Which is better -Blue Shield or Blue Cross

[beingmindful]

We are thinking of switching from Anthem Blue Cross PPO to Blue Shield PPO. We have a small business plan. Right now, DH is on Rebif which is covered at $45 copay per month under Anthem. But who knows what drugs he may be on in the future -- Ampyra, Tysabri, oral DMD's. Has anyone compared Blue Cross vs. Blue Shield coverage for coverage of MS drugs in general? Blue Shield offers much better rates for lower deductible and higher (90%) covered percentage payment for inpatient and outpatient care, and lower out of pocket maximum. But is there a catch? Does Blue Shield refuse to cover or charge more for MS medications such as Tysabri, Ampyra, the CRAB's or newer oral DMD's?
We have until the end of the year to decide whether to switch carriers.
I also think it might be a good idea to have a separate Board for insurance coverage issues. (Or maybe there is one, and I missed it??)
Thanks everybody.

[heliotrope]

In many states, these two are the same and denial/acceptence depends what state you're in (the drugs accepted will depend on that state's rules)... You might request copies of their plans (and ask about those specific drugs).

[Redwings]

Heliotrope gave you good information. How the plans operate depends on what state you live in. More specifically, it will be helpful to get, either from the plans themselves or from your insurance broker, copies of each plan's drug formulary, drug copay structure and drug approval guidelines for your state.

[gomer]

Once upon a time.........

Blue Coss was Hospital coverage..

Blue shield was doctor coverage..

(I think I got the 2 straight)

These days there is so much blurr.......

I use my diabetes center to help me compare various optinons. There is also help availabel at the local senior center as well.

Like Redwings said.. coverages etc vary by state.


Doc Gomer Doctor of, Been There, Done That.

[beingmindful]

California, that is

Sorry I should have mentioned we are in California. If anyone has any experience with both these companies in CA, and has a recommendation for PPO, please let me know. I have looked at both websites, and I do not see Tysabri or the new oral DMD's on either site. Ampyra is listed on Blue Shield, not Blue Cross. This is really hard. Shouldn't be this hard. I would appreciate any insights.

[heliotrope]

The one thing I can suggest - if (and this is a big if) your town has a disability coordinator (someone that ensures ADA), try calling. It can't hurt. Ours has been able to help with something as random as getting our phone line fixed.

[Cate Power]

From the research I have done on dental insurance, the costs and benefits are entirely dependent on what employer offers/purchases. So, I don't think it's possible to answer the question across the board.

[MSGina]

Blueshield

We have Blue Cross/Blue Shield (BCBS) PPO and as my husbands open enrollment just ended we learned BCBS is going with a different prescription p;an/pharmacy for next year.

If I remember correctly, when I was still on Copaxone, (5 years ago) my copay was $50. However, Blue Shiled does all meds like DMD's thru a speciality pharmacy at that time it was McKesson. It's important you verify costs before the speciality pharmacy ships becuase their computers don't always talk to Blue Shields Computers.

I have been treated very well by bcbs.
They pay well, they pay on time and contract with good doctors and hospitals.

Good luck.

[Redwings]

They pay well, they pay on time and contract with good doctors and hospitals.

In California, both Anthem BC and BS have been fined by California’s Department of Managed Health Care for untimely and unfair claims payment practices. Anthem BC was fined $900,000.

[Redwings]

This is really hard. Shouldn't be this hard. I would appreciate any insights.

Hi beingmindful:
I think the reason you're finding picking a plan to be so hard is that you're trying to make a business purchase decision based on generic documents and Internet information that were never intended to be used that way.

When you look at the formulary information for the MS drugs, the documents refer readers back to their insurance plan documents. You don't have those insurance plan documents, so it's impossible to know how the plans handle those meds.

If you're going to get insurance by purchasing a small business plan, then you have to approach the purchase of an insurance plan the same way a business purchaser would approach any business purchase. You can't do that based on generic Internet information aimed at consumer buyers/users.

That means that the HR person for your business has to contact the sales departments for the sellers -- Anthem Blue Cross and Blue Shield -- or an insurance broker and get specific formulary information for each of the possible business plans that your small business is eligible to purchase. Business-to-business operates differently than business-to-consumer. If you're a business, it's to your advantage to act as one. Asking for consumer experiences might be helpful, but to base a business purchase decision on plans that you have no information about or aren't eligible to buy is an invitation for trouble.

To know what your formulary and other options/costs are, you have to contact the companies' sales departments or use a broker to get that information. That's how businesses operate. Is there some reason why your business isn't doing that?

[akafearless]

BCBS

Check their formulary. My former employer offered either BCBS or Cigna. I chose Cigna (cheaper), a co-worker chose BCBS. She wanted to go on Copaxone this summer and it was not covered.
I was shocked! Still don't understand how they did not have to cover it especially since it is different. She was going to have to wait till January when her insurance could change.
Under Cigna all of the CRABs were covered, I pay $60 for a 3mos supply of Avonex.

[MSGina]

In California, both Anthem BC and BS have been fined by California’s Department of Managed Health Care for untimely and unfair claims payment practices. Anthem BC was fined $900,000.

I live in NV =)

[beingmindful]

Thanks this is very helpful

Hi beingmindful:
I think the reason you're finding picking a plan to be so hard is that you're trying to make a business purchase decision based on generic documents and Internet information that were never intended to be used that way.

When you look at the formulary information for the MS drugs, the documents refer readers back to their insurance plan documents. You don't have those insurance plan documents, so it's impossible to know how the plans handle those meds.

If you're going to get insurance by purchasing a small business plan, then you have to approach the purchase of an insurance plan the same way a business purchaser would approach any business purchase. You can't do that based on generic Internet information aimed at consumer buyers/users.

That means that the HR person for your business has to contact the sales departments for the sellers -- Anthem Blue Cross and Blue Shield -- or an insurance broker and get specific formulary information for each of the possible business plans that your small business is eligible to purchase. Business-to-business operates differently than business-to-consumer. If you're a business, it's to your advantage to act as one. Asking for consumer experiences might be helpful, but to base a business purchase decision on plans that you have no information about or aren't eligible to buy is an invitation for trouble.

To know what your formulary and other options/costs are, you have to contact the companies' sales departments or use a broker to get that information. That's how businesses operate. Is there some reason why your business isn't doing that?

Thanks to all of you for the excellent advice. Based on your advice, I contacted the insurance broker and am getting more detailed information from her. Thanks.