Kaiser vs blue shield???

[Keltron]

I'm trying to select health care and I'm confused. Ive heard that kaiser sucks but it seems like it costs more. Thoughts?

[dbx]

When each company offers several "tiers" or options for plans, it's not possible for anyone to provide you a sound answer. Kaiser used to be one of the best around, but that was over 20yrs ago. But again, it depends on the plan and actual value.

[DougTheCoder]

Take a look at the plan you are signing up for by reading the summary plan descriptions and/or the plan documents. They can vary significantly from company to company and even within the company. The Summary Plan Description should be in a readable format and it should list all the exclusions in detail.

As far as administration, Kaiser is good. Which blue you are talking about determines the quality of administration. Illinois has a very good Blue as far as administration goes.

[StressMonkey]

One thing I look for is whether or not the plan requires a doctor's authorization before you see a specialist. That can turn into a colossal PITA if that is the case.

[dbx]

One thing I look for is whether or not the plan requires a doctor's authorization before you see a specialist. That can turn into a colossal PITA if that is the case.

But you can save money with the plan that requires this! Unless you anticipate having to see a specialist (I hope not ), the savings for this plan over the other can be beneficial. I have such a plan, and yes, it's annoying to have to waste the $25 copay I have, just to get the referral to pay a $35 copay to see a specialist, lol. But we're talking your time (the "wasted" regular doc appt.) and $25. Usually, this is more cost efficient than paying for the plan that doesn't require this. Insurance is much like gambling. Hell, it is gambling...for both sides.

[Keltron]

ahh i see.. let me look into the plans and give some more details.. thanks for the replies.

[dungeonmistress]

i have blue shield and prefer it over kaiser. i had kaiser long ago and absolutely hated it. i have a kickass dr (a tattooed, pierced bodybuilder) who totally gets me and actually listens to what i say. dr. scheibel - you rock!!! not saying that you can't find a dr. scheibel type in kaiser, but that was not my experience there.

[hochspeyer]

No experience w/Kaiser, but Blue has been good for us... but, I also live in Illinois (hi, Doug!)- no telling what you'll experience in Kali.

[taf1968]

I was infinitely UNIMPRESSED with Kaiser when I was on them.

They misdiagnosed a tumor in my forearm as a "fat lump" (which 12 years later turned out to be a nerve sheath tumor) and when I broke my wrist playing softball (not a bad break at all, more like a chipped bone) the Kaiser orthopedic surgeon--who it took 2 months to get an appointment with and who walked in the room with a cast on his arm--took 5 minutes to look over my paperwork and told me he was sorry but that I would have to give up weight training because my wrist injury was too severe and that I would "never be the same."

So just my opinion . . . but Kaiser was horrible for me.

[DougTheCoder]

I was infinitely UNIMPRESSED with Kaiser when I was on them.

They misdiagnosed a tumor in my forearm as a "fat lump" (which 12 years later turned out to be a nerve sheath tumor) and when I broke my wrist playing softball (not a bad break at all, more like a chipped bone) the Kaiser orthopedic surgeon--who it took 2 months to get an appointment with and who walked in the room with a cast on his arm--took 5 minutes to look over my paperwork and told me he was sorry but that I would have to give up weight training because my wrist injury was too severe and that I would "never be the same."

So just my opinion . . . but Kaiser was horrible for me.

That sounds like a couple of bad doctors, not a bad insurance company. Health insurance companies offer two things:

1) a promise to make payments to health care providers when you get hurt or sick in exchange for a fee from you.
2) administration of claims.

Health insurance companies (like Kaiser and BCBS) negotiate rates with health care providers for reduced (in-network) rates, but the doctors that negotiate rates are often doing it for several different insurance companies at the same time (maybe even Kaiser and BCBS at the same time). Health care providers are not insurance companies and although insurance companies usually employ doctors for claims review and appeals, the doctor you see likely has negotiated reduced rates to be "in-network" for several different insurance companies.

I guess my point is: associating a doctor with an insurance company usually doesn't really make sense. Most doctors don't work for insurance companies and likely are considered "in-network" for several insurance companies at the same time.

[taf1968]

That sounds like a couple of bad doctors, not a bad insurance company. Health insurance companies offer two things:

1) a promise to make payments to health care providers when you get hurt or sick in exchange for a fee from you.
2) administration of claims.

