BCBS of Texas cuts individual PPO plans

Hundreds of thousands of Texans are scrambling to find health insurance after Blue Cross Blue Shield of Texas cut its individual PPO plans.               

Blue Cross Blue Shield is based in Richardson, and the insurer's chief medical officer says PPO plans under the Affordable Care Act were simply hemorrhaging way too much money.

Bryna Thomson and her husband are teachers at two small private schools. To add their son, Torin, to their insurance would cost $700 to $900 a month.

“We just can't afford that,” said Thomson. “That's for one child."

So they were thankful last year to sign up for a Blue Cross Blue Shield PPO for only $220 a month through the Affordable Care Act.

But that plan was just canceled, and the only alternative is an HMO -- a plan their beloved pediatrician won't take because she would have to agree to work for lower rates.

“I trust her," said Thomson. “I think she's fantastic and I don't want to change."

Carol Bell-Walton also got a cancelation notice in the mail.

Before the Affordable Care Act, she had a subsidized PPO for people with pre-existing conditions. That ended with the Affordable Care Act and she moved to a different PPO with Blue Cross Blue Shield, which is now offering her an HMO with the same monthly premium. However, she would have to give up at least one of her doctors.

“Which one would you choose, the one you had a 25-year relationship with who delivered your baby or…the one that's changed your health so dramatically?” said Bell-Walton.

FOX 4 sat down with Dr. Dan McCoy, the chief medical officer of Blue Cross Blue Shield of Texas.

“Is the Affordable Care Act not working out as planned?” said FOX 4’s Lori Brown.

“It's in its infancy stages,” said McCoy. “It's certainly going to be a long journey. When you look at the number of Texans insured under the Affordable Care Act, that's a good thing.”

McCoy says Blue Cross lost $400 million on the PPO marketplace plans, making them unsustainable.

“At the end of the day, we have really escalating medical costs in this country,” said McCoy. “It's not just a combination of healthy people and sick people; it's that we have to control overall health care costs.”

"It shouldn't be this hard or expensive for everyone to have health care,” said Thomson.

A study found that insurance companies across the country are dropping PPOs in the marketplace for 2016.

While many often see the insurance companies as the bad guys, Blue Cross points out that insurance companies are prohibited by law from earning more than 15 percent in profit.

However, on the flip side, health care providers and pharmaceutical companies have no profit cap.

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