Bay Area: Kaiser vs BCBS vs One/Circle Health

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gurusw
Posts: 310
Joined: Sun May 11, 2008 9:37 am

Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by gurusw »

Hi,

I am in Bay area, CA. Specifically Fremont in east bay. So this post is pertinent to this part of the world.
I am 48 & spouse is 46. And we are at the point where we both need frequent medical visits due to some newly discovered issues.

The last quarter is coming, and it will soon be time to enroll for new year's benefits. At this point I am proactively weighing between different Medical plans, so that I can make the choice when HR opens up the enrollment process.

I am long time user of BCBS network, but lately I am observing that many medical practitioners are leaving their network. Also the good ones are not accepting new patients. Not sure whether this is issue of this area, or is this effect of post-pandemic world, or something else. But I am wondering if I need to switch.

With BCBS I have Anthem PPO plan. But many times, the specialists need referral from Primary. Also the cross-network referrals (like from Palo Alto to Stanford) take long time to process. So I think I do not get the full benefit of PPO. Not to mention, I am unhappy with my PCP & having hard time finding a different one.

I have never tried Kaiser. But I heard that it's difficult to get specialist appt in Kaiser.

I recently heard from my colleagues in SF that they sign up for One Health or Circle Health on top of the company benefit. They pay $100 or something for One Health & nothing for Circle. And then they have vast network of providers. But my colleagues are single guys without any health complications. So I am not sure how this option will work for us with referrals & such.

Does anyone have any advice? I guess I have a few choices here:
1. Kaiser HMO
2. BCBS PPO (also available as HDHP where employer pays me $2K per year if opted)
3. One/Circle Health on top of BCBS (or maybe on top of Kaiser also, not sure)

TIA.
Catnap
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by Catnap »

Hi Gurusw,

DW and I are in Campbell and have used Kaiser on and off over the years.

The good part of Kaiser is that everything is under one roof and it is really efficient for routine stuff. No more looking for providers or filling out forms for every new practitioner—they refer you directly and already have all your medical history. It’s also a big bonus if you live close to one of their big medical centers. If your doctor needs blood work, prescribes medication, or an X-ray, they are all in the same building. Some advanced stuff like mri will need to be scheduled out but the routine stuff is quick and convenient. We also had a really smooth experience with the maternity area and the neonatal intensive care unit is exceptional.

Now for the bad part—mental health. Kaiser is terrible if you need this. The therapists are good but there is no availability. If you are suffering from a complete break from reality. They will schedule you for group therapy weekly and a one on one therapy session every 7 weeks. This is the equivalent of leaving someone with a broken leg in a soft splint with some ice and Tylenol. Helpful but not nearly enough.

To sum up, Kaiser is a great choice for folks who value efficient delivery of routine services (including giving birth with complications) but is terrible if you need mental health care. I would strongly consider this option if you are close to a big Kaiser medical center. I can’t speak about your current plan or regarding one/circle health. I hope this is helpful to you.

Best of luck!
somekevinguy
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by somekevinguy »

I’m a subspecialist physician (non-kaiser - academic medical center) and my wife is a kaiser subspecialist physician. We’re in the Bay Area. I have a choice of my academic medical center, kaiser, or another ppo for my insurance and I consistently choose Kaiser every open enrollment.

The main benefits of Kaiser really are accessibility and efficiency with very good health care overall. For instance, a primary care appt was going to take me >3 months of waiting through my medical center but could be scheduled within days through kaiser. The same applies for subspecialty appointments. They also do amazing things like have a dermatologist at their general clinics so if someone comes in with a rash, the dermatologist can weigh in at the same visit- I have never seen that before at my (highly regarded) medical center. Accessibility to your physicians is also far and away better through kaiser. I can email any of my physicians and reliably expect a response back within 2 days but usually the same day- in fact, I think that is a standard kaiser holds its physicians to in terms of communication (tougher for my wife but great if you're a patient). If I need a rx filled, super easy to do through their app. If I need labs, can email my physician and have the lab orders ready to go that same day. I’ve had some imaging done and the scheduling is quite efficient with minimal wait.the list goes on and on. (One caveat is that because of my wife's employment, we get the cadillac/platinum plan but I think that impacts things like out of pocket costs and not things like accessibility or wait times)

The only time I’d consider another center or insurance is if you have some particularly rare or complex disease that only a few people are familiar with- in that case, an academic medial center may have the world’s (or at least region’s) authority on that disease. Otherwise, if you have run of the mill stuff (asthma, diabetes, coronary artery disease, hypertension, broken bones, etc etc), I think kaiser is hard to beat.

