Health Insurance

October 5, 2004 11:51 AM

Health insurance: CIGNA vs. Kaiser Permanente. My employer offers a choice of partially-subsidised HMO plans with either CIGNA or KP. KP seems a lot (about 50%) cheaper, but my co-workers seem to prefer CIGNA. Is there a catch? Are they being snobbish? Are KP bad? Or are they just more efficient because they do everything in-house? I'm assuming that either will be a step up from the provider at the student health centre.
posted by carter to work & money (15 comments total)

the SO and i both had Kaiser in the Wash Metro area in the late 90's. it was inexpensive and we never had trouble getting appointments but without exception every doctor either of us saw was brusque to the point of unpleasantness. neither of us was ever seen within 20 minutes of the scheduled appointment time and both of us found the doctors unresponsive to questions about treatment. thank god he had switched to a private doctor by the time he actually became seriously ill. i'm actually pretty relieved, too, that i had switched to a private doctor by the time i had to have a complicated biopsy.

we didn't have a problem with KP (in terms of getting coverage or appointments or prescriptions) or feel like the doctors weren't competent. it was just the emotional quality of the care, along with the fact that you literally never saw the same person twice, that made the whole experience unsatisfactory.

i can't contrast that to CIGNA, as i've no experience with them.
posted by crush-onastick at 11:58 AM on October 5, 2004

That's a good assessment of Kaiser. The doctors are good doctors, and you get the treatment you need... but it's a little like going to the Department of Motor Vehicles.
posted by 4easypayments at 12:04 PM on October 5, 2004

I've heard people call Kaiser "Doc-in-the-Box", for their fast-food level of service.
posted by falconred at 12:13 PM on October 5, 2004

I can't comment on CIGNA as well but I have been with Kaiser Permanente since 1997. I have a major medical condition and the trick for me was to keep trying different providers until I found one that I was completely comfortable with...and this particular one became my primary care physician (PCP).

Be very vocal and become your own advocate. Once you establish a good relationship with a PCP he/she will send you to other departments if/when you need more specific care. Remember that dealing with these different departments, labs, pharmacies and other parts of the system can be very taxing and can appear to be a huge "cattle call".

You will hear a lot of folks complaining or making bad remarks about Kaiser...and there are some bad stories out there, but my experience has mostly been positive. My SO had terminal cancer and for two years we were treated very well with a wonderful hospice program (except for a few "homophobic" employees at a emergency room we had to go to outside of Portland).

Kaiser is one of the top 10 "best" places to work in Oregon so they do try to keep their employees happy. I have kept Kaiser even though my new employer offers something different. It has been worth it. Another good point is their telemedicine program link. I can email my doc anytime (non urgent) and I get a response usually within an hour...not more than a day.
posted by Jikido at 12:30 PM on October 5, 2004

I've had Kaiser since January (In Colorado) and it hasn't been as bad as I thought it would. My Kaiser internist did find the hypothyroid condition that all my other doctors had managed to miss for 7 years. I was a little dissapointed with the birth center at the hospital. The labor and delivery suite was plush and nice, but nearly as soon as your baby is born, they move you to a dingy, depressing post-partum room. I have been able to get appointments with the same doctors. I even had my regular OB deliver my baby-- although that doesn't always happen. We were able to schedule it that way because I was induced.

We switched because we were finding that BC/BS PPO was getting to be as much of a hassle as an HMO, at three times the price. Before I met him, my husband also had terrible problems with CIGNA messing things up and not paying. They decided his younger daughter did not exist and it was quite an ordeal to prove to them that she did.

All in all, I've been fairly happy with KP. Sometimes I wish I could have had my baby at the nicer birth center that is much closer to my house... but then I think of the $2000 a year we saved by switching. I don't find the bureaucracy too awful, but I've been inured to insane level of medical bureaucracy and sub-standard care by being on Medicaid for years-- YMMV.
posted by Shoeburyness at 12:45 PM on October 5, 2004

Family members who have used Kaiser have told me that it's a great plan as long as you don't get sick very often, or have a chronic condition that needs frequent treatment.
posted by grateful at 1:46 PM on October 5, 2004

If you have a primary care physician who you want to work with and that person is part of the CIGNA network (*and* is accepting new patients), go with CIGNA. If not, I'd recommend Kaiser.

Now Kaiser has different regions and I can only speak about the Northern California region (where we live) and the Colorado region, where my mother lives. I also used to (about 10 years ago) work at Kaiser.

I think Kaiser is mostly terrific, and it really feels good to have a whole medical center at the other end of your insurance card, as opposed to just having a particular doc, with whom you have to negotiate referrals to specialists, etc.

The main thing about Kaiser is that you have to advocate for yourself, but you have to do that with any health insurance company these days. I'd advise you to try to choose a primary care doc as soon as you meet one you like. My mom has had fantastic care with KP, as have my in-laws (who both have chronic health conditions). I also had no complaints when we were KP members. We switched to another company only because there was an internist who my wife had been with for years and we wanted to maintain that relationship.
posted by jasper411 at 1:50 PM on October 5, 2004

I can't comment on Kaiser but I am on my mother's health insurance with CIGNA until I graduate college. I have never had much trouble getting care or covering perscriptions. My younger sister has had to see a few specialists for her throat and everything has gone smoothly. So a positive experience with CIGNA here.
posted by asterisk at 2:09 PM on October 5, 2004

it's a great plan as long as you don't get sick very often, or have a chronic condition that needs frequent treatment.

