Saturday, January 10, 2009

BCBSNC states it will pay for 80% AFTER DEDUCTIBLE for Medical Benefits & 50% AFTER DEDUCTIBLE for mental health benefits

What a joke all the insurance matters have become. Any possible way that the public can be
duped is utilized.

I just received my BCBSNC Summary of Benefits. My family of three has a modest insurance policy. For $750/ month, and a $2500 deductible, we get access to medications for a $15-50 copay; we get office visits for a reasonable fee (under $20). If we have to have surgery, mammograms, colonoscopies (covered by law! ya know), you have to meet the $2500 deductible before you can get reimbursement at 80%-----

all except mental health and substance abuse services.

My Summary of Benefits states:


"Combined in and out of network $2000 benefit period maximum per member, and combined in- and out- of network lifetime maximum of $10,000 per member, provided in all places of service. Any services in excess of this benefit period maximum or lifetime maximum are not covered services."

Covered: 50% AFTER DEDUCTIBLE In Network

Covered: 50% AFTER DEDUCTIBLE Out of Network.


Summary of Benefits:

Outpatient Services: 80% AFTER DEDUCTIBLE
Ambulatory Surgical Center: 80% AFTER DEDUCTIBLE
Inpatient Hospital Services: 80% AFTER DEDUCTIBLE
Maternity and Elective Termination of Pregnancy: 80% AFTER DEDUCTIBLE
Skilled Nursing Facility: 80% AFTER DEDUCTIBLE
Other Services: 80% AFTER DEDUCTIBLE

I dunno: print is pretty black and white. Why do my medical benefits get more extensive coverage (no $10,000 cap) versus what mental health coverage gets and why are services reimbursed at a rate DIFFERENT than the medical benefits when the state law indicates the following:


"New mental-health law to start
Insurance industry must offer equal coverage

Starting today, insurance companies in North Carolina must provide the same level of coverage for some mental illnesses that they do for physical ailments.
That means that someone being treated for depression or schizophrenia can no longer be charged a higher co-payment (or face other inequities in coverage) than someone being treated for diabetes or a broken arm...."


Really? I can't believe they get away with these kind of things.

Think you can get the Department of Insurance interested in these things? NAH.

Think you can get your state legislator interested in what impacts their constituents? NAH.

Been there/ done that. Shame 'em is what I have to aim for.

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