Just my 2 cents.
Last edited by somekevinguy on Fri Sep 30, 2022 7:15 pm, edited 3 times in total.
fareastwarriors
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by fareastwarriors »

gurusw wrote: Wed Sep 28, 2022 10:06 pm Hi,

I am in Bay area, CA. Specifically Fremont in east bay. So this post is pertinent to this part of the world.
I am 48 & spouse is 46. And we are at the point where we both need frequent medical visits due to some newly discovered issues.
I'm in Hayward and I use Kaiser. My experience has been very positive but medical history has been minimal besides a cyst removed in my hand, ulcers, and some stiches for a cut. Nothing rare/major, thankfully.

As others have mentioned, I really like that they have everything under "one roof" and they know my medical history.
Carefreeap
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Location: SF Bay Area

Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by Carefreeap »

Catnap wrote: Wed Sep 28, 2022 10:52 pm Hi Gurusw,

DW and I are in Campbell and have used Kaiser on and off over the years.

The good part of Kaiser is that everything is under one roof and it is really efficient for routine stuff. No more looking for providers or filling out forms for every new practitioner—they refer you directly and already have all your medical history. It’s also a big bonus if you live close to one of their big medical centers. If your doctor needs blood work, prescribes medication, or an X-ray, they are all in the same building. Some advanced stuff like mri will need to be scheduled out but the routine stuff is quick and convenient. We also had a really smooth experience with the maternity area and the neonatal intensive care unit is exceptional.

Now for the bad part—mental health. Kaiser is terrible if you need this. The therapists are good but there is no availability. If you are suffering from a complete break from reality. They will schedule you for group therapy weekly and a one on one therapy session every 7 weeks. This is the equivalent of leaving someone with a broken leg in a soft splint with some ice and Tylenol. Helpful but not nearly enough.

To sum up, Kaiser is a great choice for folks who value efficient delivery of routine services (including giving birth with complications) but is terrible if you need mental health care. I would strongly consider this option if you are close to a big Kaiser medical center. I can’t speak about your current plan or regarding one/circle health. I hope this is helpful to you.

Best of luck!
Not to mention that the therapists are currently on strike because of it. I wil give them credit, they are doing outside referrals and bridging appts with a contract thereapist. It's definitely not a good time to be needing help. And even when they are up and running they do not have couples counseling in their business plan. That's a real head scratcher to me because aproximately 40% of female homicides are due to their partner.

ETA I've found almost all the doctors to be good and good with patients.
Every day I can hike is a good day.
Topic Author
gurusw
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Joined: Sun May 11, 2008 9:37 am

Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by gurusw »

Hi everyone,

Thanks for your replies. Honestly I was not expecting everyone to endorse Kaiser. So that's an easy decision for me now, esp considering we do not have rare health conditions or mental health issues. We will definitely try it out in 2023.
jmw
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by jmw »

I do NOT recommend Kaiser if you have any weird health issues that can't be remedied with standard treatment protocols by the book. Getting specialist appointments can be slow but it varies a lot. Some people get lucky. My main issue is that Kaiser docs will always stay with the book and never, ever stray outside standard protocols to suggest any treatment or drugs outside of the book if your treatment is not working. Every insurance has step therapy requirements to control costs with RX, but that Kaiser doc may be discouraged from recommending anything not on the formulary.

So choosing Kaiser depends on how standard your health problems are. If your health problems are common and can be treated successfully, Kaiser is good. If not, stay away. Finally, if you have any hint of mental health issues, go elsewhere and don't even consider Kaiser. Kaiser has had poor mental health services for over two decades. Because of this long track record, Kaiser will never make any serious effort to fix it.

You guys are still young but are approaching the age where I wouldn't gamble on Kaiser anymore as health problems begin to multiply. Your BCBS experience sounds like the pits too but I prefer having the PPO and OON options in my back pocket as an older person prone to more health problems.

When you come back to Bogleheads and choose Medicare at 65, you will see a lot of opposition to Medicare Advantage HMOs including Kaiser versus staying with Medigap and traditional Medicare. The Kaiser opposition is out there. We must have somehow missed your thread. :) Anyway I don't think it's that much of a difference now Kaiser vs. others at age 49. It will be a huge difference at age 65+.

