Blue Shield Vs Kaiser

[scottmandue]

It is that time again, open enrollment at work...

I have been with Blue Shield (IPO) since time began (15 years) been seeing the same doc, close to home, personalized service (doc knows me by name and my history).

My wife was with Kaiser in Portland OR. but when she moved down here she said "I don't care they are all the same (med insurance)" so I signed her up with Blue Shield.

Because my wife has a big heart she has slowly been sucked into being a caregiver for my parents who have Kaiser and she has been working with them on care for my parents.

Now she is all "you can email your doctor, make and cancel appointments on-line, check you medical history on-line, have your prescriptions mailed to you..."

The price of the two programs is about the same... I seem to remember last time I checked the copays with Kaiser were higher, particularly on the prescriptions... that as we are past 50 seem to be more and more pills we have to take...

Anyone have experience with both and can compare?

[Don Plumley]

I've been of the opinion that I want Health Insurance for the big, bad events - and in those cases I want to go right to the very best specialist on the planet when I want to see them without delay. So I've always happily paid more for a PPO plan that lets me go directly to specialists.

I am sure Kaiser is great for 98% of the time, and they are affordable. But I also know of a few cases where delayed treatment due to the gatekeeper effect likely worsened a condition (cancer spread) or was fatal (it's probably just heartburn/stress - instead a descending aortic aneurysm).

YMMV

[onewhippedpuppy]

My employer went with Coventry Health Care this year and it is terrible. Having to seek out a referral for any specialist visit sucks (take off work twice), as well as losing the flexibility to visit the specialist of your choice. I had been seeing the same dermatologist for almost ten years, I now cannot go to him without paying out of pocket because he doesn't belong to the same medical group as my primary care physician and they "don't refer outside of their company". Effing BS, it's all about money.

We were previously with Blue Cross Blue Shield, which I assume was affiliated with your current insurance company. Very happy with them and the independence that they provide.

[Zeke]

Kaiser is rated no. 1 in CA. But the drawbacks have been noted. The doc across the street works there as a surgeon. I think he does it because it's easy and fits his lifestyle.

It's a cattle pen for sure. I'm on the fence AFA having Kaiser as my supplemental for Medicare. I have learned lately (oh, I should go update that billing thread, I won) to speak medical speak, I might be able to force any issues that I have.

And that's another thread worth starting — how to talk to your doc.

[tadink]

I'm with Kaiser at the moment, the first experience I've had with them. Gotta say, they do a nice job of getting you in to be seen if you need to be seen, and following up with you. They are in the modern age with email, etc.

The downside, you are a number, and whatever you got gets the prescribed treatment. it seems they tend to over-prescribe for simple stuff, pretty 'bomber' anti-biotics right out of the chute. Zero alternative medicine knowledge or understanding.....so if you are at all NOT pro-pharma it is going to be a slog.

I had hernia surgery, had not met the annual deductible and was out of pocket just shy of $3k. That is WITH insurance, so I wonder what it would be without! LOL But, they got me in, cut, and released pretty quickly.....no complaints.

Probably as good an example of what Obama-care aspires to be I guess.....

YMMV

td

[kinein]

blue shield.....all day long, kaiser over medicates there patients and also if you need something serious to be done they will take forever for the approval process. PPO works great for me.

[Joe Bob]

I was raised at Kaiser......way above anything else.

[mikester]

My family is with kaiser and has been forr a few year now. They are in the 'pro' side of the list for me staying in California instead of moving to Florida. The care is top notch, I don't have to wait to see a specialist. I havent had a life threatening need but when I have asked via email I have always been given a yes via email. Only once did I ask in person for an ENT and that was equally simple.

I may be a number but the better my health the less I cost so they spend a lot on preventative and education.

Under the different ppos I had before I could never tell if my bill was right and it was always stressful. That absolutely never happens at Kaiser, it will depend on your employers plan of course but I really do love them as a provider.

[Bugsinrugs]

We had Blue Shield and a 5000 dollar deductible. Half way through the year after our deductible was met they raised it to 7500.
After that we switched to Kaiser and everything is fine except that it took four doctors and mucho pleading for them to finally do an ultrasound on my hand. They could not believe the two and a half inch splinter that I was complaining about was for real! Other than that I am happy with then.

[Tobra]

You should file a complaint with the insurance commissioner about the deductible change. They do the e-mail, check history and labs online and get meds delivered with most docs on electronic medical records system. All will have to be on system like that pretty soon.

