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Change is never fun - new changes at my husband's company

klpca

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I was skeptical and thought HMO was going to be a hassle initially after having a PPO, but once you are established with a Kaiser specialist, you don't need to worry about the primary care doc and they stay out of the way. Some specialists like dermatology/acne services for teens, optometry/opthomology don't require a referral. Can go direct. Other times it is simply a matter of emailing the PCP.

Read recently that outside of a system like Kaiser an independent or small group general practitioner or internal medicine may try to keep the patient within the private practice longer because referring to a specialist means a loss of revenue or they may not know exactly who to send the patient to. At Kaiser, specialists are plentiful, referrals by PCPs are not a loss of revenue and PCPs actually are incented to refer to a specialist because they have a limited time window with the patient and it is easier to refer to a specialist than spend too much time diagnosing something that will take time and a specialist can do better/faster.

There also have been times when we didn't know what exactly was wrong and the PCP was instrumental in identifying several specialists which we wouldn't have considered. Our PCPs have always been supportive and don't interfere when a specialist is needed. Never been a roadblock to getting services. It's actually nice to have someone who knows you to heal the simple stuff and concierge other items.
That is exactly our experience. We have had other HMO's in the past so I understand the fears that everyone has, but Kaiser doesn't run that way. In our cases, all that our primary care physician really did was order tests. Once those indicated what they did (RA, cancer) we were immediately sent to the specialists. It seemed to be their protocol.

Just the other day after the post that I read here, I emailed my doctor and asked them to add titers to my standing blood work orders (those are every 3 months) and now it will happen automatically when I get my next regular blood draw. The other thing that we discovered with Kaiser was that they do what they do, and they refer you outside when it is outside of their normal practice. For example, my husband had his cancer surgery at Kaiser, but his radiation was through UCSD, by the head of their radiation oncology department no less. We had seamless care when he had to go the the ER on the Big Island - everything was transmitted electronically to the doctors there - and of course we never saw a bill. From a patient perspective, Kaiser is awesome.

I am not sure how Kaiser is doing it, but they have stepped up their game. Hopefully in the 7 years that we have been away from the other providers/companies, they have done the same.
 

klpca

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Wow. That is $25,000 per year. Reading this makes me feel fortunate to be old enough to be on Medicare...

George
Ridiculous, isn't it?
 

klpca

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It's worth asking the employer to give your husband insurance reimbursement instead of the new plan. You'd have to buy Kaiser on your own and your husband would get a non taxable reimbursement every month. They may not cover the entire amount that you pay, but they can reimburse for the same amount they would be paying the new insurance company. It's tax free on both sides.
My boss suggested the same thing. (Our small office doesn't offer health insurance, btw). I may look into that, although as much as I love Kaiser, it will depend on how much it costs. ;) Because that would come out of my travel budget!
 

rapmarks

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I feel for you, we went through this the last few years we worked, changing insurance every year.
I like what we have now, the problem is providers don’t believe what we have.
They say they are out of network, but our insurance pays the same in and out of network.
They insist we must wait a year and a day for some services, and I have had to do a three way call with insurance to prove to them that we can schedule the appointment.
Last year I scheduled my pulmonologist and my sleep specialist on same day, and when I got there they would not allow me to see both. It was a 45 minute drive each way and very inconvenient, especially after insurance told me that was incorrect
Worse is opthamologist who insists that I need two separate appointments when my plugs fall out,which is often. I have stayed in the examination chair, called my insurance,who would get on with the office and tell them to put my plugs in. This infuriates the office girl, who glares daggers at me.
We have a copay, but after 1150 out of pocket,we are released of the copay, so those couple of months are used to squeeze in every service we need. All told, we spend close to twenty thousand a year for insurance, copay, and prescriptions. Then dental is all out of pocket.
 

Sugarcubesea

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At my company, we have 3 choices: all through Cigna

PPO-traditional
HSA-high deductible
HRA

If our employees choose the HSA plan we put $1K for individuals
$2K for anything over 1 employee

I pay $57.50 a payroll run / 24 a year
 
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klpca

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At my company, we have 3 choices: all through Cigna

PPO-traditional
HSA-high deductible
HRA

If our employees choose the HSA plan we put $1K for individuals
$2K for anything over 1 employee

I pay $57.50 a payroll run / 24 a year
Thanks for the data points. We don't have numbers yet, so I have no idea if this change will cause us to pay more, about the same, or less (lolol).

