Oct. 16--ABILENE, Texas -- Blue Cross and Blue Shield of Texas' individual PPO insurance plan is going away, affecting 1,149 customers in the Taylor County-Abilene area.
The company is dropping its Blue Choice PPO plan, a decision affecting more than 300,000 people statewide. The company has more than 5 million members statewide.
The insurance provider said the plan, the only individual preferred provider organization plan offered in Texas to individuals in 2014 and 2015, was deeply affected by the Affordable Care Act and had become unsustainable.
"In the individual marketplace plan, there was an over $400 million loss last year," said Dr. Dan McCoy, senior vice president and chief medical officer for Blue Cross Blue Shield of Texas.
Choosing to drop the individual PPO plan was a "difficult decision," McCoy said.
"We knew that members would have to make a decision about their future health care coverage," he said.
"The window shopping begins next week on the marketplace and people will be able to go on and look for their options," McCoy said. "We're going to continue to offer the HMO product, and that is available. So members will be transitioned to other plans that we intend to offer in 2016, so they really should not experience a gap in coverage."
Those with employer group PPO plans will not be affected by the change, McCoy said. Others with a grandfathered PPO plan -- plans that existed on March 23, 2010, when the Affordable Care Act became law -- similarly are unaffected, according to the company's website.
"So the PPO network did not go away, the only thing that was discontinued was the individual PPO plan that was on the (insurance) marketplace," McCoy said.
The company has two provider networks for individual plans: Blue Choice PPO and Blue Advantage, an HMO.
Certain providers are only in the Blue Choice network, and some have decided to not join the Blue Advantage network in 2016.
With individual PPO plans going away, that means those providers will no longer be an in-network option for most individual members.
Abilene Regional Medical Center is in the company's Blue Advantage network, McCoy said.
"Our networks are obviously adequate to provide the coverage that we anticipate," he said. "As far as the exact number of physicians or hospitals within each of these networks, it's difficult to give (a) number because it changes."
Physicians and hospitals continue to express interest in joining the company's Blue Advantage network, he said.
"We do feel that managing the individual marketplace is better done within an HMO," McCoy said. "These are not really the HMOs of our grandparents -- they're different. They offer better care coordination and that sort of management of patients within that product. And we think that is going to be an overall better product for the individual marketplace."
On its website, Blue Cross says that if an affected patient's doctor is not in the Blue Advantage network, the company will work with patients and their physicians to "lessen the impact of this change."
"We do recommend they contact their broker or customer service number on the back of their ID card to help them make this transition," McCoy said.
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