Curious....Medical Insurance

[MissAnn]

Our last two plans (this year) have been through my husbands company. For the first half of this year, we had an "Obamacare" type plan through my husbands company in California. The company only offered bronze, silver, gold, or platinum plans. (Like the exchanges). All were outrageously expensive and we could only afford the silver plan. I am still paying off huge medical bills from the beginning of this year.

My husbands new insurance is through Kaiser; however, the benefits are amazing. $20 copayment for doctors, specialists, and tests. So much better! (Especially when you have someone in the family who needs to use it frequently)

We paid $1 to have our son.....48 hour labor and C section with Kaiser! 24 years ago. We don't have Kaiser here. I miss it.

[Baby Beluga]

My husbands new insurance is through Kaiser; however, the benefits are amazing. $20 copayment for doctors, specialists, and tests. So much better! (Especially when you have someone in the family who needs to use it frequently)

We had Kaiser a few years back while I like the doctor everything else was horrible . We had to travel an hour to get to the urgent care ( could only use kaiser) , my dd was under a specialists care and we were told that kaiser was not going to continue to allow him to be a covered provider , we would have to travel into D.C to find a new Dr. , the customer service was horrible and most times we never had any questions answered .We also had to pay 100% until we reached our deductible limit . I have heard good things about them in other states where they have more facilities but for us and others I know who had them here in MD it was a bad experience.

I just want the good old days where they paid their % of all visits , tests, etc... right away and you paid your co-pay until you reached the deductible .

Yes!

I had my first trimester blood tests done in August. Per my insurance book the tests were supposed to be covered and my cost share was waived as preventative care if they were a) done at my first OB visit and b) with an in-network lab. I fulfilled both of those requirements and they covered NOTHING. I called the insurance company and they said the OB coded it as maternity instead of preventive. I said that make sense because it was maternity and the insurance booklet specifically says "these services are covered for pregnant women and cost shares are waived if xyz criteria are met." Insurance said it still needed to be coded as preventative.

Insurance company suggested I speak to the OB. I spoke to OB and she referred me to the billing department. Called billing and gal said she would re-code and resubmit for me. She resubmitted with the exact same codes as the first time. I called the lab and even the rep questioned why it wasn't covered because she said these are covered services under ACA. The lab re-coded, resubmitted and insurance finally covered it....in late October. It was a mess.

And the frustrating thing is if I wasn't educated about my insurance plan (and I happen to have a sister in law who works for Aetna and can help navigate insurance red tape) I would have just paid the bill and not given it two thoughts.

[mommyneedsadayoff]

Just curious for those with Kaiser. Does that operate more like a co-op? It almost sounds like it is not insurance, but more of a "membership" to go to certain hospitals for care. Is that correct? If so, do these exist in other states?

[spedmommy4]

Just curious for those with Kaiser. Does that operate more like a co-op? It almost sounds like it is not insurance, but more of a "membership" to go to certain hospitals for care. Is that correct? If so, do these exist in other states?

I think so. I can only go to Kaiser facilities, unless there is no Kaiser facility in the area. I have traveled out of state and had an emergency with Kaiser; they covered most of it.

I agree with a previous poster that it is extremely annoying to have to travel for any specialized care. I live in a large city, by Oregon standards. Its a two hour round trip for my sons neurologist, spine specialist, opthamologist, and neurosurgeon. (Each) The travel is getting to me.

[jenboo]

Just curious for those with Kaiser. Does that operate more like a co-op? It almost sounds like it is not insurance, but more of a "membership" to go to certain hospitals for care. Is that correct? If so, do these exist in other states?

Kaiser is a hospital group that provides insurance for their facilities only.

[mommyneedsadayoff]

I think so. I can only go to Kaiser facilities, unless there is no Kaiser facility in the area. I have traveled out of state and had an emergency with Kaiser; they covered most of it.

I agree with a previous poster that it is extremely annoying to have to travel for any specialized care. I live in a large city, by Oregon standards. Its a two hour round trip for my sons neurologist, spine specialist, opthamologist, and neurosurgeon. (Each) The travel is getting to me.

Kaiser is a hospital group that provides insurance for their facilities only.

Thank you both for the info! Do other hospitals do this? Seems like it would be a good idea as it provides local care (no traveling), yet also gives hospitals (and the employees) more control of healthcare pricing, as well as consumers collectively pay for the community health, versus on a national level. Am I missing something or does this exist everywhere and I am just now hearing about it?::

[Kelly]

I've had "Obamacare" for 2 years. I qualify for the subsidy and am the only one on the policy (my adult kids live at home but get Medicaid because they are disabled) so my premiums have been around $250/month. This year I have to change my plan because the company that offered it is no longer doing it. Since my daycare income is way, way down (only have 1 part-time dck; haven't been able to get any more for over a year!) my subsidy is quite a bit higher so my premium will be a lot lower.

[spedmommy4]

Thank you both for the info! Do other hospitals do this? Seems like it would be a good idea as it provides local care (no traveling), yet also gives hospitals (and the employees) more control of healthcare pricing, as well as consumers collectively pay for the community health, versus on a national level. Am I missing something or does this exist everywhere and I am just now hearing about it?::

Kaiser is a hospital, group of medical facilities, and also an insurance company all in one. I only know of one other that is similar, and that's Sutter Gould.

I had it through a non profit I worked for in California. The insurance was far less expensive. (Controlled costs) But . . . I experienced the same issues with Sutter. Even though I lived in a large city, all specialized care was a minimum 2 hour round trip. (Sometimes 3 in CA)

[Second Home]

We just got the info on the health insurance policies for next year . Kaiser is the same exact cost as Blue cross , same premium and deductible - there is no cost difference at all . I guess there is a big difference in cost regionally .