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Blue Cross Blue Shield to Leave USVI Owing Local Health Providers Massive Sums

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ms411
(@ms411)
Expert

Privatization has not been the way in the VI. Maybe if the feds took over the islands privatization might happen.

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Posted : May 11, 2016 8:23 pm
Spartygrad95
(@Spartygrad95)
Trusted Member

Privatization has definitely NOT led to savings in the states. When non profit insurers and county or Catholic Church hospitals were the norm costs were much lower. The hospitals keep consolidating and that equals less choice and higher prices. All BCBS policies in the VI are done as of August 1 per my wife who works in HR.

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Posted : May 11, 2016 9:16 pm
OldTart
(@the-oldtart)
Expert

All BCBS policies in the VI are done as of August 1 per my wife who works in HR.

Exactly as stated in the Source article which prompted this thread.

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Posted : May 11, 2016 10:03 pm
Spartygrad95
(@Spartygrad95)
Trusted Member

I've heard people say only BCBS policies from Puerto Rico though. It's all.

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Posted : May 11, 2016 10:05 pm
OldTart
(@the-oldtart)
Expert

I've heard people say only BCBS policies from Puerto Rico though. It's all.

Not sure what you mean by, "it's all". It's all clearly and concisely explained in the first paragraph of the Source article exactly how BCBS coverage in the USVI works. Couldn't be any clearer.

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Posted : May 11, 2016 10:44 pm
Spartygrad95
(@Spartygrad95)
Trusted Member

I'm not arguing with you here. I have seen people discussing this on social media as well who are misinformed. You are SOL if you have BCBS.

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Posted : May 11, 2016 10:50 pm
Spartygrad95
(@Spartygrad95)
Trusted Member

Would this be a different thing than BlueCross BlueShield of the U.S. Virgin Islands?

Seems to be the case.
http://www.bcbs.com/about-the-companies/?referrer=https://www.google.com/

Lists
Puerto Rico, BlueCross BlueShield of Puerto Rico

and then under international it lists

U.S. Virgin Islands, BlueCross BlueShield of the U.S. Virgin Islands

From websites, BCBS of the USVI and BCBS of Puerto Rico are different companies.

Both have contact addresses in San Juan but different email and telephone.

BCBS USVI has a Miami telephone extension and is part of ELAM BENEFITS per website. The BCBS that was referenced as potentially selling individual health plans is this one.

The one closing shop it BCBS of Puerto Rico.

This shouldn't interfere with policies that are not underwritten by BCBS of Puerto Rico, which is having financial problems as a result of Puerto Rico's government not paying bills.

Nonetheless, the article in the Source left far more questions unanswered than answered. I am waiting the Daily News for better information.

This is what I was referencing OT

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Posted : May 11, 2016 10:52 pm
OldTart
(@the-oldtart)
Expert

This is what I was referencing OT

And I'm still going by what I read in the Source and the expected follow-up after the questions they've raised of the parties concerned are answered. I think the poster who questions the distinction between BCBC PR and BCBC USVI is muddying waters. 😀

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Posted : May 12, 2016 12:28 am
Scubadoo
(@Scubadoo)
Trusted Member

BCBS in NC isn't in much better shape either.

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Posted : May 12, 2016 1:20 am
AandA2VI
(@AandA2VI)
Trusted Member

I wonder what that means to those of us coming with stateside BCBS insurance? I have been planning an extended PMV that would extend well past August 1st. We were able to use it there last year no problem and the claim was paid according to my EOB. I wonder if providers will still take a stateside BCBS network?

We are BCBS with OfficeMax - its of Illinois or something like that. Its different and we actually have a hard time finding providers here. Luckily I very very very rarely go to the Dr. Maybe 3 times in past 10 years and two were for shots to travel. My last visit was for my elbow - what a rip off. I called to ask what cash pay was and it was like $120. I think I will stick to cash pay from now on unless its really bad.

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Posted : May 12, 2016 4:21 am
Gator's Mom
(@gators_mom)
Trusted Member

Would this be a different thing than BlueCross BlueShield of the U.S. Virgin Islands?

