We recently relocated to Washington and have purchased ACA subsidized health insurance. The only provider offering policies in our county is Kaiser Permanente, an HMO.
It turns out that people living in our county have the option of doing the Kaiser HMO thing or, alternatively, choosing approved doctors outside of the Kaiser HMO.
I’ve never been an HMO member and know next to nothing about their benefits and disadvantages.
Any advice as to whether we should establish our primary care relationships inside or outside the HMO?
In case it makes a difference, we enrolled in a “high deductible” plan and have established and funded HCA accounts.
In most places, Kaiser is easy to use, since anything inside of a Kaiser facility is covered, but outside is not except for emergency care. This is unlike the situation with network HMOs where it is not always obvious who or what is in network (and that can change year to year).
Seems like your Kaiser has added a network component to the facility component. Cannot see any advantage to using the network providers instead of those in the Kaiser facility unless the local Kaiser facility is inconveniently far or known to be of inferior quality compared to the network providers, or if you expect to change to some other plan that also includes those network providers.
@ucbalumnus - Thanks. The situation is exactly as you described. The network component seems not to be very restrictive and would be slightly more convenient for us, so going the network route might make sense.
On the other hand, the Kaiser facility is very modern and, from my initial visit, seems to run very smoothly.
Any opinion on whether referrals within an HMO are more user friendly and/or cost effective than they might be in a random network?
I just moved to Kaiser from a different insurance company. I picked a primary care doctor, but I haven’t seen her yet. Just after I picked her, on a Saturday, I emailed her about some concerns I had regarding routine tests, and also asked what the procedure was to get care for an ongoing eye issue. Neither if these issues was at all urgent.
On the Monday, she got back to me. She asked for more details about the routine tests, and after I supplied them, she told me to come in for another routine test. She referred me to an eye doctor for the eye thing. All this was over their secure email system.
When I went to schedule the eye doctor, I was offered appointments that day. The earliest one was so soon, I wouldn’t have had time to ride over there. I was able to get an appointment that day. I was more than satisfied with the eye doc when I saw her.
For me, so far so good with Kaiser. The transfer was smooth.
I work for a physician group that are not Kaiser doctors, but since Kaiser does not have their own doctors within this specialty, we see all their patients. You do need a referral to be seen by any specialist, but if your primary doctor is on top of things, like @“Cardinal Fang”, getting a referral should be easy. We have had patients have to cancel their appointment with us as they didn’t have their referrals sent to us in time. Some Kaiser primary physicians want you to be seen by them first before granting a referral. I would suggest you make an appointment with your primary for your yearly physical exam so if you might need a specialist in the future, you should not have a problem.
My relative is an MD at Kaiser in Honolulu and has been there for over 25 years. He and his spouse and kids all get their care (including Rx and glasses) thru the Kaiser HMO and have no complaints. My H was a lifetime Kaiser member until I forced him to switch when we got engaged—I was and am lifetime BCBS and our kids have been as well.
Many of the patients I serve are Kaiser members. Mostly they are happy, especially that they can be seen promptly and get Rx easily and know what their out-of-pocket share is (no surprises).
Some have been unhappy with the specialists who are temporarily hired so they see a different one with each visit, but specialist shortages are a complaint I’ve heard pretty often, nationwide.
Network HMO referrals need extra care on the part of the patient to check whether the referred to provider is in network before using, whereas a referral to a provider in a Kaiser facility should be covered by Kaiser.
Multiple network provider situations can be extra tricky, such as going to surgery and not finding out that the anesthesiologist is out of network until the bill comes afterward.