Aetna HMO vs Aetna PPO vs Kaiser HMO (Denver, Keystone: insurance, home)

[Brianmedia]

Do any of ya'll have experience with these medical insurers coverage and quality?

My wife is getting a job that offers these, and her last insurer in California, Anthem, was TERRIBLE

Any issues with being billed for services that were originally covered?
Experience with the pregnancy part of these coverages?
Overall satisfaction?


I know like most insurance it's hit or miss, but would like to gather some opinions. Thanks!

[bluescreen73]

Had Kaiser once. Hated it. Everything they do is all in-house/in-network. All their providers are directly employed by Kaiser and (at least here in Denver) they rarely contract with third-party providers. In addition, you'll get dinged for not using the Kaiser-owned pharmacy.

[Timmyy]

I just started with Aetna in March after my company was bought but I am HSA. It is too early to say how it is working. Usually when HMO and PPO are offered they have an option to go with HSA instead. If that is an option let me know and I might be able to answer some questions about it. I was using Cigna's HSA prior to going to Aetna.

[emm74]

I've had Kaiser as long as I've lived in Denver. Yes, it's a closed network and you need to use their facilities and providers. But your care is coordinated, all of your providers have immediate access to your records for reviews and referrals, and I've been satisfied with the quality of care. Particularly since you are new to Denver, it's not like you have any established relationships with providers that would be disrupted by having to stay within the network.

I also have a very strong preference for their clinic model - I love that I go to one place, I see my doctor, I get lab work or radiology, and I can pick up any Rx all right at the same location. For any ongoing prescriptions, I use mail order.

And generally speaking, there is a cost savings when you agree to the limitations of Kaiser - if your wife's employer isn't passing those savings on by having a lower employee contribution, then maybe it's not as attractive. But usually, it's one of the lower priced options when an employer offers plans from multiple carriers.

And fwiw, I have had a couple of more serious issues, including surgery, through Kaiser, so I'm not just a casual user of health services. My mom also recently went through cancer treatment with Kaiser and along the way, I met all of her providers (surgeon, medical oncologist and radiation oncologist) and was impressed with all of them and with the care she received.

[Brianmedia]

Originally Posted by Timmyy

I just started with Aetna in March after my company was bought but I am HSA. It is too early to say how it is working. Usually when HMO and PPO are offered they have an option to go with HSA instead. If that is an option let me know and I might be able to answer some questions about it. I was using Cigna's HSA prior to going to Aetna.

Yes Aetna HDSP? Or something like that is their HSA version available.

For it and both HMO and PPO the employer is covering it 100% so no monthly contributions for any of them.

I personally have a nationwide HSA plan thru my employer with United, but rarely use insurance so i've never had experience with much of it. I also get a $1000 contribution to my HSA every year by my employer, so it keeps piling up.

[Brianmedia]

Originally Posted by emm74

I've had Kaiser as long as I've lived in Denver. Yes, it's a closed network and you need to use their facilities and providers. But your care is coordinated, all of your providers have immediate access to your records for reviews and referrals, and I've been satisfied with the quality of care. Particularly since you are new to Denver, it's not like you have any established relationships with providers that would be disrupted by having to stay within the network.

I also have a very strong preference for their clinic model - I love that I go to one place, I see my doctor, I get lab work or radiology, and I can pick up any Rx all right at the same location. For any ongoing prescriptions, I use mail order.

And generally speaking, there is a cost savings when you agree to the limitations of Kaiser - if your wife's employer isn't passing those savings on by having a lower employee contribution, then maybe it's not as attractive. But usually, it's one of the lower priced options when an employer offers plans from multiple carriers.

And fwiw, I have had a couple of more serious issues, including surgery, through Kaiser, so I'm not just a casual user of health services. My mom also recently went through cancer treatment with Kaiser and along the way, I met all of her providers (surgeon, medical oncologist and radiation oncologist) and was impressed with all of them and with the care she received.

Thanks for the great info. This sounds like something that might be interesting to her. As long as you're on Kaiser and go to their facility there should be no questions around what's covered or being surprised something is not later.

[Timmyy]

Originally Posted by Brianmedia

Yes Aetna HDSP? Or something like that is their HSA version available.

For it and both HMO and PPO the employer is covering it 100% so no monthly contributions for any of them.

I personally have a nationwide HSA plan thru my employer with United, but rarely use insurance so i've never had experience with much of it. I also get a $1000 contribution to my HSA every year by my employer, so it keeps piling up.

