Which health plan should I choose?

October 10, 2013 4:23 PM

I'm allowed to choose a health plan through my employer. Out of the nine options, I've managed to narrowed it down to five. Scanning through the comparison chart, they all look about the same. They all make you choose a primary care physician and coordinate everything through her or him. Copays are about the same. Premiums vary within $20/month or so. Does anyone have any experience with any of these? Any strong recommendations or dire warnings?

The five best options appear to be...

(1) Anthem Select HMO

(2) Anthem Traditional HMO

(3) United Health Care HMO

(4) Blue Shield NetValue HMO

(5) My current one -- Blue Shield Access+ HM0

It's generally been OK. No major problems.

The only issue is that I hit a rough patch a few years back and wanted to see a therapist. At that point it became a real nightmare. Blue Shield makes you search on their website to obtain a list of covered docs using an incredibly clunky and awkward search function. Then they expect you to call each one in turn and ask whether he or she is accepting new patients. In general, they aren't.

And you're supposed to do all this at the exact moment when you're perhaps not in your best form and less-than-optimally equipped to cope with a major research project.

After a dozen or so calls and being told not accepting patients, I just asked around among my friends, found someone that way and paid cash.

It isn't really an issue now, but if better therapist coverage were available I would weigh that.

posted by trevor_case to Health & Fitness (12 answers total)

Do you have any preferred doctors or hospitals? If so, you should check out the networks for these plans and see what's included (and what kind of costs you're looking at if you go out of network). Even if you don't have any doctors you ever want to see again, it's still worth looking into the relative sizes of the plans' networks to see how limited your options may be.
posted by zachlipton at 4:35 PM on October 10, 2013

Don't do United Health. They just suck generally.
posted by valkyryn at 4:51 PM on October 10, 2013 [5 favorites]

I think the process for seeking a therapist is the same under United Health Care. (I can't remember if I was dealing with it through an HMO or a PPO, but I remember it being as you describe with Blue Shield.)
posted by Terriniski at 4:52 PM on October 10, 2013

The current (November 2013) issue of Consumer Reports has ratings of health insurance plans by state. The data comes from the NCQA, which is the National Committee for Quality Assurance, which is a non-profit. That's where I would look.
posted by orange (sherbet) rabbit at 5:00 PM on October 10, 2013

Are any of the 4 you didn't list PPO plans? I would never do a HMO by choice. They are cheaper for a reason. You trade flexibility for the cost savings. If your primary doesn't think you need to see a specialist, you don't get to see a specialist. And the primary docs are encouraged to minimize referrals to specialists.

BTW, just so you know Anthem = Blue Cross, or at least it does in VA.
posted by COD at 6:22 PM on October 10, 2013 [2 favorites]

i would choose a PPO. i had an HMO once and it were just horrendous. if you get seriously ill they can horribly screw up your care. when one is ill you need the very best doctors you can afford as it makes a tremendous difference. you may be perfectly healthy now but if you get in an accident you will want top doctors.
posted by wildflower at 7:08 PM on October 10, 2013

it *were just horrendous

*was
posted by wildflower at 7:26 PM on October 10, 2013

"The current (November 2013) issue of Consumer Reports has ratings of health insurance plans by state. The data comes from the NCQA, which is the National Committee for Quality Assurance, which is a non-profit. That's where I would look."

The same data is also available free on their website.

HealthLawHelper.org - Insurance rankings of 987 plans - How to find a "best value" plan - In-depth feature from the print edition
posted by Rhaomi at 8:33 PM on October 10, 2013 [1 favorite]

I have United Healthcare as an HSA. I've had no problems. I had them in the past as a PPO and they were pretty great.

With any US Healthcare option there will be an element of hassle, that's just the nature of the beast. So if your current provider is giving you good service, I'd stay with them.

Unless there's a super-compelling reason to change, staying with your existing company is the easiest thing you can do.
posted by Ruthless Bunny at 5:54 AM on October 11, 2013

You might be able to log on to the websites now (before you are a member) and search through their provider directory to see if you like how it works. You might also be able to find out their procedures for finding a therapist - if it's not on their website, you can call and ask them how it works.

FWIW, what you described is the only way I've ever found a provider, and I've had 9 different healthcare plans over the past 3 years. I'm not sure if any company has a better plan than just "use our list and call to see if they will take you", although some plans might have that datapoint as one of the columns in their search results (though it wasn't always accurate).
posted by CathyG at 7:41 AM on October 11, 2013 [1 favorite]

(FYI for if you go with Blue Shield, when I search for a provider on their site, there is a checkbox on the left which allows you to only get results from doctors who are taking new patients.)
posted by thatone at 8:51 AM on October 11, 2013

I don't know if any health care provider has good mental health coverage. I had the exact same experience with Blue Cross HMO in Louisiana. I think it's designed to make you give up!
posted by radioamy at 9:42 AM on October 11, 2013 [1 favorite]