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Health Insurance Decision

Crystal Brown

By Crystal Brown
in Doctors

Recommended Posts

Crystal Brown Rookie
Crystal Brown
Posted

I decided to start a separate thread to ask this question. I originally asked it in the I Hate Kaiser thread, however, I do not want it to seem that I have a bias towards any one health insurance company.

A little recap:

1. I live in Fairfield, CA

2. I did have Health Net. My prior employer canceled their contract with Health Net. So, my only option with them is to enroll in a conversion plan and pay a very high monthly premium.

3. I do have the choice to enroll in Kaiser, which has a lower monthly premium. However, my previous employer seems to have offered this option out of the "blue", as a Cal-COBRA option. I am concerned the previous employer will drop this option like they did with Health Net.

4. My previous employer canceled all other health insurance carrier contracts besides Aetna - Aetna has not yet been offered to me (as it states should be the case in the Cal-COBRA laws - Open Original Shared Link but I am willing to fight for it, if Kaiser doesn't seem to be a viable option.

I take this decision very seriously, as I do any allegations towards any one particular health insurance company. I will also take any positive experiences, very seriously as well. I really need to make a decision and am looking to all of you, especially those within California, to help provide detailed facts. This is a hard decision, as I need a health insurance company that has the organization in order to handle their bookkeeping, scheduling and doctors with as little problem as possible. I know HMO's are a nightmare, but there has to be the lesser of the 3 evils.

I sincerely appreciate anyone who can provide their experience(s) with one of these health insurance companies.

:)

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sbj Rookie
sbj
Posted

I am in southern California.

Advice nurses: You can simply call in anytime when you are having an issue and you will speak with a registered nurse. This is helpful when you can't make an appointment or don't want to miss work. RNs are highly trained professionals and they can give you an idea of whether you need to come in for a visit or not. They do NOT attempt to diagnose over the phone and this is made quite clear when you call.

Some of my pleasant experiences: You can email any of your doctors and they are required to respond within 48 hours. My GI, in fact, has personally called me on my cell on several occasions. A record of your visits is available online - only to you - anytime you want. You can view your test results online and the system will also chart your current and past results so that you can see improvement. All of your doctors use a computer in the exam room to immediately enter into your record what you are telling them. They have immediate access to all of your other information and everything that any other Kaiser doctor noted in your record. If you are overwieight they tell you so that you can better take care of your health. They offer weight loss programs. If you smoke they tell you to stop smoking and they offer a stop smoking program. Kaiser has their own hospitals and pharmacies. They provide ophthalmologic as well as optometry services. They offer physical therapy. They offer counseling/therapy/psychiatry. I quit smoking with Kaiser's help through a free 8 week program they offer. They also offer nutritional and dieting information and programs to help those who are overweight or diabetic. They have an extensive addiction medicine program to help those suffering with drug addicition and it includes outpatient and residential treatment. You can make an appointment to see any of your doctors online, or you can call. If the lead time is too long they have after hours care, walk-in care, and emergency care. You can also make a same-day appointment if you call early enough. They are strong believers in preventive medicine. They do not overprescribe medications. You can ask your pharmacist if your meds are gluten free and they will note this on your record. Before my colonoscopy I attended as class warning me of the dangers. They offer free flu vaccinations (to the aged, young, or those with compromised immune systems) but before they poke you they warn you of the dangers and ask that you stick around to see if you have an adverse reaction. They even give you a flyer explaing what to do if you have a reaction. Same thing after I was shot up with that goop for my CAT scan.

Those are some of the benefits I can think of off the top of my head.

