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Insurance Providers: The Good & The Bad?

Do urbanMamas have experiences to share with various insurance providers - Lifewise, Healthnet, Blue Cross/Blue Shield, Standard?

My husband and I have a baby on the way. Currently, I'm on an employer sponsored insurance plan with Providence. The experience with Providence has been excellent; however, I won't be returning to work after the baby comes and we are going to need to switch to a new insurance plan. My husband has his own small company and so he is looking at getting a plan for his employees. Of course, we want to choose a plan that will be ideal for everyone participating,and will also be accommodating to our family with the new baby in mind. So, I'm hoping for a little feedback, good or bad about: Lifewise, Healthnet, Blue Cross/Blue Shield, and Standard Insurance. Does anyone have horror stories or rave reviews to share about any of these providers?

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I'd like some info on this as well. With my first one I still worked as a teacher so great insurance. Now I'm home and my husband is self employed. We pay about $400 a month to Healthnet, but basically there better be blood or a broken bone before any of us goes to the doctor :-) other than well baby checks, of course.

Good luck, this is a tough one!

Melanie

We a have BC/BS. I have been pleasantly surprised with them. They fully covered our homebirth, they cover naturopaths, chiropractors, and even acupuncture. I know not all BC/BS plans are like this, but ours is great.

I have BC/BS as well and have been happy with the coverage. We chose to purchase an independent plan for myself and our 2 boys are covered through my husbands work because it was cheaper for us that way (and have been told by friends that them, spouse and baby all have there own plan because it was cheaper)..rather then paying the family rate!

That is a tough question..hope I helped.

Same here for BCBS. I've used them for my individual coverage in previous years, and then again for my baby's coverage. No complaints so far, but we're pretty healthy. I'd certainly complain more if we weren't ;P

I again recommend BCBS, my son was in the hospital for awhile after he was born and had to have surgery. The bill was well over 100K and we had to pay 1500$ out of pocket. Also, they cover 60 therapy visits per year(physical, speech, etc.) I have been told that other insurances cover 20 to 30. And one last thing that I love, they cover massage therapist at 60% up to 40 visits per year.

We have Kaiser and I've been happy with the peds department there. Plus I find it nice to not have to deal with billing the insurance, going to another location for the pharmacy etc. I have been able to find good drs for my diabetes through them as well and since I also have hearing loss and some other ongoing concerns it's great to know my health records get to all my doctors. The down sides include long wait times on the phone and not as many alternative medicine choices (there are some though.

Another thumbs-up for BC/BS -- have been a customer for a few years under an employer plan and am currently in process of getting our own coverage. Maternity coverage is excellent; keep in mind a lot depends on your deductible level and whether you want to bet your family will be healthy or would rather assume the worst and pay a bit more for more coverage.

hhmm - We just moved and my hubby gets BC/BS via work and I'm HATING it - wondering if I just have a bad one. The corporation is headquartered in NJ - so it's Blue Horizon? We picked PPO because it seemed the least confusing and cost the most, so I assumed I would get the most out of it. But I'm finding that I have 25 and 50 copays, the RX coverage is only a percentage, not a copay - and just found out they won't cover midwife/birthcenters - and get this - they will cover a few chiro visits - but the only "in network" chiros they offer are in WASHINGTON! I'm totally screwed. And now not sure we can do anything until next open-enrollment. Did we make the mistake in choosing PPO? We are never sick - so I like to have the preventative stuff covered. The most annoying thing - my hubby works for a health industry company.

We have been using Lifewise for about 5 years now and they have never given us any trouble. I first had them through my employer, and now have them on an individual plan (I stay at home and my husband is self employed). I have gone through two pregnancies and deliveries with and they covered everything. They even covered a hospital emergency we had with my 17 month old while traveling in Mexico...100%.

Since we watch our budget closely, I do review it every year and find they are a good value.

Hope this helps!

As a provider, I can tell you that Lifewise and Healthnet (who contract American Specialty Health) are nightmares to work with. I do not recommend them.
I do recommend Blue Cross/ Blue Shield if you get the right plan. Pacific Source is also very good and cost effective for the insured. Kaiser has improved itself so much over the past couple years, I am very impressed with them.

