Blue Cross Blue Shield of Texas Ending Individual PPO Health Plans
More than 300,000 Texas members of Blue Cross Blue Shield insurance will see a major change in their plans as the company will be dropping individual PPO health plans in favor of HMO plans.
According to Blue Cross Blue Shield, the Affordable Care Act has changed the market for health insurance and some of their more affordable plans are no longer financially viable for them. Divisional senior VP and chief medical officer Dan McCoy noted that the decision to change was not taken lightly, and that the company paid out $400 million more last year in claims than it made in premium payments,
It's important for any market offering to be sustainable long term, so when the cost of health care delivery outpaces the premiums that are charged for that product, it results in a loss. The individual PPO plan was not sustainable and that's why it was discontinued off the exchange.
Customers affected by the change are concerned that their ability to see specialty doctors will be greatly limited on a HMO plan, especially those who need to see a specialist to survive. One anonymous Blue Cross Blue Shield member expressed concern over a family member no longer being able to take her son to his usual neurologist for treatment of his seizures,
She's going to go from a PPO to an HMO and she can't find a doctor that will take him as a neurologist. He could die. It's not just, oh he needs a doctor. It's imperative that he has a neurologist because he has these seizures. Sometimes he can have 10 a day.
As for Wichita Falls residents, the change in plans will mean that United Regional will not be a covered option. Only Kell West and some doctors at Community Health Care Center are covered under the HMO plan. According to Tom Wilson with Texoma AHU,
I'm trying to find a silver lining to it and something good out of it, but I really can't think of anything that's good about it right now. People are going to bleed out of this community and have to go to another part of the state to receive their health care.
The change in coverage plans will not affect members who have coverage through a group PPO plan through their employer or those who were grandfathered in back in 2010.