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Change is never fun - new changes at my husband's company

klpca

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So my husband's company just went through a merger and slowly the changes are being rolled out (all start in 2020). Vacations got better - he went from 3 weeks of PTO to 4 weeks, which was better that I hoped for and very much welcomed. Then we found out yesterday that our health insurance is changing from Kaiser HMO (which we love) to either Cigna PPO or 2 high deductible plans, also through Cigna I believe.

I have Rheumatoid Arthritis and in the past three years my husband has been treated for stage 3 cancer and had to have a stent placed in his heart after discovering a 90% blockage on the widowmaker artery. It's been a health roller coaster for sure, but one thing that we haven't had to deal with is bills. Since Kaiser is kind of self contained we never see any bills. Our former medical provider (local group called Scripps) was a nightmare with billing/insurance. I am an accountant and even I had trouble unraveling their billing errors, and we were dealing with vanilla medical issues at the time, so I can only imagine what it would have been like if we were dealing with hospital stays and complicated medical procedures.

I am sick about this change. We have to choose a new medical group, find new doctors including specialists, and pray that they will let us continue the same medications etc. Kaiser was so efficient - they had locations all over our county, each clinic had an in-house pharmacy, and their online portal was excellent. I have never been so happy with a health care provider before and I am so bummed to have this taken away. I've spent some time looking around today. Every group seems to be concentrated in a specific local area so my healthcare provider can be near our home, my husband's office or my office, but nothing is convenient to all three.

And with respect to the merger, we haven't even gotten to the 401(k) details, and of course, there is always the worry that the local site could be combined with another location.

Oh well, I am sure that I will get over this, but man, I just wish that the new company could have kept Kaiser as an option.
 
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VacationForever

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Katherine, I know how stressful it is to change from a HMO, all-in-one provider, to the strange world of PPO. We were on Kaiser Norcal for about 18 years and entered a choose your providers world when we moved out of state in 2016. We stressed about it for 6 months after our move and then realized that we never want to move back into a HMO system again.

While Kaiser was excellent with their 24-hr hotline and online application system - email and medication refills, and we both had the best PCPs, we had horrible experiences with their specialists. I have serious medical issues where their specialists either wrote me off or specialists who attended to me that were simply incompetent.

Now we love our PCP and specialists. One of my medical issues was so serious that each night I wished that I would not wake up the following day. Kaiser over medicated me on tier 1 drugs, prescribing 12 times the FDA guidelines on dosage and medications because they had no clue what to do with my condition. Kaiser also put me on narrowband UV phototherapy 3 times a week which did not help one bit. Another medical issue was never addressed because the specialist simply refused to see me and bounced me back to the PCP.

My medical issues have now been addressed by specialists here where for the one issue, I was taken off all medications prescribed by Kaiser and I was prescribed a Tier 2 drug which provided me with instant relief. I went from 1 to a 9, 1 being lowest and 10 being the highest on a quality of life scale for that issue.

I know it is scary to step away from a one-stop-shopping system but it will be fine. All the best!
 
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CalGalTraveler

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Sorry to hear about this. I understand your concerns. We have Kaiser and they are awesome. I hope we never lose them because they are far less expensive than the PPOs.

We had a family member who had an unexpected illness with life-threatening medical complications. Multiple and months long hospitalizations to recover. I was relieved that we didn't have to worry about the bills and could focus on supporting the family member's recovery. This ordeal probably cost Kaiser a million dollars but there were no questions asked. It was money well spent because that member is now leading a normal productive life.

I realized that one of the biggest differences between Kaiser and the big insurance companies is the business model: The doctor leads the decisions at Kaiser. In our case we needed to try a treatment for our loved one that required 3 days of IV administration via hospitalization and is not the lowest common denominator of acceptance and cost. Easier decision for Kaiser because their hospital staff and facilities are already paid for and fixed so all they really needed to pay for was the medication.

The insurance companies find 100 reasons to deny because they have to pay hospitals cash. So they decide, not the doc. And I was told by a doc at a 3rd party facility which Kaiser had to pay for special treatment that if we were covered by one of the PPOs they would have booted our family member out of this facility prematurely. None of this would have never been approved without a serious fight with insurance. Our loved one may never have recovered without this.

Of course YMMV but our first-hand experience was positive.

Hope this works out for you.
 
