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Bad News For Kelsey Patients Using BCBS

Bad News For Kelsey Patients Using BCBS

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by: KingwoodDotCom Active Indicator LED Icon 18 Site Admin  OP 
~ 7 years ago   Jul 27, '16 2:12pm  
Bad News For Kelsey Patients Using BCBSKelsey-Seybold will no longer be an in-network provider for patients using Blue Cross Blue Shield (BCBS) insurance starting in October.Angela, a Kelsey-Seybold patient, received a major shock this morning when she called to schedule an appointment with her Podiatrist. The operator informed her that come October, her insurance plan would no longer be accepted by Kelsey-Seybold. Angela then decided to call BCBS to get some answers. “She (BCBS agent) told me they could not come to an agreement on the contract,” said Angela. “That means, as of 10/1/16, I cannot see any doctors with Kelsey if I want to be covered…My plan does not offer any out-of-network benefits.” We reached out to both Kelsey-Seybold and BCBSTX, and here are their responses...From Kelsey-Seybold:*BCBS has terminated and dismissed Kelsey-Seybold from the PPO/POS and Traditional/PAR Plan networks. This means effective Oct. 1, 2016, we will no longer be an in-network provider for these plans. This is very disappointing to Kelsey-Seybold and our patients. We have made a long and diligent effort to continue our participation with Blue Cross. We deeply appreciate the trust which our patients have placed in us. We pledge to work with them through this transition , and hope that they will continue to choose Kelsey-Seybold for their care. Blue Cross Blue Shield patients can refer to the link below for more information about this termination and options available to continue their care with Kelsey-Seybold. ~Spencer Berthelsen, M.D., F.A.C.P., managing director of Kelsey-Seybold Clinic*http://www.kelsey-seybold.com/insurance/bcbs/pages/default.aspxFrom Blue Cross Blue Shield of Texas:*Blue Cross and Blue Shield of Texas (BCBSTX) have been in contract discussions with Kelsey-Seybold Clinic. While negotiations were held in good faith, we were not able to reach an agreement, therefore Kelsey-Seybold will leave the BCBSTX BlueChoice® PPO/POS and Traditional/Par Plan networks effective Oct. 1, 2016.  At the rates Kelsey-Seybold is currently receiving, our members  bear the burden of unnecessary and unwarranted additional  out-of-pocket costs with no guarantee of a better member experience.  Because holding costs down for our Texas members is a priority for us, the rates currently in place at Kelsey Seybold Clinic are not sustainable.  We monitor our contracts closely to ensure we offer competitive rates to health care providers that also help keep premiums affordable for our members.  Our members expect us to be a good steward of their health insurance premium dollars and to do what we can to help prevent medical cost increases. Health care is a major expense for most families, and we owe it to our members to do everything we can to keep prices down.  Even though Kelsey Seybold has made the decision to leave the BCBSTX BlueChoice® PPO/POS and Traditional/Par Plan networks, members still have access to a broad network of participating providers.*http://www.bcbstx.com/kelseyseybold/index.htmlAngela went on to add, "I am shocked to say the least! What do you do? Change all the doctors you have grown to trust over the years, or change the insurance coverage you have had for 15 years? What is more important? Your trusted physicians or the people you pay for the coverage? I believe it’s the former, but to change insurance plans is not that easy either. If I don’t change, I will now have only two months to find 13 new doctors and specialists for my family and I." 4951
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Retired_Engineer Active Indicator LED Icon 13
~ 7 years ago   Jul 27, '16 2:15pm  
This is what happens when health-care providers and insurers are more concerned with profits than patient care.  4951
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ET Active Indicator LED Icon 17
~ 7 years ago   Jul 27, '16 2:18pm  
Same thing happened to us several years ago with Aetna.  Guess at some point KS will run out of insurance companies. 4951
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BooBear Active Indicator LED Icon 16
~ 7 years ago   Jul 27, '16 2:22pm  
Great.. nothing like paying for a neurologist out of pocket. 4951
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MarT Active Indicator LED Icon 9
~ 7 years ago   Jul 27, '16 2:27pm  
@BoobearMaybe you can get the neurologist you like to recommend someone as qualified, before they stop taking your Ins.  Stinks, it's gotten so complicated! 4951
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analogkid Active Indicator LED Icon 3
~ 7 years ago   Jul 27, '16 2:37pm  
Welp, that hits our whole family.  I have UT Select PPO.  Now need to find family physicians that take this.   4951
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Spork Active Indicator LED Icon 9
~ 7 years ago   Jul 27, '16 3:11pm  
Bend over people. You might feel a little discomfort.
 
