My son has blue shield ppo silver 87 through covered california (Obamacare).
There are no surgeons listed in our city (San Diego). The surgeons who do this surgery regularly will not take Blue Shield and if they do, they are "out of network" (yes, even though a ppo, they have to be in network) and only get reimbursed 50% of the total amount, and that is only 50% of what Blue Shield "allows" for the surgery (if they approve it at all). Still trying to find a surgeon who will take Blue Shield Covered California ppo - even as "out of network". The surgeons do not contract with Blue Shield in general. One surgeon said his hospital where he operates does not take the insurance, so didn't seem to want to take the insurance. The others that were on the list a few months ago seem to have disappeared from the blue shield website list. My son plan is to get off covered california ASAP and away from Blue Shield. It was fine for seeing regular doctors, but the specialists, especially oral surgeons or maxillofacial surgeons, apparently don't feel they are reimbursed enough and so don't take it. Surgeons do not have to contract with Blue Shield if they don't want to. Very disappointing. Confusing, because we thought it was standard Blue Shield insurance with just the copays subsidized by the government. But clearly this is not the case. He cannot pay cash out of pocket. Cost appears to be around $20,000 per jaw. He is really suffering - severe malocclusion, can't eat, now having swallowing problems, TMJ issues, just in misery and pain. I hope he can hang in there a while till he can select other insurance or something. I have become a believe in single payer socialized medicine (like Canada, England). It is wrong for people to suffer like this.
