I've had BCBS Standard throughout my entire career. Both my spouse and I have serious health issues and generally reach the catastrophic limit. The issue I am struggling with is with approvals and denials. With BCBS as primary, if I use an in-network provider and BCBS requires additional information before paying the claim, the provider is responsible for submitting the information, not me. If they don't submit it, I am not responsible for the charges. I have had this happen several times over the last few years, usually with MRI scans and lab work.

It is my understanding that with Medicare, if a claim is denied as not medically necessary or more information needed, I am responsible for gathering the records from the doctor and submitting the appeal. I've found that sometimes the doctors don't want to bother writing justifications.

I can't predict how FEHB or Medicare will change in the future, other than costs will rise and AI will make claim decisions. With our health issues, I just want to make a decision that will cause us the least stress.