My celiac experience: I do not have any symptoms and no family history. My cousin informed me that he had a genetic condition called Lynch Syndrome. Because I was a relative there was a chance that I had it. I told my intern and he referred me to a genetic counselor. The genetic counselor had a blood sample taken (through Kaiser's own labs - onsite). It was revealed that I also had Lynch so my intern referred me to a gastroenterologist. My gastro scheduled me for blood tests, urine tests, a CAT scan, an ultrasound, a colonoscopy, and an endoscopy. The endoscopy was negative for cancer but the pathologist thought he saw signs of celiac disease - even though they weren't looking for it and I had no symptoms. My gastro then had me take the celiac panel and also took blood for a genetic test - both of which were positive. After being diagnosed with celiac my intern scheduled me for bone density testing and performed a CBC to look for nutritional/mineral/vitamin deficiencies. It was discovered that I have osteopenia - probably due to celiac - so I now take vitamin D and calcium as well as exercise. My intern referred me to a dietitian who gave me some excellent advice about celiac and provided some good resources. I am scheduled to do followup bloodwork for celiac in 6 months.

When it comes to celiac I don't think you can get better service than that!

Crystal Brown Rookie
Crystal Brown
Posted
  • Author

"Zella - I don't think you are trying to start drama. In the past I have posted about my good experience with Kaiser and I have been pilloried so I am somewhat hesitant. The problem with posting positive experiences is that someone here will feel the need to bash Kaiser as soon as they read what I post and I don't want to start some silly tit for tat waste of time. Since your friend had such a lousy experience will it really matter what I say?

Advice nurses: You can simply call in anytime when you are having an issue and you will speak with a registered nurse. This is helpful when you can't make an appointment or don't want to miss work. RNs are highly trained professionals and they can give you an idea of whether you need to come in for a visit or not. They do NOT attempt to diagnose over the phone and this is made quite clear when you call.

Some of my pleasant experiences: You can email any of your doctors and they are required to respond within 48 hours. My GI, in fact, has personally called me on my cell on several occasions. A record of your visits is available online - only to you - anytime you want. You can view your test results online and the system will also chart your current and past results so that you can see improvement. All of your doctors use a computer in the exam room to immediately enter into your record what you are telling them. They have immediate access to all of your other information and everything that any other Kaiser doctor noted in your record. If you are overwieight they tell you so that you can better take care of your health. They offer weight loss programs. If you smoke they tell you to stop smoking and they offer a stop smoking program. Kaiser has their own hospitals and pharmacies. They provide ophthalmologic as well as optometry services. They offer physical therapy. They offer counseling/therapy/psychiatry. I quit smoking with Kaiser's help through a free 8 week program they offer. They also offer nutritional and dieting information and programs to help those who are overweight or diabetic. They have an extensive addiction medicine program to help those suffering with drug addicition and it includes outpatient and residential treatment. You can make an appointment to see any of your doctors online, or you can call. If the lead time is too long they have after hours care, walk-in care, and emergency care. You can also make a same-day appointment if you call early enough. They are strong believers in preventive medicine. They do not overprescribe medications. You can ask your pharmacist if your meds are gluten free and they will note this on your record. Before my colonoscopy I attended as class warning me of the dangers. They offer free flu vaccinations (to the aged, young, or those with compromised immune systems) but before they poke you they warn you of the dangers and ask that you stick around to see if you have an adverse reaction. They even give you a flyer explaing what to do if you have a reaction. Same thing after I was shot up with that goop for my CAT scan.

So are some of the benefits I can think of off the top of my head.

My celiac experience: I do not have any symptoms and no family history. My cousin informed me that he had a genetic condition called Lynch Syndrome. Because I was a relative there was a chance that I had it. I told my intern and he referred me to a genetic counselor. The genetic counselor had a blood sample taken (through Kaiser's own labs - onsite). It was revealed that I also had Lynch so my intern referred me to a gastroenterologist. My gastro scheduled me for blood tests, urine tests, a CAT scan, an ultrasound, a colonoscopy, and an endoscopy. The endoscopy was negative for cancer but the pathologist thought he saw signs of celiac disease - even though they weren't looking for it and I had no symptoms. My gastro then had me take the celiac panel and also took blood for a genetic test - both of which were positive. After being diagnosed with celiac my intern scheduled me for bone density testing and performed a CBC to look for nutritional/mineral/vitamin deficiencies. It was discovered that I have osteopenia - probably due to celiac - so I now take vitamin D and calcium as well as exercise. My intern referred me to a dietitian who gave me some excellent advice about celiac and provided some good resources. I am scheduled to do followup bloodwork for celiac in 6 months.

