (in #1) valid? I called the STATE (health ins. examiners). They really were not totally sure, but said they did NOT think you could move out of the service area and keep the plan (but to tell you the truth, i didn't tell them exactly which BCBS plan/co. i was referring to, because at that time, i didn't want to "get the plan in trouble" or have them investigated (or make them change the rules, which may be silly on my part). The mentioned a state law (number) which i looked up, and it basically just said plans CAN cancel you if you move, but not that they HAVE TO. Anyway, the 2 people at the state where very sceptical about whether the contract is valid and one said "maybe it's unapproved". (??).
     
    Last edited: Sep 11, 2008
  2. Crabcake Johnny
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    Crabcake Johnny Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    BX is a strange animal - you have Carefirst in MD and Anthem to the south. Both are separate entities and different UW guidelines plans and rates.

    Now, Anthem in VA "might" be portable to Anthem in another state since it's the same business entity.

    But, only based on the research I've done and calls I've made, it is not portable to separate entities - Carefirst to Anthem.

    I have had a few of these cases. In each case, taking it to the highest level I could, I was told the plans were not portable.
     
  3. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    "Contract is amended to add the following: A members coverage will not be terminated based solely on the fact that the member no longer meets any residence requirements stated in the evidence of coverage. This amendment is issued to be attached to the evidence of coverage". (signed by the president of the bcbs plan/co.). (My comments: the earlier EOC says you must maintain a legal residence for at least 6 months in the service area".

    This would seem to be the operative language, barring any further amendments to the contrary.
     
  4. somarco
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    somarco That Medicare Expert Guy

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    Re: re-visiting the "portability" issue with BCBS plans

    I have never seen the portability that Dave Fluker (and a few others) refers to when it comes to BX. Not calling them liars, just saying I have never seen it.

    Likewise, I have had prospective clients call me who have Blue from another state . . . including Anthem/Wellpoint states . . . who have been told their coverage is not portable and when they move to GA they will be considered out of network. Similarly, I have had Blue clients leave GA only to find they cannot take their plan with them.

    So the answer to your question is . . . it depends . . .
     
    somarco, Sep 11, 2008
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  5. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    We see a fair amount of this in Florida with folks coming down from the northern states.

    They think they can just swap any Blue Cross of Up North plan for BCBSFL. Doesn't work that way!

    My understanding is that in order to be a part of the Blue Cross Association, companies have to offer a GI product for interstate transfers. No parameters for what kind of coverage though.

    Blue Florida offers a GI product for these situations that is not only very expensive, but also very limited in coverage.
     
  6. Crabcake Johnny
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    Re: re-visiting the "portability" issue with BCBS plans

    At the end of our last discussion I yet again called Carefirst on this issue. The manager I spoke with assured me that if any Carefirst client moves out of the service area their coverage terminates.

    I also dealt with a BX client who saw a BX doc in another state - got balanced billed even though she has it in writing that she can be considered "in network" while in another state if she sees a BX doctor.

    Yeah....right. She got balance billed and told her she misunderstood. Although she can indeed see any BX doctor they are NOT subject to the terms of the local BX network contract.
     
  7. indmedins
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    indmedins Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    As I indicated on a previous thread...a family member of mine moved from NY to FL and lost BX coverage. There was no mention of a J-Wire and she was left hight and dry by BX. Luckily, she was able to attain fully underwritten major medical coverage.
     
  8. indmedins
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    indmedins Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    Common. BX clients tend to get balanced billed out of State, however, from conversations with BX clients, it seems to be the luck of the draw.
     
  9. ConsumerOfHlthIns
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    ConsumerOfHlthIns New Member

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    Re: re-visiting the "portability" issue with BCBS plans

    Well, it seems only one person on this thread read my point #1 (i.e., what the contract actually SAYS). Seems that point #1 (and possibly point #2) are pretty good evidence that one can move and keep the policy.
    p.s. I've travelled around the US alot with it, and never had any problems with the national ppo network (but that's not what my post was about).
     
  10. Crabcake Johnny
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    Crabcake Johnny Guru

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    Re: re-visiting the "portability" issue with BCBS plans

    well....try with with a real client and let me know how it work out for you.
     
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