<p>Anyone here a Kaiser Permanente patient and have any words of wisdom, stories to share (good as well as bad)?</p>
<p>Thinking about switching from Blue Cross HMO to Kaiser Permanente as my BC HMO doesn’t cover yearly physical, mammogram, annual well-women check up or flu shots (until my deductible is met, and then requires a copay). KP covers all of those, without needing to meet the deductible first, and no copay for those items either. So I pay for those out of pocket yearly.</p>
<p>In general I’m a very healthy 53 yo. The last time I had to visit a doctor for anything other than a well-visit, was 5 years ago, I broke my wrist.</p>
<p>Have been a BC member for a dozen years but just don’t feel like I’m getting my $'s worth, but feel skittish about switching. </p>
<p>Premiums are about the same, deductible close, and copay close as well. It’s the extras I mentioned above that are drawing me. Is it worth it?</p>
<p>We have been very happy with Kaiser. They are very big on preventative care (that’s why all of those yearly visits tend not to have a co-pay). My mother (also with KP) has had breast cancer twice and her care has been top notch. Where we are located the facility is all in one place, so you can visit your primary care physician, get your blood drawn and fill a prescription,etc. all in one location. Everything is computerized and, for example, when you go in for an eye exam you are informed of what else you need to take care of. And you can get all of your lab results online, often the night of your lab visit.</p>
<p>I have found that the biggest critics of Kaiser tend not to be members.</p>
<p>Much depends on where you are and how the docs there are. My B works for KP. He & all his family go there; as you say, preventative care is free or very inexpensive. They have been satisfied. </p>
<p>We had a staff member who worked there. It concerned many of us that there were so few people in her position staffing the hospital at the same time, considering the size of that hospital and staffing at other hospitals.</p>
<p>They are pretty good about electronic medical records and having the docs review & respond to emails.</p>
<p>I was concerned that the staff member who worked for KP was unable to get an antibiotic for an infection she was suffering from until she had been suffering from it for about a week. She was still supposed to keep working and not get antibiotics even though she was quite ill and kept asking for the antibiotics.</p>
<p>On the other hand, a relative has been diagnosed with cancer. She has KP and was able to get a 2nd opinion from someone of her choice. She has gotten top-notch medical care and not had to pay “through the nose” for it.</p>
<p>They have allowed us to use their facilities to have support group meetings. They also print and mail out to all their members who have the relevant health condition a brochure about our annual health education day.</p>
<p>At the KP in our island, there is a free shuttle that will take patients from the main KP in town (which is one the bus line) to their hospital that is about 10-15 miles away and not on the bus line.</p>
<p>We have never switched to KP at least in part because we like the ability to choose our BCBS healthcare providers and have built up a relationship with them over the decades they have treated us. </p>
<p>One of the other reasons we haven’t switched is because at the time I married H decades ago, some of the docs were not the best. I am much more impresssed by the caliber of their physicians now, as it is VERY competitive to be get a job there. Our neighbors are KP members and have been very happy with them for decades. They have a S who has MS or MD (get the two mixed up). They are pleased with his care as well.</p>
<p>Quite a few of the patients in our support group are KP members. Most seem pretty happy with them as well.</p>
<p>I know Kaiser people who love it, and I know Kaiser people who loathe it (most fall into the former category). But as an unwilling Blue Cross subscriber trapped by preexisting conditions, personally I’d jump at the chance to get my annual exams and preventive care covered.</p>
<p>Is this an individual policy? When I looked into it, Kaiser was significantly more expensive precisely because it’s such good coverage. And if it’s individual, you’ll be underwritten so the premium might be more than the base rate.</p>
<p>My BCBS plan has me only pay a minimal co-pay for pretty much any service or preventative care I want, so have not wanted to switch policies. The premiums are similar but since have had so much trouble assembling my dream medical team, would not want to change anything. Our entire family have pre-existing medical conditions but can’t be prevented from switching during federal open season, since H is a federal employee (& will become a federal retiree). KP did reject S when he applied for an individual plan–pre-existing conditions. BCBS allowed him to sign up.</p>
