Please Help Me Choose A Private CA Health Insurance Plan (taxes, live)

[NoMoreSnowForMe]

If you are sure you need private healthcare, I think you should reconsider Kaiser. I've had every health plan you can imagine in my life, and Kaiser was the best private health plan I had.

The reason is because Blue Cross/Blue Shield, for instance, can approve something and later change their minds and send you the bill. That never happens with Kaiser.

I think what you're experiencing, as someone else mentioned, is a new law that all heath care providers have to follow regarding pain meds. It's the law that says you can be randomly tested to see how much of the drug is in your system, for instance. If you are taking your meds as prescribed, this is no problem. What was recently explained to me at my health clinic, is that the problem they are dealing with, is people who are selling their meds. So, they are actually testing people to see if they are using the meds they are being prescribed. If your test results show you aren't using them, but you keep renewing your prescription, they will assume you are selling them on the black market.

If you have a real need for pain meds, and you take them as prescribed, you'll be fine. No health provider in CA will be different than another in this regard, because it's the state/federal law that's the problem, not any particular provider.

But, really, Kaiser is the best option for an affordable provider who won't ever surprise you with a bill later on. And the health care is as good or better than any other provider, in my experience. I was born in a Kaiser hospital, and later when I was an adult and had many different types of health plans, Kaiser was always the most fair as far as cost, and just as good as far as care.

[Ruth4Truth]

Originally Posted by CNYC

I am not looking for funding. I want to buy private insurance. I guess Blue Cross/ Blue Shield is one of the best ? Can you recommend another one just as good ?

Thank You for the responses.

C

The state high risk pools are Blue Cross/Blue Shield. Most insureds pay full price. But apparently they're not going to last much longer. My insurance agent hasn't said anything about that, and I just renewed mine for a year, so it's not going to go anywhere too soon.

[Ruth4Truth]

Originally Posted by NoMoreSnowForMe

If you are sure you need private healthcare, I think you should reconsider Kaiser. I've had every health plan you can imagine in my life, and Kaiser was the best private health plan I had.

The reason is because Blue Cross/Blue Shield, for instance, can approve something and later change their minds and send you the bill. That never happens with Kaiser.

I think what you're experiencing, as someone else mentioned, is a new law that all heath care providers have to follow regarding pain meds. It's the law that says you can be randomly tested to see how much of the drug is in your system, for instance. If you are taking your meds as prescribed, this is no problem. What was recently explained to me at my health clinic, is that the problem they are dealing with, is people who are selling their meds. So, they are actually testing people to see if they are using the meds they are being prescribed. If your test results show you aren't using them, but you keep renewing your prescription, they will assume you are selling them on the black market.

If you have a real need for pain meds, and you take them as prescribed, you'll be fine. No health provider in CA will be different than another in this regard, because it's the state/federal law that's the problem, not any particular provider.

But, really, Kaiser is the best option for an affordable provider who won't ever surprise you with a bill later on. And the health care is as good or better than any other provider, in my experience. I was born in a Kaiser hospital, and later when I was an adult and had many different types of health plans, Kaiser was always the most fair as far as cost, and just as good as far as care.

It's managed care, though, so you can't self-refer to specialists, can you? And I don't know about other insurers, but Kaiser gets a lot of lawsuits, because the doctors are organized in the for-profit arm of Kaiser, so they're motivated to skimp on supplies and some aspects of care, to increase their own profit-margin. Though it's true, some people love Kaiser, and experience no problems, even when hospitalized.

On the other hand, Blue Cross/Blue Shield are very miserly with their reimbursements to providers, so some providers (including some pharmacists, IME) refuse to take patients with BCBS. So I don't know if there's a "good" insurance company out there that both consumers and providers are happy with.

[NoMoreSnowForMe]

Originally Posted by Ruth4Truth

It's managed care, though, so you can't self-refer to specialists, can you? And I don't know about other insurers, but Kaiser gets a lot of lawsuits, because the doctors are organized in the for-profit arm of Kaiser, so they're motivated to skimp on supplies and some aspects of care, to increase their own profit-margin. Though it's true, some people love Kaiser, and experience no problems, even when hospitalized.

On the other hand, Blue Cross/Blue Shield are very miserly with their reimbursements to providers, so some providers (including some pharmacists, IME) refuse to take patients with BCBS. So I don't know if there's a "good" insurance company out there that both consumers and providers are happy with.

I've never been insured by any health care provider who didn't first require a referral by a primary care physician, in order to get to a specialist. This is the same think for Kaiser. Had them for years for myself and my daughter, and yes, you have to get the PMCP to sign off on a referral, but it gets done.

But, the OPs main concern, as I understood it, was trying to find a health care provider who wouldn't give him/her a hard time about their pain meds, and from what I understand of the recent laws, they all have to follow the same procedures as far as vetting a patient who requires pain meds.