Good luck whatever you decide on.
nanciT
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by nanciT »

I feel Kaiser can be limiting. We have and will continue to have BC/BS and I have not had any issues with physicians or groups not taking our insurance. We see physicians at Stanford and Sutter which includes PAMF. I want to mention Stanford has taken over several practices and groups so getting a PCP has become easier. I mention this because once you have a PCP it is simple to get to the specialist required in Palo Alto if necessary.

I have been a nurse over 30 years and worked in surgery at Kaiser Walnut Creek for several years.

My husband recently required Spine surgery, having the ability to get several opinions is important. We had 4 and one was far more detailed and extensive. We ended up with a Neurosurgeon VS Ortho.

My experience and the experience of patients I have had over the years is not a positive one with Kaiser. If you are in great health it may be fine but if anything comes up that may require someone "top" in their field here locally at Stanford or UCSF then Kaiser can be limiting.
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JamesSFO
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by JamesSFO »

Bay Area here...

Kaiser is great/amazing for routine care and common issues (diabetes, asthma, blood pressure, etc.) and challenging for unusual conditions or if you really need a very specific specialist.

Sadly with US healthcare we have to roll the dice on this.
Californiastate
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by Californiastate »

I've had Kaiser NorCal for my entire adult life. I like the one stop shop. I don't have a reason to change.
stan1
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by stan1 »

gurusw wrote: Wed Sep 28, 2022 10:06 pm cross-network referrals (like from Palo Alto to Stanford) take long time to process. So I think I do not get the full benefit of PPO. Not to mention, I am unhappy with my PCP & having hard time finding a different one.
I'd try to avoid cross-network referrals such as UCSF to Stanford. Even if both are on the same electronic health platform (which I think they are) and you import/export records it makes coordinated care more difficult. If you are doing that and feel it is necessary primarily to find an appointment I'd consider trying Kaiser.

My PCP is a specialist who treats a primary condition I have that is well maintained. She does not refer me to specialists frequently which is an approach I agree with for my personal situation. The hospital network I use has a very capable urgent care center 5 mins from my house which has handled pop-up visits well for me (I've been 3 times in 10 years so not a regular occurrence).

I think One Health and similar use case is mostly healthy people who seek a lot of minor care for various personal reasons. I especially don't see a reason to use them if you need recurring specialist care coordinated with your PCP. One Health will just refer you to one of the specialist networks which makes coordinated care harder.
123
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by 123 »

I've pretty much been under a Kaiser plan my entire life (40+ years). I have no complaints about them and I believe they are excellent. Years ago they used to refer some patients to other medical centers if specialized surgery was required (organ transplants and some head/brain surgeries usually). But with the expansion of their hospital network in California they can now do pretty much everything in-house (but that has some geographic variations). I had an uncle that had to go to Kaiser for a cardiac stent and he said nothing gave him more comfort than talking with the doctor in the catheterization lab and the doctor saying that he did stents "all day long". Practice makes perfect.
The closest helping hand is at the end of your own arm.
miket29
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by miket29 »

I'd go with the BCBS PPO plan. For routine care Kaiser is fine but if you come down with a relatively rare disease you want to see a specialist and those are often at academic centers like Stanford and UCSF. Maybe your version of BCBS is different but when I was covered under it at megaCorp there was no requirement to have a PCP (I never bothered designating my internist as such even though I had been seeing him for many years) or get a PCP referral to see a specialist. Stanford, it turns out, does require in some departments such as oncology. You can't just pick up the phone and make a new patient appt, you need a referral from another doctor. But that is easily done and takes about a week to process from, for example, PAMF to Stanford.
I am long time user of BCBS network, but lately I am observing that many medical practitioners are leaving their network. Also the good ones are not accepting new patients.
I think part of this may be a reflection of living in this area. At PAMF for example there are pretty much no internists accepting new patients. I wonder what will happen when my doctor retires in a few years? Hopefully they don't just kick us out of their care.
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quantAndHold
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by quantAndHold »

Kaiser is the big dog in that area, so they will have more providers, and cover at least as wide a range of specialties as the others, but also have more patients vying to see those providers. My family’s experience is if you have a serious or unusual medical condition and Kaiser either doesn’t have the correct specialist or the specialists are backed up, they will send you outside of Kaiser to get the care you need. But for most things, that’s unnecessary.

