BCBS of Texas and the ACA, so much misinformation. UPDATE

[PATXgirl]

Last edited Tue Dec 10, 2013, 07:47 PM - Edit history (2)

12/10/2013: Just wanted to update this thread. I talked to ehealth yesterday and they confirmed that the Exclusion rider will be removed. I asked the guy if he could speak to someone at BCBS and have them put it in writing that it will be removed. He said yes.

I had to call BCBS this morning about other issues. The rep mentioned what my new premium will be as of Jan. 1. So I asked him when will I get a copy of the new benefits. He said they wouldn't send them out because it was the same policy I've had. So I asked, "What about the rider?" He paused and said the rider was no longer on my policy. I asked if I could get that in writing to put with my old policy. After a brief hold, he comes back, "Yes, they'll be drafting a letter for you in the next 7-14 days."

As of December 1, 2013, the exclusion rider, that has given me so much grief the past 3+ years, has been removed! I sat at my desk and cried.




Since October I've been going round and round with the people at BCBS about how the ACA would affect my policy. First, I live in Texas and they aren't extending the Medicaid option here so no subsidy for me. Second, the plan I currently have with BCBS is $1000 deductible then they pay 75% in network. It's called something like Super Saver 75 or something similar.

I applied through the ehealth website several years ago and this was the best plan I could afford. I pay a little under $350 per month for coverage for myself and my 25 year old daughter. I'm happy with this plan EXCEPT for the "permanant exclusion rider" they put against me because of 2 herniated disks back in 2009.

BCBS now tells me this plan will be discontinued as of 12/31/2013...recently extended to 12/2014 because of an ACA change...but still, they say it will be cancelled because the plan doesn't meet ACA guidelines. Just last week they told me that I can continue this plan until December of 2014 BUT the exclusion rider will stay in effect unless I apply and move to a NEW plan. Which is more money per month, higher deductibles and less coverage. AND the BCBS rep starts blaming it all on the ACA. (I was happy to tell her no, it's because of BCBS greed)

This goes against everything I've read. As far as I can tell, this plan meets the ACA except for the exclusion rider. The rep keeps telling me that I've been misinformed. I think BCBS is lying to get as many people as possible to move to more expensive plans.

So today I get an email from ehealth. Link here: http://compare.ehealthinsurance.com/renew/BCBS/bcbs-1183FU-18473N.html

The first section applies to BCBS policies in Texas and states that I can continue my policy AND the exclusion rider will be removed.

So who do I believe? What information is correct? And if everyone else says that the rider is going to be removed but BCBS insists that it's not, how do I fight them? Last year, I went through 9 months of pain and over $5k of medical tests and treatment that BCBS denied because of that freaking exclusion rider, insisting that the problem was caused by my back even though doctors insisted it wasn't. I hate BCBS with a passion and don't want to keep fighting them but there are no other carriers in this area. This is so frustrating.


Edited to add: I just found my original policy booklet and the effective date is November 15, 2010.

And there is a lifetime maximum of $5million per participant. And limits on some of the other things like $300 per calendar year on preventative care, $300k on organ and tissue transplants, etc.

[JaneyVee]

1. In 2014 exclusion riders are prohibited by the ACA.

[PATXgirl]

3. That's what I keep telling them. But they said if I opt to keep this plan, the rider stays. They say

The ONLY way I can get rid of it is to move to a new plan. The new plans are mostly $3k deductibles and cost about $50 more per month for just my coverage...with no coverage for my daughter. Or one plan with a $1000 deductible but $450 or so per month for just my coverage.

[pnwmom]

4. Did your old plan have yearly or lifetime limits on coverage?

Most of the old plans did. That is another difference in the ACA plans -- they eliminated them.

[PATXgirl]

6. I'll have to go back and look. I don't think it did though.

[PATXgirl]

9. Just found my policy booklet and there were some limits.

[pnwmom]

10. Yeah, most of them had them. I had a great plan in other respects

but it had a million dollar lifetime limit. And one serious accident could have blown through that (or a premature baby's stay in an ICU).

[JaneyVee]

7. That's BS. If you bought your plan after March 2010 it should automatically

Keep your daughter on your plan until age 26 and prohibit exclusion riders for adults starting in 2014.

[giftedgirl77]

2. What is ehealth?

I would say call them & tell the BCBS is giving you false information. Can you get anything from BCBS saying that they want to keep the rider?

[PATXgirl]

5. I'm going to call ehealth and ask them and BCBS Monday and tell them I need something in writing.

Ehealth was a one stop shop for health insurance I found back in 2010/2011 when I was looking for a plan. You type in your info and they show you all the plans available for you in your area. So technically, I bought the plan through their website.

[giftedgirl77]

8. That's what I would do, it sounds like BCBS is

being a bunch of douche bags & if they are in violation of their agreement with ehealth then they should be reported. I would call BCBS first to see if you can get it in writing that way when you talk to ehealth you will have it.