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SAMBA vs BCBS
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jagfan View Drop Down
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Joined: 06 Dec 2007
Posts: 84 		Post Options Post Options   Quote jagfan Quote  Post ReplyReply Direct Link To This Post Topic: SAMBA vs BCBS
    Posted: 18 Nov 2009 at 7:12am
Originally posted by Nearly a pro

Nalc charges 25% for co surgeons as in book.
 
Nearly...
On page 42 of the NALC brochure, I read, "The Plan allowance for an assistant surgeon will not exceed 25% of our allowance for the surgeon."  Patient pays 15% of this allowance.  It is customary that allowances for an asst surgeon are not as high as the primary surgeon.  Can you share where the 25% copay for asst surgeons is cited? 
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DazedNCo-Fuzed View Drop Down
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Joined: 19 Nov 2009
Location: Georgia
Posts: 1 		Post Options Post Options   Quote DazedNCo-Fuzed Quote  Post ReplyReply Direct Link To This Post Posted: 19 Nov 2009 at 2:52pm
This forum is a GOLD MINE of great information!!!  I am so glad to have found it.  I have been trying to make a decently informed decision about switching health insurance companies since I observed that MHBP's standard option premium is going through the roof in 2010.  . . .But now my eyes may be permanently crossed.  Dead  LOL
 
I must find a way now to afford some long-overdue dental and vision coverage for myself and my husband, so the monthly cost of our healthcare premiums must be cut.  I am happy to say, though, that we have pretty much decided to go with United Concordia for our dental coverage and United Healthcare Vision.  Wink
 
I guess I am simply fishing here for some fresh perspective on healthcare coverage.  If there's anyone else out there who is familiar with MHBP's standard option coverage as compared to the others in this state (Georgia), I'd love to get some new opinions.
 
I have been heavily considering SAMBA's standard option because the premium looks reasonable, and the coverage seems to be similar to MHBP's standard option.  . . .Any advice?  I know that SAMBA is a Cigna company, and I've heard quite a few different stories about them denying coverage for some procedures as well as a few other not-so-great things.  ALL input is much appreciated!!!
 
NALC's (only high option?) premium is way too far out of our price range.  Needless to say, it's out.
 
BCBS's basic option premium is affordable, but their coverage has always been too hit-and-miss, IMHO.  I mean, God forbid you ever got in a jam and end up using an out-of-network doctor, hospital or other provider.  Yikes!  We did actually have BCBS a looong time ago, and all I remember is that we couldn't wait to switch from it.  And anyhow, our hospital of choice and other providers have shared recently that BCBS doesn't pay worth a flip.
 
GEHA's standard option doesn't appear to pay very well for a hosptial stay, inpatient surgery or Level II or Level III Rx.  I'm thinking that an unexpected surgery with them would eat us up in coinsurance bills from everyone including the surgeon, his assistant, the anesthesiologist, the lab and the radiologist to the hospital, itself.  EEK!
 
The only other PPO that I haven't had the time to check out yet is APWU (only high option?).  However, the overview of its coverage already doesn't entice me any more than GEHA's standard option.
 
Anyway, it's just the 2 of us now (in our early 40s), he is the sole federal employee (retired) annuitant, and we're both in reasonably good health.  He's had some knee surgeries in the past, but neither of us are EXPECTING to need any major medical care anytime very soon (of course, it's always the unexpected that will get you!).
 
Thanks!  Wink
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Nearly a pro View Drop Down
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Joined: 17 Nov 2009
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Posts: 43 		Post Options Post Options   Quote Nearly a pro Quote  Post ReplyReply Direct Link To This Post Posted: 19 Nov 2009 at 8:06pm
 I agree the Insurance is getting so complex it is harder to determine what is a decent deal or not. I too thought Samaba is a well organized plan but I am deciding against it due to the prescription being not too well covered even though the rest of plan seems pretty good. I had NALC this past year and found their coverage was decent. But I will be returning to BCBS standard even though its sky high because it keeps the catastrophic low and because most medical billing offices seem to know how to bill BCBS, I found mistakes are less likely and extra premium is paying for better administrative..useful if surgery or big ticket item is neededWink
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fedman53 View Drop Down
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Posts: 43 		Post Options Post Options   Quote fedman53 Quote  Post ReplyReply Direct Link To This Post Posted: 20 Nov 2009 at 11:26am
I have a sub-question about SAMBA vs BCBS (or any other plan). I currently have BCBS-BASIC which has worked well for me. I've been looking at SAMBA because dependent daughter turns 22 in 2010 (will continue to be dependent through 2010). SAMBA offers coverage for 22 - 27 yo's for $120 per pay period. With BCBS TCC would be about $190 per pay period. Anyone used this SAMBA option or have ideas for other options?
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sparksals View Drop Down
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Posts: 33 		Post Options Post Options   Quote sparksals Quote  Post ReplyReply Direct Link To This Post Posted: 30 Nov 2009 at 9:21pm
Originally posted by jagfan

