LifeWise or Regence BCBS?

[WillowJ]

Any reviews on these health insurance companies? We are having to switch... not happy about losing Providence, but no group coverage anymore. Have three options, technically: Kaiser, LifeWise, or Regence Blue Cross Blue Shield.

Kaiser is really not an option. We've had them before.

Any good or bad experiences with the other two?

 

[zoe.a.m.]

Hi WillowJ,
Since you're in WA too, I guess you probably have similar options. Have you checked out Group Health? I was interested in them when I was looking for an individual plan almost 10 years ago, but they weren't in my area yet. I think they are a pretty solid company.

Regence and Lifewise are two arms of the same company as you probably know, Lifewise being the younger and, in the words of the woman I spoke to a decade ago about their health insurance plans, the "healthier group" of people. I got a good laugh out of that. I'm not certain of what the differences are between the two really, other than having providers in-network is always very important, or how much the company will pay for doctors who are out-of-network. Lifewise has a lot of people covered, even where I live, but they have an incredibly high deductible for out-of-network providers, like $3500, then they pay %50 or what they decide to pay, etc. Overall, they have never given me any grief over paying for tests, many quite elaborate, and the copays are generally $30 for everything. Those add up of course, and I've been told by most offices I go to that my copay is higher than most others. One thing I do know is that they are strong on eye exam coverage and "the worst" (in the words of the people working at the optometrist's office) in terms of paying for glasses or contacts. It's a measly $200 every 2 years, which will not even cover a pair of lenses, minus the frames. My acupuncturist has also confirmed that Lifewise's copays are higher than his other patients.' So, there must be something to that. The "nurse line" is something I started using a few years ago--I know Group Health had that years ago and Lifewise did not, but now they do--and I like it a lot. When I am in a bind and having many symptoms, and since I live alone and have no family support, caretaker or help medically, it's helpful to be able to go over symptoms with an RN and be told whether or not to go on to the hospital. It's still fallible obviously, as the ER or other Urgent Care clinics are hardly up on ME/CFS patients, but it's nice to have the option of discussing it on the phone when too weak to just go and hope for the best. And I know my ER will not even hear a symptom over the phone, and my doctor had no after-hours, no back-up and no true nurse on staff, so I was often at a loss.

You should be able to look at directories online for at least Lifewise, and probably Regence too, where you can look up a specific doc or specialist, or just browse by specialty, and see who is covered in your area. Lifewise has an impressive number of people contracted where I am, so I'm pleased with that. Their customer service is generally very good, they tend to be very helpful and have improved in that area over the past few years to downright pleasant, even over "why-wasn't-this-payed?!" questions.

HTH,
Zoe

 

[WillowJ]

thanks very much, Zoe; that does help.

Yes, I know that LifeWise is some kind of subsidary of Regence, which is a franchise or something of Blue Cross Blue Shield. But they offer different policies under the LifeWise name than they do under the Regence name, and the provider directory is somewhat different. I don't know whether the formulary is the same or different, can't remember if I've checked Regence's yet.

A $30 copay does seem high, but in order to get pharmacy coverage on an individual plan I'm going to have to go with a deductible then 30% plan (up to an out-of-pocket maximum amount). Hopefully they'll figure out that the new WA law about pharmacy coverage isn't working so that this will be fixed by the time most everyone else's renewal comes around.

I'm happy you had good experiences with customer service and availability, as I've heard some different stories online and that had rather worried me.

willowj

ps we do seem to have one more option, Assurant, but I don't think they cover our doctors that we want to keep

 

[IndustryInsider]

{snip}

Regence and Lifewise are two arms of the same company as you probably know, Lifewise being the younger and, in the words of the woman I spoke to a decade ago about their health insurance plans, the "healthier group" of people. I got a good laugh out of that. I'm not certain of what the differences are between the two really, other than having providers in-network is always very important, or how much the company will pay for doctors who are out-of-network.

Actually that is not correct.

Lifewise is a wholly owned subsidiary of Premera BlueCross, not Regence BlueShield. Both Premera and Regence are independent licensees of the BlueCross BlueShield Association.

In WA state, the two "blue" plans compete with each other. I've worked for both; Premera for 10 years and Regence for 5 years.

As to which is better, my sense is you'd get about the same treatment from either. Both gouge their individual plan members to subsidize their group accounts. Both do virtually nothing to truly control costs. Both significantly overpay their executives.

Premera BlueCross tried to switch to a for profit company - which was at least honest about where they wanted to go. Regence professes to be committed to the non-profit status but their actions do not reflect that of a company truly committed to their community.

All of that being said, the doctors and hospitals in WA state both welcome you with open arms if you are insured with either one so if access is a concern, either will serve you well.

Be prepared to look forward to double digit rate increases at least annually from either company.

[/quote]

 

[zoe.a.m.]

Thanks for this info II, I don't doubt any of it is true. Insurance--"Hey Obama! I voted for you because you ran on the 'single-payer' platform, and you shouldn't have caved..."--is just a matter of the lesser evil and the lesser evil and the lesser evil ad infinitum.