There is a provider shortage everywhere, so waits for appointments can be long with any of the plans you’re talking about. I had Kaiser for years, and my main complaint was the amount of time it took to see certain specialists. Then my employer at the time dropped Kaiser and I had to go with another group, and found that wait times were just as long. When I started paying for things myself, I went back to Kaiser. I liked the doctors better, and they charge less, which means something on my bronze ACA plan.

Kaiser does have its own protocols and formulary. I’ve found that the primary care docs are unlikely to deviate from the Kaiser protocols, but the specialists, especially the better ones, are less likely to follow the script.

I have family members that have One medical, including one that has a fairly complex health history. They seem happy. That’s about all I know.
engineer2012
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by engineer2012 »

My family (parents, ourselves, aunts/uncles, kids) has used Kaiser for years.

Heart surgery, colon surgery, child birth (C section), etc, never had any issues. Those of us on Kaiser have not had to worry about out of network providers.

With that said, premiums have been going up, and provider choice inside Kaiser could be limiting. I also heard that Kaiser may not be great for those with rarer medical issues, but that isn't something I have experienced.
phisher4
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by phisher4 »

engineer2012 wrote: Fri Sep 30, 2022 6:43 pm My family (parents, ourselves, aunts/uncles, kids) has used Kaiser for years.

Heart surgery, colon surgery, child birth (C section), etc, never had any issues. Those of us on Kaiser have not had to worry about out of network providers.

With that said, premiums have been going up, and provider choice inside Kaiser could be limiting. I also heard that Kaiser may not be great for those with rarer medical issues, but that isn't something I have experienced.
I agree with much of what you're saying, but I would gently suggest we all please stop using the term "provider" to refer to physicians and other medical professionals. The use of this term commoditizes the physician/nurse/therapist interaction and reinforces the notion that patients are customers and not human beings deserving of respect.

Thanks for your consideration.

For more information:
https://www.aafp.org/about/policies/all/provider.html
https://www.aaem.org/resources/statemen ... m-provider
engineer2012
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by engineer2012 »

phisher4 wrote: Fri Sep 30, 2022 6:53 pm
I agree with much of what you're saying, but I would gently suggest we all please stop using the term "provider" to refer to physicians and other medical professionals. The use of this term commoditizes the physician/nurse/therapist interaction and reinforces the notion that patients are customers and not human beings deserving of respect.

Thanks for your consideration.

For more information:
https://www.aafp.org/about/policies/all/provider.html
https://www.aaem.org/resources/statemen ... m-provider
Understood, my apologies.
Ron Ronnerson
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by Ron Ronnerson »

I’m in the East Bay (tri-valley area) and my spouse and I are the same age as you. My wife has had Kaiser for a long time and I’ve had them for several years now. It’s really nice not having to worry about the whole in-network/out-of-network issue.

I wanted to see my regular doctor last year but it was hard to get an appointment. There was nothing available for a few weeks in my town (or the surrounding towns for that matter) but doctors at the Fremont office had appointments available much sooner so I went there. It was a good experience both in terms of getting someone to see me right away and the service.

We’ve been happy with Kaiser but wish there were a Kaiser Hospital closer to where we live. It’s nice that they have a hospital in Fremont in addition to the medical offices.
Topic Author
gurusw
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by gurusw »

Again thanks for the replies. Yes, it does create some confusion now :)

For years, I went with BCBS PPO because of the flexibility. But my BCBS plan recently removed Stanford as a health provider. Most PAMF doctors are not accepting new patients. And Washington doctors are leaving the network (at least we have had that impression because we lost 2 of them).

Maybe we can try Kaiser for a year, and see how it goes. Do not know what else can be done here!
stan1
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Re: Bay Area: Kaiser vs BCBS vs One/Circle Health

Post by stan1 »

gurusw wrote: Sun Oct 02, 2022 11:52 am Again thanks for the replies. Yes, it does create some confusion now :)

For years, I went with BCBS PPO because of the flexibility. But my BCBS plan recently removed Stanford as a health provider. Most PAMF doctors are not accepting new patients. And Washington doctors are leaving the network (at least we have had that impression because we lost 2 of them).

Maybe we can try Kaiser for a year, and see how it goes. Do not know what else can be done here!
You can google the issue, it is a long standing dispute including lawsuits between Stanford and BCBS over reimbursement rates. They've come to terms in the past. Maybe they will again.

If BCBS isn't meeting your needs then try something else, sounds like you can come back at the next open season if you want.
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