I had BCBS in the Midwest and it was great. It was expensive but I never worried. My husband and I both freelance, so now we have Assurant Health, which is a HSA. HSA's are a little more work, but we LOVE that everything we have spent on healthcare this year (including the dozen or so bottles of baby Tylenol and cough medicine!) are all tax deductable. Since you basically pay for everything until you hit your deductible, it has made us much more aware of our medical spending. And I think in a way it has made us more responsible medical consumers, if that makes sense? I wait now to bring the kids in, since things often change overnight. Whereas before I figured I wasnt footing the bill so who cared, better safe than sorry? But this kind of frivolity must have SOME kind of negative impact on the system? At any rate, we are happy with Assurant. They only thing I can think is a negative is that since I have had 2 C-sections, they will not cover ANY pregnancy related claims. So if we go for number 3, it is all out of pocket on a 3rd C-setion...ouch! HTH

I am currently working on getting a group plan for my employees. Our main concern is access to alternative medicine, (naturopath, acupuncture, massage, homeopath, etc.) I thought Lifewise was our best option, but after reading this it sounds like BC/BS might be a better choice. Would someone who has excellent alternative care please post, and please give the name of your broker, (if you recommend her/him) since it sounds like getting the right plan is so crucial. You can e-mail me instead if you'd like.

I know you didn't specifically ask about Kaiser but I have to tell you how happy I have been with them. Recently my husband took a new job that carries Kaiser so we are all covered by their plan now. But before that, I paid for coverage for both my son and me. It was affordable and I've been so happy with the way the system works. It is a bit unlike traditional insurance but once I got used to it, I actually prefer it. I think it would be a mistake to not at least investigate their plans. Good luck!

I had BC/BS for Everett and it was great, no complaints at all; Tricare for Truman (through the Army) and it was a little less so -- though my labor & delivery cost *nothing* they didn't pay for ultrasounds.

Now I have United and I can't wait until next year to switch back to BC/BS (it became available this year, but as luck would have it I was travelling the last day I could change and got stuck without internet connection in NJ...). I feel like I'm always paying some more-than-i-thought-it-would-be fee or calling them to note that, yes, the people who I signed up as my dependents ARE my dependents! and, as I mentioned on the paperwork, they DON'T have other insurance! it's a real pain. luckily that's not one of your options but I thought I'd mention in case anyone else had United! the one benefit is lower-than-normal co-pays, but i end up just paying more.

When I had employees we got our insurance through a broker and had a fantastic experience. We had a wonderful plan that really worked for all of us, was totally affordable for a small company and had nice little perks for alternative providers and such. Here's the woman we used:

Joan Chamness

Strategic Planning and Insurance, Inc. / The Strategic Alliance

121 SW Morrison St., Ste 1550

Portland, OR 97204

503-242-9047 x2609, direct line 503-467-7845, FAX (503) 907-5057


And P.S.: We had PacifiCare for our plan. FABULOUS PLAN.

I too have had no complaints with BC/BS. Our premiums actually went down a little this last year and they added some wonderful vision coverage so I was very impressed with that. We have individual plans for the three of us.
We also had Lifewise a few years back and were very happy with them as well. It just got too expensive for us.

all of the carriers are good that you have listed but there are a whole host out there that you did not reference that are equal to or better than the ones you reference. Lifewise and Healthnet have a great network, not sure where you plan to deliver but they cover most of the health systems here in portland. BCBS has the market share of individual business here and i believe group too-but are a little on the high side more often for price with group insurance. I am not familiar with standards health insurance. i could go on for hours, but this is what i do for a living. if you want an opinion or any help with the process go to my website, read about us and call (503) 416-4400 x 11. just one piece of advice do not let your insurance lapse, use the continuation or cobra option until you have secured insurance.

I have HealthNet through my husband's employer. I am a 3x blood cancer survivor and this is the second time I've had HN. I have not had any good experiences with them. My primary physician dropped them because they are not good with providers either. My oncologist has also told me several times they are one of the worst for providers to work with. Since we switched to them in August 2006, they have continually delayed my claims stating they need me to confirm we do not have double coverage. I have provided this information to them more than 4 times now. It just feels like they are trying to avoid paying claims and I remember these kinds of hassles two employers ago when we first encountered HN. My husband's last job used Great West which I had never heard of before but turned out to be the best insurance company I have EVER had. (I've also had BC for a long time, no major complaints with them). Anyway I could write for hours about my dislike of HN but I'll stop!

