group health of WA (Seattle, Olympia: health insurance, how much, deductible)

[pnwretired]

Can anyone give me info on this plan compared to another? I want to hear from those who have had this insurance and other ones to compare that they have compared it too. I have a Medicare friend who has group health but she has been on it since she was 10 years old so she has no idea whether she is really getting good care. Nothing to compare it to. It seems like she pays so much less - maybe Medicare is the reason. For example: spinal shot for disk problem: cost for her $100 per shot. Aetna which my husband has $300 per shot. Big difference. She is very happy with her care but like I said she has nothing to compare it too. I do know that when she had her mri for the disk problem her doc said he could not tell if it was ruptured. What? Mri is suppose to show that as my husbands did. It either is or it isn't not can't tell. So my thought is the doctor is either incompentent or the don't know how to take mri's.

[poopskooper]

I thought you'd get a lot of varying responses pertaining to having Group Health coverage. Some love it and swear it's the best thing out there --my parents did, for instance-- and some despise Group Health ...you'll hear all sorts of references to "Group Death" etc.

I had it years ago and was satisfied as the doctors I saw at the time I felt were competent and caring. I changed to a Blue Shield PPO because at the time, I wanted to see a particular doctor. However, overall, I wish I had gone back to GHC as for me, I liked the managed and structured care provided. And even at Group Health, they will sometimes refer out to non-Group Health specialists if the need arises. For me, I'm not good at picking doctors so I like the idea of having that done for me. Many do not want to be forced into to do that and I can understand. I can't comment much on cost because at the time, my company sponsored plans were pretty equal when it came to anything extra that might have been involved from what I can remember.

I have friends who are retired who are still with Group Health and are extremely satisfied. One of them is even in the Olympia area where the facilities are not quite as extensive as they'd be in Seattle but still they are quite satisfied with their PCP and all the care they've received there through the years.

I'm surprised that nobody has responded in this thread so far as I would think this would be quite a controversial topic of comparing GHC with other health plans. Like I say, to me, it seems people either love GHC or hate them.

[BellevueNative]

I have had both GH and Regence/Premera. GH is a true HMO - it's owned by Kaiser Permanente if you're familiar with them. Anyway, GH is very cost conscious. It's a little more impersonal feeling than a traditional insurer because all of the doctors in GH insurance are exclusive to just GH. I think that may make GH take things for granted. However, I liked the doctors I had with GH, so I can't complain about that. The thing that is annoying about GH is that you have to pick one of their network doctors, and chances are that if you've been using a different insurer, the doctors you've been seeing with that insurer would not be in GH - you'd have to find new doctors. I value my long term relationships with my doctors, so that was annoying to me to have to switch doctors just because the insurance changed. Compare that to Regence/Premera (and probably United and Aetna), where most doctors in the area (not including GH) will probably be in-network.

One thing that I loved about GH was that they jumped on electronic medical records long ago, and they have it down to a science. It's great to not have to fill out all those forms when you go into a dr office, especially if you ever have to go to urgent care/ER.

Keep in mind that how much you pay for your insurance, and the coverage of your particular plan, depends on what your employer has decided it will be. One person on Aetna may not pay or have access to the same covered services as another Aetna patient with a different employer's plan.

[pnwretired]

Good info. Thanks.

[poopskooper]

From what GHC employees tell me about the relationship between GHC and Kaiser Permanente is not one where GHC is being controlled by Kaiser Permanente as the term "owned" may be too strong a term. However, they have very similar philosophies and operations.

In the late 90s, the members (or consumers) of GH Cooperative voted to approve an affiliation with KP that created a joint company. That joint company governs and makes the policies, etc. of the northwest group of the KP family which is essentially GHC.

In my opinion, that affiliation makes having Group Health coverage even more valuable as not only can the organization in general share the resources of KP but it also makes it much more convenient for Group Health members to have coverage in the Kaiser Permanente operating area (and vise versa). A good thing all around in my mind.

All this is what I've been told by employees which may not be entirely correct or not as I may be misinterpreting what they tell me. I'm also expressing my own opinion on the affiliation/relationship between GHC and KP which may not be agreed with by everybody.

