Navigating new medical insurance after years with Kaiser
Due to a job change, I have gone from a very easily health management for me and family (Kaiser) to having to figure things out on my own and I'm out of my depth! I have now a PPO with an insurance carrier in New England. To pay in-network rates, I can use the Cigna network providers. I can't begin to know how to a) find a new doctor(s) for me/hubby and 2 kids and b) where to go for urgent care. I think I left much of this work to Kaiser (with whom I was for 12 years) and I'm just overwhelmed by choice. Any advice out there? About how to learn how to do this transition from Kaiser to anyone else? (And, no, there's no chance to get back into Kaiser unless I switch to a local employer).
Jan 1, 2020
Parent Replies
I've always had either a PPO or a non-Kaiser HMO. Yes, they are confusing. To find doctors, go to the Cigna website and click on "find doctors." To find an urgent care, it is best to call the customer service number on the back of your card. Although I currently have HealthNet, I have had both Cigna and United Health Care in the past. I've found calling customer service is usually actually helpful.
One suggestion - offer to not enroll in their health plan in exchange for a cash payment each month to buy your own insurance. A lot of small employers pay insane rates to these regional insurers - far less than it costs to get a Silver plan with KP on the exchange in California. KP has a lot of efficiencies here that other carriers just don't due to their ballooning costs and lack-of-integration. You may be surprised to find that the $1200/mo your employer is kicking in toward your coverage would cover your whole family's premium on KP with little-to-no cost to you. Many employers are willing and happy to do this - I did it 2 employers ago, and my husband did it once too.
Before KP we had nightmarish experiences with John Muir (wild misdiagnoses that left me severely ill...twice!) via urgent care. I ended up sleuthing for well-recommended doctors on here and Yelp, and found a practice group I loved for me out of Eden in Castro Valley (worth the drive!) and my husband found a sutter primary care doctor he liked the same way who happened to be near Alta Bates in Berkeley. Every time we needed a specialist, we simply turned to BPN existing reviews (search them) or yelp. Dermatologist, allergist, podiatrist, etc. It's a huge PITA as you have to visit your primary every time ($$$ - your 20% co-insurance can be over $100 for an office visit vs. a $20 KP co-pay) to get the referral, and then go to the specialist. Then the costs are entirely unpredictable. We set up a savings account every year for the full amount of our out-of-pocket max and planned to need to just spend it. It's crazy outside KP.
Hence my suggestion to very, very seriously consider making the offer to your company to drop-off and take the cash amount - you may significantly save money, not to mention avoiding the nearly full-time job of managing PPO/broad network care. Just declined a job with insurance like this who refused to give me $ each month to buy my own, because managing our family's care would have been 20+ hours per week outside of KP and the quality of life to that transition would have made the "dream job" a total nightmare. Good luck!
I have Cigna too, from an out-of-state employer. I've been able to switch to UCSF/John Muir Berkeley Outpt Center on San Pablo--the only thing is that they require some documentation (at initial check-in) from your insurance company. What I did was contact the member # at the back of my card, spoke to someone who sent me verification that UCSF/John Muir is covered by my insurance. After that it was smooth sailing! We've had a great experience with them so far, with a wonderful primary doc (Dr. Johnson), easy access to Urgent Care, Labs, Radiology, etc. I know starting over is hard, but so far I have no complaints!
We have Cigna and use sutter off Milvia (2500 Milvia) for primary care, OB services, labs, and pediatricians. We love all of our providers. They also have an urgent care there open late. Sutter has many urgent or walk in clinics locally that are covered.
honestly if you call the number on the back of your insurance card and ask to speak to a representative (just keep saying representative until you get one) they can help you find who is in network. Also if you find providers you like and then call, they can confirm if they’re covered in network. You can also download their app and search there.
thankfully Cigna is one of the main insurers in the country so many providers are in network, especially if they’re part of larger group practices