Hi,
So I had a very nice Anthem PPO plan from my former employer which I’ve elected to stay on through COBRA (at a rather high cost). I am a student now and my school is offering a very affordable HealthNet EPO student group plan. I have a specialty medication for a chronic disease & it wasn’t clear that the EPO would cover it so I wasn’t able to directly switch.
Instead, I spoke to doctors, school staff etc. and enrolled in the school EPO plan with the goal of trying to get the medication covered through it, but kept my COBRA going too as a plan B in case the school plan does not cover the medication.
However, it turns out later on that HealthNet will do a coordination of benefits with Anthem now, as part of a process to determine who’s Primary / Secondary, and they are taking their sweet time with this. From what I understand, if HealthNet turns out to be the Secondary plan, I won’t even be able to apply for preauth with them to see if they’ll cover the medication which beat the purpose of this double-enrollment. Meanwhile I need to make appointments & plan to renew the Anthem PPO plan etc. based on whether or not it will turn out to be the primary or secondary plan.
So the question then is, is there some sort of known rule of thumb to determine (or guess) which plan will turn out to be the primary so that I can plan ahead? I can provide the plan documents if they are helpful.
Thanks a lot in advance!
submitted by /u/principiaMS
[link] [comments]
Hi, So I had a very nice Anthem PPO plan from my former employer which I’ve elected to stay on through COBRA (at a rather high cost). I am a student now and my school is offering a very affordable HealthNet EPO student group plan. I have a specialty medication for a chronic disease & it wasn’t clear that the EPO would cover it so I wasn’t able to directly switch. Instead, I spoke to doctors, school staff etc. and enrolled in the school EPO plan with the goal of trying to get the medication covered through it, but kept my COBRA going too as a plan B in case the school plan does not cover the medication. However, it turns out later on that HealthNet will do a coordination of benefits with Anthem now, as part of a process to determine who’s Primary / Secondary, and they are taking their sweet time with this. From what I understand, if HealthNet turns out to be the Secondary plan, I won’t even be able to apply for preauth with them to see if they’ll cover the medication which beat the purpose of this double-enrollment. Meanwhile I need to make appointments & plan to renew the Anthem PPO plan etc. based on whether or not it will turn out to be the primary or secondary plan. So the question then is, is there some sort of known rule of thumb to determine (or guess) which plan will turn out to be the primary so that I can plan ahead? I can provide the plan documents if they are helpful. Thanks a lot in advance!
submitted by /u/principiaMS [link] [comments]Read Morer/HealthInsurance