Which Health Insurance Plan?
Choosing healthcare plansFeb 2013
We're about to move to Berkeley from the East Coast and I am a bit bewildered by the health plan options offered to us by our employers. We can choose between Kaiser and Aetna, both of which offer HMO and PPO. Since I am not familiar with the area health care I don't feel equipped to make an informed decision.
If I understand correctly, Kaiser is a non-profit, and not only provides coverage but actual group practices. Those of you who use Kaiser, how does this affect your choices in PCPs, and specialist care?
Foreseeably we'd need a family physician, a pediatrician, and in a year or two, a CNM or OB for prenatal care and childbirth. I went the natural childbirth route with my first child, and it would be nice to do that with the second, to find a practice of OBs and midwives who are supportive of that, take our insurance, and have hospital privileges at a hospital that is well-equipped for that. Any advice on that?
HMO would be cheaper, BUT: In the past I have had experience with for-profit insurance companies such as BCBS, and when having a PCP was a requirement, it was a huge pain. The Boston area has a notorious shortage of PCPs and most of them don't take new patients. There might be a year-long waitlist, or you can easily find yourself stuck with one you don't like or has an office 40 minutes from where you live. Now this might be different Berkeley, but makes me cautious. In your experience, is it difficult to find a good family practice in the area? Has either Kaiser or Aetna significantly limited your choices?
Any other issues we should watch out for before signing on the dotted line? Of course we can compare terms and brochures, but there might be region-specific quirks we may not see from here. Vera
Love, love, love Kaiser. I mean, let's face it, none of the healthcare options is going to be perfect, but we have found Kaiser to be perfect for our family. Been with them for at least 15 years with no problems. Birthed my child at Kaiser Walnut Creek--his Pediatrician is in Walnut Creek--my Gyno is in Martinez--hubby's doc is in Walnut Creek. Easy, always there, great phone help, etc. V. Happy w/Kaiser
Go with Kaiser; it will be much less work for your poor brain with everything else you have to figure out iwth moving. It's much more of a full-service plan and everything is on one campus (if you go to Oakland) or easily accessible. You can pick your own physician if you want to knock yourself out, or you can just go with first available and chances are you'll like them just fine. Note that the ''good'' docs as recommended on BPN have been practicing longer and thus they get filled up. The docs w/availability are newer which in my opinion is a good thing (less set in their ways as some docs tend to get). Anyway, my whole family is very happy w/Kaiser for our whole range of needs (in specific response to one of your concerns, I had two natural childbirths at KP-Oak, attended by a doula. Worked out just fine.), which include a serious chronic health condition and a minor child surgery. We've seen a lot of Kaiser staff & facilities, obviously no place or person is perfect and there have been some bad experiences with the good, but we won't ever change willingly. Kaiser Mom
Hi! I had kaiser when I moved from the Boston area to the Bay Area 10 years ago. I love kaiser (I use Walnut Creek). They are amazing/no hassle. We picked an amazing pediatrician who always knew us and we could email (huge plus) with any questions. I also gave birth twice. It's so convenient. You need blood work, you go down the hall. You need a specialist, you get an appointment quickly. You never get bills. It's great. We recently switched to a ppo and I really dislike it. I keep getting bills, the advice for after hours pediatric is inconvenient.. I could go on and on.. Feel free to email me with any questions. Happy moving! Lindsay
I suggest you contact a health insurance broker regarding these questions. A broker can give you many options, including Kaiser, and inform you of the differences. In the east bay here, there is less and less difference between Kaiser and the other HMO's, they are becoming more and more alike. just found a new health plan
PLEASE, PLEASE get in touch with Ezra Herzog, of Integrative Insurance Solutions, ezra [at] integrativeinsurance.com Ezra is a licensed health insurance agent and can answer all of your questions and find you the best and most appropriate package for you. Good luck, June
A good insurance plan for Mental Health coverage?Nov 2012
We have severe OCD in our immediate family, and right now we are insured with Kaiser. Their services are ill-equipped for severity of our needs, but they make it nearly impossible to be covered outside of their network. I wanted to know if anyone has had good experiences with other providers concerning mental health coverage (psychiatrists, psychologists). We are strapped for money and relying on parents, but can't NOT go the (truly helpful, non-kaiser) doctor right now. We are willing to change providers if there are good ones out there! Stay Healthy
