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Re: [IP] pacificCare and Kaiser in Bay Area, CA



Janet,

For the past nine months I have both Kaiser and Aetna -- not the PPO though,
the HMO plan.  Here's what I think we've concluded:

1).  Covering pump supplies:    Kaiser always costs less, Aetna's price
varies (depends on their relationship with my husband's work's human
resources office at the moment -- they happen to be helpful advocates) but it
never as low.

2).  Getting pump supplies:  for the past 3-4 years getting pump supplies
with Aetna has been a nightmare -- it has taken as long as 6 months.  The
problem in not approval but the bureacratic.  They seem to have finally come
up with a method and provider and since the US Healthcare merger it is a
little easier.  Kaiser on the other hand is a dream -- doctor writer a
prescription and you pick them up at the pharmacy.

3).  Getting H and V:  Kaiser hasn't been a problem, but my doctor did have
to do a special request for the H.  After the first time, it is never a
problem again.  Aetna depends on the plan and the problems change every 6-9
months (I think when they reorganize their criteria).  For a few years it was
easy.  Humalog co-pays were higher though.  I will have to try again next
month when Kaiser poliicy ends so I'll be able to let you know then.

4).  Seeing an endo you like:  Kaiser is difficult.  Doctors in general seem
more helpful but less informed about specialties.  Much diabetes care is
geared toward stereotypical Type II patients.  Diabetic eye care is poor.
You can find someone you like (there is a pump CDE for instance in Martinez)
but you may have to travel long distances to do so.  My understanding
(through my regular doctor) is that there is an endo. in Pleasanton and one
in SF that know about pumps.  Referrals are very very very easy as soon as
you have any kind of doctor.
    Aetna really comes down to if you like those on their list (you can
request it ahead of time).  Referrals were horrendously bad but seem to be
improving.  Everything seems to require you first go through a primary care
physician.  My endo was my pcp but I just received a letter he is becoming
just an endo and I haven't yet figured out what that means as far as if I
need a referral to him every time.  He's probably too far away to be much
help to you -- East Bay -- but if a name helps, let me know.

Best of luck,

Ruth

Janet Wiener wrote:

> I'm trying to decide between 2 job offers. Health care won't be the
> deciding factor, but it is important. My husband's policy has a large
> deductible and only covers pumps and supplies 50%, so I'd like something
> that does better.
>
> One of the jobs only offers 2 HMO plans: Pacific Care and Kaiser. This is
> for the Bay Area of California -- I live in Sunnyvale and the job is in
> Palo Alto. Does anyone have any experience with either plan for:
>
>      * getting pump covered
>      * getting pump supplies
>      * getting Humalog and Velosulin (it was a pain under Blue Shield CA)
>      * seeing an endocrinologist they like
>
> I already know that my OB/GYN doesn't take HMO insurance, sigh. :-( And
> both HMOs require referrals for everything.
>
> The other job has Aetna PPO insurance, and the same questions apply. I
> think it's a better insurance plan, but I haven't seen any specifics and
> I'm leaning towards the first job.
>
> thanks!
>
> Janet
> email @ redacted
>
> PS I'm still behind on the digest mail, so I would appreciate responses
> that are cc'd directly to me.
>
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