Lots of votes here for BC/BS. My experience leads me to warn you to be SURE to read your maternity coverage carefully - or better yet, have it clearly explained to you by a representative. In the fine print, our BC/BS plan had a $1,500 per person/per event deductible (meaning, I assume, that if our baby had had any problems, she would have had her own deductible in addition to mine), only covered 80% of "usual and customary charges" (meaning, if the hospital wanted to charge more than the insurance thought it should for a certain service, they would only cover 80% of what they thought it should cost - not the actual bill) for certain things ... and the kicker: although the plan clearly stated that labor and delivery were covered 100%, this included the fee for the doctor to be in the room. That's it. Not the room, not any medications, not the nursery or nursing charges ... those fell under the "80% after deductible" part of our plan. Luckily, I had an extremely fast (and therefore totally drug- and surgery- free) vaginal birth. But the bills were still higher than we anticipated - not devastating, but a big blow with all the other expenses of a new baby. It's just important to really understand the ins and outs of your specific plan. Otherwise, BC/BS seems very in line with most medical plans and the providers are great.

I have Kaiser through work. They cover chiro/acupuncture at $10 a visit--which I love! I also like their ped's dept (Sunnyside--Dr. Hicks & Dr. Marie Miles). I loathe their maternity care.

You didn't mention this but one other poster did...I also really like Assurant. It's a high deductible plan with an HSA, but I LOVE how prompt they are with reporting and payments. Statements are really easy to understand. You can see the provider you want and the plan gets you pretty decent discounts, especially on pharmacy.

Before going on my hubby's insurance I had BC/BS. I wasn't happy with them. You need to really understand what kind of coverage you are paying for. Also check to see how they handle out of network items. Its not common to have out of network items, but it happens at the worst times. I was burned by the out of network items.

We found making a list of must have coverage items helps in choosing an insurance carrier and plan.

Previously my family was covered by BC/BS. I think it really depends on your plan. My previous employer was HQ out of state as well as being a small business. Despite having insurance completely covered by my employer, there were lots of out-of-pocket expenses and lots of paperwork. My plan didn't cover of all things birth control! It was a pain. With my first son, we paid about $3000 in expenses and this was a fairly text book delivery.

Currently I have Kaiser and I love it. With my second son, we paid $100 for the hospital expenses. Since it's an HMO you have to use their providers but essentially it's worth it not having to argue every billing discrepancy which happened a lot with BC/BS. I've been really happy with Kaiser and couldn't imagine switching to another plan.

Just wanted to note that Standard Insurance does not cover individual healthcare - the only individual they do is disability life insurance.

Another happy former BC/BS patient here - but do choose your plan wisely. Had to switch because I am now on my husband's insurance (who works at Standard, hence I know they don't offer their own health insurance), but I will switch back to BC/BS individual coverage next year.

I wanted to make a note here that each physician will have different experiences with carriers. Remember that their compensation is the reimbursement from the carrier, so their point of view is a little more limited than that of a peer who is actually experiencing the claims payment and benefits.

If you are lucky enough to have a group health plan, atleast 50% of the premium if not more is being paid for by the employer. The state of Oregon requires this if an employer is offering a true "Group" plan.

Many of the issues/obstacles above that are being described are valid, and stem from a lack of understanding the plan. It is SO hard to extrapolate information from the benefit summaries. My suggestion is to call the company and ask them to send you the complete Summary Plan Description. You will need to call the employer, not the carrier, as it is the employers responsibility to give these out.

Ok...so a little hint when looking at these plans because they always seem so convoluded!

your deductible is the the amount that you will need to pay before your coinsurance kicks in. So an example is a $500 deductible with 80% in network coinsurance. You will pay the first $500 individual ($1500 family) then the insurance carrier will pay at the 80% level and you will pay 20%. Remember, the carriers all have negotiated rates that lower than the billed rate. so you are getting a discount.

last...you have a total out of pocket max that you will not exceed in any year. it will look like $1500 or more...then the family has a seperate OOP, like $3,000 or more.

One of the plans referenced above, and HSA is excellent. But your will need to make sure that you have the funds in the bank account to cover up to your deductible. The IRS changed contribution limits for 2007 so they are higher, but in many cases a gap may occur betwen the deductible and the OOP.

Anyone can email me with questions! just want to help-Holly@benefitpartnersllc.com

my family is currently with regence BCBS (not through an employer), and our plan does NOT cover any "alternative" medicine- it's the blue choices premier plan. I'm wondering what plans people have with them that do cover things like naturopathic medicine, homebirth, etc???

Our BCBS is through my husband's employer. It is the PPO I think. It is BCBS of IN or IL I think. I feel very blessed to have them cover so much! They suck on some things though. I wanted to go to a nutritionist and they said I could only go once in my lifetime and only if it was for diabetes counseling! I think all plans have their perks and downfalls.

We looked into individual plans with Healthnet, Lifewise and ODS. Both Healthnet and Lifewise individual plans wouldn't cover prenatal care or delivery costs within 12mo of subscribing (this may be different for employee plans). And neither had decent coverage of birthcontrol which ticked me off!

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