There are two “provider networks” in our region: BCBS & The United Healthcare network. BCBS is supposed to be better. Were we to switch, let’s say they did cover the 1/10 out of network cases, we risk losing the 9/10 that we currently have . The “whack a mole” is a good example. In this case it’s whack a mole and one could be $50-$100k worth of coverage gone. And more importantly, when you find a good doctor, you need to hold onto them. The difference between a good doctor and a bad one is life or death for this condition.

Ouch.

Is this a somewhat remote location? With all the insurance options I've had from work, the "in-network overlap" was something like 90-95%. People didn't change insurance to get access to providers - it was mostly a better rate, etc.

So there’s nuance to this. We live near Portland —- great provider & insurance networks.

The common perception of “providers” and “network coverage” are the frontline doctors you visit.

But in this case, and what is common, is that there are many degrees of providers. Your doctor refers to pathologist refers to lab 1 refers to lab 2.

So 95% doesn’t tell you much. If only 1-2 of your providers are out of network (e.g. specialized labs ) , that’s $10k+ right there.

Does that

- turn into whackamole every year?

- expose someone to "preexisting conditions aren't covered" issues?