A helpful resource for OCD treatment is the International OCD Foundation's website. They have a treatment provider database: www.ocfoundation.org/findproviders.aspx Search options include the age of your family member (adult, teen, child), OCD treatment strategies requested (Exposure and Response Prevention, home visits), etc. The International OCD Foundation website lists OCD support groups and intensive treatment programs. Also, it has some information to help the family members of OCD sufferers think about how they can support their loved one without enabling the OCD itself - which can be a complicated balance. Best wishes, Jennifer
I used to have Cigna and it had good coverage of therapy and medication under their premium plan. There's still a deductible and I think overall coverage is limited to 30 visits/year, but it still saved me thousands of dollars and I got to see my preferred therapist. I'm now with Kaiser and paying out of pocket to stay with the same therapist and it HURTS financially. Good luck! Good insurance
I sympathize as I'm in your exact shoes. I'm the one with OCD and we have Kaiser. Their mental health services are beyond pathetic. They couldn't even diagnose me properly. I can't say enough bad things about that dept - for everything else, they've been fine. We had Health Net for a bit and I had no luck finding a decent CBT therapist who took the insurance. I finally had had enough and decided i had to pay out of pocket if i wanted to feel better. I walked into Mark Balabanis' office in Rockridge. He's expensive, but he's amazing. My OCD is SO much better - he gave me the tools I needed to combat the obsessive thoughts and compulsions. Kaiser just wanted to throw meds at me and sign me up for CBT group classes designed only to help those with generalized anxiety. I'll never be 100% since OCD isn't curable, but I'm at 85-90% and have been for about a year - and I'm med-free. Best of luck. Sympathetic
We have Anthem Blue Cross and they never give us any trouble with paying for therapy. Of course, they don't pay a large percentage but after talking with other friends it seems they may pay more than most. Good luck with this. Wendy
We are new to the area, and both me and my husband don't have a job yet. Can anyone advise me on how to go about buying a health insurance for a family with young kids? I am also looking for a health insurance that is not too expensive. Any advice will be appreciated! anon
We just bought a Blue Shield Plan (Balance Plan 2500) for our family- 2 healthy adults, 4 y.o. and 3 month-old. It is costing us about $340/month. It covers everything we need with $30 copays and a $2500 deductible. We did the whole application online, and although it took them 45 days to approve us (when the website assures 30 days) for no apparent reason, we haven't had any problems since. It does not cover any maternity, if that will be an issue for you. Good luck! Hate the red tape....
If you need medical insurance a great step to take is to contact Jean Sturges 510-845-6688. She is a health insurance broker and can address your needs by dealing with many different companies and see what best suits your family's needs. You do not pay her at all for her services. She would be compensated by the insurance company, if you do end up buying a policy through her. Many people that I have known of have been very happy working with her and benefiting from her expertise and knowledge in the field. Good luck! Leah
We currently purchase Kaiser insurance as an independent family and are being charged about $900 for a family of three per month. This is very costly, as we work for ourselves and do not fall under any employers' health plans. I'd like to ask BPN members their suggestions for a good PPO plan, if there is such a thing, and pediatricians and gynocologists that would take PPO as I will probably switch out of Kaiser's plan after a month or two of research. K
Hi, I am also self-employed and have BCBS. I used a broker-Brian Fitzpatrick from Pleasanton years ago, but don't have his contact info any more. We were paying $350 two years ago for a family of four in California and since then have moved, but still have BCBS. We now pay $455, with a hsa, they pay the first $500 of expenses without us dipping into our deductible, which is $3000 for family (and even then they cover 80% before that is met). I'm even covered for maternity, which suprised me because both of my deliveries have run into the 6 figure range. What is not included are vaccinations, well visits, dental or vision. Instead, I go to Costco for eye visits, use a sonicare toothbrush twice a day, and if my kids need a shot we go to the health department. Good luck. I'm fed up with healthcare too. Jodi
We had to purchase our own insurance up until about a year ago. Kaiser was by an enormous margin the best value for the dollar that we found. Now that I am on my employer's plan, Blue Cross PPO, the premium is much higher than what I was paying for Kaiser(but my employer pays most of it), and the deductibles/ coinsurance/ out of pocket maximums are completely ridiculous. From your post I got the impression that you were looking for a less expensive plan. If I were you, I would stick with Kaiser but maybe increase your deductible or go with an HSA to lower your premium. Good luck. Hoping for reasonable health care someday . . .
