<p>A friend of mine, who works in the health care system, says the top doctors don’t need to take insurance company rates and if you need care from one of these doctors you are going to pay out of pocket. </p>
<p>Now, I am not talking about one of these gold plated group plans. A friend of mine was covered by IBM and she received care that cost 1 million dollars from Stanford.</p>
<p>I am talking more about people like me, that have individual insurance. I was told that Kaiser is a better deal for me than Blue Cross because I am not going to be covered if I need to go to Stanford and see a top specialist with Blue Cross.</p>
<p>I also was told that although, many doctors don’t take medicaid, Kaiser does.</p>
<p>Anyway, this was kind of an endorsement for Kaiser. I would prefer to be covered by the top doctors at Stanford, but if I really am not, then I guess I will look at Kaiser.</p>
<p>Any thoughts or experiences that can be shared on this topic that I can think about?</p>
<p>I have a Blue Cross PPO plan through my law firm. I needed major surgery several years ago and only considered the best hospitals for my condition (Cleveland Clinic, Mayo, Hopkins, Mass General). ALL would accept my insurance. I ended up in Cleveland and my surgery cost $150,000. My out of pocket was $500. </p>
<p>I have heard some doctors are not accepting new Medicare patients because the reimbursements are so low. I hope that’s solved by the time I’m on Medicare.</p>
<p>For the network type PPO or HMO type of plans, you should be able to look up doctors on the plan web sites to see if they are in-network or out-of-network. Note that out-of-network doctors may still accept the insurance from PPO plans, but have not agreed to accept a negotiated rate with the insurance company, so (a) the insurance payment is less, and (b) you would be responsible for whatever they charge above, rather than the known amount of the co-payment or deductible for in-network providers listed in your insurance plan. Note also that the in-network and out-of-network lists can change every so often as insurance companies and doctor’s groups and hospitals renegotiate.</p>
<p>Kaiser is easier to figure out, since it is facility based.</p>
<p>dstark, for more accurate information, ask several local insurance agents. The top specialists may not be at Stanford, some are at UCSF so it is best to get a PPO type of insurance that would cover both Stanford and UCSF. But it would be dependent how affordable these policies are to you.
Kaiser provides great and more affordable care to young families and to those who don’t require services of tippy top specialists.</p>
<p>In my experience top doctors do not work for HMO’s. Kaiser has a pretty good reputation but if you need a “top” doctor, you will have better luck elsewhere.</p>
<p>I keep being told by a couple of people to look at Kaiser. I just don’t see Kaiser as that much cheaper. Also, Kaiser isn’t national. I don’t see Kaiser in NY, for example.</p>
<p>Yes, it is a group plan. But we’re a pretty small group. (Less than 40 people so it’s not like we have a lot of negotiating/buying power)</p>
<p>I used to work for the State of Pennsylvania. THAT is a big group! But I would never choose the HMO plans they offered. I like to be able to choose my docs. (And not be at the mercy of the HMO for referrals.)</p>