Health Net HMO vs Kaiser HMO: is there any real difference?

[Ns1]

PPO is prohibitively expensive. Kaiser has been (for the most part) good to me. I have no information at all regarding Health Net.

GF has autoimmune disorder and we're at the hospital/doctors pretty frequently (she's on my plan).


Thoughts?


The difference between HMO and PPO is $15 co-pay vs 20% co-insurance.

 

[PhoKingGuy]

<----- Former Kaiser employee

If you're young/healthy/don't really anticipate any huge chronic problems, its fantastic.

 

[mattpegher]

All HMO's suck. Basically your paying them not to take care of you.
And they pressure your pmd not to even try.
Pay the money and get the PPO. Better to get a HSA elligible highdeductable plan PPO, than an HMO.
Pay 5k to the hsa and 10k to the insurance, (family rate) and keep the freedom to go to any number of in network providers. rather than payin 15 grand to PPO 1g deductable.
HMO will cost about 12k but restrict you to one provider that has to approve (or rather delay) any proceedure, test, treatment, or referral.

 

[dbk]

I've been with Kaiser for a couple of years. I'm young and relatively healthy. No issues at all.. plus it's the cheapest plan for me.

 

[Ns1]

<----- Former Kaiser employee

If you're young/healthy/don't really anticipate any huge chronic problems, its fantastic.

I am all 3 of those, unfortunately my GF is only young.

 

[zinfamous]

<----- Former Kaiser employee

If you're young/healthy/don't really anticipate any huge chronic problems, its fantastic.

this. Kaiser is simply amazing in terms of general, long-term health care. It is great for responsiveness, patient-doctor access, and resources that are available.

I know physicians that now work there (from major University hospitals x, y, and z) and couldn't be happier. I think Kaiser, along with Mayo, are the absolute best models for healthcare in the US.

However--with chronic, serious illness, I think it is generally considered best to go to specialist, private institutions.

I have no experience with Healthnet, but for your situation, OP, I don't imagine there would be much difference between the two.

 

[Ns1]

What I love most about Kaiser is how connected everyone is. Their IT setup is really quite something.

 

[zinfamous]

What I love most about Kaiser is how connected everyone is. Their IT setup is really quite something.

yes, it's truly amazing.

If your choice is between the two, I would probably stick with Kaiser, not knowing anything else. I can only assume that Healthnet would put up more barriers, and likely increase the number of redundant and unnecessary procedures...but again: that is pure assumption.

 

[Ns1]

yes, it's truly amazing.

If your choice is between the two, I would probably stick with Kaiser, not knowing anything else. I can only assume that Healthnet would put up more barriers, and likely increase the number of redundant and unnecessary procedures...but again: that is pure assumption.

I looked up the costs and HealthNet is more expensive and offers less services. I'm basically wondering if you get anything for the added $$$.


What I hate about Kaiser is they are very, very anti MMJ.

 

[Gooberlx2]

We're on Kaiser and my wife has an autoimmune disorder, alongside a number of other chronic issues.

Really need more details about the plans. We pay out the ass for the highest tier Kaiser "Green Point of Service" plan that allows us to see docs, hospitals and pharmacies outside of the kaiser system.

Some of our Kaiser specialists are great, but in general it seems something of a place where primary care docs go for experience before establishing their own private practices.

The system's overall efficiency is a beautiful thing as far as appointment punctuality, labs, test results and doctor-patient communications are concerned, but a terrible curse in having to deal with so many damn gatekeepers, receiving non-emergency urgent care, flexibility, etc...

I'd say if you're comfortable with the specialists she needs to see within the Kaiser system (rheumatologist, infectious disease, etc.), and the costs are commensurate with the other plan, then they're a fairly safe bet. They generally won't fuck you over with billing surprises and whatnot. PPOs are always nice for flexibility, but I've never dealt with Health Net, so I dunno how they are in that regard.

 

[Ns1]

With regards to Health Net vs Kaiser, the cost difference is negligible. But I have NEVER heard of anyone on Health Net.

 

[Gooberlx2]

What I hate about Kaiser is they are very, very anti MMJ.

That hasn't been a problem for my wife. All her docs know and don't care so long as she's not smoking it. "Whatever helps" is sort of the general attitude for all her docs both in and out of Kaiser.

Still, most docs in general aren't yet willing to make the recommendation. My wife had to seek out a doc known to be friendly to the idea and pay out of pocket for the visits. She generally only sees him for the MMJ renewals, but he likes to keep communications up to see how she's doing.

 

[Ns1]

That hasn't been a problem for my wife. All her docs know and don't care so long as she's not smoking it.

"Whatever helps" is sort of the general attitude for all her docs both in and out of Kaiser.

The pain mgmt doc we visited basically called my GF a drug addict, so we need to find another one in Kaiser's system.

It's nice to know your wife's experience has been different.

 

[Corporate Thug]

All HMO's suck. Basically your paying them not to take care of you.
And they pressure your pmd not to even try.
Pay the money and get the PPO. Better to get a HSA elligible highdeductable plan PPO, than an HMO.
Pay 5k to the hsa and 10k to the insurance, (family rate) and keep the freedom to go to any number of in network providers. rather than payin 15 grand to PPO 1g deductable.
HMO will cost about 12k but restrict you to one provider that has to approve (or rather delay) any proceedure, test, treatment, or referral.

That's a pretty big generalization there. I have a Health Net HMO and have absolutely zero complaints about them. They always provide me with authorizations within a week the doc places the request. I've very happy w/ Health Net. I used to be w/ Blue Shield (or Cross, I don't remember)...also no complaints with them.

Also, where are you pulling the numbers from? It changes drastically based on the person and location just like car insurance.

