Which Health Insurance Plan?
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Which Health Insurance Plan?
Choosing healthcare plans
We're about to move to Berkeley from the East Coast and I am a bit bewildered by the health plan
options offered to us by our employers. We can choose between Kaiser and Aetna, both of which
offer HMO and PPO. Since I am not familiar with the area health care I don't feel equipped to
make an informed decision.
If I understand correctly, Kaiser is a non-profit, and not only provides coverage but actual
group practices. Those of you who use Kaiser, how does this affect your choices in PCPs, and
Foreseeably we'd need a family physician, a pediatrician, and in a year or two, a CNM or OB for
prenatal care and childbirth. I went the natural childbirth route with my first child, and it
would be nice to do that with the second, to find a practice of OBs and midwives who are
supportive of that, take our insurance, and have hospital privileges at a hospital that is
well-equipped for that. Any advice on that?
HMO would be cheaper, BUT: In the past I have had experience with for-profit insurance companies
such as BCBS, and when having a PCP was a requirement, it was a huge pain. The Boston area has a
notorious shortage of PCPs and most of them don't take new patients. There might be a year-long
waitlist, or you can easily find yourself stuck with one you don't like or has an office 40
minutes from where you live. Now this might be different Berkeley, but makes me cautious. In
your experience, is it difficult to find a good family practice in the area? Has either Kaiser
or Aetna significantly limited your choices?
Any other issues we should watch out for before signing on the dotted line? Of course we can
compare terms and brochures, but there might be region-specific quirks we may not see from here.
Love, love, love Kaiser. I mean, let's face it, none of the healthcare options is
going to be perfect, but we have found Kaiser to be perfect for our family. Been
with them for at least 15 years with no problems. Birthed my child at Kaiser
Walnut Creek--his Pediatrician is in Walnut Creek--my Gyno is in
Martinez--hubby's doc is in Walnut Creek. Easy, always there, great phone help,
V. Happy w/Kaiser
Go with Kaiser; it will be much less work for your poor brain with everything
else you have to figure out iwth moving. It's much more of a full-service plan
and everything is on one campus (if you go to Oakland) or easily accessible. You
can pick your own physician if you want to knock yourself out, or you can just
go with first available and chances are you'll like them just fine. Note that
the ''good'' docs as recommended on BPN have been practicing longer and thus they
get filled up. The docs w/availability are newer which in my opinion is a good
thing (less set in their ways as some docs tend to get). Anyway, my whole family
is very happy w/Kaiser for our whole range of needs (in specific response to one
of your concerns, I had two natural childbirths at KP-Oak, attended by a doula.
Worked out just fine.), which include a serious chronic health condition and a
minor child surgery. We've seen a lot of Kaiser staff & facilities, obviously no
place or person is perfect and there have been some bad experiences with the
good, but we won't ever change willingly. Kaiser Mom
I had kaiser when I moved from the Boston area to the Bay Area 10 years ago. I
love kaiser (I use Walnut Creek). They are amazing/no hassle. We picked an
amazing pediatrician who always knew us and we could email (huge plus) with any
questions. I also gave birth twice. It's so convenient. You need blood work, you
go down the hall. You need a specialist, you get an appointment quickly. You
never get bills. It's great. We recently switched to a ppo and I really dislike
it. I keep getting bills, the advice for after hours pediatric is inconvenient..
I could go on and on.. Feel free to email me with any questions.
I suggest you contact a health insurance broker regarding these questions. A
broker can give you many options, including Kaiser, and inform you of the
differences. In the east bay here, there is less and less difference between
Kaiser and the other HMO's, they are becoming more and more alike. just found a
new health plan
PLEASE, PLEASE get in touch with
Ezra Herzog, of Integrative Insurance Solutions,
Ezra is a licensed health insurance agent and can answer
all of your questions and find you the best and most appropriate package for you.
A good insurance plan for Mental Health coverage?
We have severe OCD in our immediate family, and right now we are insured with
Kaiser. Their services are ill-equipped for severity of our needs, but they make
it nearly impossible to be covered outside of their network.
I wanted to know if anyone has had good experiences with other providers
concerning mental health coverage (psychiatrists, psychologists).
We are strapped for money and relying on parents, but can't NOT go the (truly
helpful, non-kaiser) doctor right now. We are willing to change providers if there
are good ones out there!
A helpful resource for OCD treatment is the International OCD Foundation's website. They have
treatment provider database: www.ocfoundation.org/findproviders.aspx
Search options include the age of your family member (adult, teen, child), OCD treatment
requested (Exposure and Response Prevention, home visits), etc.
