View Full Version : blue shield ppo or kaiser?

11-13-2009, 08:14 PM
It is very hard to decide, blue shield ppo is really good but got very expensive for next year. kaiser is cheap but have heard bad things and reputation. Sugesstions?

11-13-2009, 08:46 PM
I have Blue Shield PPO as my primary. I have to pay 20 percent of the allowed charges. I chose the Blue Shield plan for its freedom to choose my providers. I also have a secondary ins. (HMO) through my DH's employer to pick up the remaining 20 percent after my PPO pays, if they happen to have a provider "in network'. I generally use both insurances for tests and my PCP only, as my specialists are out of the area and not part of the HMO's network.

Anywho, Kaiser is efficient with most services under one roof, but I understand you have to be your own advocate for referrals because they're all about saving money and to get an outside referral can be done, but it's very difficult. When I was making my decision as to what insurance to choose, I called Kaiser's GI dept and asked if they had a motility specialist on staff. When the receptionist didn't know what a motility specialist was, I knew I had to pass on Kaiser.

Just my experience

11-14-2009, 09:50 AM
We've been going through the same "open season" question.
In Texas, Aetna was an HMO. It wasn't great, but it was inexpensive and we did all right with it. We continued with Aetna when we moved here to California, but soon learned that here, it is a "Consumer-driven deductible PPO". I've been told that this is a code for High deductible PPO.
It works likes this - They pay the first $2500 each year (great if you're healthy!). Then we pay the next $1500 out of pocket. After that, they kick back in and pay 90%. My rheumy recently ordered an MRI. Just one MRI would more than wipe out that $2500, and after a huge move, we just can't afford $1500 in medical bills. I'm putting off the MRI until after the new year, and we're changing our insurance carrier.
We also decided on Blue Cross/Blue shield. It does cost a bit more, but my hubby will be getting his annual pay raise and it will just cover the added amount, so our budget won't feel it - Yeah! It does look like Blue Cross will cover a lot more of what I need, including going to a specialist in San Francisco that I need to see to get the Botox shots in my vocal chords for the Spasmodic Dysphonia.
Insurance is a pain in the backside!

11-14-2009, 10:44 AM
Last night was the deadline to sign for next year so I went with BLue shield/blue cross. it is expensive but lot more options. Kaisar is cheap but I just do not want to loose my doctor that I been seeing for last 10 year. I am in San Jose Area.