LymeNet Flash: Blue Cross or Kaiser? Which would you choose?

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»	LymeNet Flash » Questions and Discussion » Medical Questions » Blue Cross or Kaiser? Which would you choose?

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Topic: Blue Cross or Kaiser? Which would you choose?

Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707

posted

Good evening all,

In a couple of days I will finally be able to pick up health insurance once again.

I have not had coverage since August, so I am thrilled [Smile]

!

I need to do some homework on the particulars of each plan offered, but thought I would ask for your experiences with either Blue Cross or Kaiser.

The good and the bad...please.

Thanks so much in advance!
Melanie

Posts: 7052 | From Colorado | Registered: Mar 2003 | IP: Logged |

SForsgren
Frequent Contributor (1K+ posts)
Member # 7686

posted

Blue Cross

--------------------
Be well,
Scott

Posts: 4617 | From San Jose, CA | Registered: Jul 2005 | IP: Logged |

Michelle M
Frequent Contributor (1K+ posts)
Member # 7200

posted

Melanie, I'm so glad you'll be getting covered.

I do certainly hear Kaiser is the bottom of the insurance pit -- and that is one deep pit!

My dislike for Blue Cross grows daily.

You've heard all about their 30 day IV policy for Lyme. Doesn't matter to them how many positive western blots or other objective evidence you have; they really don't care. I think Timaca beat them and I'm so glad she did! I had liver problems and could not continue.

Now Blue Cross is starting to have fits over orals.

They've decided I only need 20 Biaxin XL a month instead of 60. Same song and dance for the Omnicef. You get the picture. Any pricey med becomes a war. Provigil is out of the question.

I am currently in a non-Lyme appeal process with them over a request for a breast MRI. High risk lesions, partial mastectomy, coupla stereotactic biopsies, etc. Fortunately for me, Blue Cross apparently knows what's best for me.

The really good news is that once or twice a year, your co-pays will increase and you will get a letter from Blue Cross which starts out in a cheery fashion like "Here at Blue Cross, your health is our number one priority, so we're increasing our services blah blah blah blah."

This will be a very bad sign indeed. Pour something to drink.

It's better than no insurance.

But not by much.

Michelle (Blue Cross Fan Not)

Posts: 3193 | From Northern California | Registered: Apr 2005 | IP: Logged |

Carol in PA
Frequent Contributor (5K+ posts)
Member # 5338

posted

Melanie,
My husband is in a Blue Cross plan for small businesses.
Since he has dependants, the monthly fee is humungous.

My deductable is now $5000.

The good news is, we have a family deductable of $10,000, not $5000 per member.

Carol

Posts: 6947 | From Lancaster, PA | Registered: Feb 2004 | IP: Logged |

bettyg
Unregistered

posted

BC/BS plan 3 plus has been great for hubby & me; as former RETIRED employees of STATE group plan.

Our med deductible is $250 per person which I pay in full by March.....9 months free pills!

Deductible is I believe $800 plus $15 co-pay for each visit, xray, blood labs, etc.

I've NOT have IV for lyme yet but understand it covers ONE month only. So I can't complain...

Frankly they have been very good to me with the 12 surgeries and short stay unit things I had done since 1979.

Since being approved for SSDI in 7-05; medicare is now paying for things too. Have NO knowledge about lyme ivs there either.

IP: Logged |

riversinger
Frequent Contributor (1K+ posts)
Member # 4851

posted

Melanie,

I have had the other Blue, Blue Shield, in CA, as an independant agent. Expensive as it is, it has allowed me much more freedome than my friends who have Kaiser. Kaiser works fine for people who have simple, ordinary, predictable health issues.

None of the people in CA that I know who have Lyme have been able to get treatment in the Kaiser system. If you are prepared to use Kaisre only for your day to day treatment, and pay out of pocket for any future Lyme related expenses, it might work.

However, you need to know that Blue Shield does not have a stellar reputation as far as treating Lyme either. My experience has not been too bad, but I have a catastrophic policy. Once I pay the terrible premuims, and the awful deductable, they have to pay everything else. Not all policies do so.

I suggest you find a reputable insurance broker (yes, there is such a thing) and talk to them about your needs.

--------------------
Sonoma County Lyme Support
[email protected]

Posts: 2142 | From California | Registered: Nov 2003 | IP: Logged |

mbroderick
Frequent Contributor (1K+ posts)
Member # 5220

posted

Blue Cross plans can vary a lot from one employer to another. I have my whole family covered with my Blue Cross from the school district that I work for. Practically everything has been covered almost 100%. We haven't had any problems whatsoever. Even Igenex testing was fully covered.

Posts: 2097 | From PA | Registered: Jan 2004 | IP: Logged |

trails
Frequent Contributor (1K+ posts)
Member # 1620

posted

I second everyone here in saying that ANYONE but Kaiser.

I recently moved to Crowdedfornia too and I had 3 months to review health plan options. I spent all three months studying the books, calling the numbers, researching on-line, speaking with staff, nurses, and docs from with different angles.

verdict: blue cross ppo

I, like Michelle, am involved in a NON-lyme appeal with blue cross of New Mexico, and it has been 6 months and I have barely moved inches, but I think it would happen with any other plan. And if I had Kaiser, I couldnt even think of appealling as this pertains to out of network coverage.

