Does Kaiser Permanente Accept Anthem Blue Cross Insurance Coverage?

Kaiser Permanente and Anthem Blue Cross operate very different healthcare models, which leads many to wonder – does Kaiser Permanente accept Anthem Blue Cross insurance?

The short answer is no. Kaiser Permanente only accepts its own insurance plans at its facilities and doctors’ offices. It does not accept Anthem Blue Cross plans.

However, the healthcare landscape can be complex. There may be rare instances of crossover between the two insurers, but this is an exception rather than the rule.

Here is an in-depth look at how Kaiser Permanente and Anthem Blue Cross differ in their healthcare delivery and insurance policies.

How Kaiser Permanente’s Integrated System Works

• Kaiser Permanente operates a closed, integrated health system. They provide care exclusively to members enrolled in Kaiser Permanente insurance plans at their own facilities.

• This integrated model has been Kaiser’s approach since the organization first opened to the public in 1945.

• Kaiser owns its medical offices and hospitals and employs its own doctors and providers. This allows tight coordination across all levels of care.

• Members enrolled in Kaiser plans must get their care from Kaiser facilities and providers. Care is generally not covered if gotten from outside doctors or hospitals.

• This closed-system is central to Kaiser’s model of preventive care and focus on whole health rather than just sickness.

Why Kaiser Doesn’t Accept Other Insurances

• As an integrated system, Kaiser does not accept insurance plans from other companies like Anthem Blue Cross.

• Members who have Kaiser insurance are expected to only use Kaiser’s own facilities and doctors.

• Trying to use Anthem Blue Cross insurance at a Kaiser facility will not work. These two insurance networks do not intersect.

• Accepting other insurances would go against Kaiser’s unique model of coordinated care delivery.

• Kaiser desires consistency in care through its own providers. Allowing outside doctors could disrupt this.

How Anthem Blue Cross Insurance Works

• Anthem Blue Cross operates a more open model than Kaiser. They contract with many doctors, hospitals, and healthcare providers.

• With Anthem insurance, members can visit most physicians and facilities in their network across the country.

• Anthem does not own the providers in its network. It simply negotiates contracts with external healthcare groups.

• This model offers more choices in providers. But care may be less coordinated between them.

• Anthem has grown through mergers to become one of the largest health insurers in the nation.

Rare Exceptions Where Kaiser and Anthem Could Intersect

• In very rare cases, there could be crossover between Kaiser and Anthem networks in a certain region.

• But this would be an exception from the norm rather than something to count on.

• Examples may include a Kaiser doctor also being separately contracted with Anthem.

• Or a particular Kaiser urgent care clinic that may accept Anthem insurance after normal Kaiser hours.

• However, these types of situations are not a common occurrence and would depend on specific location.

• For the most part, Kaiser and Anthem systems stay completely distinct.

Things to Know About Kaiser’s Insurance Policy

• For those with Kaiser insurance, the rules stay quite firm – you must use Kaiser facilities.

• Attempting to use Anthem or other external insurance will not work at a Kaiser doctor’s office or hospital.

• Kaiser coverage is bound to its own integrated network, so shopping around is not an option.

• This should be an important consideration for those considering Kaiser insurance plans.

• The closed-system leads to more coordinated care, but restricts choice in providers.

Impact of the Two Health Plan Models

• Kaiser’s closed-system requires members to only use their facilities and doctors.

• This restricts patient choice compared to Anthem’s broader provider networks.

• But it allows Kaiser to better coordinate care between departments and providers.

• Anthem offers wider options in providers since they contract with many external groups.

• But this can lead to less connectivity between different doctors caring for the same patient.

• The trade-off between choice and coordination is an important differentiator.

Overview of Market Position

• Kaiser Permanente

  • Founded in 1945
  • Operates in select states, including California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington
  • Has over 12 million members
  • Known for excellent coordinated care
  • Received a 5 star rating from Medicare

• Anthem Blue Cross

  • Formed in 2004 out of a Wellpoint merger
  • Provides insurance plans across all 50 states
  • Has about 40 million members
  • Offers broad provider networks
  • Has faced some criticism over coverage decisions

• Both insurers maintain an A+ rating with the Better Business Bureau

Pros and Cons of Each Insurer

Kaiser Permanente

Pros:

• Preventive care model
• Medical centers and hospitals are conveniently integrated
• Award-winning customer satisfaction
• Lower complaint rates than competitors
• Smooth coordination between providers

Cons:

• Strict network, can only use Kaiser doctors and facilities
• Availability limited to certain states

Anthem Blue Cross

Pros:

• Large national presence across all states
• Wide range of plan options
• Broad choice of doctors and hospitals in network
• Ability to visit out-of-state providers

Cons:

• Care between providers may be less coordinated
• Some public dissatisfaction with claims decisions
• Varies in quality ratings across different regions

Frequently Asked Questions

Can I use my Kaiser insurance at any hospital or doctor’s office?

No, Kaiser insurance can only be used at Kaiser’s own facilities and with Kaiser’s doctors. It does not cover treatment received outside of Kaiser’s integrated system.

Are there any loopholes that allow Kaiser and Anthem plans to work together?

In very exceptional cases there may be some crossover, but this is extremely rare and not the norm. Kaiser operates as a closed-system, so Anthem insurance is not accepted.

Should I choose Kaiser or Anthem based on the providers I want?

Yes, look closely at the doctors and hospitals in each network and choose the insurer that covers your desired providers. With Kaiser you must use their facilities, while Anthem offers a broader choice.

The Bottom Line

• Kaiser operates as a closed, integrated system that only accepts its own insurance plans.

• It does not accept any external insurance, including Anthem Blue Cross.

• The rare exceptions where Kaiser and Anthem intersect are an anomaly, not the rule.

• Those with Kaiser insurance must use Kaiser facilities and doctors, without exception.

• Shop carefully between the two insurers based on your provider preferences and healthcare needs.