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

[SSSnail]

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.

I had Kaiser, and am still under the plan until eoy. My personal experiences with the organization was less than stellar. When dealing with them, I had the impression that they care more about not treating me and reduce cost, than my well being. I was given run arounds, and one time, when I needed physical therapy, they told me there weren't any appointments available until two months after the day I called them. I could go in details, but why bother.

I'm sure your experience is much better, but for me, the one time that I needed them and they failed miserably was enough for me to make the decision to switch to a PPO plan.

I was also lured in by the perceived lower cost, but now doing the math, my HSA PPO plan is actually a bit cheaper on the premium side, and gives me much more freedom to choose.

 

[Gooberlx2]

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

We lucked out when a new facility opened up near where we live, the PCP there just happened to be awesome. But before that, yeah, my wife went through something of a revolving door of doctors for reasons mentioned above: Gatekeeper complex, shitty about prescriptions, etc...

One thing we did was have our new-Kaiser PCP and our non-Kaiser rheumatologist get in contact and sort of work out a plan and understanding of their roles. Generally, our rheumatologist is king regarding all things immune system and our PCP helps to facilitate whatever he needs.

Like I said, we pay extra for a weird plan covers non-Kaiser docs, but not every lab or test they need done is covered outside of Kaiser facilities (like CTs and certain labs). In the past, some Kaiser PCPs would throw a whole load of bullshit requiring my wife to schedule an appt with them to "verify the need" themselves and other bullshit. It was a huge PITA, and redundant anyway, wasting our time and money.

With our new PCP we just send her the orders, she puts them in the system and schedules the appointment. No fuss, no muss. She's been instrumental in making this whole thing work.

 

[Ns1]

^^

Do you just pay out the ass for your non kaiser rheumatologist?

 

[Gooberlx2]

^^

Do you just pay out the ass for your non kaiser rheumatologist?

No, we pay a higher premium for a plan that covers outside docs on a different cost tier. This is where is gets a bit complicated. Rather than typing it up, here's a clip of the page from our benefits guide:

So, if I fail to track out of pocket costs for each tier, I can get a surprise bill after I've thought should have met the deductible or MOOP for both tiers 1 and 2.

The only time tier 3 has applied was getting reimbursed for treatment for an injury when traveling abroad.

It'd all be a lot simpler if I went with a somewhat cheaper plan that forces us to stay within Kaiser, but we don't want to leave our specialists, and there's also a prescription formulary difference which would hurt us.

 

[Ns1]

ah ic, thanks. I don't have those options

Goober, you've been quite helpful. Reps++

 

[Gooberlx2]

ah ic, thanks. I don't have those options

Yeah, I kinda went off track. I guess the point I was trying to make is that Kaiser HMO can work really super well, so long as you have docs you like and can get the treatments and medications you need.

I know autoimmune disorders can be complicated and Kaiser's available specialists may not be up to snuff, so the flexibility of a PPO is certainly worth serious consideration. In our case, we pay a hefty premium to maintain as much flexibility as possible.

 

[Ns1]

I know autoimmune disorders can be complicated and Kaiser's available specialists may not be up to snuff, so the flexibility of a PPO is certainly worth serious consideration. In our case, we pay a hefty premium to maintain as much flexibility as possible.

yeah I'm just not in a position where I want to hit the maximum OOP right now....so I think 1 more year of Kaiser and then switching to PPO is in order.

 

[ztuz]

My advice would be to choose any plan other than Healthnet. My Wife has a rare form of Cancer and she signed up for There Silver 87 plan.She was told this was designed with her in mind.
Since Jan. 1, 2014 she has been trying to get in to see an Oncologist. She has been directed to every Oncologist in her network list. Ever Dr. She has contacted has told her the same thing " The doctor is in the network but the Facillity is not" Healthnet reps keep telling her they need to educate the Clinics but in the end the rejections continue and she cant get authorized to see one of them.
It has been over 4 months since her first referral and there is still no Dr. appointment.

 

[BoomerD]

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.

So am I...just send your money to me. I can ignore you and deny you services even better than ANY HMO ever could...


Ah fuck...damned necrothread.

 

[Ns1]

I'm on a PPO now ^_^ my god it's expensive.