Seems to be the case.
http://www.bcbs.com/about-the-companies/?referrer=https://www.google.com/

Lists
Puerto Rico, BlueCross BlueShield of Puerto Rico

and then under international it lists

U.S. Virgin Islands, BlueCross BlueShield of the U.S. Virgin Islands

From websites, BCBS of the USVI and BCBS of Puerto Rico are different companies.

Both have contact addresses in San Juan but different email and telephone.

BCBS USVI has a Miami telephone extension and is part of ELAM BENEFITS per website. The BCBS that was referenced as potentially selling individual health plans is this one.

The one closing shop it BCBS of Puerto Rico.

This shouldn't interfere with policies that are not underwritten by BCBS of Puerto Rico, which is having financial problems as a result of Puerto Rico's government not paying bills.

Nonetheless, the article in the Source left far more questions unanswered than answered. I am waiting the Daily News for better information.

This is what I was referencing OT

ELAN BENEFITS LLC is an independent contractor acting as an exclusive General Agent to market and sell BCBS-USVI health insurance products in the USVI.

BlueCross BlueShield of the U.S. Virgin Islands is an independent licensee of the BlueCross BlueShield Association, serving residents and businesses in the U.S. Virgin Islands.

But also ....

2012
Triple-S Salud establishes Blue Cross Blue Shield of USVI and enters the U.S. Virgin Islands market to offer health insurance products for the commercial segment.

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Posted : May 12, 2016 9:25 am
Gator's Mom
(@gators_mom)
Trusted Member

All BCBS policies in the VI are done as of August 1 per my wife who works in HR.

Exactly as stated in the Source article which prompted this thread.

So now I'm quoting the Source

“As part of our strategic decision to focus on the core and reevaluate unprofitable businesses, we've decided to discontinue offering group health insurance products in the US Virgin Islands effective August 1, 2016," the informal statement from Lisette Nunez said.
The information, she said, came from last week’s earnings call.
The statement continued, “We are currently working with the government of the USVI to ensure a smooth transition out of this market segment. We will continue serving policyholders of the Blue Cross Blue Shield Association's federal employees program who reside in the Virgin Islands and certain insurance contracts we underwrite and issue to Puerto Rico-based employers that have branch office employees there.”

BCBS of PR will be out of business in the VI. This, however, doesn't mean all doctors offices and hospitals will not accept valid BCBS insurance from other companies. I have not read that.

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Posted : May 12, 2016 9:30 am
caribstx
(@caribstx)
Trusted Member

My last visit was for my elbow - what a rip off. I called to ask what cash pay was and it was like $120. I think I will stick to cash pay from now on unless its really bad.

Its much cheaper to pay the cash price for the odd visit to a doctor, dentist or optician than the monthly insurance premium to cover those services.

That's why we only have the catastrophic coverage with Cigna Global plus the MASA emergency air service.

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Posted : May 12, 2016 11:42 am
Spartygrad95
(@Spartygrad95)
Trusted Member

All BCBS policies in the VI are done as of August 1 per my wife who works in HR.

Exactly as stated in the Source article which prompted this thread.

So now I'm quoting the Source

“As part of our strategic decision to focus on the core and reevaluate unprofitable businesses, we've decided to discontinue offering group health insurance products in the US Virgin Islands effective August 1, 2016," the informal statement from Lisette Nunez said.
The information, she said, came from last week’s earnings call.
The statement continued, “We are currently working with the government of the USVI to ensure a smooth transition out of this market segment. We will continue serving policyholders of the Blue Cross Blue Shield Association's federal employees program who reside in the Virgin Islands and certain insurance contracts we underwrite and issue to Puerto Rico-based employers that have branch office employees there.”

BCBS of PR will be out of business in the VI. This, however, doesn't mean all doctors offices and hospitals will not accept valid BCBS insurance from other companies. I have not read that.

I was mistaken yesterday. My wife's insurance BCBS Virgin Islands. They are done here too. Both policies from Puerto Rico and VI will be no more via her insurance rep.