I'll be interested to see what other BPN'ers have to say about this. I'm also self-employed and we pay about $1300 a month for health insurance for a family of four, through Blue Cross. Ouch! I investigated the possibility of a high deductible plan, which would only have cost us about $500. We would have had more out-of-pocket expenses, but those can be paid out of a health savings account (HSA) that you can set up and put money into pre-tax. All in all, they sound like a great deal, but when I applied for it for my healthy family of four, they rejected us because my younger daughter had recently had ringworm and (gasp) uses a prescription ointment for acne. Imagine, a teenager with acne! I'm going to keep trying to get one of these plans, but the experience left me wondering if the insurance companies are really granting them to anyone, or only offering them because they were mandated to by a federal bill a few years ago. It also left me more convinced than ever tha! t we have to get the insurance companies out of this business in order to get everyone covered in a fair and affordable way. In the meantime, I hope you find something, and I look forward to the other answers you receive. Single Payer Fan
We recently decided to get our own insurance and called Bett Martinez, a broker, in Berkeley. She helped us through the process of applying to Blue Shield for which we were all approved. You might ring her and tell her your needs and wants and see what she recommends...she was super helpful. Her number is 526-0312 deborah
I'm looking for any information about the Alta Bates Medical Group versus the Hills Physicians. We have PacifiCare and we were in the Alta Bates Group until I got pregnant and wanted to have a midwife for the baby's birth. We had a horrible time switching to Hill's (they cover midwifery, ABMG does not). But we were successful. (They didn't want to switch us because I was over three months pregnant. They finally switched us due to a mistake they made, otherwise they wouldn't have allowed it, apparently.) Hills will not cover going back to my midwife for an annual exam, saying I would have to see my primary care dr. or an ob/gyn. Are there any benefits to staying in Hills over Alta Bates since neither one will cover seeing an alternative practitioner for women's health issues? I just feel that Hills works even harder to deny services than anyone else would. Laura
I don't know a lot about either but a couple months ago Hills and childrens hospital were trying to decide wether or not to renew their contract. They did renew and while talking to the rep at Childrens Hospital I asked about Alta Bates Medical group and if they were in better standing with Childrens He basically said Alta bates were also on shaky ground ( At that time) and that Alta Bates Medical was part of Alta Bates Hospital Leading me to believe they tend to lean more towards ther own hospital and may not continue with Childrens. I personally would want my child to go to Childrens If she ever needed to be hospitalized. We had to go when she was 11 days old and the place is great. Anonymous
The specialist I see, Dr. Lisa Bailey, and her office manager, both thought that Hill was better than Alta Bates (while recognizing that the whole HMO concept sucks). I have a high regard for their opinion, as it's a well run office and a good doctor. anonymous
I can't help but wonder if the information you were given (about not being able to see a midwife for your yearly gyno checkup) is mistaken. I was in HealthNet w/Hill Physicians before I switched to Kaiser, and my midwife said, ''I'll see you next year!'' Ask someone else in Hill Physicians. I think you'll get a different answer. Good luck. (as a data point: my old doctor's office had nothing but trouble with Alta Bates Medical Group and was very pleased when I switched to Hill Physicians. Said ABMG was *very* difficult to deal with.) Jennie
Does anyone have any feelings about Pacificare HMO versus Healthnet? I am not sure which one to pick. They both offer about the same services, but in terms of service both are unknowns to me. The last posting regarding this was in 2001, so I would greatly appreciate updated information. Thank you Deb
Hi, I've had both Pacificare and Healthnet at various times. They are both very good plans, though lately Healthnet has been cutting costs. For instance, in the last 6 months they have stopped paying for pre-natal vitamins even though my deductible was $20 and the vitamins are $22. I also believe that they've made it a bit harder to reach a representative on their phone systems. It used to be the first option on the recording, now it's not a listed option.
When I had Pacificare (about 18 mo. ago) they let different family members have different groups. So my husband was with Hills Physicians, while me & the toddler were with Toland & Brown. (Healthnet, Blue Cross and most HMO don't let you have different groups - as I have tried.) When I called them and requested that a pediatrician be my PCP: they came through after calling in a supervisor to override their computer system. (The other health plans wouldn't, I've tried.) The only issue was that Walgreens didn't accept them and I had to go to out of the way to RiteAid, but I believe that has changed. I saw a sign at Walgreens saying they now take Pacificare.
