HealthNet/UCB Blue & Gold Plan
- See also: Medical Insurance Options at UC Berkeley
Parent Q&A
Hi, there. We are a UC family who has had Healthnet Blue & Gold for quite a while. We previously had Brown & Toland Medical Group because that's who our Doctor and her practice belonged to. But when the practice was sold, she moved to a new group, and we followed her there. We adore Dr. Audrey D'Andrea; she is now with Canopy Health/John Muir Network; they are on San Pablo just south of Ashby. This is super convenient for us; we can walk there, there's a parking garage with validated parking. There's a lab in the building. There's an urgent care facility in the building. Fantastic! Overall much more convenient for us than the old location in Oakland. A few things are less convenient: I now to go to Orinda for my mammogram, instead of to the lovely facility in Oakland. When my husband needed hand surgery, he had to have it in San Francisco. But overall, we are very happy, and we would follow Dr. D'Andrea pretty much anywhere!
I have Blue and Gold and have been able to get approval to see specialists across the Bay. Apparently the Dr. just needs to justify it. You might explore before switching.
Archived Q&A and Reviews
Healthnet HMO for pregnancy & childbirth
Dec 2011
Hi, I am wondering if anybody has any recent pregnancy and childbirth experiences with Health Net HMO. The experiences I found on this forum are quite old. This is my first pregnancy and I recently switched to Health Net HMO. My friends and other people tell me horrible stories of HMOs - they cut corners in order to cut costs, they would deny claims based on random things etc. etc. I am worried sick and am just looking to hear about some recent experiences you've had with Healthnet HMO with pregnancy and childbirth and who was your doctor btw? Worried first-timer
Please don't stress yourself out about this. I gave birth to 2 kids with the exact same plan and had no problems whatsoever. I gave birth at Alta Bates and couldn't have been happier with the care I received. My ObGyn is Jill Foley, but I also see Elizabeth Kanwit. They are in the same group & it's excellent. Enjoy your pregnancy and don't listen to the horror stories, just focus on the positive!
Feel free to email me if you have further questions. Kim
I had my son at Alta Bates in April while insured with HealthNet HMO. On the whole, HealthNet didn't give me any trouble with pregnancy and childbirth costs -- they didn't put up a fight about my urgent C-section, and didn't quabble about prenatal costs like ultrasounds. Alta Bates billed HealthNet about $50,000 for my and the baby's hospital stay (ridiculous, right?). HealthNet paid Alta Bates about $26,000 of that, but I'm not on the hook for the difference -- Alta Bates overcharged beyond what was in its agreement with HealthNet, so Alta Bates eats the difference.
The one thing I will say is that we had some squabbles between HealthNet and our medical group (Hill Physicians) about which one of them would pay for something -- the infant hearing screening done in the hospital and the pediatrician visits while in the hospital (our son's doctor didn't have privileges at Alta Bates, so he saw the in-house pediatrician). It's not that Healthnet wouldn't cover them, it's just that the two sides had to fight about it. That was kind of a pain, but I haven't heard anything more about it in a few months, so (knock wood) it seems like it's all resolved.
So, on the whole, I'd recommend HealthNet HMO for pregnancy and childbirth. My OB was Lonnie Lin, with OB- GYN Partners for Health. I liked her a lot -- though Jennifer Yarger in her practice was actually the one who delivered my son. I liked Dr. Yarger too! HealthNet mom
Dear HealthNet Mom,
The customer care team at Hill Physicians would like to help. Please contact us at Customer.Care [at] hpmg.com so we can address any concerns you may have. Thank you, and congratulations on the recent addition to your family.
Hill Physicians Customer Service
Customer.Care [at] hpmg.com
800-445-5747
Pediatric groups not accepting new HMO patients
December 1997
I am expecting my first child in early April, and have recently started the hunt for a pediatrician. I am a professor here at UCB and have been using Health Net as my health care provider since 1993. I also, ironically, grew up in Berkeley, and thus my first choice of a pediatrics group was the one my mother chose for me: Berkeley Pediatrics. My second choice was East Bay Pediatrics, which has also come highly recommended from multiple sources. Thus, you can imagine my great dismay when I called each of these groups and learned that they are not accepting new HMO patients. At the present time, in fact, there are only 3 pediatricians (none of whom have group practices) that are accepting new HMO patients in Berkeley.
