So far Kaiser is working out . I am going to have a blood test soon.
I am curious to find out the cost of the test.
I do not get three pairs of eyeglasses for free.
Actually ‘the nick of time’ is June 30, 2015 since by law they need to honor the contract for 6 months after announcing the end of the contract. So the BIG THEY have 5.5 months to continue DT’ing*
*Phallus twining.
They suck. Blue Shield sucks, and Sutter really really sucks. People want to know what they’re buying, and people have to buy their policies by Feb 15, yet Blue Shield can’t tell them what they’re buying. Will they be able to see their doctors in July? Let’s ask the Magic 8-ball. Signs point to “Sutter management is a bunch of greedy contemptible swine.”
@CardinalFang – Re the quote in post #236 -
California Pacific was in “upscale” Pacific Heights and had glass & marble & gardens & underground parking long before Sutter was ever in the picture. (Heck, it’s San Francisco - of course they have underground parking. So does UCSF. Where the heck else does one park?) Cal Pacific was originally Pacific Presbyterian, and it became California Pacific after a merger in 1991. My daughter was born there, before then, in the late 1980’s. It was upscale then, with a brand new maternity wing – that’s why I chose it over the hospital where my had born. Some of the maternity rooms had jacuzzis, though I wasn’t fortunate enough to be assigned one – but I was happy enough with the spacious shower in the ensuite bathroom. My insurance paid 100%. Good insurance was easier to come by in those days – I don’t remember what it cost, but the hospital did save money by forcing me to go home within 30 hours after delivery. It was an easy birth, DD was healthy and I was happy to go… but that cost-cutting practice led to some serious problems with new moms & infants who weren’t so robust – and the state had to pass a law against it.
But the point is, Sutter didn’t make the hospital upscale with nice amenities. Rather, Sutter went shopping and chose to acquire the pre-existing upscale with the nice amenities.
@CardinalFang - the link you included about Health Net in post #238 is from LAST YEAR - 2014 - Health Net does seem to still offer Sutter coverage on its PPO’s – though not on its EPO, which is the only Health Net offering in my county - but it is incorrect to say that they “just” reached an agreement. I know, it’s always hard to remember in January… but it is now 2015. 
And, Sutter refuses to establish an ER in our county…so …yup…all those low/no pay ER customers go to the good Catholic Hospital across the street.
But for those of us on the individual market, the deadline is February 15th. I suppose I could stick with BS, schedule my annual physical and mammogram earlier this year to be certain, and then hope that things will be fixed and/or that I won’t get sick for the last half of the year.
I’ll go to Kaiser because I don’t want to doctor-shop - not for a primary physician, and not for specialists down the line. Obviously I have to do that anyway, but at least Kaiser presents me with a menu of in-network doctors to choose from I’m not randomly making phone calls.
Someone back pages ago asked about some questions about Kaiser while out of state. One thing that is interesting about Kaiser is that yes, it will cover for emergency or hospitalization care out of state, but you might have a situation where you need more than emergency or hospitalization. Kid goes to school out of state and they will not cover things like, say PT for a broken arm or an urgent care visit. Or labs. Or medication, unless it is maintenance meds with a current Kaiser prescription shipped to her address. We kind of sweated that out for years hoping she would not need more care and was fairly lucky.
Kaiser does have a visiting member benefit in Washington state through Group Health cooperative. I was surprised when our family relocated to Washington state that they do not have Kaisers in the Seattle area. Shocked, really. They do in Vancouver, Washington and Portland, Oregon though. (Also for the record, had a little experience trying out Group Health. Beautiful facility. Not sure what I think about the doctors. 1 out of 3 we saw was good - an important test that was supposed to be ordered on 2nd visit wasn’t completed and necessitated another visit.)
On a Blue Cross Blue Shield PPO since Jan 1, but really likely this is the year we will be back on the market for shopping for health insurance for several reasons.
All in all, Kaiser was good for some things. You got coverage and care. It was a lot of jumping through hoops for some care. Delayed necessary surgeries. Some things were bad - certain prescriptions that looked like they could be refilled online and ordered, and then a message that, no you had to go to your doctor to have that one renewed without a notification that said that. It was not cheap. The fiasco surrounding my daughter’s Gardasil shots was frustrating. Our doctors changed often. I actually never even met my last two primary doctors in the last year, because they either moved to another facility or out of Kaiser. Comical. You needed to go to the Kaiser facility to pick up meds. One time I had the misfortune of not mail ordering it and ended up waiting 2+ hours because they had a pharmacist strike planned for the next business day.
I never was able, not once in four years of being Kaiser members for myself or my family, to get a same day scheduled appointment for anyone. If I needed care outside of a preventative care appt visit, had to visit the urgent care center at Kaiser. Not sure if this is the area I was in, or typical. Typical wait times for urgent care could be 1.5 to 3 hours at the West Cadillac center in Los Angeles.
Would I go back to an HMO like Kaiser? I don’t know. I need to think long and hard about it. The cost savings if you used the services was great - but the length of time it took to get care was often frustrating. I needed a specialist a couple time in last few years for a chronic issues, and had 3-5 week wait times to see them. My husband has waited even longer for his specialists.
Very interested to see what people are finding on and off exchange with rates this year.