This morning I contacted both NALC and SAMBA to inquire about the deductible.  Both assured me they have a single deductible that covers both med and surg.   There is no separate surgeon or surgical deductible.  There is a good possibility I will be having surgery during 2010 so that info was important to me. 

In addition, when I initally compared the plans I had overlooked an important detail about SAMBA .  If you are hospitalized, you pay the $200 copay for room and board and 15% for other services and supplies.   With NALC there is no charge for the other services and supplies like rads, labs, etc.  Looks like NALC now has an edge for my needs.
 
Deciding on a plan shouldn't be this difficult.  One almost needs a degree to decipher all the plans and their variances. 


Tell me about it!!!  I find this extremely frustrating.  Until BCBS  Standard's rates skyrocketed, we were happy with it.  It seems that the premiums on the most popular plan are forcing people out of it. 
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jagfan View Drop Down
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Posts: 84 		Post Options Post Options   Quote jagfan Quote  Post ReplyReply Direct Link To This Post Posted: 02 Dec 2009 at 9:46am

I recently noticed the following difference in outpatient surgery and procedures benefits offered by SAMBA that don't just pop out when comparing plans and reviewing the brochures.  This may be helpful to some.  See section 5(c) "Services provided by a hospital or other facility and....."  for oupt hospital or ambulatory surgical center...(see the list of services covered).....benefits are as follows:

SAMBA Std- 15% of plan allowance - NO DEDUCTIBLE
BCBS Std - 15% of plan allowance -  calendar year DEDUCTIBLE APPLIES
NALC - 15% of plan allowance -  calendar year DEDUCTIBLE APPLIES 


Edited by jagfan - 02 Dec 2009 at 10:09am
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sparksals View Drop Down
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Posts: 33 		Post Options Post Options   Quote sparksals Quote  Post ReplyReply Direct Link To This Post Posted: 02 Dec 2009 at 10:01am
One thing with which I have most difficulty is the 'plan allowance'.  That amount varies on each plan.  While 15% of 'plan allowance' may cost less on one plan, it may cost more on the other.  This just adds to the confusion of this whole process.  We are basing a decision on numbers we don't know.  I wish they would publish their basic amounts of plan allowances - how much a doc gets for a general visit, etc.  
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fedman53 View Drop Down
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Posts: 43 		Post Options Post Options   Quote fedman53 Quote  Post ReplyReply Direct Link To This Post Posted: 02 Dec 2009 at 10:04am
This has been my major issue with these plans (Guessing when you say BCBS you are talking standard plan) I have BCBS-BASIC and they charge a flat $100, (and facility copay) with 0 deductable (main issue with basic is you MUST use PPO). Family had 3 outpatient surgeries this year with BCBS total allowance of $7800. Would have paid $1170 out of pocket with these plans..I paid $300 for service (plus facility copay. Alot of these percentages hold true for inpatient services too. Base Room and Board covered 100 percent, but when you get into side services (tests, drugs, other doctors) you could end up paying 15 percent of that allowance. I'm the type who likes to know my cost up front and not a percent of X-unknown Many have said, and true, that drug co-pays more, but family at age where outpatient and inpatient services are used more with much bigger numbers. I amazes me, had 2 day inpatient say - cost $25,000, BCBS allowance $6800, I paid $300 plus TV
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jagfan View Drop Down
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Posts: 84 		Post Options Post Options   Quote jagfan Quote  Post ReplyReply Direct Link To This Post Posted: 02 Dec 2009 at 10:17am
Yes, I was referencing BCBS Standard and have edited the post.
 
 
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jagfan View Drop Down
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Posts: 84 		Post Options Post Options   Quote jagfan Quote  Post ReplyReply Direct Link To This Post Posted: 02 Dec 2009 at 10:33am
Originally posted by sparksals

We are basing a decision on numbers we don't know.  I wish they would publish their basic amounts of plan allowances - how much a doc gets for a general visit, etc.  
 
We will  not see fees publised  in the near future because of the competition among the insurors.  Fees vary btw providers and hospitals because each insuror negotiates separate contracts. 
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