<p>I spent my entire life (literally… I was born at one) with Kaiser until the last couple years when I moved to my college’s insurance (no local Kaiser facility and much cheaper). I was on an individual plan for about a year and a half before the change over (and my mom’s family plan before that).</p>
<p>Pediatrics: I only knew them, but they made me not fear going to the doctor. In fact, it was always kind of fun. Although I was sad when the “birdies” had flown away from my ears… they did that a lot due to a lot of infections I had :(</p>
<p>Adult Medicine: If I had had them to begin with, I would despise the doctor. As it is, they managed in a few visits to make me not want to go unless I had to. I always felt blown off and like what I was saying did not matter. However, I came from a pediatric doctor who my mom had the direct number to his desk without having to go through the phone tree. He trusted her opinion and took all things I said with the utmost seriousness due to years of seeing me complain about seemingly minor things only to find out it was something much bigger.</p>
<p>That said, the women in Women’s Health were so nice and understood how terrified I was (I had never been comfortable with that aspect of healthcare). I never had care from a man there so I can’t comment on any of them. My first annual I was sobbing so hard because it hurt and she did her best to make it quick. She didn’t make me feel bad that I couldn’t keep my composure and even tried to make me laugh to take my mind off things.</p>
<p>I spent more than my fair share of time in the minor injury clinic/urgency care. They were a proper one unlike my experience at a John Muir (urgency care was appointment only and often filled up within the first 30 to 60 minutes they were open) when I was too far from school to go there and John Muir was all that would take my campus health insurance (through Blue Cross I believe). Always based on when one arrived and severity of injury. Not when one called the line in the early morning hours to make an evening appointment.</p>
<p>Unfortunately, Kaiser can get expensive. I started at about $100/month and when I left a year and half later, it was $200/month. I forget the exact details, but it was a decent copay for visits and meds. I’ll be honest, I really had no idea at the time and my mom helped and the representative from Kaiser helped me figure out which best matched the plan I was used to and would fit my budget. Knowing a lot more about it now, I think Kaiser can end up the cheaper one just because of the extras that are covered.</p>
<p>Despite the bad (and I have some bad stories, but most are stories I witnessed of relatives of friends), I love Kaiser and cannot wait to go back to them if possible. I would recommend them.</p>
<p>Of all the thing I miss from living in CA, Kaiser is the one that I miss the most. I miss the urgent care center for when my kid gets sick on a Friday night. I miss not haggling with my primary care physician to get an OB/GYN referral. I miss the ease of having teh pharmacy there.
For success quickly, get a regular physician. It makes everything much smoother. Get a regular OB?GYN right away as well. Take advantage of the flu shots and any screenings they recommend. </p>
<p>Our BCBS is much more expensive (PPO-no HMO in Indiana, so can’t help you if you are truly comparing apples to apples. For instance, I don’t remember a deduatible coming into play at Kaiser, so I was very surprised when I moved her and had to pay $700 for a routine blood test oredered from my BC doctor). </p>
<p>I can tell you that Kaiser also does a good job with chronic conditions, but you have to really be your own advocate and don’t be afraid to be a squeaky wheel. I never had any problems not getting antibiotics for an infection, or any medication, for that matter. I had my child at Kaiser and appreciated the lactation specialists, the cheap lamaze classes, the follow up in the hospital, etc.</p>
<p>We have been members of Kaiser for 20+ years and I am a satisfied patient. No, it’s not perfect. There is no such thing as perfect healthcare system. But overall we’ve received good healthcare. I am still a patient of the same OB/GYN who delivered S2 20 years ago. We switched from BCBS to Kaiser because of their emphasis on preventive care, which is in more line with our own philosophy. And 20 years ago, the cost for Kaiser was less than BCBS. I cannot address the current day cost comparison.</p>