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klpca

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Katherine, I know how stressful it is to change from a HMO, all-in-one provider, to the strange world of PPO. We were on Kaiser Norcal for about 18 years and entered a choose your providers world when we moved out of state in 2016. We stressed about it for 6 months after our move and then realized that we never want to move back into a HMO system again.

While Kaiser was excellent with their 24-hr hotline and online application system - email and medication refills, and we both had the best PCPs, we had horrible experiences with their specialists. I have serious medical issues where their specialist either wrote me off or specialists who attended to me that were simply incompetent.

Now we love our PCP and specialists. One of my medical issues was so serious that each night I wished that I would not wake up the following day. Kaiser over medicated me on tier 1 drugs, prescribing 12 times the FDA guidelines on dosage and medications because they had no clue what to do with my condition. Kaiser also put me on narrowband UV phototherapy 3 times a week which did not help one bit. Another medical issue was never addressed because the specialist simply refused to see me and bounced me back to the PCP.

My medical issues have now been addressed by specialists here where for the one issue, I was taken off all medications prescribed by Kaiser and I was prescribed a Tier 2 drug which provided me with instant relief. I went from 1 to a 9, 1 being lowest and 10 being the highest on a quality of life scale for that issue.

I know it is scary to step away from a one-stop-shopping system but it will be fine. All best!
Interesting that you say this, because my first rheumatologist and I had an issue about medication so I went out of network to see another specialist. Boy was my doctor mad, but I didn't care. I was on methotrexate and it made me sick as a dog and he told me that there was nothing that he could do. He was close to retirement so he prescribed prednisone for me and just left me on it. I felt great but 4 months later when my PCP found out that I was taking prednisone all that time, he was livid. But in the end I got a new rheumatologist, got on a new medication and life is wonderful.

So I will keep my fingers crossed. I was scared when we moved from Scripps to Kaiser, but we had a great experience, so maybe it will be fine in the end.
 
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klpca

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Sorry to hear about this. I understand your pain. We have Kaiser and they are awesome. I hope we never lose them because they are far less expensive than the PPOs.

We had a family member who had an unexpected illness with life-threatening medical complications. Multiple and months long hospitalizations to recover. I was relieved that we didn't have to worry about the bills and could focus on supporting the family member's recovery. This ordeal probably cost Kaiser a million dollars but there were no questions asked. It was money well spent because that member is now leading a normal productive life.

I realized that one of the biggest differences between Kaiser and the big insurance companies is the business model: The doctor leads the decisions at Kaiser. In our case we needed to try a treatment for our loved one that required 3 days of IV administration via hospitalization and is not the lowest common denominator of acceptance and cost. Easier decision for Kaiser because their hospital staff and facilities are already paid for and fixed so all they really needed to pay for was the medication.

The insurance companies find 100 reasons to deny because they have to pay hospitals cash. So they decide, not the doc. And I was told by a doc at a 3rd party facility which Kaiser had to pay for special treatment that if we were covered by one of the PPOs they would have booted our family member out of this facility prematurely. None of this would have never been approved without a serious fight with insurance. Our loved one may never have recovered without this.

Of course YMMV but our first-hand experience was positive.
When my husband was being treated for cancer, Kaiser was awesome. They allowed him to be treated differently than their protocol by our request, and sent him out of network for his radiation. We had absolutely no complaints about that. And he was also treated out of network for the heart issue (due to where we live relative to the location of their hospital). But the best part was that we never had to worry about bills or billing, which is where I have had trouble in the past with other insurance companies/care providers.

I tell you, with the merger I never thought my husband would get more time off, but I thought that we'd get to keep Kaiser.
 
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Cornell

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I'm sorry that you are stressed about this. I work for "corporate America" and have had a different insurance company / plan every year. My employers have always shopped each year for a different plan to lower costs and it's been an annual change for me. I've had BCBS, Cigna, Aetna, United Health Care with PPOs, High Deductibles w/HSAs, etc. Annual headache to look at the corporate offerings and to make a "best guess" as to what is most advantageous and then research which doctors I can continue using vs dropping. Joy, joy.
 

