Re: Experiences with Blue Cross Blu Shield?

February 28, 2007

Hi : We have had Blue Cross, both self-employed for a year, and

then through my husband's work, for the past two years. We have

never had Blue Shield, although when I would call doctor's offices a

lot of them asked if it was Blue Cross or Blue Shield, and stated

they did not accept Blue Shield, don't know why. This could also be

only California doctors, but I don't know for sure. We have Blue

Cross PPO (and PPO with self-employed too), and the doctors I have

been in contact with have been good. The insurance encourages you to

use their doctors, but do pay for an out-of-network doctor at a bit

higher copay, so you can choose another doctor if you want to pay a

bit more. My prescription coverage has been good, although they will

need prior approval for some medications, i.e. Enbrel, etc. It is a

good insurance, but I would stick to just Blue Cross only. You can,

however, call around to doctors offices that you go to or are near by

and check if they take Blue Shield. It's worth a try. Blue Cross is

generally accepted everywhere.

Have you been able to ride lately? I still have not gotten out for

the past month because of kind of lousy on and off rainy weather, but

am looking foward to my next time. I hope your RA is behaving

itself - how are your medications doing? I think of you and Oliver

often and know how much you love to ride him, because I love getting

out on my guy too - no therapy can be better than a good ride:)

Take care - Kathe in CA

March 3, 2007

Hi Kathe,

In this case, it's not an option of one ot the other... the name of

the company here in MA is " Blue Cross Blue Shield of Massachusetts " .

The specific program we chose is HMO Blue, Value Plus. I did check

that all of the docs we are currently using are part of the network,

and they are. There is no problem with them covering the Humira,

though I'm still a little unclear on whether I need to get a standing

prescription authorized by them or not. I also don't know if I keep

getting it the way Harvard Pilgrim does it (it's mailed to me from

Curascript in Florida) or if I can just get it through my regular

pharmacy like everything else.

But the couple of doc's I've seen since we started looking into

switching have breathed a sigh of relief... I guess from their

perspective, it's MUCH easier dealing with Blue Cross Blue Shield

than Harvard Pilgrim. And for us, the monthly premium is lower, AND

all the co-pays are lower by 25%. So we've decided to go for it.

Health-wise, the Humira is definitely working better than anything

else. I still have ups and downs, but most of the time I'm

functioning pretty well. I'm down to 6.5 mg of prednisone as of

yesterday, and hoping that by going down 1/2mg at a time, I won't

flare as badly as I have when dropping down 1 mg at a time.

I've been riding Oliver 3-4 days a week for the winter. He's still

at the indoor, and I can't have him there all winter without half

leasing him to someone else. I ride in spurs all the time, and there

has never been a mark on him in the 9 years I've owned him. He's not

a slug... he just needs a gentle reminder from time to time. The girl

who is half leasing him is a very nice girl, and she really loves

him. But she doesn't have a strong, educated leg, and her instructor

has had her start riding him in spurs too. I had noticed that he was

getting some rub spots in his fur, but yesterday when I went to ride,

I was dismayed to find that he actually had a raw spot on one side!

So I had to talk to the instructor, and then send Kate a note saying

that she'll have to ride without the spurs. Until she learns to use

them correctly, I can't have her hurting my poor guy!

It's starting to feel a little " spring-ish " around here (though I

heard we're supposed to have another 17F day next week!!!) and I'm

looking forward to both boys coming home at the end of the month. I

haven't been able to ride Dillon in a while now, because there's been

too much ice and snow to ride outdoors.

Hope you're weather is allowing you to get out on those trails!

>

> Hi : We have had Blue Cross, both self-employed for a year,

and

> then through my husband's work, for the past two years. We have

> never had Blue Shield, although when I would call doctor's offices

a

> lot of them asked if it was Blue Cross or Blue Shield, and stated

> they did not accept Blue Shield, don't know why. This could also

be

> only California doctors, but I don't know for sure. We have Blue

> Cross PPO (and PPO with self-employed too), and the doctors I have

> been in contact with have been good. The insurance encourages you

to

> use their doctors, but do pay for an out-of-network doctor at a bit

> higher copay, so you can choose another doctor if you want to pay a

> bit more. My prescription coverage has been good, although they

will

> need prior approval for some medications, i.e. Enbrel, etc. It is

a

> good insurance, but I would stick to just Blue Cross only. You

can,

> however, call around to doctors offices that you go to or are near

by

> and check if they take Blue Shield. It's worth a try. Blue Cross

is

> generally accepted everywhere.

>

> Have you been able to ride lately? I still have not gotten out for

> the past month because of kind of lousy on and off rainy weather,

but

> am looking foward to my next time. I hope your RA is behaving

> itself - how are your medications doing? I think of you and Oliver

> often and know how much you love to ride him, because I love

getting

> out on my guy too - no therapy can be better than a good ride:)

>

> Take care - Kathe in CA

>

March 3, 2007

Thanks for the input, Debbie. The plan we are changing to covers all

lab work, and co-pays are $15. We'll have to see about the paperwork

issue!<g>

>

> Hi ,

>

> We just started BCBS EPO program Jan 1. All my doctors are on the

plan,

> thankfully. What is hard to get used to, is they send me something in

> the mail almost every day! Most of the letters are about my frequent

> lab work for low calcium. One said I owe the entire $19.?? charge and

> others said I only owe part of it. Also received one that said I owe

> $30 for an office visit. I pay for it when I see a doctor so I didn't

> know why they sent that one. Cigna was never this paper happy. But so

> they haven't rejected any of my meds.