Yes, High Deductible Health Plan (HDHP). I chose to use that over HMO for a couple of reasons. One big reason is that I don't have to get a referral for specialists. With HMO you do.

[bluescreen73]

Originally Posted by Brianmedia

Thanks for the great info. This sounds like something that might be interesting to her. As long as you're on Kaiser and go to their facility there should be no questions around what's covered or being surprised something is not later.

And for you coming into Denver with no previous provider relationships it may not be such a bad thing. We were established with a physicians group that we liked and had to switch providers when we went to Kaiser. On top of that the nearest Kaiser office is 10 miles away and the Kaiser urgent care clinic (that we had to use once) is 15-20 miles from us.

[Mike from back east]

Originally Posted by bluescreen73

Had Kaiser once. Hated it. Everything they do is all in-house/in-network. All their providers are directly employed by Kaiser and (at least here in Denver) they rarely contract with third-party providers. In addition, you'll get dinged for not using the Kaiser-owned pharmacy.

Same here. Hated Kaiser, with a passion that still burns deeply despite being away from them for 10 years. Just after moving to COLO SPGS we got a letter from CSHP, who were the sub contractor to Kaiser for business in COLO SPGS. Seems that Kaiser insisted CSHP take a 10% across the board cut in payouts from Kaiser. CSHP told Kaiser to go pound sand. During open season we switched to Anthem BC/BS and kept CSHP as our local source of doctors. It was a huge improvement. I still have BC/BS as my backstop to Medicare A&B. I'm a happy camper.

Here are some of the horror stories from people who had Kaiser.

Here are our experiences with that bunch:

It starts when you call on the phone, the unending phone tree of choices before finally reaching a human being to talk to. The advice nurses are nice but woefully overloaded with calls.

Our local office in Fairfax VA is just dreadful, especially the pharmacy where you stand in line and wait and wait and wait.

Doctors constantly run late, you sit in the exam room for up to an hour just waiting.

Wife had a hairline fracture between her toes, didn't show up on the initial xray but the pain was awful. Their foreign born doctor, from a nation that devalues women, told her to sit home for six weeks until she could see their podiatrist. No kidding, the doofus expected her to wait for six weeks for an appointment to see THEIR specialist. No thanks. Next morning we went to a local podiatrist we picked out of the phone book, he saw her the same day. He wrapped her foot in a cast and had her come back in a week at which time HIS xray showed the fracture. Wife had the cast on for six weeks but all was well and she was able to go to work and get around fine.

I have sleep apnea and Kaiser made it hard to get a sleep study. I had to wait FOUR weeks to just fill out a questionnaire to prove I had the problem and then it took SIX more weeks to get a sleep study.

Wife used to get annual pap smears, but they couldn't keep people on the payroll to do them. You had to get on a waiting list three months out to make an appointment for another couple of months out. Insane!

Wife needed a routine proctoscopy. Of course they don't do those at the Fair Oaks facility so you have to go their Falls Church mega facility that would be a major hospital in a small town. While there they told her she'd have to come back another time as their scope was out of order, but after a while they were able to borrow a scope from another exam room on the next floor up. I guess they traded two sheep and a magic charm to borrow from the other floor. While we were there the fire alarm went off and hundreds of people exited to the parking lot. Third. World. Country.

I was in COLO SPGS, having a nuclear stress test in Aug 2007 for my heart and the doctor wanted to add one more minor test to the overall set of tests. The cardiologist had to stop what he was doing and call some clerk at Kaiser to get the okay to do the one more test step. This is NOT health care, this is bureaucracy at its worst.

Kaiser cues you up for 4+ weeks for any appointment to be sure that every second of every doctor's time is fully allocated from sun up to sun down. They so over-manage the delivery of health care it's sickening.

We're on Medicare now and what a pleasure it is, we see any doc we want and we have no complaints. Do not ever let your local politician tell you we have to cut Medicare, it really works. Meantime, do your family and yourself a big favor and find another insurer, like BC/BS.

On and on it went. Every interaction with them was like a third world country run by the Keystone Kops.

[2bindenver]

I had a HMO and it took more than fours months to diagnose me with Crohns - I now have Kaiser a HSA. I have coordinated care, the communication is superior. They email me, they email each other. Mail order pharmacy 90 day supply for 60 day cost and free shipping.