Anthem BlueCross BlueShield offers two plans in Connecticut for 2012. They offer a PPO and an HMO plan. The HMO “Mediblue HMO” has been around for 3 years. The PPO is new for 2012 and has the best benefits on paper of any Medicare Advantage plan in Connecticut.
The PPO offers substantially better benefits than the HMO to such an extent it does not make much sense for a consumer to consider the plan. The PPO utilizes the nation anthem BCBS nationwide network. It has out of network benefits which are almost par withe in network benefits. They have $0 copay for a primary doctor and $0 copay for some generic drugs as well. Two of the better benefits are the Hospital benefit which is $250 a day for 6 days in or out of network. Meaning that you can go to a non participating hospital and pay the same as if it was an in network hospital. The outpatient surgery benefit is a max copay of $250 which is the best available. Lastly, the out of pocket max on this plan is $3,400 in and out of network combined which is far better than any other advantage plan in CT.
We have nearly 900 clients in this plan throughout Connecticut so we have a very good pulse on how it is working. There are some problem areas that have come up that consumers need to be aware of.
-There are a number of doctors that are listed as in network but will not see patients on the Anthem PPO. They either charge them full price or will not see them at all. This has occurred a number of times in 2012
-The customer service for the PPO leaves a lot to be desired. Many times the representative does not even understand the plan and gives out incorrect information.
-There are a number of common drugs which are not in the formulary and there are a number of generic drugs in the 2nd and 3rd tier.
While this plan is the best on paper and works well for many people, it is not administered well and generates a number of calls to our office from clients. Billing departments at doctors offices should be contacted prior to enrolling in this plan to make sure they accept it. Be very clear with the billing department that the plan is the Anthem “PPO” Medicare Advantage plan. Make sure they understand it is not a supplement plan.