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This may be being handled off to us. I just got appts for both a nutritionists and a sleep specialist, and the clinics explicitly asked ME to find out if it is

This may be being handled off to us. I just got appts for both a nutritionists and a sleep specialist, and the clinics explicitly asked ME to find out if it is covered, mumbling something about the particular insurer (blue shield of AL) requiring it

jdavis703 8y ago
This is why I'm really a big fan of HMOs (of which I'm a member). Wasteful spending hurts both the medical provider and the insurer because they're the same entity. I realize an HMO may not be for everyone, but whenever the idea of universal health care comes up Kaiser Permantee is a really good model to look at. I ran the numbers the last time a healthcare reform proposal came up in California, and it would have been cheaper for the state to just give a "Kaiser Permantee for all" scheme than to expand Medicaid/Medical for everyone.
- dragonwriter 8y ago
  Kaiser Permanente (excluding their Medicare Advantage, Medi-Cal managed care, etc., plans) covers employed or financially independent individuals and their dependents, who have a different health profile than the whole population. They also charge higher it of pocket costs for some services than would be acceptable for coverage that was expected to have utility to the medically indigent. So, yeah, it'd be cheaper to buy everyone a KP individual plan with prices set based on the cost of insuring the people that can afford KP individual plans. But it wouldn't make a whole lot of sense as a universal approach.
- kevin_thibedeau 8y ago
  Most HMOs are not as good as KP. They aren't run as a profit center like most of US healthcare.
  - dragonwriter 8y ago
    > Most HMOs are not as good as KP. There are several (but still not most, I would agree) that are if you also have a good medical group. KP is the medical group as well as the insurer, so it (aside from any benefit from synergies and absence of interparty conflict) provides a more consistent experience on that end.

jdavis703 8y ago

This is why I'm really a big fan of HMOs (of which I'm a member). Wasteful spending hurts both the medical provider and the insurer because they're the same entity. I realize an HMO may not be for everyone, but whenever the idea of universal health care comes up Kaiser Permantee is a really good model to look at. I ran the numbers the last time a healthcare reform proposal came up in California, and it would have been cheaper for the state to just give a "Kaiser Permantee for all" scheme than to expand Medicaid/Medical for everyone.

dragonwriter 8y ago
Kaiser Permanente (excluding their Medicare Advantage, Medi-Cal managed care, etc., plans) covers employed or financially independent individuals and their dependents, who have a different health profile than the whole population. They also charge higher it of pocket costs for some services than would be acceptable for coverage that was expected to have utility to the medically indigent. So, yeah, it'd be cheaper to buy everyone a KP individual plan with prices set based on the cost of insuring the people that can afford KP individual plans. But it wouldn't make a whole lot of sense as a universal approach.
kevin_thibedeau 8y ago
Most HMOs are not as good as KP. They aren't run as a profit center like most of US healthcare.
- dragonwriter 8y ago
  > Most HMOs are not as good as KP. There are several (but still not most, I would agree) that are if you also have a good medical group. KP is the medical group as well as the insurer, so it (aside from any benefit from synergies and absence of interparty conflict) provides a more consistent experience on that end.