Desperate for help… Kaiser or Anthem PPO?
I apologize for the lengthy post. Posting out of desperation. I am so confused on which insurance I should pick during my open enrollment, and I have to decide by Friday. I am in the San Diego area and currently, I have Kaiser. I have the option to go with the Anthem PPO. I would be ever so grateful to anyone who can offer up their thoughts on my situation.
My health profile:
I am 35 y/o trying to conceive and I have recurrent pregnancy loss (2 missed miscarriages); I may need to pursue IUI / IVF. I would be considered a high risk pregnancy due to my losses and medical conditions. I have Crohn's disease and I am currently taking a ~$28,000 biologic drug for which there is no generic (Stelara). I have diabetes and use a continuous glucose monitor.
Kaiser Plan
would cost me $146 a month
no deductible
max out of pocket $1,500
Office visits $20 /Urgent care $20
Pharmacy: No brand drug deductible; Brand name drugs $35 / generic $10
ER visits: $100 / Ambulance $50
*NO CHARGE for: prenatal/postnatal visits, routine diagnostics, complex imaging, inpatient hospitalization, outpatient surgery, durable medical equipment
Current context:
I love my Primary doctor at Kaiser and my gastroenterologist for my crohns, but the women's care is pretty bad at Kaiser. After my 2 losses, they wouldn't test any fetal tissue or check even my hormones. One perinatologist told me "it is not statistically significant until you have had 3 losses in a row." I decided to visit a doctor outside of Kaiser just to get my progesterone tested, which actually turned out low. After I did that, I came back to Kaiser and was paired with their infertility clinic, where a doctor prescribed me progesterone. That doctor is wonderful, but the whole department really lags in responding to messages.
The Anthem PPO
would cost me $236 a month
$500 plan deductible
total max out of pocket for plan is $2,000 (separate from pharmacy deductible and max out of pocket).
Office visits $20 / Urgent care $20
$200 brand name drug deductible w/ $2,500 max out of pocket for pharmacy; $35 copay
Both Ambulance & ER: $100 each +20% after deductible
* 20% AFTER DEDUCTIBLE: prenatal/postnatal visits, routine diagnostics, complex imaging, inpatient hospitalization, outpatient surgery, durable medical equipment
Why am I considering the Anthem PPO:
Basically, wondering if I would get better women's care – are things be better in a different system? All I have ever known is Kaiser… and having recurrent loss, it's like I fall through the cracks. Kaiser does have perinatology which helps high risk pregnancies… and they have the infertility department, which helps with getting pregnant. I don't have trouble getting pregnant, I have trouble keeping the pregnancy. So I feel like I just fall through the cracks, because I don't seem to belong in any of these departments.
submitted by /u/marinadances
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