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Any Anthem Blue Cross Insurance experts out there?

Cathyb

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I hope someone can help us! We are paying for private insurance thru Anthem for an unemployed 45 yr old daughter going through some difficulties. We have a $2500 deductible but she is able to pick her doctors thru its PPO list of doctors. Premium has skyrocketed to about $275/month.

Her last breast exam she needed to come back a second time for a recheck and they also did an ultrasound and was told there is some type of 'scarring' and they are watching it, but come back in a year.

Recently I read about a woman with Anthem that had developed breast cancer and they told her she wasn't covered for that. (It was a USA Today article). I hesitate to call Anthem because it may raise a Red Flag and they cancel her.

I had breast cancer 12 years ago and her father died of stomach cancer so it is crucial that we have insurance for her that will cover any hospital costs if that is where this will end up next year. We are retired and cannot afford to pick up the entire costs of hospital charges.

Any advice on how to get answers without causing Anthem to take actions is greatly appreciated. Is there a specific place on the policy that would list its exclusions? Thank you in advance.
 

Wonka

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Not an expert

Gosh, I'm not an "expert" by any stretch of the imagination on Anthem. We have Blue Cross (for those that don't know it's a Blue product) Anthem. They can be very difficult to deal with (like most others). I do hope her application revealed your cancer history because if it's going to be an expensive situation, they may look at the application for pre-existing conditions and truthfulness. They have covered most expenses for us, but the deductibles are pretty high and they are very slow payers to the physicians. I'd suggest looking closely at the application disclosures, and then contact them. We buy insurance to pay for problems like hers, a call shouldn't raise "red flags" if your just asking about coverage. If you have an agent, ask them first.
 

RahRah

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Not an expert either, but $3300 a year is a pretty good deal IMO, even with the higher deductible. We have an Anthem PPO that we out-of-pocket pay $396 a month for family coverage (that's in addition to the $592 a month paid by DH's company for his individual coverage that's part of his employment)....so for a family that's total $988 a month if we had to pay for the policy totally on our own!

I agree with the other poster than your biggest risk for cancellation isn't her current potential issues, but was the declarations made in the initial buy of the policy accurate to include any potential issues the insurer may face paying in the future? If they are, then it's difficult for Anthem to cancel if she does develop a problem......and I'd even go so far as to suggest that even when she finds employment, she keep the policy going rather than risk a pre-existing condition exclusion in the new policy! If she gets employer-based coverage, she should use that as her secondary coverage IMO and keep her existing policy in force to avoid any potential issues in the future.
 

Cathyb

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wonka: We have carried this insurance for her for about 3 years now. It was just this year that this annual breast exam showed some concern. I am a bit confused on your stating honesty on her application. Do they ask questions about your parents' history when you are applying for yourself??? Could you explain a little more so I understand. Thank you for replying!
 

applegirl

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When we signed up for our private health insurance through Blue Shield they sent us an extensive document that lists what's covered and what's not. At the moment I can't recall the name of this document but you need to call and get another copy of it from Anthem so you can carefully look it over and answer your question without asking them.

Janna
 

applegirl

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Oh, also be sure to keep EVERY receipt from any and all doctors she visits. AFter giving birth to my daughter we had a nightmare with doctors collecting money from us because we thought the insurance company was keeping track of what we had payed out of pocket and when the insurance would fully kick in. That was not the case so now we keep scrupulous records of all of our health care costs. We have a very high deductible so insurance won't pay unless we meet that deductible.

Janna
 

Cathyb

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rah rah: There were no problems for her when we signed up 3 yrs ago on cancer issues. Thank you for your advice.
 

Fern Modena

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Cathy,
Call Anthem Blue Cross. Play like you are your daughter, cause otherwise they probably won't want to deal with you. :) Tell them that you have "lost" your Evidence of Coverage and would like them to send you a new one. Ask them if that includes a disclosure, or list of what is covered or not, cause you want to be able to know without having to call them every time you have a question. They will probably ask you then if you have a current question, to which you would, of course, answer "No."

Sis
 

elaine

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OT--I would not wait a year to go back

first, I would go see a OB/GYN that specializes in cancer and have that Dr. tell you "come back in a year." I would guess that they would say recheck in 6 months--a lot can happen in a year--it is probably fine, but I would want to hear that from an expert--not a regular OB/gyn and not from a lab tech or radiologist.
If you have had that ins. for 3 years, don't worry about coverage--at this point, you either have coverage or not and virtually all policies cover pre-existing after 18 months, and I can't imagine a policy excluding breast cancer. Also, since she has had a breast US, her records already have a "breast issue" in them, so not going b/c you are afraid it won't be covered in the future most likely does not come into play. good luck. Elaine
 

Wonka

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wonka: We have carried this insurance for her for about 3 years now. It was just this year that this annual breast exam showed some concern. I am a bit confused on your stating honesty on her application. Do they ask questions about your parents' history when you are applying for yourself??? Could you explain a little more so I understand. Thank you for replying!
Oops, Sorry! Now, I'm not sure, but I don't think parental questions are asked.

I confused health insurance application questions with life insurance application questions on parent & siblings history.
 

isisdave

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I second Elaine. I've heard of too many cases where "come back in a year" turned into "gee, you shoulda come in a year ago".

Check http://www.breastcare.com/ ... the Breast Care Center of Orange. My nurse practitioner friends go there together annually ... it's 60 miles away from us, and they think it's worth it. Should be about the same distance from Carlsbad.

There is another breast care center in Orange with a slightly different name. It's not the same.
 

Cathyb

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isis and Elaine: Her second visit was performed and read at Hoag Hospital's Breast Cancer Center in Newport Beach -- I have always trusted their knowledge (they did my surgery). Do you agree Hoag is tops also in that field, now that you know Hoag was the one who did the ultrasound and second check?

Thank you all, I will call Anthem Blue Cross and try to get a list of coverages and exclusions.
 

elaine

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I would not worry then

I just didn't want a non-expert in that field to be saying "come back in a year." But, yes, I would not worry one bit if getting that advice from Drs. who specialize in breast health. Best wishes. Elaine
 

isisdave

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Agreed ... when you have this kind of challenge, you want help from someone who deals with it all day, every day, and not just as one part of a general practice.
 

"Roger"

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I am curious about the story in USAToday. It just doesn't sound right. Perhaps the patient was denied a specific treatment for breast cancer (considered too experimental) or a genetic test (for BRCA1 and BRCA2) to see whether she was predisposed to breast cancer or it was determined that the patient failed to disclose a preexisting condition. Can you find the story? I am interested in why any insurance would deny treatment for specifically breast cancer.

Regardless, it won't hurt of look at the the Evidence of Coverage. Good luck.
 

funtime

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In Texas HMO's cannot refuse to cover "preexisting conditions." Not sure if that applies nationwide or not. So if your daughter becomes reemployed she should strongly look into HMO's. In contrast, the PPO's have the right to exclude preexisting conditions. I am in Blue Cross, Blue Shied HMOs.
 

Cathyb

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"Roger" We were on a 3 week trip and got the USA Today in Sedona sometime between October 18-25. I'll see if I can check for it online.
 

"Roger"

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I tried looking online but without success. If you can't find it, don't worry. It just seemed like such a curious thing to have happen (but it wouldn't be the first time that something occurred that I had no idea could happen).
 

Cathyb

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Roger: I couldn't find it either, but honest -- it really was there!
 

Cathyb

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Follow-on: Was at our local street faire this Sunday and an Anthem Blue Cross rep was there. He says you double the deductible on breast cancer coverage :eek: That means $5000 before they cover a nickel :(
 
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