I am not a fan of Kaiser. I see a lot of people that pay me cash because they can't see a Kaiser podiatrist in a timely fashion or at all. Works out well for me at least.

An anecdote: Nice lady came to me for foot care because she could not get that service from them. For several years I told her she needed to have a dermatologist or podiatrist take a biopsy of a funky looking spot on her little toe. Her PCP kept telling her it was nothing to worry about and refused to give her a referral. It got bigger, so I told her to call her PCP that day demand it be biopsied, because I had advised her it was almost certainly melanoma. Next time I saw her, she had 9 toes, turned out I was right about a skin cancer, again. Maybe she could have kept that toe if they had acted a few years earlier, maybe not. If I had not been so insistent, they certainly would have continued to shine her on until she died from it.

As I say, not a fan.

[aigel]

Originally Posted by scottmandue

check you medical history on-line...

No thanks. I take my medical history with me and keep it at the house. The harder it is to come by, the better in the long run. If I ever get very ill, I can keep track of it just fine with a large pile of paper.

G

[porwolf]

I have been wit Kaiser in Los Angeles for a long time. When I had a specific need for a doctor I could get a reasonably quick appointment, mostly with specialists, after talking to a nurse administrator. I like their after hours walk-in program with no need for an appointment and they are connected to the emergency department. In a couple of cases I went directly into the emergency department and got quick and thorough treatment. I like the idea that all services are under one roof and the doctors are on salary. I always found the staff to be courteous, helpful and knowledgeable. A shoulder surgeon once treated and advised me. He was not anxious to do surgery because there is no money in it for him, he gets paid anyway, I guess. A long time ago I was with Blue Cross but I found their whole system to be too complicated, too many exemptions and exceptions. And I don't like to go from one medical service to another for the same treatment.

[Tobra]

If you don't like to do that, you don't have to, pretty much whatever insurance you have.

[scottmandue]

How is Kaiser on prescription co-pays?

Most of my scrips are $5 with the BC co-pay.

Also, I'm type 2 diabetic... my current BC doc has me pretty well under control with meds (blood sugar) and has me on some mild stuff for BP and cholesterol.

How seamlessly will I be able to transfer all my prescriptions? Or will I have to start over from square one?

Thanks for the input!

[Vipergrün]

Kids and their mom are with Kaiser. They have been nothing but top notch through all of the issues with my daughters diabetes diagnosis and treatment.

[vash]

i was Blue Shield, and switched to the big K. cant remember the exact incident that sent me fleeing. it did involve stitches at a non BS hospital ER.

i like Kaiser. but you really have to be your own best advocate. ask questions, be the squeeky wheel. lucky they make it easy, by having that nice email system.

i like how every doctor in the system can see my history with the click of a mouse. they still ask what meds i'm on..but i think that is out of habit. they can see it right there on the monitor.

i am in pretty decent health. it is TBD how they play out if i really derail the healthy train. i hope they rock!

[Tobra]

They ask about the meds because the list quite often is not accurate.

When I look at my EMR, I can make a pretty good guess how accurate the med list and history are by who the primary doctor is.

Another anecdote: When I was in Texas, there was a kid from California that I saw through the ER. Stepped on something in the lake, cut his foot, they gave him keflex in the ER and sent him on his way. 2 days later he came back, swole up red foot, with pretty red streaks going up his leg. Drained the pus, did a culture and called the infectious disease guy. Turned out he had some funky infection, exotic enough tha the ID guy called and wanted to know where he had picked it up. Kaiser never paid anyone after the first ER doctor on that deal. Said we should have put him on a plane and sent him to the nearest Kaiser facility, I believe it was in Cleveland.

Kid was exactly the same age as my son, same birthday, same year. What are the odds on that? Should have bought a lottery ticket that day.

[LWJ]

I represent both professionally. There is another solution. K has a plan called "Added Choice." It is administered by K but has a much larger panel of providers. I recommend this all the time. I think it is an excellent solution.

Larry

[Zeke]

Originally Posted by LWJ

I represent both professionally. There is another solution. K has a plan called "Added Choice." It is administered by K but has a much larger panel of providers. I recommend this all the time. I think it is an excellent solution.

Larry

Is that available as a Medicare supplement?

[LWJ]

I can't imagine it is Milt. Medicare is a whole nuther ball of wax. My firm refers all medicare business to a specialist. I know nothing. Sorry.