Biggest drawback of Blue cross at this point seems to be their very strict 30 day IV rule. More than one LLMD has told me--no way to get around it.

Otherwise they are covering Lyme related things I need. (knock on wood)

Good luck!
Trails

Posts: 1950 | From New Mexico | Registered: Sep 2001 | IP: Logged |

Healing in Santa Cruz
LymeNet Contributor
Member # 7798

posted

Over the yrs I have heard too many HORROR stories about Kaiser. I had both and Blue Cross was the best.

Posts: 905 | From Santa Cruz,Calif | Registered: Aug 2005 | IP: Logged |

Meg
Honored Contributor (10K+ posts)
Member # 22

posted

I've had both also.....RUN don't walk to Blue Cross~!

I'd almost go without insurance rather than subject us to Kaiser again....they live up to the 'practicing medicine' statement.

--------------------
Success Stories---Treatment Guidelines

Posts: 10010 | From somewhERE OVER THE Rainbow | Registered: Oct 2000 | IP: Logged |

Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707

posted

My goodness! You guys are so incredibly wonderful with all of your help!

It seems as though BC is a much better choice with all things considered. I'll have to do a bit more digging, but this looks like a hands-down winner.

THANK YOU all so much for sharing your insights and experiences, it is SO appreciated!!!

Much love,
Melanie

Posts: 7052 | From Colorado | Registered: Mar 2003 | IP: Logged |

Andie333
Frequent Contributor (1K+ posts)
Member # 7370

posted

Melanie,

Can't comment on Kaiser; I have BX PPO. I have an individual plan, and cave's right...shortly after I joined, they sent out this notice that, in order to give me better care etc etc, they were increasing my premiums by $100 a month.

Geez.

So, now I pay as much for health insurance as I do for my part of the mortgage.

Is it good coverage? I opted to do orals, rather than IV, because I wasn't up for that fight (only a month. period.) I'm able to claim 50% for out of network docs, then pay a $20 copay for in network.

Prescriptions are covered 80% for generics but for non-generic, they're only covered 50%.

I try to swerve and dodge to stay within workable parameters. My LLMD doesn't take insurance but knows a lot about it.

When I start to question the value of health insurance, I think back three years to surgery -- having my gall bladder removed. The total cost for that procedure and hospitalization was listed as
$55,000.

There's got to be a better way to do this...

Andie

Posts: 2549 | From never never land | Registered: May 2005 | IP: Logged |

geniveve
Unregistered

posted

i have bc/bs federal plan for single option. pays roughly about 80-85 percent. i only pay 15 for office visits and a small copay for prescriptions.

since hubbie was marine i also have tricare and they pay what bc/bs doesn't but it has to be a pretty high bill.

no dental but hey at this point, who cares?

definitely bc/bs.....

IP: Logged |

lymex5&counting
LymeNet Contributor
Member # 7202

posted

I would choose BCBS. I have had 2 of their PPO's.

While it depends on the coverages of the

individual employer, plans can vary. My previous

plan allowed for PPO waivers. If you went thru

the MSA dept you could request the waiver to get

out of network charges at in network coverage.

Certain restrictions apply, ie. mileage,

specialty, etc.

We had IGeneX on waiver for 3 month increments

and Dr Jones on for 6 months at a time. This

allowed for visits and labs to be covered at

in network rates. So IGeneX was reimbursed at 100%

and Dr Jones visits were about $21 per kid. MDL

is an in network provider with BCBS so those were

also covered at 100%. The LLMD I was seeing back

then was in network and cost me about $18 a

visit.

And my Naturopath was even covered at $1,000 a

year per person.

My current PPO does not

allow for waivers but they still pay at 80% for

LLNeuro and Dr Jones (although the overages can

really kick your butt on these.) I did meet my

out of pocket on meds in December so they

started paying on those at 100%, instead of

80%. But out of network Dr's don't go toward

out of pocket [Frown]

When you are dealing with

the insurance co it is just like everywhere else

you call 10x's, you get 10 different answers.

BCBS has been sued over lyme cases out East if I

remember correctly. I have never had a problem

getting anything covered this includes Neuropsych

testing, MRI's etc. Although none of us have

tried for IV therapy yet. Always get the

person's name everytime that you speak with. I

had one thing paid. I don't think it was lyme

related but they went back through the

transcripts and even though it wasn't supposed

to be covered since they knew the person had

told me yes they covered it. Most of the people

with BC are very helpful and polite. I would not

go with Kaiser under any circumstances. I have

heard that they will not cover any out of

network, but I do not have personal experience

with them. So that is just hear say. Good luck!

Hope you

get a policy with excellent coverage.

Posts: 399 | From Texas | Registered: Apr 2005 | IP: Logged |

Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707

posted

Thanks so much for the added information.

I will be a much better insurance consumer now [Smile]

Posts: 7052 | From Colorado | Registered: Mar 2003 | IP: Logged |

pq
Frequent Contributor (1K+ posts)
Member # 6886

posted

blue cross

Posts: 2708 | Registered: Feb 2005 | IP: Logged |

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