Kaiser, Blue Shield, or Cigna HMO in Northern Californai?

September 5, 2008 3:53 PM

In Northern California, which is the best: Blue Shield, Cigna, or Kaiser (All HMO).

I just started a new job (San Francisco) and get to choose from these three. I had a blue cross/blue shield PPO on the east coast, but I know they often vary by state. It seems like this question hasn't been answered for a bit, so what has people's experiences be.

Also, they will all cost the same, so that is not an issue.

posted by names are hard to health & fitness (11 comments total)

Well.... it depends.

Kaiser is a network of hospitals, outpatient clinics and doctors that all work for Kaiser- no private practice. Kaiser's pros are that wherever in the network you are, as long as you give them your medical record number, they can bring up your records, so there's none of the red tape in going from one doctor to another. There are also advice nurses, prescription services, etc. It's one-stop shopping. Cons- if you end up in the emergency room of a non-Kaiser hospital, expect to spend a ton of time trying to get anything non-Kaiser paid. You may even have to pay out of pocket and fight Kaiser for reimbursement. There are some newer procedures that are paid for by most insurances, but Kaiser deems "experimental". They don't have a lot of what I call "super specialists" so if you come down with a rare disease, don't expect Kaiser to have a doctor on staff that treats it- more red tape for you. The doctors that work for Kaiser are employees and are bound to Kaisers rules regarding treatment. Kaiser used to have a bad reputation- treating people like cattle, etc, but from what I understand, they're better now.

Blue Shield and Cigna HMO's for your purposes are probably going to be the same. Where I am in, south of SF, if you have an HMO, you choose a medical group and all of your services go through them. Cigna/Blue Shield pays the medical group a stipend for your care, and their job is to make sure you require less care than the stipend covers so they can make some money. Everything you do will go through your Primary Care Physician (PCP). If you need a specialist, you will have to be referred to one through your PCP. Pros- most of the doctors are private practice, so they have a little more leeway in treatment options. Depending on the medical group, if you have to go outside the group for treatment, your doctor can talk to the medical group and get it approved in advance, so it's paid. Cons- unlike Kaiser, there's no one-stop. You don't walk across the hall from your PCP to the Cardiologist. You need to get a referral and call and make an appointment, and drive to another office, similar to when you had a PPO. You have to be more of an advocate for yourself. You need to make sure that all of the doctors you see are in your medical group's network or you'll end up paying out-of-pocket. You'll have to ask again and again "do I need a referral for this" whenever you are sent anywhere other than your PCP. If you need blood drawn, you'll need to make sure that the lab they send you to is in-network.

There are pros and cons to each obviously. You need to figure out what's best for you in your situation. Now for the disclaimer part- I have never worked for Kaiser, but they were my insurance for the first 18 years of my life, and my Dad still has Kaiser. I have worked in the administrative side of medicine for the last 18 years, and I have worked with many, many local HMO medical groups. If I can answer more questions for you, please me-mail me!
posted by dogmom at 5:35 PM on September 5, 2008 [1 favorite]

dogmom beat me to almost all of it.
If you are relatively healthy, spend most of your time in SF and expect to remain so, and would appreciate the conenience of one-stop shopping, then Kaiser is a good fit. I had Kaiser from 1995-2000 and they took good care of me, regardless of "cattle" stories I'd heard from others.
As already said, Kaiser saves money as an HMO by putting everything under one roof - I never said I was headed to the doctor, pharmacy, hospital, specialist, etc; I just was "going to Kaiser", since it was all basically one building/campus. All in one place. But Kaiser isn't everywhere like Blue or Cigna, so it can be trickier if you do a lot of traveling, etc.
With the others like Blue/Cigna, doctors all over the place become part of their networks, so there are far more choices of doctors, geographic areas, etc. That can be a real benefit if you don't have a consistent home base, are very choosy about your care and your providers.
Things are made easier at Kaiser by keeping things in-house, but it means you don't really have access to a vast network of specialists to choose from - if you need a podiatrist (random choice), you're going to see a Kaiser podiatrist, and if there's only one, then that's who you see.
On the other hand, you don't get the "gatekeeper" problems you get with the others. If your Cigna doctor doesn't think you really need a podiatrist, you'd have to fight to see one, and may not win; whereas you could walk right into Kaiser and show them your card and ask to see a podiatrist, and if one's available, you're in. And Kaiser docs seem to be on salary, as opposed to being paid by the head as in other systems - I was often treated better by Kaiser docs who weren't worried about proce$$ing as many patients as possible in a day as I have been with my current Blue Cross.
If you go with one of the others, just make sure to get a really good PCP, since they're going to be in charge of all the care you get.