Isn't this the case with all HMOs though? They are all, by design, "health care for people who don't need health care."
posted by jjg at 3:02 PM on October 5, 2004

My mum works for Kaiser in Portland and she seems to like it there. The management makes an active effort to work with the unions and I think that helps a lot in terms of the level of service and care. Everybody I've ever dealt with there has always been polite and professional. I would say that finding a good PCP is key. As jasper said, you do need to advocate for yourself, simply because of the volume of people who pass through their doors every day. I don't think I ever had a consultation that lasted more than 20 minutes, if that. Care is more than adequate, just don't expect a lot of personal attention.

It's frightful trying to get an appointment over the phone though (I used to wait for 20 minutes on hold). Do the online appointment thing and your life will be greatly simplified.
posted by calistasm at 3:10 PM on October 5, 2004

I'll third and fourth that Kaiser is decent, if not anything special. I got better than decent care there and the copays were decent. I've got United Healthcare now because I wanted to maintain a relationship with my teenage-years primary care physician, but I wouldn't hesitate to go back to Kaiser.
I even had a major healthcare problem while I was with them, and they didn't have any problem treating and testing me as many times as was neccessary to make sure it was gone. I had to go to an urgent care facility during this time and the urgent care doctors were above par and really went out of their way to make sure I was OK, and then to write good reports so the doctors and specialists I saw for after-care were able to treat me thoroughly. I can't say enough good things about the specialists that I saw, either. They were better than just 'good', and they took the time to answer my questions while still working quickly and efficiently. (I asked an opthamologist why she wasn't in private practice, as she was the best specialist of that type that I'd seen, and she said she didn't want to deal with the hassle and management issues with having her own clinc; she just wanted to care for people and continue to learn and Kaiser allowed her to do that.)

One thing that I *have* noticed is that the medications they dispense might be, ah, past their prime, or sourced from overseas. I'm not sure if they're actually expired, but I did get Allegra from them in caplets -- which haven't been manufactured for at least three years, past the shelf life of the drug.

I'll also agree that getting appointments could be a problem sometimes, but there's usually alternate numbers or online methods or other automated systems with no wait time... just ask the receptionists about them if you have a problem.
posted by SpecialK at 4:33 PM on October 5, 2004

I unfortunately lost a very long reply about KP Northern California, and I'm loathe to retype it, but my salient points are:

It's nearly impossible to get an appointment in a timely manner. In one case, I was jerked around for nearly two years for voluntary routine minor outpatient reproductive snip-snip surgery due to administrative fuckups.

I almost always leave every contact I have with K-P feeling frustrated, screwed, or ignored. In one spectacular case, I had a doctor refuse to give me a diagnosis or prognosis while offering me an unwanted scrip for Vicodin to make me go away.

The emergency rooms -- where patients are pushed to go for even the most minor urgent problems, since they're almost always incapable of scheduling office visits -- are appalling. They are dirty, poorly run, and there are typically delays of several hours before you get in front of a doctor.

The reason I now avoid seeing a doctor for any but the most critical of situations is because K-P is such an enormous pain in the ass.

They seem to double the copayments every year or so. What was a $5 copayment a few years ago is $20 per visit. This copayment is charged even if you're just popping in to get test results or something equally mundane.

The only reason to go with K-P is if you never, ever, ever need routine health care, but you'd like some coverage for heinous health disasters. They seem to go out of their way to make it difficult to interact with them on a routine basis.
posted by majick at 5:47 PM on October 5, 2004

Having KP is like going to trial with the same person acting as judge, jury, and executioner. Fraught with conflict of interest. It is very like using the Veterans Administration hospitals.

At some point you may catch them making diagnosis on the basis of what they wish to pay for, not on a sound medical basis. This is a Very Bad Thing.

It is very wise to question WHY, in medical care, all ideas of conflict-of-interest rules no longer apply, or ideas of consumerism--While at the same time, costs continuously rise at highly questionable rates which bare no resemblance to the rest of the cost of living.
posted by Goofyy at 11:24 PM on October 5, 2004

For the last year, KP has been refusing to pay for a drug that my best friend's 4 year old daughter needs, which was prescribed by a KP doctor. The drug in question is extraordinarily common for adults, something you see fifteen commercials for every day. It's also FDA approved for pediatric use. However, for the child's diagnosis, KP will only pay for drug that happens to not be effective, isn't FDA approved for pediatric use, and isn't something doctors, including their own doctors, would ever prescribe for a child for those two (I think quite good) reasons.

As a result of KP's refusal to pay for this common script for this child, my friend has paid more than $2,000 out of pocket to buy the drug instead of $120 in co-pays. (To say that this has been hard on the family, financially, is a woeful understatement.) The decision is supposedly in some sort of "appeals process." My friend is sure that one of two things will happen before KP decides to pay for the drug: the family will have moved on to a better insurer or the child will have her own insurance converage through her own job.
posted by Dreama at 10:06 AM on October 6, 2004

Belated thanks, everybody (these things go off the front page quickly!). I think I'll get KP for the rest of 04 and test them out on a few things and if I don't like them go for CIGNA in 05. Once again, many thanks!
posted by carter at 12:41 PM on October 6, 2004