help with New York Empire BC/BS

[Guest guest]

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[Guest guest]

Lee,

We live in Long Island, and have BC/BS, but we have the EPO, so we can only use participating providers as we have no out of network benefits. My husband's hep is Dr. Hillel Tobias. He is on 30th St between 2nd and 3rd in Manhattan and is affiliated with NYU, where he is the medical director of the liver transplant team. I have a 19 year old son who has the same inherited liver disorder as his father and he is currently at Mt. Sinai in their Peds Liver program, but I am thinking of switching him over to Dr. Tobias as well, as his hep Ben Shneider left Sinai for Pittsburgh and the new doc seeing him is not participating in our plan. He has been wonderful to my family and is a kind, caring and compassionate physician. His assistant's name is Lynne, she can tell you if they accept your plan. His # is .

LizSee what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

Hi All,

My son has come to that cross road where he needs to switch from

Cobra to BC/BS. In Queens NY, they have Empire BC/BS and they have a

plan called

Healthy New York and it is an HMO not a PPO.

My questions for you New Yorkers are,

Is anyone in this HMO?

Does anyone have a Primary Care Giver to recommend with this program?

Do you need preapproval for test/ ER visits?

My son is in Queens and was in New York Presbyterian hospital where

Dr. Ira son is his hep. Dr. son does not participate in BC/

BS and we need to pay him separately anyway. For over 25 years we

have had BC/BS but we have never been in a HMO. This will be quite

different for us.

They have a BC/BS PPO but it is $1,357.68 a month versus the HMO at

231.45 a month.

I know I need to call back and ask more questions but any advice ?

Thanks,

Lee mother of Bill 24 UC/PSC 06/04 J pouch 06/05

[Guest guest]

Lee,

We have the Empire Plan through the State of NY for government

employees, so I am not sure how much help I can be. We pay $18 for

office visits. My son's Ped GI does not take our insurance, but we

stay with him and pay the fee for the office visits ourselves because

he is not a participating provider. My son has had a liver biopsy and

an MRCP both done at Mt Sinai. We have only had to pay a 35$ co-pay,

which I think is wonderful. It seems like the hospital bills are all

covered, but the Dr's bills are different. Sometimes the insurance co

sends me the payment directly and then I have to pay the Dr. This

happened with the anesthesia (sp?) bill.

My own opinion is to get my son the best care and then hope the

insurance will take care of it, if not, I will worry about it when the

time comes.

, Mom of Miles, 6, UC, PSC

[Guest guest]

Thanks and Liz.

It looks like out only option at this point anyway.

So we will start the process and hope it works.

Lee

[Guest guest]

Lee,

Sorry to ask a maybe obvious question, but I checked the PSC database of Common Abbreviations, and these ones aren't in there;

- BC/BS -

- HMO -

- PPO -

What do they mean?

Ian

Hi All,My son has come to that cross road where he needs to switch from Cobra to BC/BS. In Queens NY, they have Empire BC/BS and they have a plan calledHealthy New York and it is an HMO not a PPO.My questions for you New Yorkers are,

Is anyone in this HMO?Does anyone have a Primary Care Giver to recommend with this program?Do you need preapproval for test/ ER visits?My son is in Queens and was in New York Presbyterian hospital where Dr. Ira son is his hep. Dr. son does not participate in BC/ BS and we need to pay him separately anyway. For over 25 years we have had BC/BS but we have never been in a HMO. This will be quite different for us.

They have a BC/BS PPO but it is $1,357.68 a month versus the HMO at 231.45 a month.I know I need to call back and ask more questions but any advice ?Thanks,Lee mother of Bill 24 UC/PSC 06/04 J pouch 06/05

-- Ian Cribb P.Eng.

[Guest guest]

Ian,

BC/BS = Blue Cross Blue Shield (Insurance Company)

HMO = Health Maintenance Organization

PPO = Preferred Provider Organization

You'll need to Google the last two for specifics but they also relate

to insurance and methods of being insured.

Later my friend

- 45

PSC, Crohns 2000

> >

> > Hi All,

> > My son has come to that cross road where he needs to switch from

> > Cobra to BC/BS. In Queens NY, they have Empire BC/BS and they

have a

> > plan called

> > Healthy New York and it is an HMO not a PPO.

> > My questions for you New Yorkers are,

> > Is anyone in this HMO?

> > Does anyone have a Primary Care Giver to recommend with this

program?

> > Do you need preapproval for test/ ER visits?

> >

> > My son is in Queens and was in New York Presbyterian hospital

where

> > Dr. Ira son is his hep. Dr. son does not participate in

BC/

> > BS and we need to pay him separately anyway. For over 25 years we

> > have had BC/BS but we have never been in a HMO. This will be quite

> > different for us.

