Seeking info on insurance

[smm80]

Hi,
I was wondering if anyone in CA has an opinion on the best choice for insurance when dealing with kidney disease. My husband has IGAn, diagnosis in May 2011. Currently his GRF is down to 23 from 28 in the last month and creatnine up to 3.3 (stage 4). I am in open enrollment for health insurance and debating if HMO (Anthem Blue Cross) is the best option or if PPO would be a better choice. Does anyone has input in the cost associated with PPO (labs, visits, treatments, etc when in stage 4) I am not happy with the Neph in our HMO right now for various reasons and I am not sure that we can get approval for a second opinion with the Neph I would like him to see at UC Irvine. However, if the cost will be overwhelming that is something to consider as we are parents to three small children. The cost is not the overall factor but I want to be prepared for what we might expect. I only have 3 days to decide before open enrollment is over so any input would be really helpful!!
Thanks,

[metrogirl]

Re: Seeking info on insurance

Is Kaiser Permanente an option for you? My boyfriend (the renal patient) has Kaiser and we couldn't be happier with how well they have handled his kidney failure. When he gets bloodwork done, the results are available online for us to view as soon as they are posted, usually within a few hours.

We also have the option of emailing his doctors when we have a question or concern. Honestly all of his doctors and specialists have worked so well together and they have been so prompt with getting things accomplished for him.

[JustDee]

Re: Seeking info on insurance

I'm with you Metrogirl...Kaiser is The Best. I find it amazing that Kaiser is not only willing but also encouraging me to get a new kidney so I don't have to go on Dialysis. I understand the transplant operation is about $200,000 plus they will pay all the expenses for Hubby to donate to me. I am 60 years old and I would have thought I was too old to worry about but no....every doctor, lab tech and nurse has been totally supportive and helpful in getting all Hubby's and my tests done and sent to UCSF. If Kaiser is an option I recommend that you look in that direction. I have had Kaiser for 38 years, in Southern and Northern Ca. and I have been more then happy with the coverage.

[Marina]

Re: Seeking info on insurance

I have HealthNet HMO. I looked at an open plan PPO (blue cross/ blueshield)
While healthnet has a copay (mine is $25.00 visit) they pay the balance. There's no deductible. It also pays 100% for labs done at an approved lab. Hospital stays are 100%.
Of course this is how my employers have it set up. The bigger the company the better deals they get.
As far as PPO, I would have $2,000 deductible, it only covers 80% and they have a lifetime limit. I had thought about switching to a PPO, because I had it in the past and loved the idea of not needed referrals to especialist as long as I went to one within network.
When I looked at the 80/20 payment system, I changed my mind. It's a good thing I did. My TX and 1 month hospital stay was $721,000.00 can you imagine me coming up with 20% of that? IMPOSSIBLE.

In my opinion, PPO's are for healthy people, not for us with renal issues.

Kaiser is good too, provided you find the right location.
My brother goes to the local kaiser and hates it. While My sister goes to one 40miles away and loves ALL the kids drs.

Dee, Kaiser has a TX contract with UCSF. If you choose to get listed at UCDavies, you will have to pay out of pocket all the initial TX blood tests.
My brother is listed at UCSF, his Dr told him he might consider getting listed at UCDavies because there's a much shorter wait list. She however informed him of the out-of-pocket expenses for all the pre-TX tests. He's thinking about it, because as we know that can get pretty darn expensive.

Wait list at UCSF for a Typo 0 blood is 5-7yrs at UCDavies is less than half of that.

Take care!

Marina

[smm80]

Re: Seeking info on insurance

Thanks for all the info! I really appreciate it. Kaiser is an option for me but my only issue is that kaiser does not have a presence in our area. I have heard mixed reviews on the service and it would be a long drive into Riverside. does anyone have experience with nephrology with Kaiser in Riverside, Ca? That could be a deciding factor. I am thinking it might be better to stick with our current plan since we already started the approval proccess for a second opinion and I really dont know if I have the enegy to start from square one with a new insurance provider. I also appreciate the PPO info... We had PPO when my son was born in 2009 and switched to HMO after we paid thousands for his very easy birth. It would be great to see the neph of our choice at a research hospital but I don't that we can afford it with PPO. hoping blue cross agrees to let us get a second opinion at UC Irvine!
thanks again!

[metrogirl]

Re: Seeking info on insurance

No I don't know about the Neph in riverisde. We go to the Baldwin Park facility and the most amazing neph on the planet works there.