That is interesting, dstark. I wonder if the Northern Cal and Southern Cal Kaisers are managed differently. For the record, I was in one of the hugest networks in the So Cal area. I think they were largely understaffed. Lots of movement for doctors going from one practice to another was common.
I would change doctors. I have no problem doing that.
You do have to be proactive no matter who the doctor is. I can be very aggressive with doctors now. Polite, but agressive. The older I get, the more aggressive I get with doctors. 
If I don’t like the doctor, good-bye. One of my daughter’s did not listen to her when she was complaining about being fatigued. My daughter said it was the drug she was taking. The doctor disagreed. My daughter was right. She changed drugs. Good-bye doctor. You have to listen. 
SamuraiLandshark, I only know NorCal. I really only have experience with Santa Rosa, San Rafael, SF, and Redwood City. I have a relative who is a health industry consultant and she has a lot of experience with Nor Cal Kaiser. She has experience with other Nor Cal places too. She told me to switch to Kaiser.
Kaiser is fine with young families and those without serious medical problems, those without having to seek a second opinion or choose the best specialist …If you have managed well with Kaiser, like dstark’s parents, then you are lucky.
My ex-SIL was a pharmacist for Kaiser…and died as a result of misdiagnosis and mismanagement at age 44.
There are other cases…
This has been predicted…
Question about Kaiser for those of you who have it-- do all prescriptions have to be filled at Kaiser? Or will a Kaiser doctor give a written prescription or phone a prescription into a local pharmacy on request? The information on Kaiser web sites seems to be ambiguous – it looks like initial prescriptions can be filled at various pharmacies, but refills need to come from Kaiser?
I’m asking for reasons of convenience – I’m not concerned about cost or in-network or out, because I don’t take any expensive meds for chronic conditions. It is more common for me to need a prescription for a generic antibiotics – so I might be paying $10-$30 for a prescription at retail cost, and the Kaiser plan I would be looking at the Kaiser Bronze HMO with a $4500 deductible… so no particular financial benefit for in-network vs. out network. I just would like the convenience of being able to stop by the local Walgreens to pick up an RX rather than having to drive out of town.
Calmom, that is a good question. I don’t know. My folks get their refills mailed to their house. I am going to try and get my daughter’s birth control pills mailed to my house . Haven’t done that yet though and haven’t researched this yet .
That is a really great question. I guess if you aren’t trying to activate the prescription coverage and have Kaiser pay for it, then maybe you can. I have never done this in the four years we had coverage with them. We have always gone to the pharmacy to pick up or used mail order. And honestly, some of those times if I knew the drug was $10 or $20 I would have gone to Walgreens instead of standing in line! Note - If the copay was $30 and drug ended up only being $10, they wouldn’t charge full copay.
One thing that was quirky about the mail order refill system is that you didn’t always know how much the item would cost until it was requested/shipped. If you had a certain co-pay of say, $30 and it was regular maintenance drug, then you might end up with a $90 bill charged to your credit card. But sometimes, certain drugs could be more than the co-pay and you might not know until item shipped.
Called my mom. You can order refills online or call. I think you are calling Livermore. You have to order the refills a couple of weeks in advance .
Ordering refills online is easier than calling or dropping off prescriptions and picking them up on site. But I think Calmom is asking about one time prescriptions, not maintenance scrips?
It sounds like Calmom is asking about asking the Kaiser doc to call it in to Walgreens which I don’t think will happen. But they may give you a paper script (I think they have to) and I have done it the other way around having a non-Kaiser doc call a script in to the Kaiser pharmacy. That worked fine and cost 10-bucks.
Ok. Then I misunderstood.
I have had Kaiser doctors write me a paper prescription for a drug which was not on their formulary but that both she and I thought would be a good choice for me. It wasn’t covered, like a non-formulary drug with any insurance, but I was able to get it.
I have also found Kaiser doctors, in my care and that of friends, to be quite open to looking at treatment options that came from a second opinion with a non-Kaiser doctor. Yes, we had to pay out of pocket for the second opinion, but we were able to get the treatment suggested at Kaiser and covered by them.
And absolutely it all works better if you can advocate for yourself or your loved ones. I had cancer treatment at a Kaiser, got the treatment that UCLA recommended, and never had to make one phone call to argue about coverage of anything the doctor ordered. I liked it.
I have been tinkering with my income tax to see if I will get a refund this year. A lot changed last year in that I lost my employer-paid group health and had my income increased by the cost of the group plan (which was less than ACA). I also increased my withholding because my mortgage interest is no longer enough to itemize. Plus I qualified for a subsidy on the marketplace. I am worried that the IRS is going to make me pay back part of the subsidy that they figured for me. I did rough calculations that said I should pay a certain annual amount in premiums, and I paid less than that. I will be royally…hacked off…if that happens.
In my case, the status of the hospital leads the policy re: OON docs or services. Eg, at an in-network hospital, that anesthesiologist would be treated as in-network. I do see this doesn’t seem to be the case in all states.
Here’s one table that may give some view http://kff.org/private-insurance/state-indicator/state-restriction-against-providers-balance-billing-managed-care-enrollees/
You’d want to see if there is some updated version.
@txmom14 As far as feeling like you have coverage but not care, regretfully that may have been part of the ‘plan’.
As per the recently often referenced Mr. Gruber…
Note: This bill is about COVERAGE! Could be this Sutter/BS dispute is the beginning of a more entrenched two tiered system than we ever have had in the past. The ‘good’ hospitals and docs will be able to demand greater fees, and those that can, will pay them…yes…just like in the past. The difference is the increased number of ‘covered’ individual who will attempt to access care are being restricted to a smaller and smaller (and lower quality?) number of providers. If Kaiser is as overrun as indicated in some of these posts, they will either need to ramp up capacity ASAP or simply limit clients.
Some people will be in a better position to manage their declared income. The self employed and the small family business can often move their income into a different bracket. It really comes down to a complicated spread sheet analysis. If, for example, we were to go to an exchange plan, and bring our income to maximum subsidized levels we could purchase a plan which has some obvious and glaring issues - lack of network providers being at the top of the list. However, if one chooses a plan with some OON coverage and calculates the potential OOM anc compares that to the full cost of an off-exchange plan with better coverage, one might find it better to take the subsidies and apply the large savings to the OON costs.
Frankly, the subsidy structure makes no sense. We know of one individual who is worth millions and is getting a fully subsidized plan running them about $150/month. This person could easily cover whatever expenses they’d incur at the best facility, if needed. But they reason…why pay the higher plan costs? Why not take the subsidy.
It’s really all quiet funny (in a black comedy sort of way)
Medicaid reimbursement for doctors was cut 50 to 60% in some states. The feds cut their reimbursement and the states also cut.
That is GREAT news about Kaiser. Conversations with some local physician buddies (who have been absorbed by the big Sutter Beast) say they used to resist Kaiser tooth and nail. But now…they secretly wish they’d just hurry up and get into this county.
According to my broker…people do muck with address on record just to get into a Kaiser area…
What is the reason they want Kaiser to move into their area? Do they want to work for Kaiser?
Actually, the link that Dstark posted is from an article written in 2004 – hard to say one way or another how a 2004 tend plays out in 2015 … though I can’t see Blue Shield’s move against Sutter as anything other than a big boost for Kaiser.