Re: Does a Uro. do kidney biopsy exams


Jason...I googled your insurance and apparantly you must have one of
the HMO versions (versus PPO) of "Blue Shield of California". I say
this since you have all the referral rules you mentioned. You may
want to consider switching to a non HMO type during open season,
although it may cost more, and may not suit your specific needs...Pete

Thanks for your post. Yes--it clearly states HMO on the front of the
card. However, it has a special feature. The official term that is
written on
the cover of the booklet is "Access + HMO". I copied this statement
from the booklet:
"You may arrange an office visit with a specialist in the same medical
group or IPA as your Personal Physician without a referral from your
Personal Physician, subject to the limitations described below..."

I found out the hard way that one of the "limitations" is that the
specialists in the medical group or IPA mentioned above have to agree
to see you without a referral. If they refuse--that option becomes of
no benefit to me. One of the ladies that works for one of the
specialists
told me that Blue Shield may not pay the specialists unless patients
were referred. In other other words, it's related to money. I blame
Blue Shield--not the specialists--for this problem. If they always
paid the specialists--they would see and treat Blue Shield Access +
HMO patients without a referral. It's a mess.

So, in fact, all that I have is an HMO. I plan to choose a different
plan (PPO) during the next open enrollment period. It was my
impression--that what I had was more like a PPO than a HMO but I was
wrong. The booklet contains misleading information. Lots of my fellow
employees were misled
by the information in that booklet--we all believed that we were
getting a PPO type program.
Thanks for your help.
Jason

Good idea...I could not work with an HMO type program, like I explained
earlier. Make sure to inform your fellow employees also if you can :-)
....Pete


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Relevant Pages

  • Re: Does a Uro. do kidney biopsy exams
    ... the HMO versions (versus PPO) of "Blue Shield of California". ... specialists in the medical group or IPA mentioned above have to agree ...
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