Health insurance companies (like Kaiser and BCBS) negotiate rates with health care providers for reduced (in-network) rates, but the doctors that negotiate rates are often doing it for several different insurance companies at the same time (maybe even Kaiser and BCBS at the same time). Health care providers are not insurance companies and although insurance companies usually employ doctors for claims review and appeals, the doctor you see likely has negotiated reduced rates to be "in-network" for several different insurance companies.

I guess my point is: associating a doctor with an insurance company usually doesn't really make sense. Most doctors don't work for insurance companies and likely are considered "in-network" for several insurance companies at the same time.

These were Kaiser employed doctors at Kaiser facilities.

When you are with Kaiser, they are the insurance company AND the provider. They are the network. You see Kaiser care providers at Kaiser facilities. That's how they manage care and costs. Most insurance companies are like you say--they are the middle man who provides payment to physicians/facilities that are either in network or out of network. But that's not how Kaiser works.

My experiences go beyond just those 2 examples . . . although going 0-for-2 on those significant ones was bad enough to sour me on Kaiser.

[DougTheCoder]

These were Kaiser employed doctors at Kaiser facilities.

When you are with Kaiser, they are the insurance company AND the provider. They are the network. You see Kaiser care providers at Kaiser facilities. That's how they manage care and costs. Most insurance companies are like you say--they are the middle man who provides payment to physicians/facilities that are either in network or out of network. But that's not how Kaiser works.

My experiences go beyond just those 2 examples . . . although going 0-for-2 on those significant ones was bad enough to sour me on Kaiser.

You are right. My bad. I forgot that Kaiser worked a little bit differently.

[nikkiloo2]

I'm trying to select health care and I'm confused. Ive heard that kaiser sucks but it seems like it costs more. Thoughts?

I work for BCBS in Rhode Island. I have no experience with Kaiser.
If it costs more there is a reason. Has your employer given you sub agreements to look at before you make a decision? Maybe a lower deductible or out of pocket cost (copay/coinsurance) on the Kaiser? Better prescription plan with lower copays? Are there restrictions on the Blue plan that aren't on the Kaiser plan? Are there services that apply to the deductible on the Blue plan that have a flat $ copay on the Kaiser plan?
A few other things to consider that most people don't ...
1) Customer Service. You will need it. See what hours each is available and try to find out which was rated higher by JD Power Association. My employees (yes, I work in Customer/Provider Service) will jump through hoops to assist our members, often coming to me with requests for exceptions on denied services or work arounds for other problems. Our customer services are located in state and not out of state or in another country and many of my employees have relationships with our members (RI is a small state).
2) Health & Wellness initiatives ... does either plan offer a discount for being healthy, going to see your doc yearly? Do they provide any discounted or free services for things like diabetes, smoking cessation, weight loss, etc?
Those both are big added values to any plan you choose.
Also, in California there are several Blues. Your professional services (docs, o/p surgeries, x rays, labs) go through one place and your facility services (the hospital, surgical center) go through another. It could be that the administrative costs are higher for the Blue plan than they are for Kaiser.

[Rasc170]

Dude kaiser has some of the dumbest doctors around. I think I can convince my primary phys. to prescribe me some HGH

[oldPlumber]

For years, I had a union plan that rocked, but lost it when I went solo. The union would charge me over a grand a month as the owner--no discount for the paycheck signer and bill payer.

Instead, I got on state workman's comp insurance as an owner to cover me in the field. Any owner at all levels can get covered that way, btw. I pay cash for the other visits, which are few and far between.

Anyway, I'm waiting on ObamaCare before I commit to a personal plan. I haven't had a doctor good enough to warrant the prices they charge.

All the plans that I looked at sucked. I'm waiting it out.

[invega]

Me- "Hey doc can you check my test levels? I'm feeling tired, depressed and drive is lower. These are some symptoms of andropause." Doc-"no, you're making testosterone, you have facial hair." That was a Kaiser doctor. I almost had to demand BP meds as i had hypertension. Anyway, too many bad experiences with Kaiser. Al others i've had you can pick your doc. Blue Shield and others. I have Aetna right now and found a great doc. Although their rx coverage is a little less than desired.