The International OCD Foundation website lists OCD support groups and intensive treatment
programs. Also, it has some information to help the family members of OCD sufferers think
they can support their loved one without enabling the OCD itself - which can be a complicated
I used to have Cigna and it had good coverage of therapy and medication under
their premium plan. There's still a deductible and I think overall coverage is
limited to 30 visits/year, but it still saved me thousands of dollars and I got
to see my preferred therapist. I'm now with Kaiser and paying out of pocket to
stay with the same therapist and it HURTS financially. Good luck!
I sympathize as I'm in your exact shoes. I'm the one with OCD and we have Kaiser. Their mental
health services are beyond pathetic. They couldn't even diagnose me properly. I can't say
enough bad things about that dept - for everything else, they've been fine. We had Health Net
for a bit and I had no luck finding a decent CBT therapist who took the insurance. I finally
had had enough and decided i had to pay out of pocket if i wanted to feel better. I walked
into Mark Balabanis' office in Rockridge. He's expensive, but he's amazing. My OCD is SO much
better - he gave me the tools I needed to combat the obsessive thoughts and compulsions.
Kaiser just wanted to throw meds at me and sign me up for CBT group classes designed only to
help those with generalized anxiety. I'll never be 100% since OCD isn't curable, but I'm at
85-90% and have been for about a year - and I'm med-free. Best of luck. Sympathetic
We have Anthem Blue Cross and they never give us any trouble with paying for
therapy. Of course, they don't pay a large percentage but after talking with
other friends it seems they may pay more than most. Good luck with this.
We are new to the area, and both me and my husband don't have a
job yet. Can anyone advise me on how to go about buying a health
insurance for a family with young kids?
I am also looking for a health insurance that is not too
expensive. Any advice will be appreciated!
We just bought a Blue Shield Plan (Balance Plan 2500) for our
family- 2 healthy adults, 4 y.o. and 3 month-old. It is costing
us about $340/month. It covers everything we need with $30
copays and a $2500 deductible. We did the whole application
online, and although it took them 45 days to approve us (when
the website assures 30 days) for no apparent reason, we haven't
had any problems since. It does not cover any maternity, if
that will be an issue for you. Good luck!
Hate the red tape....
If you need medical insurance a great step to take is to contact
Jean Sturges 510-845-6688. She is a health insurance broker and
can address your needs by dealing with many different companies
and see what best suits your family's needs. You do not pay her
at all for her services. She would be compensated by the
insurance company, if you do end up buying a policy through her.
Many people that I have known of have been very happy working
with her and benefiting from her expertise and knowledge in the
field. Good luck!
We currently purchase Kaiser insurance as an independent family
and are being charged about $900 for a family of three per month.
This is very costly, as we work for ourselves and do not fall
under any employers' health plans. I'd like to ask BPN members
their suggestions for a good PPO plan, if there is such a thing,
and pediatricians and gynocologists that would take PPO as I will
probably switch out of Kaiser's plan after a month or two of
I am also self-employed and have BCBS. I used a broker-Brian Fitzpatrick from Pleasanton years ago, but don't have his contact info any more.
We were paying $350 two years ago for a family of four in California and since then have moved, but still have BCBS. We now pay $455, with a hsa, they pay the first $500 of expenses without us dipping into our deductible, which is $3000 for family (and even then they cover 80% before that is met). I'm even covered for maternity, which suprised me because both of my deliveries have run into the 6 figure range. What is not included are vaccinations, well visits, dental or vision. Instead, I go to Costco for eye visits, use a sonicare toothbrush twice a day, and if my kids need a shot we go to the health department.
Good luck. I'm fed up with healthcare too.
We had to purchase our own insurance up until about a year ago. Kaiser was by an enormous margin the best value for the dollar that we found. Now that I am on my employer's plan, Blue Cross PPO, the premium is much higher than what I was paying for Kaiser(but my employer pays most of it), and the deductibles/ coinsurance/ out of pocket maximums are completely ridiculous. From your post I got the impression that you were looking for a less expensive plan. If I were you, I would stick with Kaiser but maybe increase your deductible or go with an HSA to lower your premium. Good luck.
Hoping for reasonable health care someday . . .
I'll be interested to see what other BPN'ers have to say about this. I'm also self-employed and we pay about $1300 a month for health insurance for a family of four, through Blue Cross. Ouch! I investigated the possibility of a high deductible plan, which would only have cost us about $500. We would have had more out-of-pocket expenses, but those can be paid out of a health savings account (HSA) that you can set up and put money into pre-tax. All in all, they sound like a great deal, but when I applied for it for my healthy family of four, they rejected us because my younger daughter had recently had ringworm and (gasp) uses a prescription ointment for acne. Imagine, a teenager with acne! I'm going to keep trying to get one of these plans, but the experience left me wondering if the insurance companies are really granting them to anyone, or only offering them because they were mandated to by a federal bill a few years ago. It also left me more convinced than ever tha!
t we have to get the insurance companies out of this business in order to get everyone covered in a fair and affordable way. In the meantime, I hope you find something, and I look forward to the other answers you receive.
