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Trick no Treat from Blue Cross Blue Shield Illinois

Photo by Flood G

Published in ChicagoNow, October 31, 2015

If you have a Blue Cross Blue Shield Illinois (BCBSIL) PPO plan purchased through the Marketplace, you should have received a letter that looks like the one above. Unless you act, you will automatically be enrolled in the Blue Choice Preferred PPO, and that could be a disaster for you and your family.

Please read the letter carefully … all of it. BCBSIL may scare you this Halloween. Depending on your situation, if you take their new plan without exploring all of your options, including finding another insurer, one of these tricks could happen to you:

You could go to the emergency room you always use, only to be turned away or sent to a different ER once you are not in mortal danger. Even in an emergency, you can’t choose a hospital that is not in your narrow Blue Choice network. If you live in Evanston like my children and grandchildren, you can only go to St. Francis Hospital. Evanston Hospital is no longer an option for you unless you want to pay a huge amount out of pocket.

If you live in Chicago, you have more choices, but may find your preferred hospital missing from this list: Aurora Chicago LakeShore Hospital, Children’s Memorial Hospital, Holy Cross Hospital, LaRabida Children’s Hospital, Louis A. Weiss Memorial Hospital, Mercy Hospital and Medical Center, Mount Sinai Hospital and Medical Center, Norwegian American Hospital, Our Lady of the Resurrection Medical Center, Presence Saint Joseph Health Centers, Presence Resurrection Medical Center, Rehabilitation Institute of Chicago, Resurrection Medical Center, Riveredge Hospital, Rml Chicago Schwab Rehabilitation Hospital, St. Anthony Hospital, St. Elizabeth Hospital, St. Mary of Nazareth Hospital, Swedish Covenant Hospital, Thorek Memorial Hospital, and University of Illinois Hospital.

So, if you thought you could use Northwestern or Rush or University of Chicago hospitals, for example, you can’t.

Ditto for being hospitalized if you are sick or need surgery. And consider that your children’s pediatrician, your primary care physician, or a surgeon or specialist you want to use may not accept Blue Choice if he or she is not affiliated with the hospitals in the network.

You could discover you can no longer use the doctors and providers you know and trust. This could be especially devastating for those who have highly specialized therapists.

Blue Cross Blue Shield Illinois claims that they are “updating the plans we offer to make sure we are offering plans that have the benefits our members may need at a price they can afford.” [Emphasis mine] Every person’s needs are different, and for many “members,” these changes will not meet their needs.

Here are some changes outlined in the letter BCBSIL sent to a “member” whose plan has been terminated

  • if she enrolls in Blue Choice:Her in-network co-insurance (the percentage of the bill she needs to pay) increases from 20% to 30%.

  • Her in-network individual out of pocket maximum increases from $3,000 to $5,250.

  • There is no out-of-pocket maximum for out of network services. So, if she chooses to use the hospital or providers she already has who are not part of the Blue Choice Network, she may have to pay for most of the charges herself.

  • There is also a preferred pharmacy network, so if she gets her prescriptions filled elsewhere, she will have to change pharmacies or pay full freight.

  • Even if she uses the preferred pharmacy network, it may cost her more. If she uses any medications other than Blue Choices preferred generics, she will pay. A non-preferred (not by her doctor but by someone at BCBS who decides) brand name drug will come with $100 surcharge. Some brand name drugs have been excluded from the new Blue Choice drug list formulary.

  • She will need to get prior authorization for some services under this new plan. If they are out of network services, she will need to obtain the authorization herself. Sounds more like an HMO than a PPO.

  • If she travels outside of the US, she may only receive emergency care. I guess she will have to get home somehow and stay within the new network for treatment that is covered by the Blue Choice plan.

I have written about some of the truly scary consequences of this change in Health Insurance That Doesn’t Ensure Healthcare. I hope anyone affected by these changes will look into other options after open enrollment starts on the Healthcare Exchange this Sunday, November 1. If you will be choosing a new plan, you have until December 31 to do so.

Thanks, BCBSIL for this Halloween treat. You have made health care truly horrifying for many folks out there. To those who received this letter: Don’t march blindly into what is being offered to you by the Blue Choice plan like a zombie. It may end up being a truly frightening experience for you. Happy Halloween from your friends at Blue Cross Blue Shield.


by Laurie Levy
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