HEEEELLLLP!!! I have an insurance crisis!!

[Rosemary2205]

I'm in Atlanta - I am loing my old insurance and have to choose either Kaiser HMO or BCBS PPO.

Anyone got Kaiser? Tell me, does it suck the big one?

Thanks in advance.

[AlCzervik]

1. i have Kaiser, the co pay for us $15 and the meds are pretty cheap, they're ok

i like my primary care Physician but the referral process seems to take forever.

[KitchenWitch]

2. YMMV, but we had Kaiser in CA and it sucked elephant dick

I had to wait 4 months for a procedure that should have been done within two weeks. I had to wait 7 weeks for an Echocardiogram (I have mitral valve regurgitation - and should never have had to wait that long.)

[Flying Dream Blues]

3. I'd definitely go PPO over HMO any day. With HMO you have to do everything

through a primary care physician. So if you need to see a dermatologist, for example, your PCP has to okay it first. And if I'm not mistaken, you can usually have a better selection of doctors with a PPO as well.

Good luck with it! Insurance all sucks the big one, IMO, but certainly having it is great compared to the alternative.

[yellowdogintexas]

21. definitely check the doctor list on the PPO, if it is a nice comprehensive list

then it is your better choice.

Also make sure you don't have a gatekeeper arrangement on your PCP. That has mostly gone by the wayside except in HMO type plans, but is a definite drawback when it is there.

I had Kaiser for a while, and also a PPO arrangement that had a gatekeeper and it was a pain in the ass. I like being able to get a specialist w/o having to be prescreened by my attending. We have an EPO which means I have to stay in network but it is a very comprehensive network. If I need a specialist I call either my Fam Prac or my Gyn and ask them who they like from the EPO list. I trust their opinions of their peers very much, but they don't have to sign off on the referral for me to get it covered.

[MonkeyFunk]

4. That's an insurance crisis?

Having to choose a plan?

Some people lead charmed lives, I guess.

[Rosemary2205]

7. yes my life is so charmed

I am recently in a wheelchair, been through absolute hell, am over $50,000 in medical debt because I didn't have any insurance at all. My husband was disabled by the same car accident and is still using A LOT of medical care.

I am not college material, but I had a job that, matched with my husband's income, managed to keep our head just barely above water if we didn't miss any work and lived small. Now I have only my income, which is just a little over half of what I earned before the wreck. My employer is one of the good guys and sprung for half the cost of catastrophic coverage for me only, since my income is just barely too much to still qualify for medicare/medicaid. I've had to find soft hearted doctors and charity programs since I lost that.

Now, FINALLY, I have the chance to get into a regular healthcare plan. I am not even sure I can afford it. But yes it's CHARMING to have the opportunity to decide if spending almost half of what little I make is worth it compared to what I'll gain over having to constantly look for charitable or low cost sources of medical care. I'm asking people if paying the $8000 plus dollars a year to Kaiser will get me out of some of that headache, or is it just a more expensive headache.

I'm charmed. What can I say.

[MonkeyFunk]

10. Sorry you're in a tough spot

but I still don't think having to choose a plan is a "crisis".

I don't have insurance. Can't get insurance. Had a heart procedure a couple years ago which my insurance refused to cover.

I've been sitting on the couch for 8 weeks with a herniated disc and there's little I can do about besides scarf alleve.

I wish I had the luxury of choosing between plans.

[LaurenG]

19. I don't know where you live but you may have a clinic in your area

that can help. Here in Cincinnati, University Hospital has tons of help and goes on a sliding scale. Since there is a medical school attached they do quite a bit for the community. My sister had to move here from New Mexico last summer and they have been really good to her.


I hope you can get a break, I see every day what chronic pain can do to lovely human beings. :hugs:


Not to bring up politics in the lounge but this is why we have to elect a democrat in November.

[Lil Missy]

5. I'd take the PPO, any day over an HMO.

[KSinTX]

6. I am a total PPO fan.

Having the option of a specialist-on-demand is the absolute best (and it saves on gas, to boot).

[Rosemary2205]

9. I'm wondering about the expense.

The PPO will cost me about $8700 a year in premiums, plus $1500 deductable and 10% co-insurance.

What concerns me the most is that office visits are not covered, but it says I am only responsible for Maximum amount allowed by BCBS. -- Which seems to be a mystery amount that can change on a whim. I use A LOT of office visits because I have so many health problems.

I'm not even sure I can afford it. AND I wonder if the constant fight to get claims paid is any easier than my current fight to find low cost or charitable medical care.

Kaiser is $8000 a year - $10 bucks for the doctor and that's it. But almost no choice and I will have to leave a supportive group of medical professionals that got me this far and start all over again. -- That is scary. If it takes 5 months for them to care about chest pain then being even more disabled isn't worth the 'savings' over BCBS.

