• Local pediatricians not accepting United Health Care (2006)
• Pediatric groups not accepting new HMO patients (1997)
• Pediatric groups not taking Blue Cross (2004)

Local pediatricians not accepting United Health Care

I'm getting desperate here and hoping someone out there has better or more information than I do. As anyone with kids and United HealthInsurance probably knows NONE of the local pediatric offices are accepting United after June 22. I've contacted Berkeley Pediatrics, Kiwi Peditrics, Pediatric Mecial group - to name a few and the folks at Pediatric Medical group said they knew of NO pediatricians in the state of California that were going to accept United's contract offer. I've contacted United to find pediatricians but they apparently don't update their lists very often and so tell me doctors are contracted when apparently they are not. I'm at my wits end. We may have the chance to move to Kaiser, but otherwise we're stuck with United and no doc. for my kids. I could give a hoot who my own doc. is, but my relationship with my peditrician so important. We're very lucky and have 2 healthy kids so we don't have an immediate need to see the docotr, but in case something happens - there's no way could pay out-of-pocket. If anyone else is in this situation or has ideas how to deal - I'd love to hear them - now I'm off to put that Universal health care sticker on my bumper America's health system sucks

The only thing that really stinks is that there is NO way to find out how much something will cost before you get it done-- like a bloodtest, x-ray, etc. The insurance company tells you that they promised the provider not to let me know, and the providers tell you that you need to ask the insurance and insist that they're fine with you knowing what it is, but ''can't possibly tell you what exact cost is, since they deal with so many insurance companies''. I learned the hard way that an x-ray at a clinic is several hundred dollars less than one at Children's Hospital ($180 vs $740 for the exact same procedure!). I've even called Barbara Boxer's office about this, but was told there is no law that requires me to be told how much a medical service will cost before it is performed (unlike dry cleaning and haircuts, ugh!) Now that we've been doing this plan for a year, we're learning how to work it, and it's going okay. I've been told it's the same for every company.

I do recommend going to a website like ehealthinsurance.com for an overview of what's out there. However, I strongly recommend speaking with a health insurance broker to actually get your coverage. They can help you through the approval process (mind did it 3x as fast as a website said they could) and also know the ins and outs (for example, my daughter had croup one time, I forgot to put it on the application and the insurance broker helped up from getting denied because of the omission, which was very helpful!!! Our broked was Bill Killips in Walnut Creek (925-906-0630), and I would highly recommend him! He is the kind of guy who would help you find a pediatrician for your current plan, if you decided to stay with it. Regardless, good luck with our very messed up system! -supporter of health care reform

1) we cut our association with United through my job and enlist with my Husband's provider (BCBS). They'll accept us under the '' life changing event'' clause.

2) Stay with UH and pay ''out of network'' prices You might want to contemplate asking your work/HR dept if under the ''life changing event'' clause, because of what UH is doing, they can let you sign up with some other option they may carry. This is the best I can offer Equally frustrated

Lastly, as I understand it, if you have to see your doctor, you wouldn't necessarily have to pay completely out-of-pocket, but you would just have to pay a bigger chunk to see an out-of-network provider. Also I'd recommend calling your pediatrician's office- in our office we've dedicated one of the staff to help answer questions and get the right info out to our patients. Hope that helps. Maybe the sunny side is that this will help Universal Health Care! L.

The HR group contacted UHC, who claimed that our pediatrician's practice would in fact still be covered (through a pre-existing Pacificare contract); I told HR this was incorrect (after confirming with the doctor's office). We went back and forth for some time but the result was that I was given conflicting information from my pediatrician and from UHC (via my HR group).

Ultimately, I asked if my company could open enrollment for me and my family this month and allow me to change providers (as there was another insurance option I could elect) mid-year. They went with that, thankfully.

So my advice is to appeal to your or your partner's HR department and document everything they tell you. I hope you get a constructive response Anon

Pediatric groups not accepting new HMO patients

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

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