Asking for last-minute advice; local people most useful, but any experience helpful

[pameladean]

So I filed our taxes late again and am therefore only now narrowing down the not-very-appetizing choices remaining on MNSure for health insurance for David and me. I found a pretty good and a slightly better plan; the first is through Health Partners and the second through UCare. Both of them have a lot of complaints on the BBB site and scattered about here and there. My mother, who used to work for an insurance company and still has an interest in how they operate, is not very enthusiastic about Health Partners, though the anecdotal evidence she has is somewhat outdated. Health Partners seems to have inspired a lot more annoyance and dislike in the people it billed for premiums they had paid, whose doctors it made repeatedly re-authorize the same prescriptions, and so on. I have had a UCare plan before and, aside from having a very primitive website, they did not do anything egregious during the year I was their customer. But the Health Partners plan has a lower co-insurance and a lower co-pay. What to do, what to do? I'm leaning towards UCare, partly because they use the Fairview provider network.

A major annoyance in all this is that no plan available on the exchange includes HCMC in its network. I've been at HCMC since 2002 and I really don't want to leave, but we are eligible for quite a hefty subsidy on the exchange and really couldn't afford any health insurance if we had to pay all of it. But I am viewing all other provider networks with a very jaundiced eye. Anyway--

If anybody has experience with either provider that seems relevant to this choice, I'd love to hear it.

Thanks so much. One day I will make a post with actual content.

P.S. The upshot of the last problem I asked for advice about was that lsanderson most kindly came over and took down all the tiny trees with a Sawsall and a green-wood blade. He did this on the last day before it snowed for the first time back in November. I failed to bundle up the branches in time for the last yard-waste pickup of the year and was still contemplating doing so and calling the city, as the city say sone may, to arrange for an out-of-the-ordinary yard-waste pickup. In the meantime I took coffeeem's recommendation of A-Tree Service, and they dealt with the larger trees that had got tangled up in the powerl ines, and with the one branch of the Chinese elm that was hanging threateningly over the garage and rubbing on the tree's main trunk while it did so. The day, which involved Xcel energy's dropping the power lines and the power consequently being out for about five hours, felt quite traumatic at the time, but it all worked out well aside from the hole left in the bank account. As a very nice bonus, when they cleaned up all the branches they had cut themselves they also took all of Larry's. Thanks to all who made suggestions and recommendations.

Pamela

Comments

[dreamshark.livejournal.com]

We have been using Health Partners Freedom Vital, which is a Medicare Advantage program, and have been very satisfied with it.

The Freedom programs are basically HMO style health plans with very good coverage in-network and limited coverage out of network. This really isn't that limiting, since their network includes both the former Group Health network and the entire Park Nicollet network and possibly other major clinics as well. We've been using Park Nicollet for years and they have always provided every service that we need. I think Methodist Hospital is an excellent hospital and the people who work there seem to like and respect each other.

The MNSURE plans will be different from the Medicare plans, but they probably offer an option similar to this one. I found them easy and pleasant to deal with during the signing up process, and they have been no trouble at all in terms of coverage. Both Richard and I have had several pricey procedures this year, and none of them required prior approval. There have been a few co-pays and surprise bills for random stuff that for some reason wasn't quite covered, but nothing egregious compared to the costs of the procedures.

There is probably an online way to check the formulary of the plans you are considering to make sure that your specific meds are covered.

I had no idea that one could get primary care from HCMC. Are they part of a larger system, or do they operate standalone?

We've been using ParkNic for years, but of course there was a mildly painful paperwork transition to get onto Medicare. Every ParkNic clinic has at least one insurance consultant on site to answer questions and help with the paperwork. I chatted with the one at our clinic and he volunteered that the HP Freedom plans had been especially easy to work with (from his point of view) and had excellent coverage. You might check to see if there is an insurance consultant at your primary clinic and see if they have any wisdom to impart.

[pameladean]

Thanks very much for the information. The plan we'd have is, to my great amusement, called Peak Individual; but as you say, there should be a lot of similarities. I'm very much encouraged by your long experience with Health Partners.

