California: Kaiser or United Health Care ppo?

esther7

Mon, Jan 29 2024, 12:29 am

It probably depends where in California you are...
But in general, kaiser is a more unique arrangement.
I haven't heard of UHC, but afaik many drs will take a PPO plan.
Kaiser is their own network and have almost any medical professionals you need in house,and their own hospitals. very rarely will outsource you out if they don't have that specialty. Which has advantages and disadvantages... Do you have anyone IRL you can speak to about them? I don't know if I'm knowledgeable enough to give you the full scope of the answer, including the advantages and disadvantages of each

amother

Mon, Jan 29 2024, 12:53 am

amother Mintgreen wrote:

Who are your doctors? Or are you new to CA? Personally, I would only go with an insurance plan that Cedars Sinai will accept.

I’m new to California. Why is it important that cedars Sinai will accept the insurance. If it is a ppo is it for sure accepted by cedars Sinai?
I need to call tomorrow and ask them.

amother

Mintgreen

Mon, Jan 29 2024, 1:14 am

amother OP wrote:

I’m new to California. Why is it important that cedars Sinai will accept the insurance. If it is a ppo is it for sure accepted by cedars Sinai?
I need to call tomorrow and ask them.

Are you in Los Angeles? As a previous poster said, Kaiser has a very unique arrangement. Cedars Sinai is the top hospital and that’s where you’ll usually find the good doctors. If you choose an HMO or a medi-cal plan you will be very very limited in who you can see. In the tri state area you find frum doctors who take Medicaid, Fidelis etc. You don’t have that here.
It’s probably best to speak to an insurance agent who is knowledgeable about the frum community here and the local doctors.

amother

Mintgreen

Mon, Jan 29 2024, 1:25 am

OP, I’ll give you an example. My child and a friends child had a similar serious injury a couple of months apart. We were in cedars, my friend was in Kaiser. We were given superb emergency care, surgery the next morning with the top pediatric surgeon and amazing follow up care. Our pediatrician is affiliated with cedars and was in touch the entire time both with us and the hospital. His support was invaluable to us! Made a stressful time a lot easier.
My friend on the other hand, was not happy with the care at Kaiser, felt they messed up and even paid privately to switch to another hospital to make sure that her child was cared for properly. Kaiser also opened a CPS case on them to investigate for abuse. This was a typical toddler accident. No abuse in that home at all. They stopped using Kaiser after that.

Amarante

Mon, Jan 29 2024, 9:30 am

If your child is in Europe, it is unlikely that your medical insurance will cover him - whether PPO or HMO except treatment for an emergency. You need to get insurance in the country he is a resident of.

In terms of Kaiser versus a PPO, it really depends on the details of the plans which you haven't provided. What is the cost - what are the co-payments - what is the deductible - what is the annual out of pocket cost.

Kaiser is a true HMO. You go to a central building for treatment. The care can actually be quite good and I know many people who are pleased with it because it simplifies things although it can be a bit bureaucratic of course. In general it is less expensive.

A PPO means that there are certain doctors in the network. Often networks are limited. There are also issues when a doctor isn't in the network and you find out only after you have been there because you didn't get accurate information. With Kaiser, you don't have to worry about that because all of the Kaiser doctors are in the network and also if they prescribe a test or whatever it won't require pre-authorization or be performed by an out of network facility.

But really it depends on the cost and how you like to access medical care.

If you hate what you have, you can change during your company's next Open Enrollment.

amother

Mon, Jan 29 2024, 6:18 pm

Amarante wrote:

Thank you

amother

Celeste

Mon, Jan 29 2024, 6:34 pm

UHC is not usually limited to California. Kaiser is pretty much only in that part of the country. You mentioned a son in Europe, it wouldn’t cover that but if you have other kids going to learn or live in other US states it should cover them there. Check your plan to double check that it’s not state specific.

amother

Electricblue

Mon, Jan 29 2024, 7:49 pm

amother Celeste wrote:

UHC may have plans in other states but they likely would not cover you out of state.

PPO means no referrals generally needed and has a wider selection of covered doctors. I would look to see what the UHC covers. We like Cedars but UCLA is also decent.

Kaiser- as explained above have a unique set up.

My work gives me Kaiser but I won't use them and joined my family plan (through DH) so I wouldn't have to use it. You get what you get. Bureaucratic. Hard to get referrals from what I have heard from others. You can't just go to any urgent care- only their urgent care.

Amarante

Mon, Jan 29 2024, 7:53 pm

amother Celeste wrote:

Almost no plans provide coverage out of the state of your residence.

The only exception is a medical emergency where you are treated until medically stable to be released.

There are a "names" in the insurance business like BC, BS, Anthem, Aetna etc. but they generally operate only within the state of the residence because they set rates and have contracts with doctors in that state.

Also plans even with the same carrier can differ greatly including having different networks. So people asking about coverage of Aetna are asking a meaningless question because each Aetna plan may be different.

Also large corporations are often self insured even though you deal with a major insurance company. The company hires them solely for administrative functions but the company decides the terms of the coverage they will ever - so long as it is ACA compliant.

amother

Celeste

Mon, Jan 29 2024, 8:40 pm

Amarante wrote:

Insurance plans from employers many times are not state specific. Especially if the office is near other states and has commuting employees. Maybe less common in LA than say NYC but worth finding out instead of making assumptions.