Amarillo, TX - Thousands of Texans are being forced to change their health care plans and some locals are concerned they won't be able to see the specialty doctors they need.
Blue Cross Blue Shield of Texas is dropping individual PPO plans and moving to HMO plans instead. The company said the Affordable Care Act has created a new market for health insurance and in that market some of their affordable plans are no longer affordable for the company to sustain.
Anita, who asked to remain anonymous, is one of more than 300,000 Texas customers who will soon find it difficult to see specialty doctors. The change from individual PPO plans to HMO plans limits the doctors who are in the network of coverage.
For Anita, this means a family member whose son suffers seizures will not be able to see their normal neurologist. "She's going to go from a PPO to an HMO and she can't find a doctor that will take him as a neurologist. He could die. It's not just, oh he needs a doctor. It's imperative that he has a neurologist because he has these seizures. Sometimes he can have 10 a day."
Blue Cross Blue Shield divisional senior VP and chief medical officer Dan McCoy said eliminating the plan was not an easy decision to make. However, last year the company paid out $400 million more in claims than it collected in premiums for the product.
"It's important for any market offering to be sustainable long term, so when the cost of health care delivery outpaces the premiums that are charged for that product, it results in a loss," said McCoy. "The individual PPO plan was not sustainable and that's why it was discontinued off the exchange."
McCoy said the insurance company wants to work with customers like Anita to help lessen the impact of this change and encourages them to call customer service.
The insurance change does not affect customers who have a group PPO plan through their employer or those who were grandfathered in back in 2010.