Whose Your Daddy???


1000 Post Club
Alright folks, let's rate em.

Based on your experience in your respective state(s) who is the best HMO based on the following factors and anything else you can think of that is prudent.

1) Quality of Plans
2) Broker Support
3) Large network
4) Customer familiarity with company.

yadda, yadda, yadda

I am still working on the PA and VA winners, but I have to go with Carefirst for the MD market. Broker support is non-existent, everybody knows the name, they have a large network, and their plans "overal" are good. Some of the caps do not make me feel warm inside, but their HSA's are good, but not great.
Kaiser 'owns' the HMO market in CA. The Blues each have one or two, but they are not nearly as popular as their PPOs (for indiv./family plans (IFP)... not sure about group). There are some regional HMOs that have pockets of popularity... Western Health Advantage is one where I live.

Kaiser 'hates' agents when it come to IFP. They pay a crappy $100 per person and $50 per person on first renewal. Not sure about second renewal.

I don't write HMOs unless the client absolutely wants one... and if they want Kaiser I tell them to get it on their own.

The abuses that HMOs have made in CA are the stuff of legends. There is an entire regulatory agency (Dept. of Managed Health Care) that was set up just to oversee these companies. I worked there for almost a year and there is a REASON such an agency is necessary. The complain file would curl your hair. True, they also oversee PPOs, but it is the HMO operations that 'cause' most of the 'issues.'

Bottom line, HMOs like Kaiser who own the whole stack have an incentive NOT to treat you. They know they have to have a brain surgeon and a gastro guy and other high-priced specialists. However they want to minimize the case loads so that they don't have to hire too many of these guys. It's somewhat the same for the non-bricks/mortar HMOs. So if they can put your treatment off for a year or so, that's a good thing.

As for Kaiser, I don't care for their quality of care. I won't say why as I don't want to be sued. But I would never have a major procedure done at any of their facilities. Kaiser is great for young healthy couples and children who scrape their knee a lot. For people who really like to go to the doc a lot (everytime the kid coughs!) Kaiser is fine. They have pretty good OP care and the maternity is not bad from what I hear. But if I have to have a hip replacement, I'm going to choose my OWN surgeon and my own gasser from anyone in the network (assuming it's a large network like the Blues have here.)

I've watched my wife have three (yeah THREE) major hip replacements (one wore out after 10 years) via the PPO coverage where she could choose her own docs and hospitals ... compared to those I know who use an HMO... and please 'trust me' when I tell you that freedom of choice is the way to go. If you are 'stuck' in an HMO and are ever faced with a major problem, you will know what it means to be limited to "the guys they have" as opposed to whom YOU might want to do the job.

Sorry to rant here, but I see no reason for HMOs to exist ... except the money.

If I had all my clients with KP my life would be much easier. They do an outstanding job in Atlanta.
Most states don't have HMO's. It's RARE.

California seems to be the only state that most carriers have that as an options. Kaiser is in GA, MD adn OH I believe, Other than that I only know of Carefirst in MD.