Discussion in 'The Watercooler' started by witzend, Mar 18, 2014.

  1. witzend

    witzend Well-Known Member

    I got a notice from our Blue Cross group in the mail this weekend that I could choose to use their "ComplexCare" services. I can only get it if I sign up for it "at no extra cost to you". on the other hand, it doesn't actually say what this is. It has something to do with a nurse manager. I'm sure I'm being offered it because of my Muscular Dystrophy.

    Does anyone have any knowledge of or experience with this? Honest to Pete, the medical services around here HOOVER big time. It's been two years that I have been attempting to find a low/no cost opportunity to be in a swimming pool that I can safely get in and out of at my pace and leisure. NOT. HAPPENING.

    I'm not actually all that thrilled at the idea of turning my healthcare over to some fly-by-night "this is how we're going to fix it this year until we're found out as frauds" group. The only thing I can find online is about working for them, and employee reviews of them are poor to say the least. Every single one talks about disorganization and laziness at the management level. "A great place to work if you want to get paid for doing nothing", "A great place to get paid until you find another job".
  2. Signorina

    Signorina Guest

    It's part of their 360 program and coordinates care. It's being rolled out across the country. I don't think it creates obligations on your part and if the program works like it's supposed to - it could be beneficial and cut through a lot of annoyances. It is my understanding that it it can coordinate multiple physicians/services - like if your doctor refers you to physical therapy - the nurse manager assigned to you will help you find a therapist, set up the appointments, makes sure the info and records are shared between the prescribing doctor and the PT and that medications are appropriate, don't interact etc and that they can be filled.

    I only know this because I manage our company's benefits and we too have Blue Cross. That's the shiny version - how it works in real life may be different. However, I think it's a value added service and not one that creates any obligation on your part - but check to be sure.
  3. witzend

    witzend Well-Known Member

    Thanks, Signorina. My insurance company wants to charge me for everything as a deductible anymore. This is a big concern for me, so I will want to check with them to see what the true cost of using this service is. If it is free, I might consider it, especially along the lines of trying to coordinate some sort of low cost "do it on your own" pt.

    I'm interested in learning more if you hear further details. I don't really need anyone to coordinate prescriptions or appointments for me. I thought it was odd that the sent me a one page letter saying "There's a new service called ComplexCare. You have to sign up for it if you want it. The sign-up page is on the next sheet." Then there was a sign-up sheet for my name and signature - that is literally the extent of what they sent.

    Most often I find that my doctors etc really know very little about the particular type of Muscular Dystrophy that I have. Usually they say "I read a paragraph about it in Medical School one day", but I've actually had a doctor tell me that he "wouldn't test me for it because only little boys get Muscular Dystrophy." Um - hello? There are 43 types of Muscular Dystrophy, they affect people of both sexes and all ages, I was diagnosed when I was 12, and my DNA test results would beg to differ with him. What a waste of a perfectly good expensive well-visit exam that was! I'd honestly rather skip out on a service than have to educate one more doctor at the cost of $50 a whop out of my pocket because they're a "specialist". Even the MDA is $50 a visit, because hey, I have insurance! Obviously I don't need their financial help with a co-pay! I don't need their stinking "clinic", and I don't need to donate to them, either.
    Last edited: Mar 18, 2014
  4. DammitJanet

    DammitJanet Well-Known Member Staff Member have medicare dont you? Is your BCBS your medicare advantage plan?

    Now I know I am in some sort of specialized group that oversees people with chronic conditions but I wasnt given a choice. I also dont notice anything except I dont have to deal with only having a certain number of visits each year.

    I would call BCBS and ask them what the advantages would be to you.

    Oh and about the pool. I am also having that problem here but I would think your area would have many more opportunities. Do you have a YMCA anywhere close? How about any of the health clubs? I know one that should be close to you...I am trying to think of the name...ummm... First something. If you can get a doctor to prescribe water therapy you can probably get in easier at least much cheaper. I am trying to find out if I can get water therapy at the only health club in lumberton. I think I can. I do know that there is a limit to physical therapy per year though.
  5. witzend

    witzend Well-Known Member

    Janet - I have Medicare Part A only - for hospitalizations. So essentially, "no". I don't even want to get anywhere near that place where BCBS denies every claim because I have Medicare and I have to write them a letter of explanation as my credit crashes.

    BCBS says that they're not local and just administrate, so they would have to assign a nurse to me first and then that nurse can coordinate with me to see if anything fits my needs. I'm very concerned that their idea of local and my idea of local won't be the same. It takes everything out of me for the day to make it to a doctor's appointment. I'd poke my eyeballs out before I let someone actually schedule outpatient PT for me on any kind of a regular basis. There's no way I could manage if I have to get up, get dressed, drag everything with me, get to where I'm going, do what I have to do, pack everything back up, drag it back home, clean myself up, do all the things around the house I missed for the 4 hours that takes, and not be ruined for 2 - 3 days. I know for certain I don't need to manage a nurse who doesn't know what's available that meets my needs along with my appointments and prescriptions. And honestly, I'm terrified that a nurse will say, "Well I fixed her up with swim therapy three times a week in Charlotte and she said it was "too hard" - she's uncooperative."

    There is a YMCA 12 miles away and a YMCA 29 miles away. Their "special deal" for disabled people is that you can go to their onsite clinic for the only referral they will accept, and they're hospital sponsored so it applies to my $2,500 deductible a year. After I've paid that it's only $50 a swim. I tried that last year and before I even checked into the clinic they told me that my copay that day would be $380 until I paid the deductible down. Or I could join the Y for $400 registration + $50 a month like everyone else and swim at "free swim" with the children. The local college has no pool.

    There are several private outdoor pools in the County that will open Memorial Day - Labor Day. They are outdated cement things with 10 foot tall cyclone fences and tiny cinder block toilets that you can use as a dressing room. They use buzzwords like "safe family environment" and have a $600 initiation fee, plus a $500 Annual fee, and you must be nominated by an existing member. Being in NC, I'm pretty sure I know what they mean when they say "safe family environment" and you must be nominated by a existing member. "Health club"? Why would they have a pool at the health club when there is a Y in town? Health clubs in this area are for running indoors when it's too hot.

    I met the new County manager at Rotary yesterday and he's very proud of their new "Priority Funding System". He was very specific that there was no reason to offer yoga classes or swimming when there are health clubs and the Y in the area that people can join. He's none too pleased that 22% of our residents are on SNAP, either.

    I think you might be thinking of "FirstHealth" Centers? They're up by Raleigh. And they're hospital affiliated, so that would be my $2,500 deductible again.