Should I use Kaiser Permanente or Blue Shield for health …

  • I just took a new job in San Fran. and have the option to select either a KP HMO plan or a Blue Cross PPO plan. I had never had a HMO option before.

    Some necessary context: I am a 31 year old healthy and fit male BUT based on my medical history I am high risk for both MS and liver problems, and while hardly a guarantee that I will develop either , being protected against more serious diseases from a treatment and financial perspective is even more important for me than it would be for another healthy 30 year old without my medical history. I know its important for everyone, but you get my point…

    The reason I mention the above is to hopefully help you to trust me when I say I have done A LOT of research on the difference between these two plans over the past week. As such I feel I have a bit more credibility on this particular question than the average bear.

    I focused not on those lame HMO vs. PPO articles that are all over the internet that all say the same thing (“Well it depends on which is a better fit for you.” Yeah. No shit it depends. Worthless.) but focused more on what actual patients faced when going through this process with both types of insurance and I think I identified some very consistent takeaways:

    i.) Seriously sick people despise HMOs, be it Kaiser’s or whomever’s, with the intensity of a thousand suns.

    Based on reports of patients, if you develop an exotic and/or serious disease, you better pray to God you are on PPO. Patients dealing with chronic ailments that required long term and substantial medical care and surgeries, to a one, railed against Kaiser’s HMO and HMOs in general with a very acute ferocity. You could really feel their frustration through their posts. Constantly denied requests for treatment/drugs/referrals/diagnostics/physical therapy, countless hours on the phone, countless dead ends, etc., and a general bafflement at the fact that their insurance company would not help them.

    “Back hurts? You need to lose weight. Go see this nutritionist.” 6 months later you finally get diagnosed with cracked vertebrates. Lots of stories like that and worse. It was obvious that the were being screwed financially as well as emotionally. I really felt bad for them.

    ii.) Healthy people love Kaiser. The people who love Kaiser HMO, also to a one, never mentioned serious illnesses. They were generally very healthy people (and good for them!). The ailments they talked about were rashes and twisted knees and minor cuts/burns – things that frankly are nothing compared to cancer, blown discs, paralysis, and other issues that would require long term medical care and/or surgeries. The positive things they cited all seemed rather superficial to me when framed against whether or not this decision could end up killing or bankrupting them or causing them huge amounts of pain. They talked about things such as how great it was that they could get their meds in the same building as their doctor, the convenient parking, etc. If you think I would mind walking a few blocks to a Walgreens to pick up my meds in order to avoid some of the incredibly unfair and unpleasant horror stories I read about you would be very wrong.

    The vast majority of of people who review Kaiser HMO review it very favorably. Based on what Ive learned this past week I believe this is because the majority of that patient population (just like the majority of the general population) aren’t that sick, thus get to this type of insurance through rose colored glasses.

    So I guess it comes down to your philosophy on insurance (if you even have one). Plenty of people either think they are bulletproof so will n ever have to worry about getting really sick OR are too scared to confront the fact that they definitely are not bulletproof and very well could get very sick OR, having never been really sick themselves have a very mild and incorrect perception of what “really sick” even is.

    I think insurance’s greatest benefit is helping you when something truly catastrophic happens. No one thinks it will happen to them and its hard to confront the fact that normal people like you and me go to the doctor all the time and get very bad news. Im not trying to scare you but its an empirical fact. It happens.

    So would you rather pay an extra $200 on a PPO plan when your kid needs stitches or pay countless more in money/time/physical pain/frustration/futility when something really serious happens to yourself or someone you love?

    Seems like a no brainer to me.

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