I just had to go through this myself. Actually I just take a muscle relaxer, but they have to ask you if you take pain meds. If you answer "yes," they have to send you to a nurse or doctor who does an intake with you regarding your pain and your meds. When I did this, the nurse quickly determined that it was not necessary for me to go through this process, because I don't take a narcotic. She explained the new law to me, which I explained above, according to what she told me.

[Ruth4Truth]

Originally Posted by NoMoreSnowForMe

I've never been insured by any health care provider who didn't first require a referral by a primary care physician, in order to get to a specialist. This is the same think for Kaiser. Had them for years for myself and my daughter, and yes, you have to get the PMCP to sign off on a referral, but it gets done.

But, the OPs main concern, as I understood it, was trying to find a health care provider who wouldn't give him/her a hard time about their pain meds, and from what I understand of the recent laws, they all have to follow the same procedures as far as vetting a patient who requires pain meds.
.

Well, yes, the pain med issue is something that applies to all providers. I was just saying that other insurance companies give patients more flexibility. If your doc at Kaiser doesn't think you need a specialist, or doesn't want you to run up a bill for the system, he can refuse to refer you. With non-HMO insurances, you can self-refer to specialists.

[shooting4life]

Originally Posted by Ruth4Truth

It's managed care, though, so you can't self-refer to specialists, can you? And I don't know about other insurers, but Kaiser gets a lot of lawsuits, because the doctors are organized in the for-profit arm of Kaiser, so they're motivated to skimp on supplies and some aspects of care, to increase their own profit-margin. Though it's true, some people love Kaiser, and experience no problems, even when hospitalized.

On the other hand, Blue Cross/Blue Shield are very miserly with their reimbursements to providers, so some providers (including some pharmacists, IME) refuse to take patients with BCBS. So I don't know if there's a "good" insurance company out there that both consumers and providers are happy with.

The best part of kaiser is the allow faster to ways to get to a specialist. I had a syst I needed removed. I sent my primary care doctor a picture on line, he approved via email and The first time I saw someone in person was to have the syst removed. I was able to get the Rx filled while walking out of the hospital, so no additional stops. When the stiches needed to be removed I have was able to make an appointment near work to save time.

The kaiser system works for me, I really have no desire to see the same doctor. When I have to stay home from work I see a doctor near my house, when I am at work and need an appointment I go to a different doctor. As a relatively young male without any health problems it is a perfect model. My wife has had more issues and every time kaiser has taken care of her, they don't skimp on supplies or push her out too fast, etc. Ever hospital will have horror stories.

[CNYC]

Originally Posted by Ruth4Truth

It's managed care, though, so you can't self-refer to specialists, can you? And I don't know about other insurers, but Kaiser gets a lot of lawsuits, because the doctors are organized in the for-profit arm of Kaiser, so they're motivated to skimp on supplies and some aspects of care, to increase their own profit-margin. Though it's true, some people love Kaiser, and experience no problems, even when hospitalized.

On the other hand, Blue Cross/Blue Shield are very miserly with their reimbursements to providers, so some providers (including some pharmacists, IME) refuse to take patients with BCBS. So I don't know if there's a "good" insurance company out there that both consumers and providers are happy with.

I think you may be on to something.

I currently have United Health Care and nobody tests me to see what medicines I am using. I have a prescription for pain meds but I use them as needed....not because I need to show proof of my usage. Sometimes I don't touch them for a month or two YET according to Kaiser I would be in the wrong ?


I was told that Kaiser is a union based company that is why they have weird policies. Don't kill the messenger. The billing lady at Scripps told me this.

[CNYC]

Originally Posted by CNYC

I think you may be on to something.

I currently have United Health Care and nobody tests me to see what medicines I am using. I have a prescription for pain meds but I use them as needed....not because I need to show proof of my usage. Sometimes I don't touch them for a month or two YET according to Kaiser I would be in the wrong ?


I was told that Kaiser is a union based company that is why they have weird policies. Don't kill the messenger. The billing lady at Scripps told me this.

I was also told if I take pain meds I get tested for illegal drugs as well. I am a medical MJ patient and use it for my pain until it gets too bad. That is when I take a pain medication. According to other people Kaiser would take my prescription for pains meds away ....RIGHT ?

[CNYC]

Originally Posted by Ruth4Truth

If your doc at Kaiser doesn't think you need a specialist, or doesn't want you to run up a bill for the system, he can refuse to refer you. With non-HMO insurances, you can self-refer to specialists.

Any suggestions for a non HMO insurance ?

[Ceece]

It's all going to depend on where you live. All individual CA health insurance companies are location/zip code dependent. If you don't want to mess with the CA exchange I suggest ehealthinsurance for some quick location based rates and info.

I have United Health Care PPO through an employer too, but will be losing it soon and they do not sell similar policies on the open market to individuals. Depending on where you live there may not be a lot of options for you so don't get carried away with "suggestions" that won't even matter. You aren't shopping for shoes here.