Oh, and one note that may discredit all my information - I was in my early 20's and I was influenced by the fact that "Kaiser Permanente" totally sounded like a supervillain - I enjoyed a giggle at imagining that it was all run by an immortal dude made of bronze with a handlebar mustache and a pointy helmet.
posted by penciltopper at 6:04 PM on September 5, 2008

I've had Kaiser Permanente for the past seven years or so, because it was the only coverage provided by my job at the time. My employer has since offered a range of other HMO and PPO options, and I've decided to stick with the same coverage, largely for two reasons. One, it's cheaper than hell. Two, it's really easy to get in if you need something. With my old private insurance, if I had something wrong, I'd have to really exaggerate my symptoms over the telephone in order to get seen in a reasonable amount of time. With Kaiser Permanente, I can get seen on the same day for minor complaints, even on weekends or holidays. Moreover, had an ultrasound recently for something minor that was nonetheless freaking me out something terrible; in similar situations with my past insurance, getting a test like that scheduled took weeks. Kaiser Permanente got me in the following day, with no hassle or begging required. For someone like me who is prone to occasional bouts of hypochondria, this was immensely helpful.
posted by infinitywaltz at 6:56 PM on September 5, 2008

BCBS is BS, personally. I had their Tonic program which started at $35 a month for "full" coverage that basically covered absolutely nothing. Within six months, the fees for the coverage were at $163 per month without notice. It hit the fan when BCBS announced by mail (and I think a lot of people got this letter) that to continue the service they asked all Tonic subscribers to pay up front for the next six months of insurance.
posted by parmanparman at 7:11 PM on September 5, 2008

I can tangentially help. I'm in the bay area (Welcome, btw!) and I've had Kaiser, and now have Blue Cross PPO. I changed programs when I changed jobs.

Under Kaiser I dealt with some biggish medical issues (motorcycle accident/surgery) ER and outpatient stuff. They were fine. Only on occasion would I get a cattle-car feeling. I never really dealt with them on a check-up/ongoing health maintenance basis because I hate going to the doctor.

Now I have BC-PPO and it seems fine as well. I'm in the process of finding a doctor and acting like an adult about getting checkups, but I have noticed that a lot of the docs I was looking into WON'T take Blue Shield for whatever reason.

If I were you, I'd go with Kaiser and sleep easy, but you may want to check out what doctors are available under the blue shield program.
posted by gofargogo at 8:07 PM on September 5, 2008

I was a Kaiser member for a while, and unfortunately had to give it up and switch to Blue Cross.

Apparently to many people, BCBS is a step "up" from Kaiser, but I didn't think so. At least at the point in my life when I was using Kaiser, it worked very well for me. There wasn't any screwing around, trying to find a local doc who was taking new patients — when I signed up with them, they gave me a doc at a local clinic, end of story. They were efficient as hell with lab work (virtually no waiting in lines or being shuttled from place to place), and I never felt like my time was being wasted when I dealt with them.

Their records management was also pretty cool. Everything was electronic and web accessible if you wanted to see it. It really cut down on redundant "tell me what the problem is again..." questions, too. (Anecdote: had a throat infection one time, so bad it was agony to talk. Had a friend call up and make the appointment, and then went over to the clinic. From that point on, nobody ever asked me what the issue was again. The information from the call got propagated to everyone in the clinic, from the receptionist to the nurses and MDs, and all I had to do was show my ID card. Brilliant.) It squicked me out a little that all that info was — and probably still is — sitting in a database somewhere, but it really worked well. I can only hope they know what they're doing as well as they appear to.

