Help me find the Rolls Royce of health insurance in the SF Bay Area.

April 2, 2013 9:05 AM

I'm talking the absolute BEST, at any price.

After some astonishingly bad care at Kaiser, hubs and I are looking for new, super awesome health insurance. We're looking for individual coverage and we want:

-no month-long run-around to see a specialist (derm, psych, etc.)
-awesome doctors who are accepting new patients
-no 40+ hours on the phone trying to resolve an $800 bill that should have been covered (Blue Cross nightmare from years ago)
-mental health coverage
-maternity coverage (including midwives if we choose to go that route)
-prescription coverage
-anything else important I'm forgetting

Does this exist? Is it a combination of plans? Help!

posted by tealcake to Health & Fitness (17 answers total)

Best answer: All insurance is going to be a hassle.

The Rolls Royce would be to do a high deductable HSA, put your own money into an account and use that for your day-to-day regular stuff (bascially paying out of pocket for your regular healthcare with untaxed dollars). No paperwork, no hassle, all doctors accept cash.

Having coverage for catastrophic coverage will take care of everything else at the other end of the spectrum.

The idea is that you have tens of thousands of dollars in a bank account that you only use for medical expenses.

It's a very different way to look at health care expenses, but it's darn powerful when it's your own money you're spending, and you become pretty vigilent about how you want to spend it.

My HSIA covers Well-Woman, one complete Annual Physical and Mammograms. Beyond that, I pay with my HSA money. I spent $4000 last year on a medical issue. Now I'm restocking the fund.
posted by Ruthless Bunny at 9:13 AM on April 2, 2013 [1 favorite]

There are doctors who maintain "concierge" practices, and don't take health insurance at all. For those who can afford it, it is an end to insurance bureaucracy. I know of a GP who charges a monthly retainer, but you are guaranteed an appointment when you need one, she will make house calls, the whole nine yards.

If that sounds possible, it might be worth doing the math and getting a catastrophic policy for the major stuff, and going out of pocket for the routine stuff.

Individual coverage can be very difficult to obtain, at least until next year.
posted by ambrosia at 9:15 AM on April 2, 2013 [2 favorites]

I would start by finding a doctor you like who is accepting patients and seeing what insurance they accept. Great insurance isn't helpful if the doctor you want doesn't take it.
posted by cecic at 9:16 AM on April 2, 2013 [1 favorite]

People who want the absolute best, at any price, generally avoid the routine medical insurance path, which is typically a way for folks to get services when cost definitely is a factor.

The HSA may be a way to go. But this route may be in flux with health care reform.
posted by 2N2222 at 9:24 AM on April 2, 2013

I will agree that the "at any price" answer is to pay cash.
posted by ThePinkSuperhero at 9:29 AM on April 2, 2013 [1 favorite]

Best answer: This is not an insurance company, but it will help with your first two criteria:

http://www.onemedical.com/sf/doctors

Basically you pay an annual fee to "subscribe" to a group of doctors who can guarantee same-day appointments, referrals to specialists, and multiple locations in the Bay Area.
posted by pocketfullofrye at 9:39 AM on April 2, 2013 [3 favorites]

no 40+ hours on the phone trying to resolve an $800 bill that should have been covered (Blue Cross nightmare from years ago)

Things like this statement negate the "at any cost" qualifier you've given. Every single health plan in the world allows you to not spend 40 hours on the phone trying to save $800 for an extra $800.

How much money are you *actually* willing to spend? Clearly it is not "infinite".

I have a plan with Blue Shield through my employer that covers anything I want at any doctor I want to see (I have never seen a doctor that would not accept Blue Shield, and I could submit a claim myself even if I did). It costs me about $140/month for two people. That's because my employer pays for most of it. And you probably can't get it unless you happen to work for my employer. Is going to work for a company that offers excellent health coverage inside the scope of "any cost"?
posted by tylerkaraszewski at 9:43 AM on April 2, 2013 [4 favorites]

I have United Healthcare HSA. So I have a formulary for prescription drugs, I can see any specialist that's in-network without hassle, there are agreements and arrangements for reduced fees for labs, imaging, etc. (I paid a bit extra for the 3-D imaging on my mammogram.)

