Advice about HealthNet

Parent Q&A

  • CalPERs Health Net HMO experiences?

    (1 reply)

    Hi,

    I was born and raised in the Bay Area and have been within the Kaiser HMO system since birth. I'm growing increasingly frustrated with certain aspects of it now that I'm using it as a parent and am considering other HMOs offered by the CalPERs system. The Health Net is most similar in price, which is appealing, but the Health Net HMOs don't seem as well regarded as Anthem or Blue Shield's offerings on sites like California's Office of the Patient Advocate. I'm wondering if those who have had experience with the Health Net HMO, particularly the SmartCare HMO network, would mind writing in with their experiences. Or if you have another HMO from CalPERS that's not Kaiser, I'd be interested in hearing too. 

    Thank you!

    CalPERS employee

    I've had CalPERS BlueShield coverage for a long, long time.  For me, it is significantly more expensive than Kaiser (not sure if this would be true throughout CalPERS though), but it has been excellent coverage.  We had a child on chemotherapy for years, extensive stays at CHO (months!), second opinions at UCSF, and didn't pay a dime other than co-pays of $5 or $10.  We've never had to submit claims, it's just covered.  So that's been our experience and we will be sticking with BlueShield. Sometimes I think it might be the CalPERs name that make BlueShield behave so well and maybe other people who have BlueShield not through CalPERS have a different experience.  I really don't know...

Archived Q&A and Reviews


Healthnet HMO for pregnancy & childbirth

Dec 2011

Hi, I am wondering if anybody has any recent pregnancy and childbirth experiences with Health Net HMO. The experiences I found on this forum are quite old. This is my first pregnancy and I recently switched to Health Net HMO. My friends and other people tell me horrible stories of HMOs - they cut corners in order to cut costs, they would deny claims based on random things etc. etc. I am worried sick and am just looking to hear about some recent experiences you've had with Healthnet HMO with pregnancy and childbirth and who was your doctor btw? Worried first-timer


Please don't stress yourself out about this. I gave birth to 2 kids with the exact same plan and had no problems whatsoever. I gave birth at Alta Bates and couldn't have been happier with the care I received. My ObGyn is Jill Foley, but I also see Elizabeth Kanwit. They are in the same group & it's excellent. Enjoy your pregnancy and don't listen to the horror stories, just focus on the positive!

Feel free to email me if you have further questions. Kim


I had my son at Alta Bates in April while insured with HealthNet HMO. On the whole, HealthNet didn't give me any trouble with pregnancy and childbirth costs -- they didn't put up a fight about my urgent C-section, and didn't quabble about prenatal costs like ultrasounds. Alta Bates billed HealthNet about $50,000 for my and the baby's hospital stay (ridiculous, right?). HealthNet paid Alta Bates about $26,000 of that, but I'm not on the hook for the difference -- Alta Bates overcharged beyond what was in its agreement with HealthNet, so Alta Bates eats the difference.

The one thing I will say is that we had some squabbles between HealthNet and our medical group (Hill Physicians) about which one of them would pay for something -- the infant hearing screening done in the hospital and the pediatrician visits while in the hospital (our son's doctor didn't have privileges at Alta Bates, so he saw the in-house pediatrician). It's not that Healthnet wouldn't cover them, it's just that the two sides had to fight about it. That was kind of a pain, but I haven't heard anything more about it in a few months, so (knock wood) it seems like it's all resolved.

So, on the whole, I'd recommend HealthNet HMO for pregnancy and childbirth. My OB was Lonnie Lin, with OB- GYN Partners for Health. I liked her a lot -- though Jennifer Yarger in her practice was actually the one who delivered my son. I liked Dr. Yarger too! HealthNet mom


Dear HealthNet Mom,

The customer care team at Hill Physicians would like to help. Please contact us at Customer.Care [at] hpmg.com so we can address any concerns you may have. Thank you, and congratulations on the recent addition to your family.

Hill Physicians Customer Service
Customer.Care [at] hpmg.com
800-445-5747


Pediatric groups not accepting new HMO patients

December 1997

I am expecting my first child in early April, and have recently started the hunt for a pediatrician. I am a professor here at UCB and have been using Health Net as my health care provider since 1993. I also, ironically, grew up in Berkeley, and thus my first choice of a pediatrics group was the one my mother chose for me: Berkeley Pediatrics. My second choice was East Bay Pediatrics, which has also come highly recommended from multiple sources. Thus, you can imagine my great dismay when I called each of these groups and learned that they are not accepting new HMO patients. At the present time, in fact, there are only 3 pediatricians (none of whom have group practices) that are accepting new HMO patients in Berkeley.

Apparently a dispute is occurring between the HMO's and pediatricians in particular. The dispute seems to involve, unsurprisingly, the lack of satisfactory payment to doctors for treating HMO patients. Negotiations are ongoing, but no one is willing to predict the outcome of this sad state of affairs.

I am writing to let those of you who will be looking for a pediatrician know that this situation exists, and to urge any of you who belong to HMO's to voice your concern about this situation. My OB-GYN believes that pediatricians are being very poorly treated by the HMO's and that this situation may escalate and even affect existing patients. Perhaps added pressure from HMO patients (I suppose they call us customers) will provide additional incentives to settle this matter and provide the level of choice that the HMO's had previously promised. I will not hesitate to quit Health Net and pay more and join a PPO in order to be able to use the pediatrician of my choice. Of course, this will involve the inevitable HMO-type hassles, such as the open enrollment window (Nov. for UC employees) being closed.

If anyone has any more information than this small amount I have gathered, or any sage advice, I would be most grateful! Jenny


Note: UC Bencom administers medical plans for university employees.

UC Bencom web page: http://www.ucop.edu/bencom
UC Bencom Customer Service: 1-800-888-8267 (9-4 M-F)

The above web page also lists phone numbers for all the medical plans at: http://www.ucop.edu/bencom/info/hw.html


To the poster who was having trouble finding a pediatrician covered through the Berkeley HMO's: I was at East Bay Pediatrics the other day and apparently negotiations have progressed, though they are still not accepting new patients. They thought it was a thirty day thing originally, but it's been four months. Myrium


It was mentioned a few weeks (months?) ago that the BPMG was not accepting any new HMO patients. I just had my prenatal interview with our wonderful Ped. there, Dr. Howard Gruber, and thought I'd post an update. They are still not accepting new HMO patients, but if you have an older child who is currently a patient they will take any new siblings that come along. The reason for the trouble is that ABMG is refusing to compensate them at a level sufficient to even cover their overhead. So, the more HMO patients they see, the more money they lose.... Unfortunately, it sounds like this could go on for a long time. Lee