Apparently a dispute is occurring between the HMO's and pediatricians in particular. The dispute seems to involve, unsurprisingly, the lack of satisfactory payment to doctors for treating HMO patients. Negotiations are ongoing, but no one is willing to predict the outcome of this sad state of affairs.
I am writing to let those of you who will be looking for a pediatrician know that this situation exists, and to urge any of you who belong to HMO's to voice your concern about this situation. My OB-GYN believes that pediatricians are being very poorly treated by the HMO's and that this situation may escalate and even affect existing patients. Perhaps added pressure from HMO patients (I suppose they call us customers) will provide additional incentives to settle this matter and provide the level of choice that the HMO's had previously promised. I will not hesitate to quit Health Net and pay more and join a PPO in order to be able to use the pediatrician of my choice. Of course, this will involve the inevitable HMO-type hassles, such as the open enrollment window (Nov. for UC employees) being closed.
If anyone has any more information than this small amount I have gathered, or any sage advice, I would be most grateful! Jenny
Note: UC Bencom administers medical plans for university employees.
UC Bencom web page: http://www.ucop.edu/bencom
UC Bencom Customer Service: 1-800-888-8267 (9-4 M-F)
The above web page also lists phone numbers for all the medical plans at: http://www.ucop.edu/bencom/info/hw.html
To the poster who was having trouble finding a pediatrician covered through the Berkeley HMO's: I was at East Bay Pediatrics the other day and apparently negotiations have progressed, though they are still not accepting new patients. They thought it was a thirty day thing originally, but it's been four months. Myrium
It was mentioned a few weeks (months?) ago that the BPMG was not accepting any new HMO patients. I just had my prenatal interview with our wonderful Ped. there, Dr. Howard Gruber, and thought I'd post an update. They are still not accepting new HMO patients, but if you have an older child who is currently a patient they will take any new siblings that come along. The reason for the trouble is that ABMG is refusing to compensate them at a level sufficient to even cover their overhead. So, the more HMO patients they see, the more money they lose.... Unfortunately, it sounds like this could go on for a long time. Lee
We also had blue and gold and hated it, couldn’t believe how hard it was to find a doctor nearby.
Not sure what your salary level is because that plays into the premium cost benefit analysis. We chose the HSA, because for us, even if we met our super high deductible every year it would still be cheaper than the sky high premiums that uc care requires. However it is extremely unpleasant to pay huge out of pocket bills for the first months of the year. I’d say we are medium utilizers and really like to have our choice of doctors, and have been mostly satisfied with the plan so far. If you’re a very heavy utilizer, then uc care might be better. None of the options are stellar unfortunately. Best of luck in your decision!
Curious to know why you aren't considering Kaiser--we switched from Blue and Gold before our kids were born and have never looked back. The single biggest benefit has been how predictable (and minimal) the costs are, and the integration and proximity of care is huge. (We are in Oakland so of course that helps a lot, but the new Berkeley Kaiser has expanded options for friends there as well.) It might be worth taking another look, especially if your Kaiser experience was many years ago. (The caveat, of course, is that if you need specialty care that Kaiser does not offer, it can be a pain to work out of their network--but we have found that, with the notable exception of mental health, their Oakland-based specialist bench is pretty deep and easy to get referrals for compared to our previous non-Kaiser plans.)
I have UC Care and prefer it because the costs are more predictable. I have a chronic health condition that requires labs/imaging several times a year. It seems like Health Savings Plans are suited for people who usually only need for preventative care.
Hello,
Have you considered switching medical groups with UC Blue and Gold? I'm in Hill Physicians and have been able to continue to see my same doctor (through One Medical) and have most of my referrals to facilities in Berkeley or Oakland. (A couple have been to UCSF in Mission Bay, which is really not that far away.) I had been on my husband's PPO, so I was worried my options for specialists would be much more limited, but so far have been pleasantly surprised. It helps that I really love and trust my PCP.
As an aside, I was on the UC Health Saving Plan (or equivalent) years ago when my daughter was born. It was a nightmare having to keep all the costs straight -- I got so many bills from so many different providers. Plus it was so much money out of pocket for the delivery! Was much easier when my son was born (on an HMO) -- $250 and done! I think the HSA plans are best for people who rarely go to the doctor.
Good luck!