klpca

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I'm sorry that you are stressed about this. I work for "corporate America" and have had a different insurance company / plan every year. My employers have always shopped each year for a different plan to lower costs and it's been an annual change for me. I've had BCBS, Cigna, Aetna, United Health Care with PPOs, High Deductibles w/HSAs, etc. Annual headache to look at the corporate offerings and to make a "best guess" as to what is most advantageous and then research which doctors I can continue using vs dropping. Joy, joy.
His former company was the same and we finally tried Kaiser because at least we knew exactly what our cost would be. It was great being with one company and set of doctors for 7 years. Oh well, easy come, easy go. ;)
 

bogey21

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Switching from the known to the unknown is a hassle and a pain but you are going to have to live with it. Clear your mind and study your new plan in minute detail and figure out the best way to use it. It will be a hassle but the bottom line is you are stuck with it. Keep remembering you have insurance. Many don't...

George
 

klpca

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Switching from the known to the unknown is a hassle and a pain but you are going to have to live with it. Clear your mind and study your new plan in minute detail and figure out the best way to use it. It will be a hassle but the bottom line is you are stuck with it. Keep remembering you have insurance. Many don't...

George
So true George. :)
 

WinniWoman

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It stinks for sure. I will tell you you will survive it. We are so used to this kind of thing now. Every year my husbands company (and mine when I was working) makes changes and they are always in the company’s favor- not the employees. But- what’s the choices? Either accept it or get another job. Not easy when you are older.

Right now his company is once again conducting some layoffs. We should be so lucky my husband would be one of them and maybe get a small
package instead of just putting in for his planned retirement on 12/31 with his chopped up small pension and jumping through all the health insurance and Medicare hoops and so on. And I will need health insurance myself until I am 65.

I don’t blame you for worrying because I would be too, but you will have to accept it and adapt unfortunately. Good luck. It will be ok- just different and not as good as before.
 

silentg

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Sorry you are having to change insurance. We just did Frank retired August 1 st and now we both are on Medicare with a supplement thru Freedom Health.
All new doctors, closer to home, but have to get PCP up to date on Medications etc.
Have an appointment this week, will be second time seeing her. So far is all good.
Hopefully, you will find your new plan will be better.
Both of us retired now is so fun! Lots of trips coming up!
Silentg
 

PcflEZFlng

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Katherine, I'm so sorry you're having to go through all of this. I've heard good things about Kaiser, so I can imagine it being hard to leave it. I've been blessed to be with Sharp HMO (as you know, another local self-insured health organization, and very well-managed) for the past 6 years, and would hate to leave that one, too. I hope the very best for you and your husband.
 

chellej

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I have always avoided hmos because I have always believed I can get better care through PPOS. The premiums for PPOS have always cost more but I have always thought it worth it. I never cared for having to get a referral before getting care I know I need. I also like to be able to choose my doctor.
 

klpca

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Katherine, I'm so sorry you're having to go through all of this. I've heard good things about Kaiser, so I can imagine it being hard to leave it. I've been blessed to be with Sharp HMO (as you know, another local self-insured health organization, and very well-managed) for the past 6 years, and would hate to leave that one, too. I hope the very best for you and your husband.
I think that we are either going to look at Sharp or UCSD. Kaiser just felt so efficient. We never had any issues other than my first rheumatologist. I'm sure that it will be fine, but you know how it is when you have to change something with which you are comfortable.

But as George mentioned, I am so thankful to have insurance.
 

CalGalTraveler

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I have always avoided hmos because I have always believed I can get better care through PPOS. The premiums for PPOS have always cost more but I have always thought it worth it. I never cared for having to get a referral before getting care I know I need. I also like to be able to choose my doctor.
I was skeptical and thought HMO was going to be a hassle initially after having a PPO, but once you are established with a Kaiser specialist, you don't need to worry about the primary care doc and they stay out of the way. Some specialists like dermatology/acne services for teens, optometry/opthomology don't require a referral. Can go direct. Other times it is simply a matter of emailing the PCP.

Read recently that outside of a system like Kaiser an independent or small group general practitioner or internal medicine may try to keep the patient within the private practice longer because referring to a specialist means a loss of revenue or they may not know exactly who to send the patient to. At Kaiser, specialists are plentiful, referrals by PCPs are not a loss of revenue and PCPs actually are incented to refer to a specialist because they have a limited time window with the patient and it is easier to refer to a specialist than spend too much time diagnosing something that will take time and a specialist can do better/faster.