I've never used Pacificare for surgery, lab, x-rays, etc - so I can't say how good they are there. I delivered my baby with Healthnet (3 years ago) and there was no trouble with bills, the hospital, blood tests, etc. - all went well. Also had a cat scan (1 year ago) with Healthnet, and more ultrasounds just lately. All the big bills went through without any problems. Though I notice Healthnet costs have changed, I don't feel that they are skimping or would jeopardize one's health. Both companies are really great and better than most health plans out there (at least from my experience). They are both great choices. marian
When we were looking at plans we asked the billing office at our Dr.'s office which plans they were covered by and which they preferred dealing with. They were very forthcoming with useful info. susan
I just switched from HealthNet to Pacificare HMO, because I did not like the service my family received from HealthNet. The customer service department at HealthNet is not very good at explaining benefits/reasons for non-payment of physcian services. I had Pacificare a prior to HealthNet, and was satisfied with them. The reason I had switched had to do with changing employers, at the time they did not offer Pacificare, now they do so I have switched back. Lisa
Hello, I have no experience with Healthnet, but we have had PacifiCare for the past four years with mixed satisfaction. They were extremely unhelpful, in fact antagonistic, when I was pregnant and trying to switch medical groups from Alta Bates to Hills so that midwifery would be covered. However, when my son was born a month early and needed hospitilization for a week in NICU they covered absolutely every charge without even a co-pay. My entire prenatal, delivery and postnatal care was also fully covered. We have not had any problems getting referrals to specialists okayed, but we have had billing problems (they would not pay a lab bill for 6 months, saying it was the medical group's problem. It may have well been, but it seemed that they did nothing to try and resolve the problem).
One thing I found important with PacifiCare was that if I had a problem, being firm and talking to different people on different days helped. (So, is everyone acutally on the same page there or does it depend on the customer service representative as to what kind of service you get?!)
We are actually leaving PacifiCare because we are now eligible to receive health coverage through my husband's employer.
Good luck deciding. It seems like all of the companies out there are reducing services and charging more and more. Laura
If you know in advance that you or your family will need particular prescription drugs under Pacificare or Healthnet, I encourage you to review the drug formularies for each as part of your research. The drug coverages/exclusions made a difference for our family, even though our physicians accept insurance from both HMOs. I think both Pacificare and Healthnet have administrators rather than doctors making decisions about patient referrals. anon
I've had Pacificare (though UC) for 4+ years and have been happy with it. They are easy to reach by phone. And amazingly, there has never been any problems with claims (I've never even seen a bill!). The prescription service they use is less than wonderful, however. Gen
We've had both these HMOs within the past five years. We had a lot of trouble with Healthnet making careless errors and then taking months and months to fix them. Our experience with Pacificare has been great. Their customer service people are much more successful at resolving problems. Of course, I have no idea how representative our experience is. Good luck. Dana
I just wanted to follow-up on a post that a member made about HealthNet, she said that Healthnet doesn't let family members enroll in different medical groups. That is not the case, my husband and I are with Alta Bates Medical Group and my two children are with Hills Physicians. There was no problem anonymous
I would like to hear people's experience with Healthnet and Pacificare. Pros and cons for each. It's open enrollment time and the recommendations on the UCB parents' site are old. Simona
Hi- I spent a lot (too much!) time in the hospital insurance biz, and generally I would say that the medical group is more important than the actual insurance company most of the time. It's the med grp that authorizes (or not) your medical care. If you should be unlucky enough to end up in a non-plan E.R., it's your medical group that you will have (most likely) hassles with regarding getting the bill paid. The carrier, however, may ultimately be responsible for the benefits under your plan, so if you are likely to want something exotic (infertility treatments are one example), you may wish to see if it is covered by the carrier. Hope this helps, -michael s.
