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HealthNet or Anthem PPO
updated: Nov 07, 2012, 1:15 PM

By Edhat Subscriber

I am lucky to have UC health insurance. I have HealthNet Blue and Gold HMO coverage, but now is open enrollment. What is better in Santa Barbara...HealthNet, or is it worth it to pay more for Anthem PPO? I am concerned with a choice of doctors, and access to specialists. I lived in a much larger city before, so am not sure what's best in this smaller market.

Comments in order of when they were received | (reverse order)

 COMMENT 340260 agree helpful negative off topic

2012-11-07 01:21 PM

Careful with Anthem. That's what I have, and doctors are always dropping off their list. I've had to switch doctors (or pay out of network cost) and the ones I'd really like to get into see aren't taking Anthem patients....nice huh?

 

 COMMENT 340266 agree helpful negative off topic

2012-11-07 01:40 PM

I'm happy with Anthem PPO. The doctors/specialists who normally do not take insurance have been willing to bill Anthem.

 

 COMMENT 340267P agree helpful negative off topic

2012-11-07 01:42 PM

I've had surprisingly good luck with HealtNet's PPO, but it sounds like that may not be one of your options.

 

 COMMENT 340268 agree helpful negative off topic

2012-11-07 01:45 PM

Depends upon who your employer is. I've had Anthem PPO for years and have been very satisfied.

 

 COMMENT 340269 agree helpful negative off topic

2012-11-07 01:46 PM

Anthem PPO gives you more choices with co-pays. HealthNet gives you fewer choices and no (or lower) co-pays. If you or any of your dependents have any kind of health condition that requires specialists, you're probably best off with the PPO. If you're young and healthy, and don't anticipate needing any specialists and want to save a few bucks, you're probably better with the HMO. (And while some doctors may leave Anthem, the provider network is still much bigger than it is with the HMO.)

 

 COMMENT 340270 agree helpful negative off topic

2012-11-07 01:47 PM

I've had both in past years. Currently with Anthem. I have many medical needs and require a host of specialists. Never had a problem accessing them, actually easier to access the specialist vs my primary care...

 

 COMMENT 340273 agree helpful negative off topic

2012-11-07 01:55 PM

If the Sansum Clinic is the place you get medical service, it does not matter which of those insurance plans you have, the doctors are the same.

 

 COMMENT 340275 agree helpful negative off topic

2012-11-07 02:03 PM

If you are a UC Employee and do not have a lot of health issues, DEFINITELY Health Net Blue and Gold. It basically covers 100% with $15 co pays for dr. visits. You have to visit a primary care care dr. to get referred for every issue, but it is so worth it. With PPO, the coverage is more like 80/20 with you paying 20% = money out of your pocket. I made the mistake of switching out and paid an arm and a leg for many tests that otherwise would have been at no charge. Plus, the monthly premium for Anthem PPO is higher. Ask around your colleagues, also it is now open enrollment so there are workshops to help you make the decision that is best for you. I just gave you off-the-cuff non-researched personal experience, fwiw.

 

 COMMENT 340276 agree helpful negative off topic

2012-11-07 02:05 PM

Have you looked into the Anthem Lumenos plan? That is a true PPO--you can choose whatever provider you want. You pay more for outside network, but you are provided with an HSA account to cover the first $1000 of expenses. I switched to this last year from Anthem Blue & Gold and have spent much less money on health care expenses.

Health Net is an HMO, so if you have the need for a specialist, you won't have any choice if you're with them. Good luck! This Open Enrollment time is always interesting...

 

 COMMENT 340279 agree helpful negative off topic

2012-11-07 02:26 PM

I have been on Heath Net for years and years at UC. Now it is the Health Net Blue/Gold. Great doctors here in SB at Sansum clinic, I would recommend!

 

 COMMENT 340291 agree helpful negative off topic

2012-11-07 02:58 PM

Anthem! Health Net is very limited

 

 COMMENT 340294P agree helpful negative off topic

2012-11-07 03:03 PM

My kids have Anthem from their non custodial parent and the coverage isn't that great. I have Blue Cross Blue Shield and it is okay, not an option for you, but I think if you have the option for HMO with Healthnet it may be better. I loved HMO, cost me a lot less and with Sansum being the main network I was happy. Now that I am forced to have PPO I still choose to use Sansum because I like them, seems more efficient to go to Sansum Dr's than to use an Independent.

 

 COMMENT 340301 agree helpful negative off topic

2012-11-07 03:29 PM

269 & 273 are pretty spot on. I've had both, and prefer Anthem BC PPO, mostly because they are accepted at the docs I've always seen (had to switch providers for a year or two when I had Healthnet). It seems to be that more doctors will accept a PPO insurance, because you don't have to be part of an HMO network. But I'm also young & in good health. If you see a number of docs & specialists, it might be more time consuming with having to get referrals from your primary, but you'll save quite a bit with a HMO. But if you're the type who might need to make an appt right away with a specialist, that's not really something an HMO is good at.