I can't believe either corp claims to be non-profit; that rivals the most hilarious things I've ever heard.

Willow, I don't know much about the WA pharmacy plans, maybe you can share more? I can attest to the almost non-existent efficacy of Medicare, and the zero help it has given with medications, absolutely zero.

It is about being stuck between a rock and a hard place, and perpetually squeezed, but I'm grateful to have the Lifewise given the parameters of Medicare, which I'm pretty sure is meant to cover someone in the last 3 days of their life (and to spend those 3 days battling for the coverage of a simple lipid test while the patient succumbs). The system is so broken that I can only speak to specifics of day-to-day experiences. My rates have increased by about 1/3 since signing up. I remember speaking to a LW representative about how now counseling and mental health is covered as much as is needed, and I said I thought it was about time that the law required that and she said, "yeah, but you'll see it in your premiums," and I said, "yeah, but I'd rather pay for that than the other epidemics of approved conditions!"

 

[WillowJ]

nice to meet you, IndustryInsider, and thanks for the info.

Most of what you said is a problem with insurance companies in general, AFAIK. In your experience, do both companies tend to at least pay what the summary sheet says they will pay, without argument?

I don't understand how they can raise rates when there is a contract... but I have seen this happen

and do you know what exactly counts as a 'preventative care' visit when a plan doesn't cover these? a follow-up visit to manage a chronic health condition? a pulmonary function test to monitor a chronic health condition? labwork to monitor the possible effects of medications on a chronic health condition? an MRI to check for a possible condition?

or just 'yearly physical' type visits?

 

[IndustryInsider]

While there are a lot of problems with original Medicare, it is the only health insurer in the country that at least tries to base reimbursement on the actual cost of care. I could go on for months about what the insurance industry has actually done to make health costs in the US 3-4 times what they are in other industrialized nations, but I'll spare you that discussion.

If you have Medicare, you must have a Medigap (aka Medicare Supplement plan) or choose to enroll in a private Medicare plan through Medicare Advantage. In this arena, Premera has chosen to only offer Medigap plans; whereas Regence offers both Medigap and Medicare Advantage plans. For prescription drug coverage, Regence has a pretty solid Medicare Part D plan available as well.

I've been working for insurance companies for 30+ years and I voted for Obama so we could have a single payer system. Yes - it means I'd likely be out of work - with little prospects of finding something else at my age - but the truth is the US health care system is painfully broken. My disabled son and I know first hand how hard it is to find good care and we've got good group health coverage. My heart aches for those who aren't as lucky as are and die because they don't have access to quality health care.

 

[IndustryInsider]

nice to meet you, IndustryInsider, and thanks for the info.

Most of what you said is a problem with insurance companies in general, AFAIK. In your experience, do both companies tend to at least pay what the summary sheet says they will pay, without argument?

I don't understand how they can raise rates when there is a contract... but I have seen this happen

and do you know what exactly counts as a 'preventative care' visit when a plan doesn't cover these? a follow-up visit to manage a chronic health condition? a pulmonary function test to monitor a chronic health condition? labwork to monitor the possible effects of medications on a chronic health condition? an MRI to check for a possible condition?

or just 'yearly physical' type visits?

Nice to meet you too WillowJ.

Both Regence and LifeWise pay what they say they will - in general. Keep in mind that if they say they pay 25% - the appropriate follow up question is "of what"? What is the 25% based on? I can tell you it is based on their negotiated rate. And both LifeWise and Regence have very similar negotiated rates as do most of the commercial health plans operating in the individual and group market.

Mediare rates are slightly less than commercial but in general, Medicare reimbursement to providers is based on actual costs. For a real good read on health care in the USA - the Medicare Payment Advisory Commission (MEDPAC) - is responsible for reporting to Congress about health care in the US.

http://www.medpac.gov/

Medicaid rates are significantly less than commercial so if you can find a good plan that pays providers based on Medicare or Medicaid, you will pay less even if the 25% coinsurance is the same. By that I mean that 25% of a commercial health plan's negotiated rate is going to be more than 25% of a Medicare based negotiated rate and significantly more than 25% of a Medicaid based negotiated. Of course, doctors and hospitals love commercial plans because they pay them significantly more than Medicare or Medicaid - greed knows no bounds.

With respect to what counts as a preventive visit - both typically follow the Medicare guidelines for preventive care. Here's a link to a good link to see what Medicare considers preventive services.

http://www.medicare.gov/navigation/...ive-services/preventive-service-overview.aspx

Keep in mind that it all depends on how the service is billed to the insurance plan. For preventive care, the billing codes must use the appropriate "G" code to be identified by the claims system as a preventive service.

PS - my son has Epilepsy so he needs regular liver function blood tests. For him, this is definitely preventive. But the insurance doesn't see it that way. I share this because it is a good example of how impersonal our health care system really is. What is preventive for one person may not necessarily be preventive for another, depending on the condition.