We had a HUGE problem with Health Net when we took our daughter to the emergency room in Denver and HealthNet never paid the bill until we were threatened with collection and I went through the University health care facilitator. I was told that HealthNet and Alta Bates medical group were having a war, so neither would take responsibility for the bill and each one told me that the other party was responsible. I was very angry and have now switched to Pacificare, who, according to the University health care facilitator, has not had any problems like this so far. Toby
If you are a University employee and use either HealthNet or PacificCare, would you please write about your experiences with your HMO. We currently have HealthNet, but have had some major billing problems with them over a relatively minor occurrence. We are thinking of switching to PacificCare, but want to ensure as much as possible that the same problems won't happen with them. I spoke to the University Health Facilitator and she said that HealthNet is having a dispute with Alta Bates Medical Group about who's supposed to pay which bills which is why she thinks I'm having a problem. She also said that she has not heard the same complaints from PacificCare users. Thanks. Toby
My husband and I have been with PacifiCare for about 5 years, I think, and we have never had any billing problems with them -- and this includes fairly complicated things like a series of neurological tests, and a visit to an emergency room in another state. Karen
I used to have HealthNet (5 years ago), and now I have Pacificare. I found neither one to be particularly easy to use. By dint of much hammering, we managed to get Pacificare to pay for a midwife-assisted birth, for instance, but it took a LOT of work. And right now I am engaged in a struggle with them over their formulary--they don't want to pay for any of the medications that my doctor wants to put me on. I have never had the kind of billing problems you describe, however. FYI: It may very well be that the problem is not with the insurance, but with Alta Bates Medical Associates. There is a sign up at our office (Berkeley Internal Medicine) that lists several insurances that they no longer accept, including Blue Cross, Aetna, and Lifeguard. My doctor also mentioned that another doctor in the practice is leaving because she works very hard, and doesn't get paid [enough]. All this, along with my experiences previously, seems to indicate to me a bad atmosphere in ABMA, and in the insurance industry as a whole. My doctor seems to think that things will get *much* worse before they get better.... Feel free to write me individually if you want more specific information on any of my interactions with Health Net or Pacificare. Dawn
I had an absolutely horrible experience with Pacificare when they were my primary insurance for eight months. They screwed up every claim (approximately 10) that was submitted to them, and it took me more than a year (after cancellation) to get everything resolved. Louise
I switched from Healthnet (or Healthnot as some call it) to Pacificare a few years ago and so far, so good. The switch was made because of a billing problem which I had one heck of a time resolving. I was visiting family in Oklahoma and developed an eye infection which resulted in having to visit the hospital on Christmas Day. I followed all procedures to the letter, contacted my doctor to approve care, etc., but Healthnet wouldn't cover the hospital bill. Everytime I spoke to a respresentative over the phone, they agreed that it should be covered and they would look into it. But every month I got another bill from the hospital, then finally from a collection agency. This went on for months, until I was finally able to speak to a supervisor and get it cleared up. The problem wasn't refusal of coverage, just sheer incompetancy, as far as I could make out. I wrote a number of letters to them, but never got an answer. I switched to Pacificare at the first opportunity, and so far have had no problems with billing, coverage, or anything else for the last 4 years. One Walgreens Drug Store I went to would not take Pacificare, but don't know if they still have that policy. Good luck on your decision. Dianna
I would recommend using Pacificare insurance. I had coverage for only 3 weeks before going into unexpected premature labor. This insuracne company has surprisingly paid for everything without a single complaint or problem, including an excessive and expensive 3-week hospital stay before and after my preterm labor, and the past two gruelling months of the (extremely expensive) neonatal intensive care unit for my son. I have had absolutely no problems with the insurance coverage and would recommend this insurance company and especially the Alta Bates medical group to anybody who is going to be having a child.
I'm a new postdoc here, with my wife. Our health insurance will be mostly (or completely, depending on the plan we are to take) paid by U.C. However, we're having difficulty in choosing a medical plan among those provided by U.C. (e.g. Health Net, Kaiser, PacifiCare, UC Care). We're living in El Cerrito, and plan to have a baby soon. Could you please kindly provide us with some suggestions regarding which plan to take, which medical group to join, which PCP to register to, etc. After some study of the information provided by U.C., we still feel very much confused.... I think planning on having a baby is our primary concern.
Questions about health insurance are best addressed by which doctor you wish to use. I have used both healthnet and pacificare at various jobs and my experience has been that they are virtually identical in terms of coverage. Right now, healthnet is the free one at UCB and pacificare costs $1.29 a month. I found both bueracracies similarly annoying.
Using them, you can pick your OB/GYN and pediatrician from one of the groups (around here it is Alta Bates or Hill Physicians (lots of recs on the UCB Parents Web Site)) and then use the hospital that they use (Alta Bates for ABMG, Summitt for Hill). Kaiser you use their doctors, at their facility, although now you deliver at AB. A lot of people like Kaiser because they have extended drop in clinic hours, so you don't have to get to sick kid appointments at the time. My best advice in terms of insurance is to figure out where you want to deliver your baby and work from there.
An additional note: AB and Summitt are trying to merge, so things may change and your choice for delivering your baby may end up being Alta Bates, no matter what you choose. There is an anti-trust trial in process which will decide this.