In my area people are flooding into Kaiser in droves. No kidding. The other night my husband went at 1 o’clock in the morning to pick up a prescription because twice before that day the line had been out the door with a 3 hour wait. The lobby guy said it was a new and amazing development. There are no more decent choices, though.
Marie, there is a certain comfort in knowing that you can get one stop shopping with Kaiser. If they authorize it, you got it, if you are patient at being a patient.
I always felt like a number there, because we really hardly ever saw the same practioners from visit to visit. The only time saw same doc more than a couple of times was with a family member’s surgery.
The trouble seeing the same practioners visit to visit has never been an issue for my daughter or my parents. (My parents have been Kaiser members for 60 years). The timing of surgery was an issue for my daughter.
Kaiser is benefitting by the network issues. If you go to Kaiser, you know everybody is in your plan. Also, their premium pricing is more competitive this year than last year.
Yeah…the pharmacies are crowded. Definitely not as convenient as going to CVS.
I chose my doctor. I liked him. He is a nice guy. He has had a great career. He is winding down. We will see what happens. I chose a guy in his 60’s. 
We have some of the same lousy choices here in Texas. Two years ago I had Blue Cross, now we have United HealthCare…I often feel like I have health insurance but not healthcare.
Last year my out of pocket costs were over $20,000…the plan advertised that the out of pocket max was $4,000 per person (we are a family of 4). I had foot surgery so met my out of pocket, my son is a type 1 diabetic.
But what the plan outlines don’t mention is that co-pays do not count toward out of pocket. One of his medications costs me a $187 per month copay (tier 3…was a $30 copay with Blue Cross). One of his medications is not covered, they want me to use a different medication that his doctor does not believe is in his best interest, that one costs me a little over $200 (can get it for $201 with a coupon).
My son’s diabetes requires test strips, lancets, infusion sites for his pump, reservoirs for his pump, glucagon, etc. etc. each of which has a $50-60 per month copay.
I also paid $1400 for the anesthesiologist was “out of network” even though the surgeon and the facility were in network (I didn’t think to check if the person I was never going to meet was in my network).
Medications that were tier 1 when I choose the plan quickly became tier 2 or tier 3. Medications that were covered became totally ineligible. I have given up shopping for plans since they are subject to radical change during the year.
Heavy sigh…
Your parents and daughter are fortunate. My sister had same Kaiser doc for 18 years until he retired last year. Now she has a new doctor, but does not care for him. She cannot get in to see him when she needs to, either. She never understood my issues with it, till now. Her view about Kaiser has changed as a result.
Might be the location, the practice or the clientele which shapes the experience.
Calmom, good catch! Thanks. I apparently still haven’t realized it’s 2015.
TXMom, you might try appealing that anesthesiologist being out of network, I had that happen in a state other than TX and the company did eventually pay up the full price of the out of network fee for a provider the patient never met and in whom they never had a choice, but it was only after a written appeal.
I hate that, hate it, hate it. We had a long discussion of that problem one of the previous threads. Some hospitals do the same thing with ER docs-- they hire docs who are in nobody’s network, and then the docs bill every single patient for out-of-network charges. Essentially, they can charge anything they want, and the patients have to pay. It’s an outrage.
Fang’s Law (if a patient goes to a hospital or doctor in their network, everything that happens there is billed in network) would solve that loophole.
SamuraiLamdshark, thanks for the out of state explanation.
Your sister should be able to switch doctors. Has she tried to switch online?
Somemom - thanks for the tip, I’ll definitely try to appeal the out of network anesthesiologist. Now if I could just figure out a plan for them to cover some of the standard diabetes stuff I’d be a lot happier.
I am Canadian so I have a little experience with socialized medicine. Some of the issues faced by those in California (not getting to see the same doctor, long wait times etc) are scary. My brother (still lives in Canada) has had a pace maker for three years but is still on a waiting list for a cardiologist. Hope we aren’t heading in that direction.
My wife saw 3 different doctors this week. She is seeing a dermatologist on Monday. Next day appointments were available for 4 different doctors at kaiser in San Rafael , Ca.
I was able to see my primary care doctor with one day notice. My daughter saw her obgyn in one day. There were many appointments available. I wonder if Kaiser hired more people.
My wife’s anesthesiologist was out of network during her cataract surgery last year. The anesthesiologist cut her price in half.
Changing doctors to someone else isn’t the main issue. It is very easy to change online at Kaiser. It’s that once you go in for a visit and you have a chronic existing health issue, establishing a relationship with a doctor you can trust can be difficult. The consistency of care is difficult. It feels like you are starting fresh every time you contact them. That is often when things can be missed.
Last week, when we attended Group Health for suspected mono, told the nurse about symptoms. She put it in the notes. The doctor came in and did a review of symptoms, but somehow missed this one. Only because I was in the room with daughter and brought it up, did the doctor acknowledge it and say, oh yes, we need to test. My daughter is an adult - don’t normally go into exam room with her -but after the previous visit wanted to make sure she mentioned everything because she was feeling pretty lousy and out of it.) Just a few weeks before, had seen another doctor at urgent care…where it also said suspected mono. When you bounce back and forth between doctors, things get missed whether a chronic or an acute condition. It is always just hard to start with a new doctor. You may not love your doctor, but resigned to sticking with them to keep care consistent.