 

[Corporate Thug]

What I love most about Kaiser is how connected everyone is. Their IT setup is really quite something.

My medical group implemented their current model from Kaiser.

 

[Gooberlx2]

The pain mgmt doc we visited basically called my GF a drug addict, so we need to find another one in Kaiser's system.

It's nice to know your wife's experience has been different.

Kaiser is paranoid about narcotic prescriptions and all that. They had my wife sign some sort of narcotic prescription agreement recently, promising not to abuse and seek opioids from multiple docs.

I mean, I understand the issue. I wish all drug seekers who clog up the ERs would drown because all they do is make things difficult for those with real pain problems.

 

[Ns1]

Kaiser is paranoid about narcotic prescriptions and all that. They had my wife sign some sort of narcotic prescription agreement recently, promising not to abuse and seek opioids from multiple docs.

I mean, I understand the issue. I wish all drug seekers who clog up the ERs would drown because all they do is make things difficult for those with real pain problems.

yeah...funny, when the GF was on medi-cal she could get opiates prescribed to her like candy.

 

[drebo]

We just switched to Kaiser from Blue Shield PPO. The thing I like the most about Kaiser and hated the most about Blue Shield was knowing how much we'd actually be billed for shit. With Kaiser, we know exactly how much we'll owe for any particular visit/procedure/etc. With Blue Shield, it was a guessing game and we never really knew what the costs would be.

My wife was 6 months pregnant when we switched and her OB was not a Kaiser contracting physician, so we had to settle. They told us when we first started that the entire pregnancy, including delivery, would be about $450. She saw them 4 times, I think. The bill they sent us was for $550. Stupid fucks.

With Kaiser, we know how much it'll cost.

That, right there, is reason enough for me to prefer Kaiser over a PPO.

 

[SSSnail]

After 2013, my employer will only have HSA option for health care, so I figure I start early. Since I'm healthy, figure the HSA will stay with me when I need it later on. With an OK employer contribution to the HSA, it's better than paying and not retaining anything.

Besides, all preventative cares under the HSA PPO plan are free, no deductible, no copay. Works out better, max out of pocket is higher, but whatever.

Edit: I'm going to have to agree that HMO sucks. You have to be literally dying to see a doctor.

 

[ichy]

My girlfriend has Kaiser and I have a more traditional HMO. For "regular" stuff Kaiser seems to be great. Easy access to doctors, great IT setup, no waiting forever for a primary care appointment. If god forbid you come down with something really serious I wouldn't be thrilled about being limited to their specialists though.

 

[ichy]

Edit: I'm going to have to agree that HMO sucks. You have to be literally dying to see a doctor.

I never had problems seeing my primary care doctor or a specialist with my HMO. The main problem I have is my PCP's office staff sucks and it can be a pain to get a referral to a specialist. I recently was diagnosed with a broken ankle at an urgent care center & was told I needed to see an orthopedist. The next morning I managed to snag a same day orthopedist appointment but the assholes at my PCP's office wouldn't give me the damned referral I needed. Every time I called I got some BS explanation from someone else. At least in the case of my HMO a well organized primary care physician's office is very important.

 

[Ns1]

After 2013, my employer will only have HSA option for health care, so I figure I start early. Since I'm healthy, figure the HSA will stay with me when I need it later on. With an OK employer contribution to the HSA, it's better than paying and not retaining anything.

Besides, all preventative cares under the HSA PPO plan are free, no deductible, no copay. Works out better, max out of pocket is higher, but whatever.

Edit: I'm going to have to agree that HMO sucks. You have to be literally dying to see a doctor.

Under the PPO offered to me, PCP's/Specialists/XRays + labs are only covered up to 80%.

Under the Kaiser HMO, PCP is $15 Specialist is $25 and xray's + lab tests are covered.

I will also vehemently dispute your assertion that you need to be dying to see a doc, because we have no problems seeing docs as part of Kaiser (my GF has been to Kaiser almost every week for the past 6 months)

I can also email my doc and get a reply within 24 hours. Doc was nice enough to make 3 followup calls - 2 from his assistant and one himself. Massive, massive win.

 

[The Stigenator]

I had healthnet PPO in college, it was a basic plan, 600/yr for the indivdual pay, but they covered my $12000 surgery and all the pre-investigative stuff.. however my out of pocket expense was high, i was paying 50-75 for doctor visits, and they would bill the insurance on top for another 250 or so. After all was said and done I spent more time chasing down billing issues.

I have kaiser now, and I am all for it. I can email my doctor for stuff, getting appointments are so easy and referrals are automatic. I absolutely love it. I dont have to go chasing after billing issues or doctors.

viva kaiser!

 

[Gooberlx2]

I never had problems seeing my primary care doctor or a specialist with my HMO. The main problem I have is my PCP's office staff sucks and it can be a pain to get a referral to a specialist. I recently was diagnosed with a broken ankle at an urgent care center & was told I needed to see an orthopedist. The next morning I managed to snag a same day orthopedist appointment but the assholes at my PCP's office wouldn't give me the damned referral I needed. Every time I called I got some BS explanation from someone else. At least in the case of my HMO a well organized primary care physician's office is very important.

Within any system, this is really variable by doc, and his/her support staff. My wife had to search long and hard within the Kaiser system to find a decent PCP who wouldn't give her bullshit about referrals or ordering procedures (especially when asked for by our non-kaiser specialists). At the same time, we've had a number of PCPs outside of any HMO who've pulled the same crap.

 

[Ns1]

My wife had to search long and hard within the Kaiser system to find a decent PCP who wouldn't give her bullshit about referrals or ordering procedures (especially when asked for by our non-kaiser docs)

What did you do, run through the entire list of docs on Kaiser's site???


(Goober, YGPM)