[Mz Pip]

8. I've had Kaiser

for decades. The one where we live is very highly rated. I have not had a bad experience with them in the 34 years I have had it.

I like in CA so I can't really say much about ones in other states but I think the one here is terrific.

[Tikki]

27. Also, SoCal Kaiser.....

It has worked fine for us (3 years)....there is no Dental Plan for us with this Kaiser, though.


The Tikkis

[Coyote_Bandit]

11. Crisis?

Give me a break.

I'm sorry your life is challenging. But you have the ability to work. You have the option to actually choose a heath plan. Yes they are expensive. Yes having access to health care often requires sacrifice in other areas. I'm sorry. It should not be this way. Everyone should have meaningful access to health care and no one should be bankrpted by it or forced to choose between health care and housing or food or clothing or other basic needs. Still you are fortunate.

I know several folks who are completely uninsurable. They have one choice for health care insurance and that is the state pool available to folks who are otherwise uninsurable. They have to provide several letters denying coverage to qualify for this insurance. The premium is more than double what was quoted to you - about $16,000 annually for minimal high deductible coverage.

And then there is a fellow I know. Single man, 40 something. He has a congenital spinal disease that forced him to have his first spinal surgery before the age of 30. At that time he was told that his disease was progressive and eventually he would require additional surgery. He was able to return to light duty work and did so. About five years ago his employer ceased operations in the state where he lived and he lost his job. Two weeks later he was on his way to a job interview when he was involved in an auto accident. He was not at fault. He was struck by an uninsured illegal resident who fled the scene. He had enough med pay coverage on his own insurance policy to pay for the ER visit which documented the injury. This fellow has no kids or family. Aside from the brother with alcohol problems who lives under a bridge - and the brother serving in Iraq. Shortly after the accident the guy sold his possessions and his small house to convert what assets he had into cash. For the past four and a half years he has been fortunate to be able to stay with different friends in different houses in different states for varying lengths of time. He has no home. No place to call his own. He has exhausted what little cash he had seeking medical care. And he has been refused care for being noncompliant simply because he did and take and could not afford pain meds that were prescribed to him. He filed a disability claim which went to a full hearing some three and a half years later. There was one question asked at that hearing: "when did you last earn a paycheck?" There were no questions about his quality of life or prognosis. The extent of his disability was clear and well documented (makes one wonder why his claim was twice denied before this hearing). He was awarded full 100% total permanent disability. He got a nice chunk of change and now gets a monthly payment. But the payment he gets every month is not enough to enable him to be self sufficient. And his health has deteriorated while awaiting his disability determination. The surgery that he could have had three and a half years ago would have enabled him to return to light duty work. But it is no longer a viable option because his body's ability to generate new bone growth has deteriorated. This is a fellow who would like to work - but lacks the physical ability to load a dishwasher or a washer or dryer or to keep his home clean or do much of anything that requires him to use his hands in front of his body. And that includes the use of a computer. Your crisis is nothing compared to his.

Be grateful for the choices you have and what you can do. There are others far less fortunate.

[Rosemary2205]

13. LOL

Amazing how one word can set people off.

DU is getting bad when you get attacked in the lounge over one single word and completely ignored for who you've been on the board for 4 years.

Jesus people! -- shoulder chips aplenty.

[suninvited]

14. I was a little surprised at the response, too

I am glad you will be able to replace the lost insurance, and it is obvious that you are more fortunate than a lot of other people on here.

I would definitely go with the PPO, I have never been on an HMO but have heard horror stories aplenty.

[The Velveteen Ocelot]

15. Strange, isn't it?

You describe something that's a real concern for you and inevitably somebody shows up to bitch about how THEY have it so much worse than you do, so what are you whining about with your trivial little problem that isn't nearly as bad as theirs! What's with some people? You have a serious concern with your health insurance. Yes, it's good that you can get it; yes, it's a shame other people don't have it and/or can't get it. But the fact someone else might be worse off doesn't mean that your situation isn't a problem for you. Get a grip, people, and have a little compassion and understanding, even for people who aren't suffering quite as much as you are.

BTW, I'd go with the PPO. Good luck!

[suninvited]

17. Very well said.

Exactly what I was thinking, I am just not able to put my thoughts into words as well.

[Gormy Cuss]

18. You call that a crisis?

j/k.

cri·sis
1. a stage in a sequence of events at which the trend of all future events, esp. for better or for worse, is determined; turning point.

For you it is a crisis even if it seems trivial to others. I'm guessing that you don't have a lot of time to decide (crisis) and have very real concerns about which offering is better to mitigate the cash crisis in your household. Anyone with chronic medical conditions can not make the choice of insurance lightly.