[jm31828]

I had group Health for 1 year before my insurance was changed yet again because Group Health was trying to bump our rates up 50% the next year. They seemed decent, but one thing made me concerned- they have everything under one roof, so they are the medical care provider AND the insurance company. Under normal circumstances a doctor has your best interests in mind and if lab tests or procedures are needed he/she will order them to be done no matter what it might cost insurance (since they are not tied together, of course), because he/she wants to do anything they feel they need to diagnose or treat an issue even if it's a shot in the dark, so to speak. With Group Health I just had this fear that in an attempt to save themselves money, they would try to limit what their doctors order for patients, maybe recommending only doing certain things is absolutely necessary, or even worse, maybe trying to talk patients out of them. I had no evidence this was the case, but that setup just seemed ripe for that to happen since they could directly benefit themselves- the insurance carrier- by keeping their costs low. And I as a patient didn't see any benefit as I was always told I would from Group Health having that setup- office visits and procedures cost just as much there as they had anywhere else, unfortuantely.

[509]

I think the previous poster has a very valid point. They are an insurance company.

We had Group Health (AS ONLY AN INSURANCE COMPANY) for a couple of years in Wenatchee. They came in and underbid the entire health insurance market in Wenatchee. Lots of insurance carriers could not compete and dropped out of the Wenatchee market.

Well, guess what? After a couple of years or so they decided that they were not making any money in Wenatchee and pulled out. We were left with VERY limited insurance choices for almost a decade as a result of their business practices.

I thought they were a public interest non-profit. That went by the boards. I would be careful about doing business with them for that reason.

[poopskooper]

True, GHC can offer PPO coverage but it's also one of the best coordinated care HMOs in the country. I'm not trying to sell anybody on Group Health coverage but if the "Coordinated Care HMO" option works well for a LOT of folks. And, as I've said, many swear by it. My parents in the last years of their life always told me that they couldn't have had better care than from the Group Health coverage they had and they both had severe health problems toward the end. Of course, they had "coordinated care" with their PCP located in Factoria, the eastside hospital being close, and even when going to the main facility in Seattle, they had excellent care ...and also from Virginia Mason, a partner of GHC.

So, one has to determine what kind of coverage they want from GHC also. The have not only their CC-HMO plans but PPO, and POS plans as well. Take a look: =click here

[secret_squirrel]

I grew up with GHC insurance, left it as an adult and have since returned. IMO, Blue Cross/Regence were a tremendous headache of claims that would be denied first, then covered when I protested. It felt like their business strategy, as they did cover the claims eventually, but I had to call and wrangle with customer service.

I have coverage with Premera and GHC, but due to the lack of deductible, I only use GHC and have had very positive experiences since returning (9 years now). I needed to go to an ER on vacation, and they covered it 100%. My PCP ordered an ultrasound and I didn't want to wait a month for it to be scheduled, so I went to a local clinic thinking I would use my secondary coverage, but GHC still paid for that 100%. I'm currently pregnant and will have zero out of pocket medical bills with this pregnancy (vs. 15% with Premera). They have paid for extra elective tests during this pg. to ease my mind.

You do have to think about where you live and work vs. clinic and hospital locations. All GHC hospitals were a 20 - 30+ minute drive for us to deliver at, but I have been told we can deliver at any area hospital if the baby comes fast and it turns into an emergency. I don't need to risk having my baby on the interstate to get it covered.

All insurance is a trade off. For us, GHC has more pluses than minuses.

[pnwretired]

Originally Posted by secret_squirrel

I grew up with GHC insurance, left it as an adult and have since returned. IMO, Blue Cross/Regence were a tremendous headache of claims that would be denied first, then covered when I protested. It felt like their business strategy, as they did cover the claims eventually, but I had to call and wrangle with customer service.

I have coverage with Premera and GHC, but due to the lack of deductible, I only use GHC and have had very positive experiences since returning (9 years now). I needed to go to an ER on vacation, and they covered it 100%. My PCP ordered an ultrasound and I didn't want to wait a month for it to be scheduled, so I went to a local clinic thinking I would use my secondary coverage, but GHC still paid for that 100%. I'm currently pregnant and will have zero out of pocket medical bills with this pregnancy (vs. 15% with Premera). They have paid for extra elective tests during this pg. to ease my mind.

You do have to think about where you live and work vs. clinic and hospital locations. All GHC hospitals were a 20 - 30+ minute drive for us to deliver at, but I have been told we can deliver at any area hospital if the baby comes fast and it turns into an emergency. I don't need to risk having my baby on the interstate to get it covered.

All insurance is a trade off. For us, GHC has more pluses than minuses.