What are you MA insurer experiences?
December 15, 2012 10:55 AM   Subscribe

[MA Health Care Filter] I've recently become ineligible for health insurance from my erstwhile employer and need to choose a Massachusetts based insurer to individually purchase coverage from. What is your insurer anecdata?

Myself and my spouse are trying to decide between the insurers offering plans at the 'Silver' level. We don't care about keeping our current physician (as we moved to MA recently and don't really have a current physician). We primarily want to avoid getting yanked around in unpleasantly long billing procedures. I'm willing to pay an extra $x per month to avoid phone conversations about how this form should have been signed under a full moon in fresh goat blood.

I've heard bad things about CeltiCare refusing reimbursement, nothing about Fallon, that BlueCross has the biggest network, and nothing about Harvard Pilgrim or Tufts. Have you had any of these insurers and what has your experience with them been?
posted by andorphin to Health & Fitness (8 answers total) 3 users marked this as a favorite
I have a self-employed Blue Cross plan. It's absurdly expensive compared to a group plan, but the coverage is decent within MA and I've had zero hassle with what has lately been a fairly large number of claims. The main catch is that only emergency care is covered out of state, so when my wife wanted to see a specialist in NY we had to pay out of pocket for that, and I had to go to a surgeon hours away in Springfield instead of the one ten minutes across the border in Vermont.
posted by ook at 11:18 AM on December 15, 2012

It sounds to me like you're looking for Commonwealth Choice - it's a low-cost state-subsidized insurance plan for people in your situation, regulated through the MA Health Connector and managed by several managed care organizations covering various portions of the state.

I happen to work for one of the MCOs that offers Commonwealth Choice, so I don't want to list them (We're state-regulated and have pretty severe marketing guidelines.) But there's a short questionnaire that will get you the information you need at the Health Connector link above.

Sometimes the Choice plans are given different names by the different managed care organization; you'll need to read carefully to make sure you're reading the right info. But in spite of the naming conventions, Choice plans are identical at every plan and every "metal" level. So the only differences will be in two areas:

1) Extra benefits, usually in the form of things like subsidies for fitness clubs or weight watchers, which plans offer to different degrees/amounts, or "stuff" like free bike helmets, that kind of thing
2) Customer experience / customer service

If you need any more info, feel free to PM me. I'm happy to help.
posted by kythuen at 12:21 PM on December 15, 2012

ook: Thanks, that is a useful data point!

kythuen: I think we are in agreement about looking at Commonwealth Choice, assuming it is this kind you get by going through the health connecter's flowchart (we make a bit over the cutoff for the the Commonwealth Care plans). We definitely care about difference 2 and that is what we are trying to figure out.
posted by andorphin at 3:38 PM on December 15, 2012

I just started on the silver level Tufts plan and I like it. One of my doctors said she greatly preferred Tufts, and has had issues (though she didn't say what) with Fallon. Every doctor I need to see (kind of a lot) is in the network.

I had some questions about referrals and the Tufts rep was very helpful and it was easy to get to a human quickly.

I haven't had to have anything but a physical covered yet, but all seems good so far,
posted by dayintoday at 3:50 PM on December 15, 2012

A couple more things I thought of about Tufts, which may or may not be the same for the other options:

1) They don't require that you see your primary care doc in person to get the referral. Your doc may want that, but it isn't required by the insurance. They could just do the referral by phone request instead, for example. (That's what I learned talking to the customer service rep I mentioned.)

2) I got sent a special CVS ExtraCare card in the mail to replace my old one that gets me 20% off all CVS-brand products. Minor thing, but a benefit I will definitely use. I think I got this b/c Tufts uses the CVS Caremark prescription program. Others may as well.

3) I found their site pretty easy to use, which was so very not the case when I had BCBS and United Healthcare previously.

4) There are discounts for other things like 20% off an annual fitness club membership. Also nutrition counselors, massages, acupuncture, etc.
posted by dayintoday at 5:04 PM on December 15, 2012

dayintoday: Thanks, that is another great data point! Also, the phone based referral option sounds convenient!
posted by andorphin at 6:16 AM on December 16, 2012

Mrs qurlyjoe and I have been enrolled in Neighborhood Health Plan through the MA Connect system since September 1st this year. Based mainly on the relative cost of the premium we went with the gold level coverage since it cost the same as silver level coverage with the other providers.

We've both had our PCs at Harvard Vanguard Med Assoc for the past 30 years (through several names changes for them) and so keeping our PCs was an issue for us. When I went through the online enrollment process, there was a place to specify the PC and I did so. When we got our enrollment package, however, neither of us was assigned to the doc we'd chosen. A long phone call with a rep did result in success for us, but it seemed really unnecessary. He had to call HVMA, while we waited, and they initially told him our desired PCs weren't accepting new patients from NHP, until we explained that we were not "new" patients, just using a new provider. In the end, we got what we wanted, but we're not sure why there were obstacles.

The coverage, as outlined on the web page, is pretty good, except for dental care, which is minimal, basically emergency care only except for 1 annual cleaning, and x-rays every two years. The problem there is that NHP contracts out dental coverage to Delta Dental. Our dentist, when I called, said that they accept Delta Dental. But when my wife went for a cleaning, she was denied coverage because the clinic accepts only Delta Dental HMO and not PPO (or vice versa, I forget.)

As for referrals, HVMA allows online request for a referral, doesn't require in-person visit, and NHP has accepted this.

In the end, aside from bureaucratic hassles, we're satisfied with NHP so far, recognizing that the actual doctoring is done by our long-time familiar docs.

The other issue that might be relevant is that NHP's coverage area seems to be mainly metro Boston, so you should definitely check their web site to see if you live within their area.

Drug coverage is actually pretty good. A tad cheaper in fact than what we were getting while covered by BCBS through my former employer's group plan.

I should probably also say that another reason we went with the gold level coverage is that we both have long-term chronic medical issues, with a higher likelihood of hospitalization than for most folks, and also possibly lots more visits to the doc than normal, so the no-deductible aspect of the gold plan is attractive.
posted by qurlyjoe at 2:25 PM on December 16, 2012

qurlyjoe: Thanks for the data point!

For folks who may stumble on this later, the information I was looking for (basically, customer frustration levels with insurers) and a whole lot more is cataloged in the NCQA health plan rankings. These seem to be the Consumer Reports or Cooks Illustrated level reviews and evauluations of insurers. They aren't confined to Massachusetts plans, but you can generate a state specific report card for insurers in your area.

The only insurers they don't have evaluations for appear to be those which are new to the market. So, while BMC HealthNet has a really high ranking for their medicare plan, their individual Massachusetts Choice plan isn't ranked yet as it has only recently been introduced.

We went with BMC HealthNet, feel free to message future-me to find out how it went!
posted by andorphin at 3:26 PM on December 19, 2012

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