Anyone in California have experience with GHPP?

[LindseyRose]

Here's my situation:

I got married in May and my husbands insurance (HMO) isn't really that good. Not bad, but not good. The social worker at the CF center I go to told me to apply to GHPP because everything that my HMO won't pay for GHPP will. When I called and spoke to the lady at GHPP she said that because I have an HMO they will only pay for one doctor consultation per year! That's it - just the appointment, not even tests, proceedures, etc. I feel like I'm caught in between a rock and a hard spot because they won't do anything for me with my HMO, but if I drop my HMO for them then I'll just be screwed altogether. I don't want any lapse in coverage for obvious reasons, and also because then it'll be harder to be picked up by any other insurance (if that ever comes up) because of a preexisting condition.

Sorry if this doesn't make a lot of sense. I don't even understand it!! I hate dealing with insurance companies because everything basically goes over my head. If anyone is currently enrolled in GHPP could you share with me what the guidelines are - as far as what they will pay for?

Thanks

 

[CowTown]

Hi Lindsey, I am on GHPP. They cover me 100%, for everything. I don't understand why they told you that " because you have an HMO they will only pay for one doctor consultation per year! That's it - just the appointment, not even tests, proceedures, etc."?? What does having an HMO have to do with it? I do'nt know how having an HMO makes them not want to cover you. For me, since I don't qualify for Medical, they are my only source and cover 100% med bills, visits, etc...everything. I do know that they just added something this year to their application process that you now have to basically apply to Medical and see if they turn you down or accept you. GHPP's purpose in doing this is to try and not be 100% responsible for as many people (cause it's priceeeey). So, if you do qualify for Medical than they will force you to use them as your primary and GHPP will cover the rest. That's what they are saying. And what I've been told, if you have any other type of insurance, you have to use the others as your primary always and GHPP says they will be secondary. They trying to be secondary more now. I've never heard of them denying anyone because of the primary that they do have! That sounds aweful.

One thing to remember, as bad as it may sound, the people at the front desk who answer the phones often times don't know their feet from their hands! A lot of times, they don't know squat about the company they're working for, this is from experience. You get much more information once they asign a case manager to you. I would ask to speak with someone else because the person who told you that might not know what she's doing. Or...ask your social worker to get in on the action and have him line stuff up for you or get the correct answers since they know who talk to. That just doesn't sound right, and that's what the social workers are there for.

By the way, what insurance carrier does your husband's company use??? Just curious.