From Kaiser to Blue Shield: what's a newbie to know?

September 26, 2009 12:44 AM

Going from Kaiser to Blue Shield - what's the transition like? What (not) to expect?

I recently got a job whose employer only has Blue Shield medical plans. Since birth, I've been covered by a Kaiser family plan, but since I'm no longer a dependent child, that is set to expire at the end of this month. So really, other than getting my own insurance, which is kinda dumb when the employer plans are pretty generous, I don't have much choice.

In transitioning to Blue Shield, how different is it from Kaiser? I've done a bit of research, even found this question, but I'm still a bit in the dark about Blue Shield. How easy is it to see a specialist like a psychologist or ob/gyn? What frustrations and perks will I get with BS that Kaiser doesn't have? Can I expect the same quality care I have now?

For reference, I never had any problems with Kaiser, except when my dad's employer changed plans to a deductible version, and even that wasn't too much of a big deal for me. Kaiser even has free classes for things like social anxiety and depression, which I really needed at some point. I never got anything serious like a broken bone or illness worth worrying about. Finally, the fact that Kaiser has that all-under-one-roof convenience meant I could see a doctor then pick up my meds right afterwards - a big plus since I don't have a car and could save a trip.

Anyone went through a similar transition? What are your experiences? Should I go for HMO or PPO (if location makes any difference, I live in San Jose suburbs, work in San Francisco, and hope to move to Oakland by the beginning of next year).

posted by curagea to health & fitness (15 comments total)

When I transitioned from Kaiser to Blue Shield, I was shocked by a few things:

1) No one tells you what doctor to go to, and you have no idea initially whether or not a doctor you see accepts your insurance. So, the burden is now on you to research which doctors you think will be a good fit AND accept your insurance. It kinda sucks. But once you get over the onerous task of researching, it's kinda cool.

2) Lack of a nurse hotline. God, I loved the Kaiser nurse hotline-- they did everything for me. Now all my calls go directly to my doctor's (rather the doctor's aide, probably).

Mostly... Kaiser takes the thinking out of taking care of your health, but Blue Shield requires you to do the front-end research of who to see, how to go about it, and how to pay for it. With the freedom of choice comes the burden of choice.

Think of it like going from a private high school (where the teachers dumb things down, remind you to do homework, etc) to a top-ten public university with 700 kids in your lecture (where the opportunity to excel is greater, but you have to work harder to pass).
posted by samthemander at 2:29 AM on September 26

For what it's worth, in my experience nearly everyone accepts BC/BS. They're huge. Call ahead of time of course.
posted by cj_ at 4:30 AM on September 26

BS (ha) has a site where you can see which docs are in your area. You can select a doctor there, but confirm with the docs office that they accept your insurance when you make an appointment. I also call BS to confirm that said doc takes my plan. Takes notes of who said what at what day/time all in one place. At this point you shouldn't need it, but you'll have it if you do.

Can we please have socialized healthcare already?
posted by cestmoi15 at 5:21 AM on September 26

HMO v. PPO is a big decision and worth doing the research & comparison. In short, HMO's typically offer more complete coverage at very little cost to you BUT all your care must go through your primary care physician, even when you need to see specialist, you must get a referral from your PCP. This can be good/bad depending on what PCP you have & how busy they and their office are. With PPO's you have greater freedom to see a specialist directly which for me is a big plus. Like mentioned above, practically everyone takes BCBS BUT it is more expensive. They also give you an option to see "out of plan" doctors which allow you to see doctors that may not be in-plan, but still not have to pay full price. Also, I know with the BCBS plans we have at work, there are actually two different PPO plans to choose from so essentially, we have 3 options to choose from.

I don't know how Kaiser works, but see if you can get records from your current PCP in order to prep your new one (if your current one isn't in plan).

Good Luck!
posted by SoulOnIce at 6:07 AM on September 26

I'm a little baffled at the sentiment that there's any value to an HMO over PPO besides price. Yes, Kaiser is cheaper, because it's drastically substandard compared to having insurance that will let you choose your own care. You get what you pay for, as they say.

What you can expect is better health care and more choice. I'll eat my hat if there's a doctor you want to see who doesn't accept BCBS.