4951
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ctl74 Active Indicator LED Icon 10
~ 7 years ago   Jul 27, '16 3:28pm  
BCBS doesn't play well in the sandbox and refuses to negotiate. It's a major issue up in Pittsburgh with them and the UPMC health system (though I'm not a fan of how UPMC was playing the game either). Good luck finding a new PCP. 4951
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Chrisinkingwood Active Indicator LED Icon 8
~ 7 years ago   Jul 27, '16 3:33pm  
In this day and age this is just nuts. KS is a big healthcare provider, we love our family GP, Dr.  Scorbecia and my DW just started seeing the Neurologist at the main office down near the Medical center. We got a letter yesterday from BCBS saying that that after December Walgreens will not be on their list of pharmacies and that my Advair Diskus for asthma will move from Tier 3 to Tier 4 which makes no sense as there is not a generic substitute and it has been on the market for many years so the cost of the drug has not changed. 4951
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CC1974 Active Indicator LED Icon 8
~ 7 years ago   Jul 27, '16 3:37pm  
We need real Healthcare Reform. 4951
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Chrisinkingwood Active Indicator LED Icon 8
~ 7 years ago   Jul 27, '16 3:39pm  
We need real Healthcare Reform.
 
@CC1974: Or maybe a single payer plan instead of all this rate rigging.
4951
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CC1974 Active Indicator LED Icon 8
~ 7 years ago   Jul 27, '16 3:44pm  

- - - - - - - -
>> We need real Healthcare Reform.
 
@CC1974: Or maybe a single payer plan instead of all this rate rigging.
 
@Chrisinkingwood:
 
Like Canada...no thanks. 4951
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CC1974 Active Indicator LED Icon 8
~ 7 years ago   Jul 27, '16 3:44pm  

- - - - - - - -
>> We need real Healthcare Reform.
 
@CC1974: Or maybe a single payer plan instead of all this rate rigging.
 
@Chrisinkingwood:
 
Like Canada...no thanks. 4951
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HollyHobby Active Indicator LED Icon 9
~ 7 years ago   Jul 27, '16 3:48pm  
I'm going to look into a concierge physician. I have a friend in Northern California and that's what she uses. No insurance and she doesn't have to pay the Obamacare fine. 4951
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Spork Active Indicator LED Icon 9
~ 7 years ago   Jul 27, '16 3:48pm  
maybe a single payer plan instead of all this rate rigging.
 
@Chrisinkingwood:
 
I agree as long as the single payer is the consumer and not some government bureaucracy.
 
If politicians were committed to making health plans mandatory, they should have mandated individual health savings accounts with a high deductible insurance component for catastrophic events. 4951
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ctl74 Active Indicator LED Icon 10
~ 7 years ago   Jul 27, '16 4:00pm  
I'm going to look into a concierge physician. I have a friend in Northern California and that's what she uses. No insurance and she doesn't have to pay the Obamacare fine.
 
@HollyHobby: I did a story on a concierge PCP in Dallas last month As he explained it, the thought is that you still have health insurance (in case something major comes up) but the concierge doc (while still has minor costs for prescription drugs and some tests and blood work) is free outside of the monthly membership. If you need to see him or contact him 30 days out of the month (bc of being a hypochondriac - lol), than he'll see you. And plans are based on age range (I think I feel in the $80/mo range). So, there is something to be said about switching to a concierge doc.
4951
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