I have checked the formulary and that part is all good. I am taking a lot of medications, but they are all bog-standard generics and usually give no trouble when I'm trying to choose an insurance plan.

As best I understand it, HCMC is a standalone system. It's pretty big just on its own. I started there in the ER with incidentally-detected staggeringly-high blood pressure. They determined that it would not kill me immediately and referred me on to the Downtown Medicine Clinic, where I was treated very well until 2013, when the influx of new patients from the ACA made it very difficult to get an appointment in less than nine or ten weeks. The scheduler said they were hiring new people as fast as they could, but for the short term suggested that I try the new Whittier Clinic, which is right at 28th and Nicollet. I've really loved going there. It's walking distance from our house in reasonably decent weather, and they used a lot of patient input in its design. It has a tiny rain garden and native plants and trees in the landscaping. Everybody there is very nice and very helpful. HCMC in general has really good mammography technicians.

There are other HCMC clinics in other locations; the only one I can recall offhand is in Richfield.
P.

[dreamshark.livejournal.com]

Note that we have years of experience with Park Nicollet, not Health Partners. HP and PN merged just a few years ago. I was apprehensive about that, but they seem to have done a surprisingly good job of it. The Park Nicollet system still operates as a semi-autonomous network within the larger Health Partners.

[pameladean]

Whoops, sorry. I used Park Nicollet myself in the eighties and early nineties, though I don't even recall now who the actual insurance provider was.

P.

[dreamshark.livejournal.com]

Since you mention website capability, the HP one is very comprehensive. You can look up information about their doctors and clinics, make appointments, check test results, review their formulary, and all sorts of other helpful features I have never even tried to use.

[pameladean]

UCare had the usual information and formulary and so on available, but you couldn't pay online one month and send a check another. Either you let them at your bank account all the time to take money out on a designated date, or you got a paper bill and wrote and mailed them a check. It was hard to check the status of payments, too. They have definitely upgraded since then. They were pretty new when we had insurance through them. But since HP has been around forever, I'd expect a much more sophisticated site, and am glad I won't be disappointed.

[naomikritzer]

I have been using the HealthPartners network pretty much exclusively since 2000. Ed worked there for years, and they provide employees an excellent health care plan but it's a much better plan if you stay in-network.

I like the clinics and the doctors. When I need to ask Member Services a question they've picked up quickly. The one bad experience I ever had with a provider was an eye care person (not an ophthalmologist but the next level down, optometrist maybe?) who was very impatient with me when I was trying to keep my eyes open for an exam; I didn't even complain about her at the time, but when I called for my next appointment, I specified that I didn't want to see the person I'd seen last time and they said, "oh, she's long gone, apparently there were a lot of complaints." There are certain things I've had to wait a long time for, but never when it was urgent. (For example, when I wanted a general exam from a dermatologist that was a six-month wait. When I was really suffering from an extremely itchy skin problem that was not going away, I was seen within 36 hours.) Their clinics seem to be well-managed and it's rare that I have to wait past the appointment time to be seen.

Regions Hospital is an excellent hospital. It's where my mother was taken last summer after she suffered a catastrophic complication of a surgery that was supposed to be minor. (The surgery was at Abbot, I think. Outpatient. She was discharged home and seemed fine, then collapsed a few days later.) Regions doctors initially thought she was having a heart attack and were doing a catheterization to figure out what was going on when she went into cardiac arrest in the cath lab. They did open heart surgery in the cath lab and actually pulled her through. Then two days later the wound in her heart re-opened and this time they were not able to save her. I don't blame the Regions staff for that, though; she received excellent care and not everyone gets a good outcome from a catastrophic health situation.

