HealthNet vs. PacificCare
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November 2002
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
November 2001
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
Sept 2001
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.
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