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Posted : May 12, 2016 11:59 am
Alana33
(@alana33)
Expert

Many doctors and med services give discounted prices to those that are uninsured and pay directly, I've found. I get a senior discount from my dentist as well. Every little bit helps, especially when uninsured.

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Topic starter Posted : May 12, 2016 12:04 pm
quirion
(@quirion)
Advanced Member

This is what I was referencing OT

And I'm still going by what I read in the Source and the expected follow-up after the questions they've raised of the parties concerned are answered. I think the poster who questions the distinction between BCBC PR and BCBC USVI is muddying waters. 😀

I'll make sure to run all future questions I may have on any subject past OT first from now on.

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Posted : May 12, 2016 12:38 pm
OldTart
(@the-oldtart)
Expert

I'll make sure to run all future questions I may have on any subject past OT first from now on.

And (and this may slide by you) always follow up on recent contributions to threads. 😀

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Posted : May 12, 2016 12:53 pm
quirion
(@quirion)
Advanced Member

I'll make sure to run all future questions I may have on any subject past OT first from now on.

And (and this may slide by you) always follow up on recent contributions to threads. 😀

Can always just follow posts by OT since any updates will include hers.

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Posted : May 12, 2016 2:01 pm
Daval
(@Daval)
Advanced Member

AandA2VI - Are you on STT or STX? Our Illinois BSBS worked at the urgicare on STX last summer as well as at the pharmacy. They paid the claim before we got back home.

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Posted : May 12, 2016 2:14 pm
OldTart
(@the-oldtart)
Expert

Can always just follow posts by OT since any updates will include hers.

Seems my posts irritate you as I dart in and out during the day but there's always a really easy fix for that - don't read any of 'em! 😉

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Posted : May 12, 2016 3:15 pm
watruw8ing4
(@watruw8ing4)
Trusted Member

AandA2VI - Are you on STT or STX? Our Illinois BSBS worked at the urgicare on STX last summer as well as at the pharmacy. They paid the claim before we got back home.

Office Max is most likely what BCBS association calls a National Account, since they have 1000's of members throughout the US. That's a different marketing, processing, and provider arrangement than a smaller group might have. So you can't compare AandA2VI's coverage to yours, unless you know your company has the same arrangement. And what worked before, may not work the same after BCBS pulls out here, anyway.

As I indicated before, your stateside coverage determines whether your claims will be covered this time around, and how much you will be paid. The best thing to do is call your company's membership line and ask them how these new developments will affect you.

The only difference I see, if your coverage hasn't excluded the VI since your last trip, is that you may have to submit the claims yourself, you may have to pay the total charge up front, and you may be responsible for the balance remaining after the insurance has paid, up to the provider's total charge, instead of up to your company's allowed amount. That is all up to the providers' participation arrangements with other BCBS companies and the BCBS association, and/ or their willingness to smooth the way for you, whether they want to receive reimbursement directly, and possibly their generosity. Nobody except the specific providers you deal with will be able to answer those maybe's.

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Posted : May 12, 2016 3:33 pm
caribstx
(@caribstx)
Trusted Member

Man...what a clusterf**k. I'm glad I just pay as I go.

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Posted : May 12, 2016 4:55 pm
Gator's Mom
(@gators_mom)
Trusted Member

Man...what a clusterf**k. I'm glad I just pay as I go.

That sounds like a plan as long as you don't become seriously ill.

I look at health insurance as wealth insurance.

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Posted : May 12, 2016 5:18 pm
CruzanIron
(@cruzaniron)
Expert

My yearly insurance premium was completely paid for after a 2 day hospital stay.

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Posted : May 12, 2016 5:48 pm
Gator's Mom
(@gators_mom)
Trusted Member

My yearly insurance premium was completely paid for after a 2 day hospital stay.

Insurance paid $150K in medical bills on my behalf last year.

All fixed now - but illness can happen when you least expect it.

DNA=Do Not Argue

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Posted : May 12, 2016 6:12 pm
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