Some confusion/clarification related to Healthcare:
Preferred Provider List:
There are 2 tiers of in-network doctors: Tier 1 (waives the normal $15 co-pay) and Tier 2 (normal $15 co-pay is charged). The only difference is whether the co-pay is waived or not.
To find out if a doctor is Tier 1 or Tier 2, link to the Anthem search-page of doctors or UnitedHealthcare search-page
Site-of-Service:
This is a little trickier. When lab work or radiological imaging is needed, the insurance plan wants to push this work to "non-hospital" sites when practical. This means, if you need an MRI or blood work, the insurance plan calls for having this work done outside of a hospital unless you are actively in the care of the hospital. If this is not properly scheduled outside of a hospital (when reasonable to do so) the co-pay is 20% for in-network facilities, which doesn't sound too bad until you see how much an MRI costs (out-of-network facilities carry a 40% co-pay). Use this list from the Comptroller's Office or use the same websites as above to search for in-network, non-hospital facilities which will be covered at 100%: Anthem search-page of doctors or UnitedHealthcare search-page.
There has been some administrative confusion and "miscoding" of these facilities which generated some expensive bills being mailed out, if the bill was incorrectly formulated, it will be corrected. As a result of the improper coding, implementation of the Site-of-Service changes have now been delayed until December 1, 2017 (as opposed to the original October 1, 2017 start date).
Anthem vs HartfordHealthcare Group:
The dispute between Anthem and HartfordHealthCare Group is having an extreme impact on many of our members. Their dispute is about money - HartfordHealthCare Group wants to charge Anthem more money - but the impact is severe: those members insured by Anthem may not be able to access their own doctors and local healthcare providers as Anthem now considers them out-of-network.
Recognizing the severity of the impact, A&R, along with the other leaders of the State Employees Bargaining Agent Coalition (SEBAC), have written to the HartfordHealthCare Group . We have urged that they "stop using our members, and the thousands of others who rely on your hospitals and providers, as leverage in your contract dispute". The letter continues, "we are particularly driven to write by the fact that Hartford HealthCare continues to refuse Anthem's public offer to remove the fear and stress that comes from the current conflict by paying Harftord HealthCare reimburesments under the current reimbursement rates with a committment to retroactively compensate Hartford HealthCare for any increases in the rates that is agreed to in the next contract".
The full letter can be read here: SEBAC's Letter to Hartford HealthCare.