So I have the purchasing power of a large insurer, but I have the discretion of someone who's spending her own dough.

I'm very pleased. I wouldn't have selected this, but it's the only option my employer has.
posted by Ruthless Bunny at 9:51 AM on April 2, 2013

Concierge doctors (at least the practice that I am familiar with) does take insurance, and insurance pays for all the tests they order as well as procedures, prescriptions etc. It's a nice service that you pay to access, in addition to insurance.
posted by halogen at 10:09 AM on April 2, 2013

Best answer: I think what you want is a solid insurance plan that covers standard things like office visits, lab tests, emergency care, etc. Get the best PPO that you can find. Then ALSO get a concierge doctor (maybe get them first and find out which plans they work with, surely they have opinions). Having a great concierge doctor means avoiding waits for appointments, delays in care, etc. So from the sounds of it you want a really great in-office experience and that's (theoretically) how you get it. Insurance is sort of the layer underneath that and if money is no object then anything the insurance doesn't cover (that gap between the basics and super catastrophic situations) you pay for out of pocket.

Also, I have regular old Blue Shield HMO via my employer and I do all my medical care, except the dentist, at the Palo Alto Medical Foundation and my experiences there for the last 10 years have been excellent (with one urgent care exception, but I complained and I understand there was some disciplinary action taken). They have a new concierge office attached as well.
posted by marylynn at 10:16 AM on April 2, 2013 [1 favorite]

The "Rolls Royce" also reminded me that PAMF has an Executive Health department. How that works is... kind of mind-boggling. But short of a personal physician that might be it.
posted by marylynn at 10:19 AM on April 2, 2013

Yes, if cost is really not a consideration at all, then find the best GP you can and whatever specialists you'll use regularly (ob/gyn, urologist, etc.) and pay cash. Maybe get a hit-by-a-bus insurance plan in case you get hit by a bus.

(re: your bad experience at Kaiser: anyone who has had been on any insurance plan for more than 10 minutes can probably tell you a horror story that happened to them or a friend on whatever that plan is, so please don't use that as your main way of deciding to switch!)
posted by rtha at 10:24 AM on April 2, 2013 [2 favorites]

This may not meet all of your needs, but I have a friend in the Bay Area who swears by this doctor and his concierge service.

She wrote: "My primary care doctor offers a "premium membership" -- I pay a yearly $400 fee (for the whole family), and he makes himself available 24/7 by email or direct phone. He will prescribe by phone or email if the need is clear. He even makes house calls if needed.
Premium membership is probably the best money I've ever spent."
posted by donovan at 12:05 PM on April 2, 2013

High deductible indemnity plus HSA and concierge subscriptions are only going to get relatively better under full implementation of the ACA.

The tax benefit of HSAs is being reduced slightly but the indmenity umbrealla is going to get more attractive because high deductible plans won't attract many of the people with pre-existing conditions whom low-deductible plans will have to cover. With the expansion of coverage the delays for appointments at non-concierage practices could get truly terrible.

Expect to pay up for the maternity coverage you want, but be glad you plan to have a kid -- women of childbearing age are charged as if they are going to have a kid even if they don't plan to do so!
posted by MattD at 12:47 PM on April 2, 2013

PPO's have all that freedom. You don't even need referrals, you just call up a specialist and go see them. Hell you don't even need to have just one doctor, you could see a new one every time you have a problem.

Mind you, the policies usually cost well over a grand per person - per month, and their are high copays and deductibles.
posted by couchdive at 2:45 PM on April 2, 2013

HSAs are like paying cash (till you hit the deductible limit, if ever), but at insured prices (you know docs charge more to the uninsured, right?). Also tends to be less hassle over "is this covered?" because the insurance company isn't paying for it, just charging it against your deductible.
posted by rikschell at 6:17 PM on April 2, 2013 [1 favorite]

Seconding One Medical. That + a standard Blue Shield policy gives me most of your list, including midwives, specialists, etc.
posted by judith at 12:37 AM on April 4, 2013