Our last two years at Scripps we had an HSA through someone (maybe United Healthcare?) and without much effort we went up to the full deductible, so that didn't work out too well for us. We paid premiums plus the full high deductible ($7,500ish, as I recall) and insurance didn't cover much of anything else. Our out of pocket those years was a lot more than any other choice we could have made. I swear it felt like Scripps and the insurance company were working together on that one. After two years of that we switched to Kaiser.

I remember the one big claim was when our daughter took a fall while bouldering. It was a short fall and she landed on her heel. She went to in-network urgent care who did an xray and sent her home, diagnosis: bruised heel. After two weeks she was still in pain so she scheduled another appointment. Prior to her appointment, she spoke to her friend/college mentor who is a sports medicine doctor as well as a climber. She told my daughter that it probably was a fractured talus, mentioned that she needed an MRI, and not a CT scan because it is hard to see without the MRI. So when my daughter saw the next doctor she mentioned all of the info - and the doctor ordered a CT scan which showed nothing. Of course. Two more weeks of pain, another visit then the MRI was ordered. It showed a broken talus, but it was already starting to mend on it's own and it was too late for a cast. Then the bills started rolling in. Urgent care visit, x-ray, primary care visit, CT scan, specialist visit, MRI. I balked at paying for the CT because she specifically asked for the MRI. Some bean counter asked me if *I* was a doctor and told me that the correct treatment had been ordered. I asked him if *he* was a doctor :rolleyes:. The total cost to us (all out of pocket) was over $4k and in the end, no treatment was actually done. Just diagnosis, and a late one at that. So very frustrating.

So we're probably not choosing the high deductible plan, lol.
 

clifffaith

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I pay $1260/month for my PPO plan with Anthem/Blue Cross. That plan goes up over $100/ month each time it renews. They were the only ones who would insure me when my COBRA through Boeing expired in 2007 after Cliff retired (at the time I had chronic migraines). I bitch mightily about the increase, but continue to re-up every year. I was "looking forward" to starting Medicare research next spring because I turn 65 in December 2020. Much to my dismay, a couple months ago Anthem advised me that they were discontinuing my high deductible/HSA compatible plan at the end of this year. Somewhere in the back of my brain I recall Anthem getting out of the California market all together.

So now I have to go through the process of finding an insurance company to cover me for eleven months. My main concern is my quarterly epidurals for back/leg pain. Anthem pays, but grumbles every other time. I basically stay out of it and the doctor's staff fights the battles and or turns the process over to a third party (every so often the third party has me sign that my injury isn't work or accident related). Dr. Wu has already told me he doesn't take Medicare patients, but I think my first foray into research for next year is to ask his staff which insurance companies "pay up". My next epidural is on Sept 23, and "hopefully" it will wear off as planned mid-December so I can get another on Anthem's nickel. I've found what works and keeps me relatively pain free, and don't look forward to having to deal with a new insurance company a year before I planned. Wonder if Dr. Wu would take timeshare weeks in trade?
 

rickandcindy23

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We have had Kaiser for 44 years, so I totally understand not wanting to change. I just love my Internal Medicine doctor, and Rick liked him so much that when his regular doctor was moving part-time to administration, Rick opted to go with my doctor instead. His doctor was needing to let go of some of his patients to move toward part-time adminstration.

I hope it all works out for you.
 

PcflEZFlng

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I'm simply SICK of healthcare in the USA and wish ACA had never happened. (And this is coming from someone with pre-existing conditions and longterm healthcare needs.)
There seem to be very mixed results from the ACA depending on who is impacted and how. It was a boon to me because I was able to keep my son insured on my employer's plan until he was 26. And, when COBRA runs out for me next year, I anticipate being able to buy the same Sharp HMO coverage I have now, which is offered on the exchange for the same (non-subsidized) price that I currently pay. But more than that, I'm looking forward to Medicare in two years.
 

Sugarcubesea

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Thanks for the data points. We don't have numbers yet, so I have no idea if this change will cause us to pay more, about the same, or less (lolol).

Our last two years at Scripps we had an HSA through someone (maybe United Healthcare?) and without much effort we went up to the full deductible, so that didn't work out too well for us. We paid premiums plus the full high deductible ($7,500ish, as I recall) and insurance didn't cover much of anything else. Our out of pocket those years was a lot more than any other choice we could have made. I swear it felt like Scripps and the insurance company were working together on that one. After two years of that we switched to Kaiser.