My time with Kaiser was one of the few periods of my life where I actually bothered to go to regular GP checkups; since switching to BCBS — where you're expected to bring your own physician, or at least find one — I've never bothered. If I had to pinpoint the difference, it's that Kaiser felt like a healthcare company; BCBS feels like an insurance company.

Of course, the downside to all this is that if you already have a doctor you want to use, Kaiser probably won't cover going to see them. But if you don't care about that, and if you can stay in-network for everything, I'd recommend them.
posted by Kadin2048 at 10:00 PM on September 5, 2008

I know nothing of Blue Cross or Cigna, but Kaiser in northern California terrifies me. If you are healthy, they seem to do okay with preventative medicine, but...

...from the brother-in-law who went in with a compound toe fracture that the nurse missed, swabbing his foot with alcohol and trying to get him out the door...

...to the best friend who had his chest cracked for reconstuctive surgery and then had the nurse refuse to give him anything but tylenol when his anesthetic wore off, forcing him to call his doctor, at home, at 2am to get permission for the meds he was supposed to have...

...to the aunt who was told by her Kaiser OBGYN that she didn't need mammograms until she was 55, who is now in the advanced stages of breast cancer...

...Kaiser just seems like risky business. Granted, I'm not in San Francisco, I'm an hour north, so your results may be much better. My boss will pay for Kaiser or for most of HealthNet coverage up here. I'm happy to pay the difference.
posted by Phineas Rhyne at 11:04 PM on September 5, 2008

If you're in California and trying to choose between HMOs, you're much better off than most people; the state of California invests pretty substantial resources (compared to most other states) in getting non-biased information out about the quality of each HMO to help consumers choose which company to go with.

You should spend some time surfing around the 2007 HMO report card, put out by the California Office of the Patient Advocate. These ratings are based on 2 types of measures that are used nationally to measure "quality of care"--the first being the percentage of all people in that plan who receive what experts call the minimum standard of care for a specific disease or condition (for example, the percentage of pregnant women who had at least one prenatal visit in their first trimester), and the second being how patients themselves rate their health care plan in large surveys (for example, how many said they get care quickly when they need it).

As you can see there, Kaiser is more highly-rated than either Blue Shield or Cigna on both measures. You can investigate specific measures that are particularly important to you by clicking on those links on the right side of the report card.
posted by iminurmefi at 6:16 AM on September 6, 2008 [2 favorites]

BCBS is BS

Note that Blue Cross and Blue Shield aren't the same in California.

Blue Cross California is a for-profit company associated with the Anthem/Wellpoint. Blue Shield California is a not-for-profit founded by the California Medical Association 70 years ago. My experience pricing between the two bears out the difference -- BSC was more competitively priced in nearly every kind of plan, and had similar or better ratings, if I recall correctly.

You should spend some time surfing around the 2007 HMO report card, put out by the California Office of the Patient Advocate.

That's awesome, iminurmefi! I hadn't seen that earlier this year when I was looking for information, and I'm amazed that the state department of insurance didn't tell me a thing about it when I called them looking for information earlier this year.

I'm somewhat surprised to find out HealthNet apparently measured higher on standards of care and satisfaction than anybody but Kaiser, and they definitely had one of the most price competitive HSAs available...
posted by weston at 10:17 AM on September 6, 2008

weston--the only problem with the report card is that it's exclusively HMOs. So if you're looking at a PPO or high-deductible plan + HSA or any other non-HMO flavor of insurance, you can't necessarily assume that the company with the top-rated HMO also has the best type of plan you're looking at.

It's too bad, since my impression is that people tend to shop across insurance types, and of the people who restrict themselves to one type, it's much more likely to be that people want anything-but-HMO rather than HMO-only.
posted by iminurmefi at 3:20 PM on September 6, 2008

Thanks everyone for the great information! I think I'm going to go with Kaiser for the "ease" factor, but hopefully I won't run into some of the problems with them discussed here. Thanks again--this has been a great help.
posted by names are hard at 12:51 PM on September 7, 2008