Anyhow, this page covers your concerns pretty thoroughly. Not that they frame the entire thing as affordability. If you can afford PPO coverage, don't look back.
posted by cj_ at 6:23 AM on September 26

*Note that
posted by cj_ at 6:24 AM on September 26

cj, maybe I wasn't as clear as I could have been, but yes, I meant the biggest value with an HMO is price, especially for those with families. I did have an HMO plan for a year or so and the only other slight advantage is it seemed that the handful of doctors (including specialists) seemed to have greater access to all my records/information but that could be more a function of the nature of how HMO's operate (everything comes from the PCP) and/or the health system I used. Needless to say, PPO, for me, was the way to go.
posted by SoulOnIce at 7:42 AM on September 26

I have just switched and am trying to find a primary care physician. So far not ONE of them has called me back, despite a couple calls. I go into voicemail and that's it. At the moment I'm not sick so it's okay, but I'm a little frustrated.
posted by small_ruminant at 8:00 AM on September 26

I'm a little baffled at the sentiment that there's any value to an HMO over PPO besides price. Yes, Kaiser is cheaper, because it's drastically substandard compared to having insurance that will let you choose your own care.

Do you have a cite for this?

Kaiser is a non-profit that has all of its services in-house. The advice nurse helps cut down on unneeded visits. You can choose your doctor from their doctors- not really sure how this differs substantially from looking at a list of BS/BC physicians and trying to pick one that will see you and not make you wait two months for an appointment. If you don't like your doc at Kaiser, it's very easy to switch because all your records are part of the system. If you have some documentation on how being able to choose your own doctor eliminates "substandard care" I'd like to see it.
posted by oneirodynia at 9:32 AM on September 26 [2 favorites]

One thing I know anecdotally is that a lot of people are unhappy with, and go outside of, their Kaiser mental/behavioral health options these days, and pay out of pocket. Blue Cross/Blue Shield has a pretty massive network of MH providers, or people who they will partially cover as out-of-network providers on a PPO. I think that you'll be able to find a lot of similar (and maybe even better and more suited to you, because of the wider range) MH services, outside of Kaiser.
posted by so_gracefully at 10:29 AM on September 26

It's worth mentioning that not all Kaisers are created equal. My father got malpractice-level bad care in San Diego but pretty good care up in the Bay Area.
posted by small_ruminant at 11:44 AM on September 26

IMHO you are making a huge step up in terms of care when you switch from Kaiser to *anything*. Ugh.

Most doctors accept BCBS. BCBS also has a website where you can search for doctors in their network. I think it still depends on your exact plan, but you probably don't need a referral to see a specialist anymore.

If you're nervous about finding new doctors, ask some friends and coworkers. Most people are happy to share their experiences with you. Hell, I'm sure you can get recommendations from some MeFites!

I find that most doctors have practices in buildings that are near hospitals (and they have privileges at that particular hospital, which means they're affiliated with it and can do surgery there, etc). And there are usually a couple of pharmacies within a block or two of almost any hospital.

If you want that "all in one" feeling of Kaiser, you could look for some doctors at UCSF. They have a couple of different campuses with tons of doctors. They also have some clinics and may have some community classes and such.

For getting your meds, large pharmacy chains (Rite-Aid, etc) have nationwide networks, which is really nice. That way if you run out of something when you're out of town, you can get a refill from the closest branch. A lot of them have pretty comprehensive websites where you can order refills.

BCBS also has an internet-order pharmacy where you can order 90 days-worth at once. This is pretty awesome for meds that you take regularly. They claim that their prices are cheaper but it's usually the exact same for me as at Walgreens, it's just way more convenient. The downside is that if you run out something and aren't paying attention, you can't get your refills as quickly.
posted by radioamy at 5:52 PM on September 26

> Do you have a cite for this?

No, just my completely anecdotal personal experience that Kaiser is awful if you need anything beyond basic care/checkups. "drastically substandard" may be a bit hyperbolic on my part, but perhaps not for those who have had the system fail them utterly, which is, by my (also completely anecdotal personal experience), a lot of people.

You get what you pay for.
posted by cj_ at 8:47 PM on September 26

You get what you pay for.

Considering that between 2002 and 2007 eight thousand Californians were dropped from insurance policies they had paid for, I can only assume this statement is meant to be ironic.
posted by oneirodynia at 12:40 PM on September 27

Blue Cross and Blue Shield are actually two separate entities in California, unlike many other states. Experiences with one won't necessarily translate to the other.

Here is the state quality report card, which you can use to compare plans (for the PPO you have to click through to the NCQA ratings.)

I went in the other direction, from Blue Shield PPO to Kaiser. I don't miss Blue Shield and all of the paperwork and cost a bit. You will have a lot more paper to deal with: bills, notices of benefits, etc. It takes more research to figure out who you want to see, although the number of physician choices seem about the same (for people actually taking new patients.) I had to shell out a lot more money, either at the time of an appointment or when the bill came. I feel that the quality of my care is better at Kaiser, but I am also a relatively healthy individual.

I will say that I don't really like either one of them for mental health coverage. I was never able to find a therapist who I liked who was on the Blue Shield list, so I sucked it up and used my FSA to pay for therapy. I haven't tried with Kaiser, but I don't think it's any better.
posted by gingerbeer at 8:13 PM on September 27