Pacific care anyone?

gdf18 · April 14, 2008

I've received my surgery okay from Blue Shield, but my office is now considering switching to Pacific Care. Both are HMOs. Anyone have any especially good or bad experience with either? I'm very concerned about a change.

Thanks.

Gwenn

Dori · April 14, 2008

I work for a managed care company and am very familiar with the benefits for both health plans. Depending on what state you live in the benefits could differ. PacifiCare has a "healthy roads" program that they require most bariatric patients who are considering surgery to complete.

Since you have already received authorization from Blue Shield I'm not sure if they will require you to complete that program. Please be sure to read your EOB (explanation of benefits) completely, as your copayment if you have one could be significantly different.

Hope this helps. Good luck.

April 14, 2008

We had Pacific Care many years ago so I dont know if they have improved or not. It is an HMO that we had. My husband was out of town working and we lived in a rural area. I broke my ankle. I went to emergency room and they taped it up and said to go to family dr. the next day. Did that and he said because of the insurance company he could not cast it and had to wait for approval. We waited over 3 weeks for approval. (I had no help at home and was bed ridden). My dr called several times and explained the situation. I had also called and almost 4 weeks later they approved my cast but I had to go to a specialist. I had to go to an orthopedic specialist once a week until the cast was removed (6 weeks)

My family dr. had the facilities and the means to do all that in his office. Not only did they pay premium prices for the specialist my ankle never did heal right because of the delay of the casting.

I guess you would say I am not a big fan of HMO's. Sorry I couldnt write about better experiences.

Good luck and be sure and find out every thing you can about their coverage.