I remember the one big claim was when our daughter took a fall while bouldering. It was a short fall and she landed on her heel. She went to in-network urgent care who did an xray and sent her home, diagnosis: bruised heel. After two weeks she was still in pain so she scheduled another appointment. Prior to her appointment, she spoke to her friend/college mentor who is a sports medicine doctor as well as a climber. She told my daughter that it probably was a fractured talus, mentioned that she needed an MRI, and not a CT scan because it is hard to see without the MRI. So when my daughter saw the next doctor she mentioned all of the info - and the doctor ordered a CT scan which showed nothing. Of course. Two more weeks of pain, another visit then the MRI was ordered. It showed a broken talus, but it was already starting to mend on it's own and it was too late for a cast. Then the bills started rolling in. Urgent care visit, x-ray, primary care visit, CT scan, specialist visit, MRI. I balked at paying for the CT because she specifically asked for the MRI. Some bean counter asked me if *I* was a doctor and told me that the correct treatment had been ordered. I asked him if *he* was a doctor :rolleyes:. The total cost to us (all out of pocket) was over $4k and in the end, no treatment was actually done. Just diagnosis, and a late one at that. So very frustrating.

So we're probably not choosing the high deductible plan, lol.

We hit our deductible of $5K every year as my daughter is a Type 1 diabetic. My financial planner has me in this plan as he has me cash flow the out of pocket amounts and put the max amount each year allowed into the HSA to reduce my tax liability.

If my company didn’t have such a generous employer contribution into the HSA, I might be in a different plan.

The PPO plan that our company offers is very expensive. It would cost me $195 a payroll run for the family plan per payroll (24) per year. I would still have to hit a deductible in that plan
 

pedro47

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Wishing you good luck with all those major changes in your health coverage .
 

susieq

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...we finally tried Kaiser because at least we knew exactly what our cost would be. It was great being with one company and set of doctors for 7 years. Oh well, easy come, easy go. ;)

Hope all goes well for you, I just wanted to say that we have had Cigna, and it is great, no paperwork, no bills, just EOBs on what they have paid!!
 

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We are considering Cigna for my husbands Medicare supplemental. SusieQ, that is really good to hear that you think it easy it is to deal with billing. My mom has had Cigna since her retirement 30 years ago and she never has to make tons of phone calls to take care of her bills.......she just doesn’t get too many.
 

SmithOp

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We have PPO and the only billing issues have been self-inflicted. My wife decided to be a hyphen when we got married and invariably her maiden name gets put in as middle name, then the bills don’t match names and I have to call to correct. Some of them have online updates and I have been able to resubmit with the name corrected.

Once we hit the $2500 out of pocket max for the year the bills stopped showing up, so that was nice.



Sent from my iPad using Tapatalk Pro
 

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We have PPO and the only billing issues have been self-inflicted. My wife decided to be a hyphen when we got married and invariably her maiden name gets put in as middle name, then the bills don’t match names and I have to call to correct. Some of them have online updates and I have been able to resubmit with the name corrected.

Once we hit the $2500 out of pocket max for the year the bills stopped showing up, so that was nice.



Sent from my iPad using Tapatalk Pro

Cliff celebrates his birthday on the day his mother told him he was born 81 years ago -- April 8th. His birth certificate however says April 10. I stood for 20 minutes at the hospital pharmacy last month trying to pick up the pain meds prescribed after his hand surgery. Finally they told me Healthnet didn't have him in their system. Well they just paid for his surgery. Where does he usually get his Rx? Around the block. They called over to our regular pharmacy, who also claimed to not know him. Then it dawned on me -- try April 10th as a birthdate. Problem solved. Even his passport says April 8th, and as I recall we had to present a birth certificate to get that, but social security/Medicare/Healthnet picked up April 10th.
 

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We are considering Cigna for my husbands Medicare supplemental.

By law all Medicare Supplements Plans are the same as to coverage; that is a Plan G sold by one Insurer has the same terms as a Plan G sold by any other Insurer. The two things to key on when you buy one are the reputation of the Insurer and the price...

