Blue Cross Blue Shield Standard v. Basic Option

[Anonymous]

Does anyone have an opinion or experience with maternity costs associated with the BCBS Standard versus Basic options? It is open season for insurance and I am trying to decide which of these two plans would be the best for giving birth at Sibley in June. I can't figure out which I should be more wary of: Basic option which will not reimburse for out of network providers (do out of network providers frequently provide services without a patient's explicit consent? do I have to take additional steps to prevent receiving services from an out of network provider when I am in the hospital?) or the Standard option which makes me pay percentages of the services rendered no matter who provides them.

[Anonymous]

Go with Standard. Sometimes the pediatrician on call at the hospital who or other physician tending to the delivery will not be in the network. You don't want to be sitting there, post delivery, asking whether someone is covered or not.

[Anonymous]

I have BCBS Basic. The maternity coverage was great. Pretty much everything was 100% covered. There was only a $100 copay for my c-section.

However, as the PP mentioned, one of the pediatricians who examined my DS at the hospital was out of network and we ended up having to pay the whole $300 charge as basic does not cover out-of-network. As far as costs go this was not a big deal, but it did happen.

I think coverage on both is great but the difference in the biweekly premium can be a lot.

[Anonymous]

As far as maternity is concerned, with Standard you are covered at 100%. Completely. You do not have to pay a percentage of services rendered as long as you go with a preferred provider. And nearly everyone is a part of this network (it seems). If your OB participates, there are no copays for office visits. If you are high risk, you go to a peri's office for ultrasounds and don't pay a penny. If your hospital is in network, very nearly everyone working at the hospital participates. The benefits are outstanding. I don't have experience with the basic option, so I can't fairly compare the two. But I do believe that participation by providers in the Standard option is higher. And, my high-risk pregnancy has been virtually free...I think I have to pay the $200 hospital copay. And for next year, you'll have to pay the individual amount due under the policy before all the great benefits kick in (I can't remember...around $300 this year?). I guess it just depends on how much risk you are comfortable with under the basic option. And the PP is correct....biweekly premiums are different. You might calculate the difference in biweekly payments through your estimated delivery date, and see if you think you'd run into that much, or more, of out-of-network provider costs.

[Anonymous]

I actually called BCBS to discuss the differences between the two. I had basic last time. I needed it because my son was a premiee and the Syngerist (RSV) drugs he needed were much cheaper under the basic than standard (I think around $400/shot difference). The basic has a $100 hoptial visit co-charge but the rest of maternity care is covered, including any high risk procedures as long as they are medicially necessary. I will be having numerous ultrasounds and be given progesterone and it is all covered. There is the issue with out of network providers. My friend who just delivered at IOVA two months ago didn't have any people involved in her pregnancy out of network. BCBS is one of the bigger networks so the chance is slimmer of having someone involved who is out of network but there is a chance.

[Anonymous]

I had BCBS Standard when I delivered at Sibley in March of this year. I think the only hospital bill we had to pay was the fee for having a private room, which I think was $230/night (FYI you can get reimbursed from your FSA for your private room fee, so plan ahead). I paid nothing for all of my prenatal care, with the exception of my first visit when I had an u/s to see the heartbeat. I was billed for the u/s (I want to say it was around $100). I called BCBS to ask about this, because I thought that all prenatal care was fully covered. The rep explained to me that the appt. when the pregnancy is confirmed is not considered prenatal care, so it's not covered. I'm sure that's probably the same whether you have Standard or Basic, I just thought it was a great example of typical insurance company BS! And I think we are going to switch to an HMO this open season, because the rates for Standard are going up quite a bit, and I am not super-attached to any of our docs, so don't mind if we have to switch.

[Anonymous]

I have BCBS Basic and my first U/S to see the heartbeat at 8wks was covered. In fact, everything so far has been covered. (I'm 23 wks along) I have not paid anything out of pocket except visit co-pays, but even then I don't always have to make a co-pay -- not sure why that is.

[Anonymous]

Anonymous wrote:I had BCBS Standard when I delivered at Sibley in March of this year. I think the only hospital bill we had to pay was the fee for having a private room, which I think was $230/night (FYI you can get reimbursed from your FSA for your private room fee, so plan ahead). I paid nothing for all of my prenatal care, with the exception of my first visit when I had an u/s to see the heartbeat. I was billed for the u/s (I want to say it was around $100). I called BCBS to ask about this, because I thought that all prenatal care was fully covered. The rep explained to me that the appt. when the pregnancy is confirmed is not considered prenatal care, so it's not covered. I'm sure that's probably the same whether you have Standard or Basic, I just thought it was a great example of typical insurance company BS! And I think we are going to switch to an HMO this open season, because the rates for Standard are going up quite a bit, and I am not super-attached to any of our docs, so don't mind if we have to switch.

I have BCBS standard and did not have to pay for the first OB appt - but I did not have an ultrasound at that appt. I haven't paid a penny and am 24 weeks. From calling them, I believe everything is 100% covered.

[Anonymous]

I have basic and I only had to pay one copay at the first appointment and then after I was deemed "pregnant" everything was covered and I have had not more copays. They covered all ultrasounds as well.

[Anonymous]

Not sure if this relates or not, but we're also trying to decide about BCBS standard vs. basic. We have basic but my husband thinks we should switch to standard because of ER coverage specifically. Basic only covers ER visits related to pregnancy. I had to go the ER during my pregnancy and thankfully the cost was covered. The total ER bill came out to over $10,000. Our concern is that if the baby or one of us has to go the ER in the future we'd be responsible for the high deductible under the basic plan. Something to think about when it comes to healthcare post pregnancy.

[Anonymous]

We had 2 children with BCBS basic and coverage was wonderful and as described by the others. With Standard everything is covered, whereas with Basic there is the $100 hospital charge co-pay, which I think might be $150 in 2010. Also, if you have a boy and choose to have him circumcised, that is considered a surgery and was a $100 co-pay for us. (I think its 15% of plan allowance under Standard) Premiums for Standard are significantly higher though.

I was a little confused by the previous post about the ER, however. Basic does not have a calendar year deductible, Standard option does. If you go to the ER of a preferred facility with the basic plan, it is a $75 co-pay. If it is a medical emergency/accidental injury and no preferred ER is availble BCBS will cover the initial treatment. It looks like the Standard plan differentiates between an accidental injury - whereas everything is covered vs. $75 copay with the Basic and a Medical Emergency which requires you to pay 15% of the plan allowance vs. Basic which is again the $75 copay.

[Anonymous]

I heard on NPR today that both are going up 14%!!? Is it just me or that sounds like A LOT, especially in this economy?

[Anonymous]

Yep, it's going up a lot! I looked into switching for this reason, but in the end decided to stick with BCBS.