3 ms·

Isn't this basically how an HMO works? I've heard those have lower costs and patients seem to like them. What's different with United?

by ars 3y ago

toast0 3y ago
I've been with Kaiser in Northern and Southern California. But not really with other HMOs. I think the difference is Kaiser (in most places) is really a closed system; if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. If you're not with Kaiser, you don't go to Kaiser facilities, other than the emergency room maybe. Everyone you interact with is a Kaiser employee or contractor. You don't get recommended care that won't be covered, you don't get treated by someone who isn't in network, you show up, you pay your copay, and that's it, you're done. For HMO plans with other providers, it seems like the doctors are often independent; you have to stay in network, but you still have to deal with network BS like this office is in network, but only some of the doctors. There's not a Blue Shield medical center with doctors, specialists, and a pharmacy at one location.
- lotsofpulp 3y ago
  Because Blue Cross Blue Shield is neither a healthcare provider nor a managed care (health insurance) seller. BCBS is kind of like a franchising business, where the franchisors get access to other members’ negotiated pricing and administrative services to create a larger (nationwide) network. For example, your employer could purchase managed care from Horizon BCBSNJ, and if you get into trouble on vacation on the west coast, then they coordinate with Elevance or BlueShield California or Regence in Washington/Oregon to figure out how much they are paying providers. And this way Horizon BCBSNJ does not have to do all the legwork of negotiating with every healthcare provider in the country. I’m sure it is quite a bit more complicated in practice though. > if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. Kaiser also sells PPO plans where you do not have to see a Kaiser employee for covered healthcare.

Isn't this basically how an HMO works? I've heard those have lower costs and patients seem to like them. What's different with United?

by ars 3y ago

Isn't this basically how an HMO works? I've heard those have lower costs and patients seem to like them. What's different with United?

toast0 3y ago

I've been with Kaiser in Northern and Southern California. But not really with other HMOs. I think the difference is Kaiser (in most places) is really a closed system; if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. If you're not with Kaiser, you don't go to Kaiser facilities, other than the emergency room maybe. Everyone you interact with is a Kaiser employee or contractor. You don't get recommended care that won't be covered, you don't get treated by someone who isn't in network, you show up, you pay your copay, and that's it, you're done. For HMO plans with other providers, it seems like the doctors are often independent; you have to stay in network, but you still have to deal with network BS like this office is in network, but only some of the doctors. There's not a Blue Shield medical center with doctors, specialists, and a pharmacy at one location.

lotsofpulp 3y ago
Because Blue Cross Blue Shield is neither a healthcare provider nor a managed care (health insurance) seller. BCBS is kind of like a franchising business, where the franchisors get access to other members’ negotiated pricing and administrative services to create a larger (nationwide) network. For example, your employer could purchase managed care from Horizon BCBSNJ, and if you get into trouble on vacation on the west coast, then they coordinate with Elevance or BlueShield California or Regence in Washington/Oregon to figure out how much they are paying providers. And this way Horizon BCBSNJ does not have to do all the legwork of negotiating with every healthcare provider in the country. I’m sure it is quite a bit more complicated in practice though. > if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. Kaiser also sells PPO plans where you do not have to see a Kaiser employee for covered healthcare.