George
 

Icc5

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We had a different situation about 10 years ago that didn't have to do with work but had to do with our insurance and the family Dr. we had for about 25 years. We started out with our Dr.'s father who had the practice and his son was one of the Dr.'s in the office. We really liked the son so myself,wife, and both kids all saw him. The father passed away and the son took over the practice. We have Blue Shield Insurance thru work and when we went in all of a sudden the Dr.'s office told us they weren't part of Blue Shield anymore. What happened is since it was the son's practice now Blue Shield considered him a new practice and they weren't insuring any new practices in our area. So basically even though they were covering the patients for years and years now our Dr. wasn't included so we had to find a new Dr.
Never have found one any of us have liked ever since.
Bart
 

Timeshare Von

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Wow. That is $25,000 per year. Reading this makes me feel fortunate to be old enough to be on Medicare...

George

Exactly George. I'm fortunate my small association (too small for a group plan) is paying me the amount of my premiums each month. Unfortunately, it is taxable to both my employer and me. So my $13,600 of it isn't exactly as much as I get to pay the insurance company.
 

klpca

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Got the details of the plans yesterday (but no cost numbers, lol). We have two high deductible plans and one "traditional" health plan. No specific PPO but all of the plans have in network and out of network differences in coverage (80% coverage for the most part). Deductibles range from $2,400 (traditional plan) to $4,000, and max out of pocket goes from $7,000 - $10,000. We can do an HSA, no idea if the company is putting any money in. Of course all of this is meaningless without the premium information. By the way I pulled out last years W2 - the cost of our insurance for Kaiser was $11,500, and we paid almost $5,000 of that. I find it difficult to believe that any of these plans will cost less than Kaiser and if anything, it makes me even more salty about this decision. I'm going to spend some quality time this weekend figuring out the ins and outs. I told my husband that I am going to approach this like timesharing - prepare for the obsessive researching.

One interesting thing that I have already found is that they are providing prescriptions primarily through an online pharmacy (or Walgreens if you need it right away). My medication (generic) is $245 through the online pharmacy for 90 days, $3,200 for the name brand rx for the same, but if I just pay for it out of pocket it is $145 (generic) through Costco. The only downside is that if I pay that way it won't count against the deductible but to save $400 per year - on my medicine alone - will probably make it worth it.

All of the games! This is insanity.
 

Sugarcubesea

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Got the details of the plans yesterday (but no cost numbers, lol). We have two high deductible plans and one "traditional" health plan. No specific PPO but all of the plans have in network and out of network differences in coverage (80% coverage for the most part). Deductibles range from $2,400 (traditional plan) to $4,000, and max out of pocket goes from $7,000 - $10,000. We can do an HSA, no idea if the company is putting any money in. Of course all of this is meaningless without the premium information. By the way I pulled out last years W2 - the cost of our insurance for Kaiser was $11,500, and we paid almost $5,000 of that. I find it difficult to believe that any of these plans will cost less than Kaiser and if anything, it makes me even more salty about this decision. I'm going to spend some quality time this weekend figuring out the ins and outs. I told my husband that I am going to approach this like timesharing - prepare for the obsessive researching.

One interesting thing that I have already found is that they are providing prescriptions primarily through an online pharmacy (or Walgreens if you need it right away). My medication (generic) is $245 through the online pharmacy for 90 days, $3,200 for the name brand rx for the same, but if I just pay for it out of pocket it is $145 (generic) through Costco. The only downside is that if I pay that way it won't count against the deductible but to save $400 per year - on my medicine alone - will probably make it worth it.

All of the games! This is insanity.

We just concluded our benefits meeting with all the global HR folks and Kaiser went up like 19% for our group company’s in CA. So that group company decided to move to Cigna which only went up 7%

Hope this helps
 

vacationhopeful

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When the ACA became the "law of the land", my insurance bill for an individual policy MORE than tripled for less coverage. I was before and since, self-employed.

Oh, yes, my insurance policy was cancelled on the day before ACH went into law. It "did not met the afford care act's requirements"

And so began my "count down" to Medicare with all its supplement plans.
 

Luanne

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the cost of our insurance for Kaiser was $11,500, and we paid almost $5,000 of that. I find it difficult to believe that any of these plans will cost less than Kaiser.
Are you talking about the cost to you, or the cost to the company? My guess is the company found a cheaper healthcare plan for them.
 

klpca

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Are you talking about the cost to you, or the cost to the company? My guess is the company found a cheaper healthcare plan for them.
Cost to us was $5k, total cost was $11,500 so the company paid $6,500. We would have gladly paid the premium difference but that wasn't an option.
 
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