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Northern California Babies
legaleagles
member
Kaiser v. United HealthCarePPO Plus
legaleagles
member
So with DH's job we have the option of staying with Kaiser, having $5 and $15 copays for visits, no cost for labs, x-rays, etc. or a PPO Plus which would have a deductible, I' can't remember how much, I think less than $1,000 some copays for prescriptions.
I've had KP my whole life, I generally like my primary care doc and I'm currently seen at the REI clinic. Turns out I'll have similar coverage for my IF treatments regardless of the plan I choose so that's not my deciding factor anymore.
Who knows if/when I'll be PG and if it will happen this year, but for those who delivered at KP did it bother you that it wasn't your doctor, or a doctor from your practice? If you'd have the option, OOP contribution being fairly similar (my company will pay up to $800/month of our OOP expenses so essentially our annual deductible with a PPO would be paid back to us) would you choose a PPO or would you have stuck with KP?
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Re: Kaiser v. United HealthCarePPO Plus
Not nearly at much as I THOUGHT it would. The doctor was in the room for such a small part of my L&D (well... really... just the 'D')... it was the nurses who I relied on.
Also, FWIW... I've heard that many PPO OB practices are going to the "co-op" program - rotating Drs on duty for delivery for different days. So even if you switched to a PPO... you might end up in a practice that has a similar format to Kaiser anyway.
If that's the only reason you're thinking of changing... for me, the "same" Dr. at delivery was not that important/is not a priority for me.
I'm Kaiser and have chosen to stay with Kaiser even though I could have switched to my employers healthcare.
I'd say the big thing to price is delivery. My coworker has PPO and paid a few thousand in delivery while I paid $200 with Kaiser. I'm not sure how deductibles work. Some say you only have to pay up to the deductible, some say that after you reach the deductible a certain % is covered. I'd say read the fine print and figure just how much things will really cost.
As for delivery, it didn't matter who delivered. The dr or midwife or whoever will deliver is only there for the last 20-30 minutes of the delivery. During all of the work up to it, it's nurses. Even when I pushed 3 hours with Emmy, it was a nurse for 2.5 of those hours. So for me it didn't matter.
Plus, my Kaiser has you rotate through the staff each appt so you get to meet a lot of the people who may be on call during your delivery.
By the end, I didn't want to see my doctor! LOL
I really liked the midwives and feel like OB clinic and L&D are very different animals and I like having someone there who's an expert in their field (which I felt like I got with the midwives...many of whom only do L&D)
I liked that all my appointments were with the same doc though.
Personally, by the end, I didn't care who was doing the catching. I think you could consider (at least at San Jose) that all the docs were from the same practice (because they're all from the clinics right there)
I know a lot of practices where every appointment is with someone new because you need to get to know everyone in the practice. I'd rather have all my appointments with the same doc and deliver with someone else rather than have my appts with different people but deliver with someone I knew.
We're TTC and during the last two open enrollments with my company, I've done a fair bit of research (including asking this same question on this board and talking to my good friend who is a Bradley instructor and has had two Bradley births with Kaiser in Redwood City) and ultimately decided to stay with Kaiser. There is comfort for me in staying with what I know (what I've pretty much always known), and I've only really heard of positive pregnancy/childbirth experiences with Kaiser. Good luck!
I really thought it would bother me but in the end it didn't and I really liked the Dr who did the C-section, which was by the way at the ST Kaiser and not the Santa Clara which I had done my visit and ALL of my appointments at previously. TBH, the team of doctors saved my life and took excellent care of Amaya. We had great communication and for $200 for the cost of what I think would have been a hundred thousand dollars for my entire stay I consider that a bargain. We also considered changing but we stuck with Kaiser and I have been very happy with that decision.
GL!
Like you, I have had Kaiser my whole life and I do not know any other health care option.
Since I can not speak from experience, I was there when my niece was born (my sister has KP too) and I think she saw the doctor 3x (and one of them was her OB). Most of the time it was the nurses who came in to check on my sister and help with the L&D. There was a doctor there after my niece was born since b/c of her shoulder-she got stuck in the birth canal. Other than that, that was it. They did a great job with my sister and my niece.
I delivered at a non-KP hospital with a PPO. Most of the PPO networks in the south bay and penninsula use a medical practice model that does not ensure your own OB at delivery. I think there are maybe a half dozen OBs who have such small practices that they do all their own deliveries. All the others are in group practices and rotate with their partners for being on call at the hospital and doing all the group's deliveries. So no matter which you choose, you are unlikely to have your own OB delivery your baby, unless you make a big effort (searching out the few OBs who do it and are accepting new patients).
Having said that, I switched my primary insurance to the PPO in Sep. got pg in Oct, hated the group practice I picked by week 12, and switched to an OB with a tiny office at week 18 and he was by my side several times a day for my entire 80 hour induction, stayed overnight in the hospital on the last day and sat by my side holding my hand as I begged for a cesarean. He did the surgery and visited us several times a day for my entire 4 day hospital stay post surgery. He was awesome.
If I had stayed with KP, I'm sure I would have had wonderful care and a perfectly fine birth. And it would have cost me $50.
My actual doctor was wonderful, the hospital less so, and the whole thing (4 day labor, surgery, 4 day recovery, nursery stay for DS) cost a small fortune.
I have had nothing but terrible experience with KP my whole life. One of which ended with a med-mal lawsuit when they stitched up my foot with a piece of glass still inside, the glass severed my tendon and I lost mobility in my foot and toe. All this while on a college scholarship for soccer.
While their prices are cheaper OOP, IMO you get what you pay for. I have never been a fan, and won't go back. BUT, the reason why is truly very specific.
I would find the OB with the best reputation in the area, and I would find the pediatrician with the best reputation and see where they are in terms of taking what insurances and go from there. If they both end up being KP providers, that settles it then and there. I'd just work backward from provider to insurance coverage. IMO, pricing alone is not a good enough reason to switch or stay. If the best providers are KP, stay, if the best providers will accept UHC PPO, switch. KWIM?
I LOVED delivering at Kaiser. The nurses were wonderful and so were the midwives. They were super supportive of my natural birth plan and one nurse even stayed on late to see the baby be born.
I switched for one month to a PPO and did not like it nearly as much...I look at it this way...if it aint broke dont try to fix it.
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