> >

> > They have a BC/BS PPO but it is $1,357.68 a month versus the HMO

at

> > 231.45 a month.

> >

> > I know I need to call back and ask more questions but any advice ?

> > Thanks,

> > Lee mother of Bill 24 UC/PSC 06/04 J pouch 06/05

> >

> >

> >

>

>

>

> --

> Ian Cribb P.Eng.

>

>

[Guest guest]

Thanks ,

I've added them to the PSC database of Common Abbreviations. I'm praying all goes well for you next week.

Ian (51) PSC 89

Ian,BC/BS = Blue Cross Blue Shield (Insurance Company)HMO = Health Maintenance OrganizationPPO = Preferred Provider OrganizationYou'll need to Google the last two for specifics but they also relate to insurance and methods of being insured.Later my friend - 45PSC, Crohns 2000> >> > Hi All,> > My son has come to that cross road where he needs to switch from

> > Cobra to BC/BS. In Queens NY, they have Empire BC/BS and they have a> > plan called> > Healthy New York and it is an HMO not a PPO.> > My questions for you New Yorkers are,> > Is anyone in this HMO?

> > Does anyone have a Primary Care Giver to recommend with this program?> > Do you need preapproval for test/ ER visits?> >> > My son is in Queens and was in New York Presbyterian hospital where> > Dr. Ira son is his hep. Dr. son does not participate in BC/> > BS and we need to pay him separately anyway. For over 25 years we> > have had BC/BS but we have never been in a HMO. This will be quite

> > different for us.> >> > They have a BC/BS PPO but it is $1,357.68 a month versus the HMO at> > 231.45 a month.> >> > I know I need to call back and ask more questions but any advice ?

> > Thanks,> > Lee mother of Bill 24 UC/PSC 06/04 J pouch 06/05> >> > > >> > > > -- > Ian Cribb P.Eng.>

>

-- Ian Cribb P.Eng.

[Guest guest]

Hi Ian,I see that answered these for you, thanks .The HMO and PPO are different plans with different cost.In our case, NY EMpire was charging $232 for the HMO which means you must use their providers and over $1,300 for the PPO which means you can travel outside your network.It looks like price will make us go with the HMO but this makes me nervous when you need specialist.Lee. 

[Guest guest]

Ian,

Thanks for the consideration for next week. I've lived long enough

to know that the power of prayer is strong. I'm remaining hopeful

that the experts at Mayo can get through the CBD, where 3-4 (I've

lost count) previous attempts have failed.

Thanks again Ian ...

Later my friend

- 45

PSC, Crohns 2000

> > > >

> > > > Hi All,

> > > > My son has come to that cross road where he needs to switch

from

> > > > Cobra to BC/BS. In Queens NY, they have Empire BC/BS and they

> > have a

> > > > plan called

> > > > Healthy New York and it is an HMO not a PPO.

> > > > My questions for you New Yorkers are,

> > > > Is anyone in this HMO?

> > > > Does anyone have a Primary Care Giver to recommend with this

> > program?

> > > > Do you need preapproval for test/ ER visits?

> > > >

> > > > My son is in Queens and was in New York Presbyterian hospital

> > where

> > > > Dr. Ira son is his hep. Dr. son does not

participate in

> > BC/

> > > > BS and we need to pay him separately anyway. For over 25

years we

> > > > have had BC/BS but we have never been in a HMO. This will be

quite

> > > > different for us.

> > > >

> > > > They have a BC/BS PPO but it is $1,357.68 a month versus the

HMO

> > at

> > > > 231.45 a month.

> > > >

> > > > I know I need to call back and ask more questions but any

advice ?

> > > > Thanks,

> > > > Lee mother of Bill 24 UC/PSC 06/04 J pouch 06/05

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > > Ian Cribb P.Eng.

> > >

> > >

> >

> >

> >

>

>

>

> --

> Ian Cribb P.Eng.

>

>

[Guest guest]

Lee -

Having lived with HMO's for about 20 years (maybe more!), overall we

have had good experiences. There is a process for obtaining 2nd

opinions (or 3rd) and for obtaining authorization to see someone

outside of the group, if needed. Sometimes it takes effort and

perseverance, but can be done.

My last experience with a PPO was not so positive - I had lots of

labwork done, MD follow-up with the third tier of the group, and the

most humongous co-payments - much more than I would ever have

imagined. Those bills were not pretty, nor expected.

Good luck!

Joanne H

(, Ca., mom of , 17, UC/PSC 2-06)

> The HMO and PPO are different plans with different cost.

> It looks like price will make us go with the HMO but this makes me

> nervous when you need specialist.

> Lee