>

> Debbie L

> Texas

>

March 4, 2007

One thing to keep in mind with all of the replies you are getting is

that each BCBS of each state is separate. So just really keep in

mind the ones that have dealt with BCBS MA if that's the one you'll

be going through.

--- In , " Randall " <krandall@...>

wrote:

>

> Hi folks,

>

> My husband is a self employed small business owner, and as such,

we

> pay for not only our own health insurance, but that of his few

> employees also. The premiums for the HMO we have used for the

last 20

> years (Harvard Pilgrim Health Care) have become prohibitive. He

just

> received a quote from BC/BS of MA that looks to be very comparable

to

> what we're getting with HPHC, and in some ways better (lower co-

pays,

> and less restrictions on some things like PT) for a lower premium.

>

> I did check with them to make sure that my current docs are in

network

> and that they cover the meds I'm taking. As we all know,

insurance is

> pretty important with an expensive illness like this, and we don't

> want to make a mistake. Does anyone have any personal experience

with

> them, good, bad or luke warm?

>

> Thanks,

>

March 5, 2007

Thanks for the heads-up. I did realize that because one of our

providers brought it up to me... They said BCBS of MA (which is what

we are getting) was easier to deal with than some of the other

states. So far, I've heard mostly positive comments, particularly

from our providers who are THRILLED we're leaving Harvard Pilgrim.<g>

> >

> > Hi folks,

> >

> > My husband is a self employed small business owner, and as such,

> we

> > pay for not only our own health insurance, but that of his few

> > employees also. The premiums for the HMO we have used for the

> last 20

> > years (Harvard Pilgrim Health Care) have become prohibitive. He

> just

> > received a quote from BC/BS of MA that looks to be very

comparable

> to

> > what we're getting with HPHC, and in some ways better (lower co-

> pays,

> > and less restrictions on some things like PT) for a lower premium.

> >

> > I did check with them to make sure that my current docs are in

> network

> > and that they cover the meds I'm taking. As we all know,

> insurance is

> > pretty important with an expensive illness like this, and we

don't

> > want to make a mistake. Does anyone have any personal experience

> with

> > them, good, bad or luke warm?

> >

> > Thanks,

> >

>

March 6, 2007

Hi : Glad to hear that there is no problem with the insurance. Overall,

blue cross has been a good insurance for us. I am sorry to hear about poor

Oliver's misused sides - yes, if you don't know how to use spurs Don't!~ You

can really hurt the horse until you learn to use them correctly. You handled

that just right, and hopefully the girl will learn to use the spurs before she

uses them on a horse again. I have not ridden in a while, have not been feeling

well. Thought I had a cold with sore throat, then a fever, and then I began not

being able to take a deep breath without pain and coughing like crazy. I went

to the doctor and he took chest x-rays and diagnosed pneumonia. I feel like

pooh. I had stopped already my Enbrel and Mtx when I knew I was getting sick,

now will be off of them longer. Will see how that works on me. Anyway, I need

to get back to bed, but wanted to get this off to you. Hang in there, , we

horsie people have to stick together:)

Kathe in CA

" Until he extends the circle of his compassion to all living things, man will

not himself find peace. "

— Albert Schweitzer, French Nobel Peace Prize-winning mission doctor and

theologian (1875-1965)

---------------------------------

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March 7, 2007

Oh, that's miserable Kathe! I had pneumonia a couple of years ago

(pre-RA) and I was laid low for almost 6 weeks. Hope you are on the

mend soon!

--- In , Kathe Sabetzadeh <lv2ryd@...>

wrote:

>

> Hi : Glad to hear that there is no problem with the

insurance. Overall, blue cross has been a good insurance for us. I

am sorry to hear about poor Oliver's misused sides - yes, if you

don't know how to use spurs Don't!~ You can really hurt the horse

until you learn to use them correctly. You handled that just right,

and hopefully the girl will learn to use the spurs before she uses

them on a horse again. I have not ridden in a while, have not been

feeling well. Thought I had a cold with sore throat, then a fever,

and then I began not being able to take a deep breath without pain

and coughing like crazy. I went to the doctor and he took chest x-

rays and diagnosed pneumonia. I feel like pooh. I had stopped

already my Enbrel and Mtx when I knew I was getting sick, now will be

off of them longer. Will see how that works on me. Anyway, I need

to get back to bed, but wanted to get this off to you. Hang in

there, , we horsie people have to stick together:)

>

> Kathe in CA

>

> " Until he extends the circle of his compassion to all living

things, man will not himself find peace. "

> — Albert Schweitzer, French Nobel Peace Prize-winning mission

doctor and theologian (1875-1965)

>

> ---------------------------------

> The fish are biting.

> Get more visitors on your site using Search Marketing.

>