Health insurance recommendations (no political rants please) (Portland: buying, deductible)

[sketchbooks]

I'm returning to Portland after 8 years, self-employed (more or less successfully) and will need to get my own health insurance. When I was there before I used Fortis (now Assurant) and their recent bad press is more than justified- I won't be using them again, yuck.

I've looked at the websites for Regence BCBS, Kaiser, Providence and a couple of others I've forgotten. Aside from their rate sheets, they don't give me much useful information to go on.

For the record, I try to stay out of doctor's offices, basically healthy but have a pesky chronic illness that's easily managed with the proper bloodwork and meds, and have become more physically active in the last few years- better for my overall health but more minor injuries to deal with.

Anybody here who is buying their own insurance, what are your experiences? Any provider make you feel that the premiums are actually worth it?

**I won't be sharing my opinion on recent legislation, and I don't want yours. I want to know what is the best value for the money right now.

[sayulita]

Your pre-existing condition may keep you out of most plans. If you get rejected, check out OMIP. They have to take you once you've been rejected. Premiums and deductibles are very high but I was grateful for the coverage when I had emergency surgery recently.
Here's the link. It's pretty comprehensive. Good luck!
State of Oregon: Oregon Medical Insurance Pool

[lawmomma]

Originally Posted by sketchbooks

I'm returning to Portland after 8 years, self-employed (more or less successfully) and will need to get my own health insurance. When I was there before I used Fortis (now Assurant) and their recent bad press is more than justified- I won't be using them again, yuck.

I've looked at the websites for Regence BCBS, Kaiser, Providence and a couple of others I've forgotten. Aside from their rate sheets, they don't give me much useful information to go on.

For the record, I try to stay out of doctor's offices, basically healthy but have a pesky chronic illness that's easily managed with the proper bloodwork and meds, and have become more physically active in the last few years- better for my overall health but more minor injuries to deal with.

Anybody here who is buying their own insurance, what are your experiences? Any provider make you feel that the premiums are actually worth it?

**I won't be sharing my opinion on recent legislation, and I don't want yours. I want to know what is the best value for the money right now.

If you don't have a lot of luck here, you may also get some good advice if you find a non-profit that supports your illness. They usually have message boards just like this one, where you can ask others for advice on which companies they've been the most successful with.

[Nell Plotts]

I don't buy my own insurance but my son's family has a Providence policy and they like them very much. We had Kaiser before moving out of their service area, they were great to us. My niece, BIL & SIL have Kaiser and have received wonderful care for serious, life threatening, illnesses.

Medical care is a human endeavor, in any group there can be missteps. Knowledge of your own condition is key.

[Minervah]

I would check out Kaiser. I liked them when I had them but unfortunately I have an unusual chronic illness that they really couldn't help me out with as well as my Legacy doctor. I have heard that Providence has a good PPO Plan and I think they also have an HMO plan. I have had both Kaiser and Providence in the past and they are both very good facilities.

I used Legacy doctors whom I like the best but I am covered under my employer's group health plan. I don't think they have anything similar to Kaiser or Providence though.

If all else fails, check with the state of Oregon as has been suggested. Six years ago when I applied they only had insurance coverage for mothers and children. However I believe now they do have plans for anyone who is unable to obtain coverage from other sources or who cannot afford the private plans.

One more thing comes to mind. Have you checked into OHSU having any type of medical programs?

[Xanathos]

I have experience with all 3 you listed.

Kaiser is great...so long as you never leave the area to go to someplace where Kaiser doesn't have a presence. You're restricted to THEIR doctors and THEIR facilities. So if you find yourself in, say, Austin, and need medical attention, you won't be covered because they don't have facilities there.

I had Providence through my work when I lived in Portland, and I found it to be subpar. It was a two-tiered program, and if you went to something outside the Providence network, you were charged a very high fee.

Regence is what I have now, and I have no real complaints, aside from the fact that they put an annual limit on homeopathic therapy (chiropractic, acupuncture, massage) of like 1500 a year. So if you have to see a chiro regularly, you can run out of coverage real quick. On the plus side, however, it's one of the first I found that actually pays for massage, which I'm a huge fan of. Also, you can go see any doctor anywhere.

So out of the 3 you listed, I'd give my nod to Regence, though I've always been a big fan of UHC.

[Nell Plotts]

Originally Posted by Xanathos

Kaiser is great...so long as you never leave the area to go to someplace where Kaiser doesn't have a presence. You're restricted to THEIR doctors and THEIR facilities. So if you find yourself in, say, Austin, and need medical attention, you won't be covered because they don't have facilities there.

That wasn't my experience, they have covered urgent care outside of their service area when traveling to their facility wasn't practical. They do use specialists who are not their physicians by referral. For example, heart surgery is done at St. V's. There are Kaiser facilities in the Bay area and elsewhere. When we moved from Portland to Seattle and were on Kaiser we were told that we could use Group Health docs & facilities without having to change our plan before open season. Kaiser participates in Portland's emergency care triage system - if you are badly burned or shot you will likely end up at Emanuel and your care will be covered.

It is true that if Kaiser thinks they can meet your needs in their system they won't pay for treatment elsewhere.

I have two relatives with colon cancer cared for by Kaiser. In the case of one she received a colonoscopy as a part of a physical because the plan wanted to increase their vigilance in that area - no family history or indications of cancer at all. They found an aggressive form of colon cancer and treated it immediately, she is doing well after about 10 years but because of the profile of the cancer cells they don't regard her as 'cured'. Because of this her parents receive colonoscopies. Colon cancer was found in her father and he is under treatment. In any other setting I doubt that the woman's diagnostic colonoscopy would have happened until symptomatic, too late for effective management.

[Minervah]

Kaiser also sent a friend of mine for cancer treatment to Providence because Providence doctors dealt better with her type of cancer. They will pay for some out of area treatment depending upon the circumstances. You have to check with your policy to see what options you have.

[Jillaceae]

I spent some time doing medical billing follow-up in Portland, and having worked with tens of thousands of claims in the Portland area, I can tell you that the Providence insurance is the least likely to screw their customers, by far.

Growing up, my family was definitely a Legacy family, but probably in the last ten years they've we've switched over to Providence providers and been much happier. (Although I don't count anymore because I moved away. But my parents are much happier). One plus with Providence is that they are everywhere.

[PNW-type-gal]

I'd suggest applying to all of them - see who will actually offer you insurance first and decide amongst them.

As two healthy over-50s, we expected to be able to find private insurance... uh, no, we were turned down by 7 companies for the flimsiest of reasons.