Single Payer Fan
We recently decided to get our own insurance and called Bett Martinez, a
broker, in Berkeley. She helped us through the process of applying to
Blue Shield for which we were all approved. You might ring her and tell
her your needs and wants and see what she recommends...she was super
helpful. Her number is 526-0312
I'm looking for any information about the Alta Bates
Medical Group versus the Hills Physicians. We have
PacifiCare and we were in the Alta Bates Group until
I got pregnant and wanted to have a midwife for the
baby's birth. We had a horrible time switching to Hill's
(they cover midwifery, ABMG does not). But we were
successful. (They didn't want to switch us because I
was over three months pregnant. They finally switched
us due to a mistake they made, otherwise they wouldn't
have allowed it, apparently.) Hills will not cover
going back to my midwife for an annual exam, saying I
would have to see my primary care dr. or an ob/gyn.
Are there any benefits to staying in Hills over Alta
Bates since neither one will cover seeing an alternative
practitioner for women's health issues? I just feel
that Hills works even harder to deny services than
anyone else would.
I don't know a lot about either but a couple months ago
Hills and childrens hospital were trying to decide
wether or not to renew their contract. They did renew
and while talking to the rep at Childrens Hospital I asked
about Alta Bates Medical group and if they were in
better standing with Childrens He basically said Alta
bates were also on shaky ground ( At that time) and that
Alta Bates Medical was part of Alta Bates Hospital
Leading me to believe they tend to lean more towards
ther own hospital and may not continue with Childrens.
I personally would want my child to go to Childrens If
she ever needed to be hospitalized. We had to go when
she was 11 days old and the place is great.
The specialist I see, Dr. Lisa Bailey, and her office
manager, both thought that Hill was better than Alta
Bates (while recognizing that the whole HMO concept
sucks). I have a high regard for their opinion, as it's
a well run office and a good doctor.
I can't help but wonder if the information you were
given (about not being able to see a midwife for your
yearly gyno checkup) is mistaken. I was in HealthNet
w/Hill Physicians before I switched to Kaiser, and my
midwife said, ''I'll see you next year!'' Ask someone
else in Hill Physicians. I think you'll get a different
answer. Good luck. (as a data point: my old doctor's
office had nothing but trouble with Alta Bates Medical
Group and was very pleased when I switched to Hill
Physicians. Said ABMG was *very* difficult to deal with.)
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
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
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.
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.
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.
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
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,
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.
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
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.
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,
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.
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.
I used to have HealthNet (5 years ago), and now I have Pacificare. I found
one to be particularly easy to use. By dint of much hammering, we managed
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
want to pay for any of the medications that my doctor wants to put me on. I
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.
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.
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,
my doctor to approve care, etc., but Healthnet wouldn't cover the hospital
Everytime I spoke to a respresentative over the phone, they agreed that it
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
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
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
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
Good luck on your decision.
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
I'm a new postdoc here, with my wife. Our health insurance will be mostly
(or completely, depending on the plan we are to take) paid by U.C.
However, we're having difficulty in choosing a medical plan among those
provided by U.C. (e.g. Health Net, Kaiser, PacifiCare, UC Care).
We're living in El Cerrito, and plan to have a baby soon. Could you please
kindly provide us with some suggestions regarding which plan to take,
which medical group to join, which PCP to register to, etc.
After some study of the information provided by U.C., we still feel very
I think planning on having a baby is our primary concern.
Questions about health insurance are best addressed by which doctor you
wish to use.
I have used both healthnet and pacificare at various jobs and my experience
that they are virtually identical in terms of coverage. Right now,
healthnet is the
free one at UCB and pacificare costs $1.29 a month. I found both
Using them, you can pick your
OB/GYN and pediatrician from one of the groups (around here it is Alta
Hill Physicians (lots of recs on the UCB Parents Web Site)) and then use
that they use (Alta Bates for ABMG, Summitt for Hill). Kaiser you use their
at their facility, although now you deliver at AB. A lot of people like
because they have extended drop in clinic hours, so you don't have to get
kid appointments at the time.
My best advice in terms of insurance is to figure out where you want to
your baby and work from there.
An additional note: AB and Summitt are trying to merge, so things may
your choice for delivering your baby may end up being Alta Bates, no matter
you choose. There is an anti-trust trial in process which will decide this.
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