Blue Cross of California | California Blue Cross | Blue Cross in California | Blue Cross of California

Many people favor the Individual HMO plan that Blue Cross of California offers for several reasons. One of the most important reasons that many people choose the individual HMO plan over a PPO plan is because there is no deductible, and the maximum annual out of pocket expense annually is $1500 per member. Like the PPO plans, only two members have to satisfy the annual maximum in order to satisfy the maximum for the entire family. This plan has minimal $10 copay for doctor’s visits with no charge for office-related services such as X-rays, lab work, anesthesia, and other similar services.

In-patient hospital stays are covered at 80% of the negotiated fee, which is fairly standard for most health care coverage. The $100 copay for emergency room visits is waived if you are admitted, and you pay the normal 80% of the negotiated fee for the time you are an in-patient. Maternity care is subject to a $10 per visit copay, and the hospital stay is covered at 80% like any other hospital in-patient stay. Generic prescriptions have a copay of $10, and brand names are $30 after a $250 deductible for brand names. For those who prefer brand names, you still have that option, but the difference in price is an encouragement for subscribers to use the generic brands that are on the Blue Cross of California formulary list of approved drugs.

Some people find the regulations governing the HMO restricting since the subscriber must choose a primary care physician who in turn will handle authorization of any care that you require by a specialist. It may seem inconvenient, and at time irritating, but the HMO saves the cost of deductibles, and for that, perhaps the inconvenience is worthwhile. Another advantage to having one doctor follow your care is that you avoid unnecessary trips to the specialist or emergency room. People can sometimes be their own worst enemy when it comes to their health care and think they need more treatment than they really do.

For those who are unfamiliar with other types of physicians, being able to depend upon your primary care physician to make referrals to specialists in whom he has faith is a big advantage. Your primary care physician or PCP is more familiar with the care that you need and can refer you to the proper specialist for that care whenever he feels that it is necessary to do so. Certainly, there are times that this appears to be not in your best interest, and you feel that you need to see someone else, but leaving it up to your doctor to make that decision is more appropriate than relying on others who may not be familiar with medicine at all. It is important to leave your medical care in the hands of one person who knows what you need and what can be the most beneficial to your medical well being. Though a PPO will allow you to make that choice since no referrals are required to see a specialist, the requirements of the HMO allow you to place the decision in the hands of someone who knows your needs better than you do.

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