At a more minor level, Kiera wound up in the Regions ER two years ago with a broken finger (it turns out that urgent cares will not set displaced bones). She was seen promptly, treated kindly and respectfully, and the ER doc did an excellent job setting the finger, according to the Orthopedic surgeon who examined it a few days later after the swelling had gone down. My Grammie was seen in the Regions ER last month after falling and hitting her head: she was treated with respect and compassion. Also, when we were waiting for the results of her CT scan, I had mentioned to one of the people who came in that I was really hoping to get her home to her assisted living residence that evening: the results came in at the same time as an ABSOLUTELY CRITICAL patient and every staffer was being paged to this other room...and yet the Resident who'd been handling her care came dashing in to basically say, "everything looks fine, you can take her home now, if you have any questions stick around and I'll answer them later because I can't right now but if you want to just take her home you can!" Everyone also just took my word for it that I was her proxy, which was good. (It's unusual to have your grandchild rather than your child managing your health stuff, but see above about my mother's death. :-\ I didn't have the forms with me when I went running over to the hospital.)

Anyway. I know people who have run into major frustrations, but that is true of 100% of all health care providers and insurers. My experience has been that it is a really good network.

[pameladean]

Thank you so much! This is why I decided to make the post -- people who are pleased very seldom post reviews on the BBB site. You and dreamshark are making me feel much better about the choice I'm presented with, though I can't say it's actually getting easier. 8-) Still, feeling that I'm unlikely to be able to make a major mistake here is very helpful.

I am so sorry about your mother -- I've said this before, but didn't understand the circumstances, yikes (and as for Abbott, pfeh, they misdiagnosed my mom with stage 3 brain cancer in 1995), but glad that she got the best treatment.

P.

[grenacia.livejournal.com]

I like HealthPartners. I've been using their clinics since I was a kid (when they were Group Health) so I like how if I go to any HeathPartners clinic they have all my medical history and I don't have to remember it and write it out for them. For insurance I've gone back and forth between HealthPartners and some other companies, and I haven't had any problems with HeathPartners insurance.

[pameladean]

Thank you! I begin to sense a consensus here.

P.

[aedifica]

I have no advice, but a sense of community: today I started navigating the MA health connector website to sign up for January. I'm so glad I realized in time that the deadline for January is tomorrow!

[pameladean]

Eeep! Yes! I was aware of the deadline, but that didn't do much good til I actually got it together to file taxes.

MA should have a pretty good site by now, with all the practice they've had. I hope you find what you need and it goes smoothly.

P.

[aedifica]

I had a vague idea that there might be a deadline, but I was making school stuff a priority (I vastly underestimated how long my share of the group term paper would take me to write, so I was scrambling to get it done.*) Monday I realized that if there was indeed a deadline it might be soon, so I checked. I'm so glad I did!

I'm all signed up now, even though partway through investigating plans the website decided I didn't get to see plans anymore and wouldn't let me get past the "yep, you finished your application" page. I ended up calling them, which could have been frustrating. The hold time was remarkably short and the representative remarkably helpful, though!


* I did finish my part of the paper on time, and the rest of the group all finished theirs too, and I think the paper turned out really well! We turned it in yesterday.

[pameladean]

Yes, school moves in its own timeline and integrating other things is always interesting. I'm glad you got covered.

The representatives I've dealt with here have been uniformly polite and helpful and patient, though they can't always fix problems.

And yay for finishing the paper in a timely fashion, especially with a group effort where you can't control completely if it goes in on time.

P.

[inlaterdays.livejournal.com]

This is nothing to do with your post (sorry!) but I just wanted to wish Happy Holidays to you and yours.

I hope you get the insurance situation resolved and I'm glad the situation with the trees worked out.

[pameladean]

You never have to apologize for commenting! Happy Holidays to your and yours as well. I really appreciate the sentiment this year of all years.

P.

[redbird]

Cattitude and I had a similar experience with that website and needing to call and talk to someone on the phone, but got it all sorted out. (We did this a couple of months ago, with the "qualifying event" being that we'd used up our COBRA coverage.)

[Sorry, I have no advice to offer on Minnesota, and am not even sure we made the best choice for Massachusetts, but am hoping it's a good-enough one.]

[pameladean]

The plan I ended up with is better than this year's and costs notably less -- not in itself, but when you add in the subsidy provided by the feds -- and has lower copays and lower coinsurance. Still not the greatest, what with the deductible, but better.

I really hate how choosing a plan essentially requires that one predict the future. I hope yours is indeed good-enough. Often they are.

P.