[Rosemary2205]

20. Found out Fri at 5pm I have to decide by April 30.

It's a "crisis" for my only because I have to gather a heck of a lot of info in a very short period of time and if I make a mistake it will cost me at least $2000 that I don't really have - spent badly. Compound that with the fact the insurance industry makes it next to impossible to find out how they behave in advance.

I'm torn between spending a lot of money I can't afford to spend or going through the mental insanity of being me with not even the catastrophic safety net again (been there done that, eeeeek).

[Coyote_Bandit]

22. I guess

it is good that you can laugh. But I suspect that there are a bunch of folks who don't have your choices that are not laughing with you and do not share your concept of crisis.

It isn't anything personal. I don't think I've encountered or interacted with you on this board before. As far as I am concerned you do not have a reputation that preceedes you. Good or bad. I know you by the words you posted in your OP and in this thread. Your need to make a choice does not appear to be a volitile situation requiring immediate action. You have at least some time to consider your decision. Nor is it the kind of turning point or crossroad that would arise if you were facing the loss of your health care coverage. It may be an important decision for you but it is not a crisis. Losing all access to your health care coverage would be a crisis.

Several years ago I was notified by my employer at mid-day that effective midnight that day our health care coverage would no longer be effective. That is a crisis. Either coverage was allowed to lapse with resulting preexisting conditions arrising for folks or those folks scrambled to find an agent and submit an application and necessary records within just a matter of hours. And then there was the issue of finding appropriate coverage. Try doing the research, making a decision, securing records, finding an agent and making necessary transportation arrangements to submit an application and the required premium payment within about three hours or so.

Perhaps I just shouldn't give a damn or bother to mention the plight of those less fortunate.

[The Velveteen Ocelot]

24. A crisis is in the eye of the beholder.

Just because you had a more dire crisis doesn't mean the OP isn't experiencing something she perceives as one, based on her circumstances. Don't belittle her problem just because others have worse ones.

If I'm so broke I can't buy a pair of shoes, and I post on DU that I'm experiencing a crisis because I have no shoes, someone is bound to tell me I shouldn't whine because at least I'm lucky enough to have feet and the commenter doesn't; and that I'm *so* fortunate just to have feet, unlike those who don't, that I should STFU about not having shoes. Well, fine. I feel sorry for the person who doesn't have feet and I'm thankful that I do, but I still don't have any shoes and that's still a big problem. It's a crisis, for me.

[WritingIsMyReligion]

29. Some people love to play "horror story" oneupmanship.

"I totaled my car.."
"OH YEAH? I haven't been able to afford a car in _____ years, ever since the last one was _____________ by ___________...."

You know how it is. :)

[Iris]

12. I'm in Atlanta

We've ALWAYS used BCBS - it is great insurance, both individual and group coverage. We are on COBRA right not but are trying to get individual policies right now. I wouldn't use anything but BCBS.

[FloridaJudy]

16. My sister has Kaiser and loves it.

They've taken very good care of her and her family for decades. But this is the original Northern California group: people from other areas have had less satisfactory experiences, from all I've read.

[kath]

23. Kaiser in the Denver sucks big time. They totally mismanaged my (now deceased) father-in-law's

oncology and hospice care. The freakin' Kaiser "hospice" people didn't even manage my fil's pain competently - which is one the main things hospice care is supposed to be about, keeping the dying person comfortable.
The whole thing was a nightmare all the way around - didn't put in a port for chemo injections (which is pretty standard procedure these days), so he had to be stuck repeatedly for IVs; put in a crappy old-fashioned type g-tube that was harder to manage than current types and didn't tell my mil how to care for it (communication was absolutley terrible all the way around), no information about nutrition for cancer patients, and, worst of all, they dicked around for months and months before figuring out that he had relapsed - he might have done a lot better if treatment had begun 8 or 9 months earlier.
Colorado has frickin' goddam "tort reform", with a cap of something like $250-300K. Cancer care is expensive, and our impression was that Kaiser figures that rather than giving appropriate care, they'll just do the barest goddam minimum. They do the math -- Heck, even if someone sues, all they'll get is is 250K or so, and Kaiser still comes out ahead by scrimping on care. We absolutely think that that was their thinking - cheaper to do the bare minimum, even if they lose some settlements -- who gives a shit abut providing "standard of care" treatment?? It's too expensive, and we won't be able to pay our CEOs billions of dollars!

Fuckers.

[suninvited]

25. I have a question

wasn't Kaiser the insurance company profiled in "Sicko", where the little girl died because Kaiser denied treatment in an emergency room?

[Rosemary2205]

26. uh. oh. yeah. I think so.

Well. OK. Then.

[livetohike]

28. I had Kaiser for 14 years while living in CA

I liked them. My husband and I haven't had any serious health problems (just my migraines) and we always received great care for emergencies and office visits. No complaints. I wish they were here in PA :hi:.

[triguy46]

30. Expect monthly premium higher for HMO than PPO, but out of pocket to be less.