Friday, November 15, 2013


Several years ago I launched this blog as a way to reflect on recent experiences or esoteric discoveries from which I'd learned something useful, something to remember for future endeavors. 

Finally, at long last, I might actually have a post that fits that original mission.

Yes, this is another story about health-insurance reform.  I've been a supporter.  I thought I knew all about it.  I thought we'd have no problems.

Blue Shield told me it would automatically convert me to a new plan that's not only better but would save me about $200 a month!  It sounded so good, I was going to add my wife and daughters (who have been covered by Aetna, which is leaving California).

Then I heard something on the radio.  It suggested checking your new policy's network of physicians to make sure your doctors are still included.  I hadn't thought of that.

Sure enough, the new and better plan had found a legal way to skimp--by shrinking the "network."  None of my doctors would be part of it.

When I called Blue Shield to double-check, I got a confusing answer.  "I don't know," said the customer service agent.  "Our computers might not be up to date.  Call your doctors' offices."

So I did.  The doctors' offices reassured me that they WILL still be part of the Blue Shield Preferred Provider Network.  No worries, right?

Still, the discrepancy bothered me.  I particularly didn't want to be recommending Blue Shield to my family if it was going to suck.

I called Jeni Blumenthal.  She's a local insurance broker.  Why didn't I call her sooner?  Well, I'm the kind of guy who goes directly to the insurers, that's why.  I never used a travel agent either.  (You older folks may remember when there used to be travel agents.)

Jeni instantly understood my problem, practically finishing my sentences for me.  "UCLA--" which is the group most of my doctors are part of "--is in the Blue Shield Preferred Provider Network only for group plans, not individual policies," she explained.

Aha!  In one sentence she had solved a mystery that had been dogging me for weeks!

Blue Cross, on the other hand, would cover the UCLA doctors but did not offer a PPO plan in my area, meaning if I went out of network I'd have to foot the entire bill.  Also, some of my doctors are affiliated with Cedars-Sinai, which I guess is so far away (half-hour drive, in Beverly Hills) that none of the local carriers would cover them!

But, she said, CIGNA was going to be offering a plan in my area that would include all of my doctors.  Details such as price won't be released until next week.

That's assuming, of course, that Washington doesn't change everything before then.  Honestly, health insurance has become like the weather in Boston.  If you don't like it, just wait a few minutes and it'll change.

So stay tuned!