When it comes to celiac I don't think you can get better service than that! "

SBJ,

Thank you for the information. And for transferring it! I had copied your post from the other thread and I see you did the same :)

May I ask which Kaiser you have had success with? I see you said you're from Southern California - which part? I would be interested in knowing which Kaiser hospitals you recommend down there. I grew up down there and have a lot of family I go and visit. If anything happens to me while down there, it would be great to know where I can go in case of emergency.

I appreciate the description of the advice nurse, I'm assuming in my friend's case, he had a rogue advice nurse who didn't obey the rules. He thought it very strange that she canceled the appointment without telling him. Do advice nurses take care of scheduling as well?

That is good to hear that they understand gluten-free medications. Did the dietitian seem to have a thorough understanding of Celiac and the GFD? I think with any health insurance company, you end up with some really good dietitians and some not so good ones.

Thank you for the detailed description. :)

sbj Rookie
sbj
Posted
May I ask which Kaiser you have had success with? I see you said you're from Southern California - which part? I would be interested in knowing which Kaiser hospitals you recommend down there . . . I appreciate the description of the advice nurse, I'm assuming in my friend's case, he had a rogue advice nurse who didn't obey the rules. He thought it very strange that she canceled the appointment without telling him. Do advice nurses take care of scheduling as well? That is good to hear that they understand gluten-free medications. Did the dietitian seem to have a thorough understanding of Celiac and the GFD? I think with any health insurance company, you end up with some really good dietitians and some not so good ones.

Thank you for the detailed description. :)

I am in Long Beach, CA so I go to a local facility in Long Beach - less than 2 miles from home - to see intern, get blood work, pharmacy, and even physical therapy. Hospital/emergency/walk-in/colonoscopy/endoscopy/CT scan and other procedures I have done at both South Bay/Harbor City Medical Center in Harbor City, CA and Bellflower Medical Center in Bellflower, CA (hospitals at both sites). They've got a spiffy new hospital in Irvine at Orange County/Irvine Medical Center. You can probably get to a list of all of their medical facilities on the website.

I haven't had a problem with scheduling appointments but I certainly do think it is possible. The RNs I have spoken with never scheduled anything for me - they transferred me to an appointments person. I'm sure mistakes happen, though. The dietitian prepared herself for my one-on-one consultation extensively and had even listened to a seminar that Kaiser had offered to their medical practitioners in their continuing education efforts. I think the key is to see a dietitian and not a nutritionist - dietitans have extensive medical training. Good health to you!

MaryJones2 Enthusiast
MaryJones2
Posted

Your premiums will be very high on COBRA (102% under federal COBRA and 110% under cal-COBRA) so another option is to look into private insurange with BCBS, Aetna, etc. You will likely see significant savings and have a lot more control over your plan options.

Here is the DOL site on COBRA: Open Original Shared Link

If you lost your job after September 1, 2008 you should also look into COBRA continuation assistance program created by The American Recovery and Reinvestment Act. You can get a 65% reduction in premium. Here is a link to that: Open Original Shared Link

Cal-COBRA only applies to very small companies so if your company has more than 20 employees in your group plan then you are likely goverened by federal COBRA laws.

happygirl Collaborator
happygirl
Posted

In many ways, what matters more is the SPECIFIC plan each carrier is offering, not just the name of the company.

You can have two plans from the same carrier - and one has great coverage, and the other one - not so great.

Crystal Brown Rookie
Crystal Brown
Posted
  • Author
In many ways, what matters more is the SPECIFIC plan each carrier is offering, not just the name of the company.

You can have two plans from the same carrier - and one has great coverage, and the other one - not so great.