 

[WillowJ]

Willow, I don't know much about the WA pharmacy plans, maybe you can share more? I can attest to the almost non-existent efficacy of Medicare, and the zero help it has given with medications, absolutely zero.

sure, https://www.lifewisewa.com/lwwa/groups/public/documents/xcpproject/healthplans.asp#please
or if you were asking about plans covering pharmacy, I will post that one in the NW group (go to Groups, My Groups, in order to see it).
See here https://www.ehealthinsurance.com/individual-health-insurance for a plan finder

I suspected Medicare would be little help. Sad to see my suspicions are true.

Nice to meet you too WillowJ.

Both Regence and LifeWise pay what they say they will - in general. Keep in mind that if they say they pay 25% - the appropriate follow up question is "of what"? What is the 25% based on? I can tell you it is based on their negotiated rate. And both LifeWise and Regence have very similar negotiated rates as do most of the commercial health plans operating in the individual and group market.

...

With respect to what counts as a preventive visit - both typically follow the Medicare guidelines for preventive care. Here's a link to a good link to see what Medicare considers preventive services.

http://www.medicare.gov/navigation/...ive-services/preventive-service-overview.aspx

Keep in mind that it all depends on how the service is billed to the insurance plan.

Thanks for that.

yes, I do know about 'allowed amounts'; some providers will drop the difference between original bill and allowed amount (though some won't).

Regence said they followed AHRQ's guidelines about what was 'preventative', but I couldn't find any guidelines there. Hopefully Medicare is similar. I'll phone the companies tomorrow also.

I suspected it might depend on how the service was billed. That's good to know.

I said enough about the PPAHCA on the other thread, although I heard some new things today. ETA: (though please don't get the idea that I disagree that the system is broken--it is, or that we need reforms including some of the things that the PPAHCA did--we do)

 

[zoe.a.m.]

Wow, this is a really interesting amount of information. As stressful as it is, I'm glad to see everything listed here so succinctly.

II, I am in total agreement with your statements about the US vs. other industrialized nations and the premise and general workings of Medicare; it's really great to hear this coming from someone who has been dealing with it every year from inside the system.

I should have added that I am not able to get a supplementary plan--which is highly unusual--due to my age and location. All I could opt for was an Advantage plan, to which there were no advantages, only 1 company, and they pointed out that what they had to offer would not cover anywhere near what I needed covered outside of Medicare, and told me to save my money. If I stay in the county I am in currently, I have to wait 29 years for a supplementary plan: this is not a joke. I called all the major ins. companies in WA when I got Medicare to see whose supp. plan I could get and every single one said they did not offer one to someone in my area at my age. Almost 10 months later, when on the phone with a Medicare cust. service person, they told me that Regence does offer such a plan. I called Regence immediately and asked (I had been told "no" by them months before) and was told yes, but I had just missed the six-months-after-being-enrolled-in-Medicare deadline and that now I had to wait 29 years to reapply. I was pretty enraged and asked how they could simply give me that cut off when they had given me incorrect information in previous calls. All they had to say was "you were given the wrong information." I still can't believe there is no advocacy available for ins. companies screwing people over in this way--it just blew my mind.

I have had few bill disputes with Lifewise, for what it's worth. Usually it's more an issue of getting the doctor to order the tests--I too am supposed to get liver function tests every six months, but in 10 years, I've gotten 3--with the doctor asking me how he/she was going to justify it?! Lifewise never had an issue with it though. I was also pleasantly surprised that my out-of-network CFS doc's ordered tests (some quite sophisticated and some genetic) were covered. Willow, depending on your workups, you may incur some bills. I had a major workup done about 8 yrs into my illness and the amount billed was about $4600 (this was literally tubes and tubes and tubes of send-out, specialty, and blood cultures, etc.) and I think I ended up being on the hook for about $700. I chewed that down with the hospital as they have a sliding scale. I've learned to use PacLab for most things, as they are far less expensive than the hospital, but the hospital is the only place for cultures and such. With PacLab and a CBC/CMP/hormones/D panel/virus panel/etc., I pay between $30 and $60 generally. Sometimes it's as little as $12 or $20. Radiology is one to always be aware of as 20% of a CT or MRI is going to hurt; again, I was able to work with the hospital, but I don't think I've ever been charged more than $200 for such a procedure. Lifewise does not charge me a copay for blood draws (the nurse or phlebotomist's time/procedure) or for my weekly IM shots. Actually, with the IM shots, my charge is usually about $15 every 3 months. Lifewise doesn't cover the actual compounded pharmaceuticals though, which is probably no surprise. As II states about coding, I personally have been told by a few offices that, if the claim is rejected, they look at other codes until the ins. company will pay whatever portion they should. I always let the office know that I'm more than willing to go to battle for my coverage should a problem come up. Occasionally that helps.

I'm glad someone here understands the preventative guidelines better than me, those drive me a little nuts.

Thanks for the links Willow!