BCBS plans for individuals to change
According to a document sent to health insurance underwriters and agents in
People with employer-provided PPO plans will not be affected by the change.
"The retail market has evolved significantly since the opening of the
And by "sustainable", the company means its sustainability.
BCBSTX told agents that based on 2014 numbers, the company lost
In all, the change will affect more than 360,000 Texans.
"Let's just say you happen to be in the hospital
"You think about the dynamics associated with that, and it's going to throw a monkey wrench for a lot of this community."
Fristoe said more details on how BCBSTX will change their plans should come out in early October. He said the insurance provider has said the change might not be a transition to a traditional HMO, but it could be a middle-of-the-road option between an HMO and a PPO.
A PPO, he said, allows for coverage, to some degree, for in-network and non-network providers. An HMO only provides coverage for in-network providers. For example, under the HMO plans for this area, Kell West is part of BCBSTX's HMO coverage and only a few primary care physicians and specialists accept HMO insurance.
Fristoe said the change BCBSTX is going through is a result of the economics of the Affordable Care Act. He said his hope is BCBSTX will choose a hybrid of the PPO and HMO plans to lessen the blow on consumers.
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