There also have been times when we didn't know what exactly was wrong and the PCP was instrumental in identifying several specialists which we wouldn't have considered. Our PCPs have always been supportive and don't interfere when a specialist is needed. Never been a roadblock to getting services. It's actually nice to have someone who knows you to heal the simple stuff and concierge other items.
 
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Timeshare Von

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I feel for you Katherine!

We're not on any group plan, so we must fend for ourselves on the exchange or through private insurance policies. To keep our prices down (which is a relative term) we had to go with an EPO this year . . . Exclusive Provider Organization. Everything we do must be in-network or we get ZERO paid benefits. Only exception is emergency treatment when more than XX miles from home.

We pay $2,100 per MONTH for this plan for the two of us. Our former PPO plan with the same company would have been $2,500 per month! Both policies were also with significant increases in deductibles and max out of pocket expense.

I'm simply SICK of healthcare in the USA and wish ACA had never happened. (And this is coming from someone with pre-existing conditions and longterm healthcare needs.)
 

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Depending on your comfort with current doctors, keep them. Sometimes the out of pocket is a very reasonable amount. I had a PCP that would accept any insurance, they did the work of becoming in-network for me.

I would at least suggest finding out how much visits and procedures from current doctors on new plan would be before you decide that you have to ditch them. I had $400 charges from specialists that cost me $40 with no insurance. My current network is very narrow, and premiums very high, so I am not paying insurance any longer and paying out of pocket for actual costs incurred, which ends up being far less than $700 month premium.

Good luck, take a deep breath.
 

presley

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It's worth asking the employer to give your husband insurance reimbursement instead of the new plan. You'd have to buy Kaiser on your own and your husband would get a non taxable reimbursement every month. They may not cover the entire amount that you pay, but they can reimburse for the same amount they would be paying the new insurance company. It's tax free on both sides.
 

dougp26364

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I know how you feel. We’ve been thru Conventry, Blue Cross, Cigna and Aetna in recent years. All have had the headaches and a few pluses. Where fortunate in that we live in a small enough community that most providers accept every company we’ve been with and haven’t had to change physicians...... yet.
 

amycurl

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All of this stress about insurance and accessing care is not healthy--for anyone. Look at the US health outcomes for our population as a whole, look at what we spend as a country on healthcare, and then tell me our system doesn't need radical, radical changes.

We're killing ourselves trying to maintain the status quo, when every other developed country in the world--while not perfect--has figured it out (more or less.)

" 'No way to avoid this,' says only country where this happens." --The Onion
 

bogey21

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I have always avoided hmos because I have always believed I can get better care through PPOS. The premiums for PPOS have always cost more but I have always thought it worth it. I never cared for having to get a referral before getting care I know I need. I also like to be able to choose my doctor.
My way of thinking. I could have a Medicare HMO Advantage Plan at $0 cost but would be limited to their network. Fortunately I am able to pay for flexibility with traditional Medicare plus paying for a Medicare Supplement and a Medicare Prescription Drug Plan. To my way of thinking avoiding the need for referrals and the ability to choose one's doctors and hospitals is well worth the extra I am paying...

George
 

klpca

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All of this stress about insurance and accessing care is not healthy--for anyone. Look at the US health outcomes for our population as a whole, look at what we spend as a country on healthcare, and then tell me our system doesn't need radical, radical changes.

We're killing ourselves trying to maintain the status quo, when every other developed country in the world--while not perfect--has figured it out (more or less.)

" 'No way to avoid this,' says only country where this happens." --The Onion
100% agree with this.
 

PcflEZFlng

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All of this stress about insurance and accessing care is not healthy--for anyone. Look at the US health outcomes for our population as a whole, look at what we spend as a country on healthcare, and then tell me our system doesn't need radical, radical changes.

We're killing ourselves trying to maintain the status quo, when every other developed country in the world--while not perfect--has figured it out (more or less.)

" 'No way to avoid this,' says only country where this happens." --The Onion
Amen. I could probably add one of my own: "I envy the US for the healthcare they get" said NO ONE from any other developed country.
 

bogey21

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We pay $2,100 per MONTH for this plan for the two of us. Our former PPO plan with the same company would have been $2,500 per month! Both policies were also with significant increases in deductibles and max out of pocket expense.
Wow. That is $25,000 per year. Reading this makes me feel fortunate to be old enough to be on Medicare...

George
 
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