Monday, October 29, 2018

MyChoice: Part 2

Last Friday, we posted on a new product being rolled out by Blue Cross/Blue Shield of North Carolina (BX):

"MyChoice is a less expensive option for families and small businesses who may not be able to afford other, higher-priced ACA plans"

The product's "hook" is that, instead of paying negotiated rates (as in PPO and HMO models), the plan reimburses "up to" 140% of what Medicare would pay. So, for example, if the doctor charges $100, and Medicare would have paid $60, MyChoice would reimburse $84 (leaving $16 as a potential balance to be billed). Now it's possible, given the "up to" wording, that the carrier may, in fact, send a check for (substantially?) less than this.

But it gets even more interesting: I had at first taken this to be a plan for small employers, but BX is also offering it on the individual market for 2019. Note, though, that even though it's ACA-compliant, it's not going to be offered on the Exchange, and therefore it's not subsidy-eligible (which makes sense, given it's already bare-bones pricing). On the other hand, it does include ACA-required EHB's and no exclusions for pre-existing conditions. And, of course, no extra charge for folks with those conditions.

So Henry, you may ask, how can they offer ObamaPlans with premiums discounted by up to 30%?

Well therein lies a rather interesting tale: while pretty much all carriers are now moving to narrower networks and abandoning PPO-style plans, MyChoice eschews the network model altogether, and, in fact tosses out UCR (usual, customary and reasonable), as well. Instead, you go to any doc you choose, and the plan will pay up to that pre-arranged number. And this is the case with both the individual and group models.

Patrick and I have some questions about this, and have reached out to the carrier for clarification (which we'll share in a future post providing they reply). But in the meantime here's my takeaway:

On those individual plans, the anti-choicers went ballistic over the new, expended Short Term Medical plan rules; one can only imagine the paroxysms they'll have on these.

And what about employers: will they be able to explain the potential balance billing nightmares to their employees? The carrier provides at least a partial answer:

"Blue Cross NC encourages myChoice customers to talk with their provider before any appointment or procedure to make sure they will accept the benefit payments that are provided, or find providers who will."

Now again, this touches on the Holy Grail of transparency, but as I alluded to in the previous post, who shops for the cheapest brain surgeon?

Patrick was concerned about how prescriptions would be handled in these plans, and now we know:

"The plan has a contracted network of pharmacies with agreed-to prices. There is no balance billing if a member goes to an in-network pharmacy."

And they're also HSA-compliant, which may help mitigate some of the balance billing concerns (or no).

Patrick also noted that these plans aren't available state-wide:

"BCBSNC is only offering the product in counties where they couldn't leverage providers."

Which makes sense, in a macabre way. Again, this is ripe for balance billing.

Will be interesting to see how this fares.

Looking forward to reporting on BX's answers.
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