 

 COMMENT 340304 agree helpful negative off topic

2012-11-07 03:51 PM

Absolutely, positively HealthNet! We had it for years, then our coverage was switched to Anthem. THAT was a nightmare! Fortunately, we're back with HealthNet again and it's far, far superior to Anthem in every way, from what is covered down to customer service. I would never, ever go with Anthem if I had a choice.

 

 COMMENT 340313 agree helpful negative off topic

2012-11-07 04:10 PM

I have HealthNet Blue and Gold (thru UCSB) and I have ongoing health problems. I do not need to get referrals over and over to the three specialists that I need to go to regularly. Once you're referred, if that specialist wants you to return, you don't need to go back to your PCP again. I like my Sansum PCP and Sansum specialists very much.

 

 COMMENT 340325 agree helpful negative off topic

2012-11-07 04:44 PM

Which ever the insurance is, make sure Sansum is the physician group.

 

 COMMENT 340351 agree helpful negative off topic

2012-11-07 05:31 PM

I also recommend HealthNet Blue and Gold if you are with UC. Very satisfied.

 

 COMMENT 340352 agree helpful negative off topic

2012-11-07 05:31 PM

What's better is subjective. And if you have doctors already, you have to compare the list of in-network providers to your doctors to see if they're covered.

Avoid ones that include only doctors from Sansum. None of those doctors are generalists and you'll get bounced around from "specialist" to "specialist." You're better off with a list of in network private doctors than that.

 

 COMMENT 340433P agree helpful negative off topic

2012-11-07 11:35 PM

I have to self insure myself with Anthem, and it goes up twice a year, once for a birthday and the other for a new year. I have had to step in with EVERY single thing they were supposed to cover. I have never had a problem getting their bills, but they claim they send out the EOB 's and money due me, but it takes forever to come. Good luck with prescriptions. They don't seem to have a problem sending the allergy meds, but the drugs for my diabetes require an act of Congress. If you and the others you have to insure are fairly healthy then go either way. If you do suffer from illnesses the other insurance might be better. Just watch the start of the year co -pays.

 

 COMMENT 340445 agree helpful negative off topic

2012-11-08 06:45 AM

Anthem. Healthnet is very restricting. Say no to the cattle drive that is known as Samsun. The doctors are over worked and many leave the minute they can.

 

 COMMENT 340447P agree helpful negative off topic

2012-11-08 06:58 AM

I have HealthNet PPO with a $2800deductible. I pay a little over $300/mth. Never had to use it until this year. Had a minor heart attack. After deductible was met they paid for everything and am very happy with the care I received at both Cottage and Sansum.
2days in Cottage and a few follow ups with 1 outpatient procedure to fix a genetic defect. Total billed @$70K, total paid out of pocket: $2800.
So far, so good.

 

 COMMENT 340452 agree helpful negative off topic

2012-11-08 07:15 AM

Great question! We had HealthNet for about 20 years without incident but SBCEO dropped them so I just about had a panic attack and took the Anthem PPO and have actually loved it, particularly when I had a need to see a doctor while visiting northern California. All I had to do was go to the Anthem PPO website and find a doctor to go to...no hassles, no calling anyone to report an out-of-area visit, etc. I can get to any specialist without a referral, and I can still see all of my regular doctors. No complaints.

 

 COMMENT 340457 agree helpful negative off topic

2012-11-08 07:24 AM

Go with Anthem PPO. My husband used to work for the University and we had Healthnet. We had a huge problem with them when our daughter broke her arm in a different city with their pre-approval process. It was a green willow break and needed to be completely broken to reset it, which meant hospitalization. The out of town hospital stabilized her arm and sent us back to SB because they were not certain Healthnet would pay. This delayed the operation 24 hours in which time she could not eat or drink.

 

 COMMENT 340488 agree helpful negative off topic

2012-11-08 08:43 AM

For the most part I've been happy with Anthem's PPO (unhappy about where they've underbilled me for copay then caught it later and adjusted). You may pay more out of pocket with the PPO, but if you've got any health issues, it is so worth it. Freedom of choice and not having to wait or wonder if you'll get approved to see a specialist. I speak from personal experience since I have a rare condition caused by a tumor and have to occasionally go out of town to USC. I was on an HMO years ago and on the HMO your choices are limited and they seem more "stingy" about giving approval for things v.s. PPO.

 

 COMMENT 340492 agree helpful negative off topic

2012-11-08 08:50 AM

HealthNet is okay but make sure to get a referral from someone they like to be your primary, or interview your primary right after you choose him/her to see if they consider the money your health plan sends them to be theirs and will be reluctant to spend any of it by referring you to a specialist. How happy you will be with the health plan seems to be related to your relationship with your primary. Unfortunately most of the best doctors don't have any openings for new patients because this information has already been passed around by the existing patients.

Really I am looking forward to Obamacare as the current system only seems to be working well for the HMOs and their CEOs.

 

 COMMENT 340586 agree helpful negative off topic

2012-11-08 11:08 AM

I've been on Healthnet for years. They have stuck with me through numerous health crises. Sansum Clinic rocks!

 

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