Some employees of the Mayo Clinic in Scottsdale have their group health insurance with Blue Cross Blue Shield of Arizona. They can use the Mayo Clinic and its doctors and have their medical bill paid by Blue Cross. Some Arizona employer groups insured by Arizona Blue Cross - our information puts the list at less than 100 – may also visit Mayo providers.
But I, the possessor of an extremely high quality Arizona Blue Cross policy, can only see Mayo providers on the “out of network” side of my Blue Cross health insurance plan. The Mayo providers are not available, in network, to people who live in Arizona and are “individual” policyholders of Arizona Blue Cross, like me. At least we can still go there if we choose – we just have to pay more.
But if you live in New Jersey, or Michigan, or any other state and have an individual health insurance policy from your local Blue Cross company and your insurance ID card has a picture of a little suitcase with the letters PPO in the suitcase (as does MY card), you CAN go to the Mayo providers in Arizona and get medical care – your Blue Cross company will pay those medical bills and consider the Mayo providers “in network” for you. But not for me. Why?
This is not a practice confined to Arizona. In Pennsylvania, Highmark Blue Cross, located in Pittsburgh, has just stopped allowing its policyholders to access one of the highest ranked hospitals in the state, the University of Pittsburgh Medical Center and its affiliated doctors. See this newspaper article, published March 5, 2013: http://bit.ly/Wt6NDO – this is a new development, and it is creating hardship and nightmares for scores of Highmark Blue Cross policyholders who just found out that they could no longer see the people they THOUGHT were their doctors. It appears they can’t even pay cash to continue seeing the doctor of their choice. According to UPMC’s spokesman, Paul Wood, “We have decided that a Community Blue subscriber’s willingness to self-pay or ability to self-pay is not one of the approved exceptions” that would allow them access to UPMC’s provider network.
When we find out why we, as Arizona residents with a health insurance policy from Blue Cross Blue Shield of Arizona, don’t have in-network access the Mayo Clinic or its providers, we’ll let you know. If you have any ideas why this is happening, please feel free to comment.