BCBS PPO – except it covers *nothing* out of network

HOW do they get away with calling this plan a PPO if literally every category it lists “none” under out of network coverage.

I’ve always needed highly specialized behavioral health treatment (I have a dissociative disorder most clinicians will not touch because it’s above their pay grade and a liability because it can get worse with the wrong treatment) so I always have to see out of network doctors. I can submit an out of network request, but they won’t do single case agreements anymore and OON request only pays the Medicare rates so clinicians and treatment facilities won’t take those rates.

How is it possible to have a PPO with no out of network coverage? Isn’t that the definition of a PPO? Are there any work arounds? It’s Blue Cross Blue Shield VantageBlue Platinum, which is the “best” plan my state offers and the only PPO.

I’m considering residential treatment but none of the in network facilities will treat my delicate illness and can’t find anywhere to go. It’s ridiculous because I’m on Spravato which is costing my insurance one million dollars a year (yes, you read that correctly, 20k per week) but they won’t pay for a treatment facility which may very well help me get OFF of that medication (or reduce it), which would save them way more than they are currently paying. It’s insane. If anyone has tips or ideas navigating this with BCBS, I would be massively grateful for any help. I’m trying to get better so I don’t have to go on disability as I’ve been unable to work.

(37, RI, 40k)

submitted by /u/_jamesbaxter
[comments]