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Individual Health Insurance Review - BCBS

My family and I are covered with an HMO plan by Blue Cross in the state of Missouri. While I am very glad that I have health benefits, sometimes I get very annoyed by the coverage this affords me. As with most HMO's, I chose a primary care physician from a list in the book they provided me with when I signed up. While this book states very clearly that you should always call to find out if the physician that interests you still accepts your coverage, I would also recommend that you call your own doctor to see if he accepts your insurance if he or she is not listed in the book. While those listings are up to date, they are printed and every update is not necessarily covered in the edition you received.

Obviously, the thing I like best about my HMO is the peace of mind, that in an emergency, “how am I going to pay for this?” is not a primary concern for me. One of the things I like the very least about my HMO is the whole concept of “network” hospitals and care providers. If the only hospital that will accept my HMO is a hospital that is not located conveniently, what happens if I need to go to the emergency room in a hurry? Going to an "out of network" emergency room could result in denial of claims which brings me back to the original worry of “how am I going to pay for this?”

I understand the idea of the doctors working in a specific network and I really have no problems with seeing a doctor that is affiliated with a specific network. I don’t think I’d even have too many issues with needing to use a particular hospital for outpatient or scheduled procedures. But I do not think it’s right that one’s insurance hassles a patient for their choice of hospitals for an emergency situation. I wish every hospital was included in standard HMO's so if Hospital A was closer, you just go to Hospital A. In an emergency, one doesn’t always have time to worry which hospital is “in network.” Spending twenty extra minutes driving to Hospital B is just delaying treating the emergency.



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