Just so I am clear, are you referring to each plan offered by the company? Like deductible $500 vs $1000? Are you familiar with which plan options are the best? Thank you for pointing that out :)

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happygirl Collaborator
happygirl
Posted

Each plan is different. There is no one "universal" BCBS plan, or universal Aetna plan, ... etc. Its important to know the contents of each plan that you have (potential) access to. What are the costs? What are the deductibles? What are the co-pays? Do you have to go to an in-network doctor? What type of coverage do you get for out of network doctors? Do you have to have referrals, even to in network doctors? What are the plan limits and maximums? What type of prescription coverage do you have? Do they include a mail order option?

Questions like that will help you compare your results. Determine what you need or your preferences, and then compare it against the policies. Everyone has personal preferences for which one is best. An policy with options of X, Y, and Z, and restrictions A, B, & C is great for one person, but terrible to another.

Crystal Brown Rookie
Crystal Brown
Posted
  • Author
Your premiums will be very high on COBRA (102% under federal COBRA and 110% under cal-COBRA) so another option is to look into private insurange with BCBS, Aetna, etc. You will likely see significant savings and have a lot more control over your plan options.

Here is the DOL site on COBRA: Open Original Shared Link

If you lost your job after September 1, 2008 you should also look into COBRA continuation assistance program created by The American Recovery and Reinvestment Act. You can get a 65% reduction in premium. Here is a link to that: Open Original Shared Link

Cal-COBRA only applies to very small companies so if your company has more than 20 employees in your group plan then you are likely goverened by federal COBRA laws.

Hi Janet,

Unfortunately, I became unemployed a LONG time ago. All the way back in 2004 to be exact. I have already been paying COBRA premiums for over 4 years now and was paying Cal-COBRA premiums from June 2008 - January 1st, 2009. I worked for Bank of America, who definitely has more than the 20 employees, however I know there is a section in the code that covers the continuation coverage of COBRA. I will locate that when I get back from class. I did try to apply for individual coverage and was denied by BCBS, Aetna, Health Net and Kaiser.

From what Bank of America has told me (time and time again) is that first you exhaust the extended insurance at a premium of approx $145, then you go to COBRA at a premium of approx $215 and then you go to Cal-COBRA at a premium of approx $480 and then you are eligible for a guaranteed conversion plan with your insurance company at a premium of approx $560. So, had they not dropped Health Net, my Cal-COBRA would have gone until March 2010.

Thank you for providing that information though, that's great to know for any of my friends who have recently become unemployed.

:)

Crystal Brown Rookie
Crystal Brown
Posted
  • Author

Hey Everyone,

I just wanted to report that I was able to retain the Health Net coverage. :) I appreciate all the input. It's a big relief to be able to keep the coverage where I had finally found such a great hospital, Orthopedic surgeon and Primary Care doctor.

If anyone lives in Contra Costa, Alameda or Solano County, I would recommend checking out the John Muir Network. The Walnut Creek campus has a very dedicated staff, excellent training and a wonderful Dietitian. If anyone would like her name, let me know.

Thank you again,

=D

Darn210 Enthusiast
Darn210
Posted
Hey Everyone,

I just wanted to report that I was able to retain the Health Net coverage. :) I appreciate all the input. It's a big relief to be able to keep the coverage where I had finally found such a great hospital, Orthopedic surgeon and Primary Care doctor.

If anyone lives in Contra Costa, Alameda or Solano County, I would recommend checking out the John Muir Network. The Walnut Creek campus has a very dedicated staff, excellent training and a wonderful Dietitian. If anyone would like her name, let me know.

Thank you again,

=D

YaY!!! . . . now get thee to the doctor and get your little friend looked at pronto!!! . . . and good luck!!

Crystal Brown Rookie
Crystal Brown
Posted
  • Author
YaY!!! . . . now get thee to the doctor and get your little friend looked at pronto!!! . . . and good luck!!

Haha, thank you!!

And you bet I'm getting my butt to the doctor (pun slightly intended) and my little friend too. I'm hoping for a Friday appointment. Have to wait one more day for Health Net to process my enrollment form, but once that's done, I'm good to go :D

*Happy dance*

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