<p>The thing I have learned over the past 20 years is to be assertive & advocate for yourself. If something doesn’t sound right, don’t settle for the first opinion or doctor. Insist on a second or third opinion or an out-of-network specialty consultation. </p>
<p>Kaiser has been responsive to our requests for out-of-network specialty appointments, such as a neurosurgeon for a head injury or a radiologist for radiation therapy. KP has also been responsive to out-of-area medical treatment, such as a dislocated shoulder during a CO ski trip last year or hospitalization in ME for a 9-yr old with mono (15 yrs ago, during the vacation from h*ll). Finally, we have received cutting edge medical treatment, such as surgery using the da Vinci robot which was quite advanced at the time of surgery. We had a good relationship with the surgeon, who was one the first in our area to be certified in robotic surgical techniques. But to receive quality care requires advocacy & research on the part of the the Kaiser patient. In this sense, Kaiser is not that different from any other health insurance.</p>
<p>Long time Kaiser member here. Some tips to get the most of your membership:</p>
<ol>
<li><p>Go to the website and carefully review the biographies of the doctors at your nearest facility. Search their names on the CA medical board “Dr. lookup” website to verify no disciplinary actions. Choose an internal medicine specialist, the waiting room won’t be filled with infectious children when you go for an appointment, since IM specialists only care for adults. You will probably have few choices showing they are accepting new patients. Don’t let that deter you. Call the message center and ask the receptionist to send a message to your choice of Dr. imploring them to accept you as a patient. This has worked twice for us.</p></li>
<li><p>If something arises and you question the treatment you are receiving go ahead and schedule a consultation with a specialist outside of Kaiser, preferably at one of the fine UC med schools in CA. You will pay for the consultation out of pocket, but any tests suggested will usually be provided by Kaiser. </p></li>
<li><p>Use the e-mail system to communicate directly with your Dr. This has been a huge time saver for us, many issues can be resolved without an office visit.</p></li>
</ol>
<p>Walk in mammograms, on site labs, pharmacies and imaging equipment, no paperwork. I can’t imagine going back to “regular” health insurance.</p>
<p>I spent my first 50 years of life as a Kaiser member and the last decade in Blue Cross. I, too, like Kaiser and my only knock on Kaiser is that you are “stuck” with them for any surgeries that become necessary and will have to go to whatever facility specializes in that type of surgery. For example, should you need back surgery and you live in Walnut Creek CA, you would have to go to Redwood City, on the opposite side of the S.F. bay area from Walnut Creek. As a Blue Cross member, you could go to John Muir Hospital, right in Walnut Creek, and you could basically cherry pick the best Neurosurgeon of your choosing who take Blue Cross. At Kaiser, there isn’t much flexibility on what surgeon you get and you may have to travel a distance to have the procedure done.</p>
<p>Kaiser is great if you are healthy and are sure you will remain so. I think continuity of care and physician choice are very important.</p>
<p>Against my advice, one of my kids signed up with Kaiser through his employer, and he was very sorry when he had a sport’s injury. The PT was awful, and he had to travel to a site an hour away to get an MRI. Then, it took Kaiser weeks to get the MRI results to the ordering physician. Next enrollment period he switched to another provider (not Anthem).</p>
<p>This was a Kaiser in Ca. I believe Kaiser also contracts with the Feds to provide care to Medicaid patients, and that may bother some. I also know a NP who has worked for Kaiser for years with sketchy education. Years ago in Ca. and other places one could become an NP without a BSN and you didn’t receive a MSN as NPs do today. </p>
<p>And wasn’t it Kaiser colluding with Reagan in some movie?</p>
<p>I agree that KP can be great if you are willing and able to be an advocate/squeaky wheel for yourself and/or if you are healthy and fairly sure you will remain healthy. Most of the folks I know who are happy with KP fit into the category.</p>
<p>One caveat for folks with college kids–be careful if the kids sole coverage is KP. A friend whose D went to SMU had an emergency & needed to have it attended to immediately. She want to the nearest ER, transported by her U. It was NOT a KP facility & she & her family had a 5 figure bill that was wholly their responsibility. I think it rivaled or exceeded college tuition for that year. Thereafter, the family bought the U insurance for each of their college kids to avoid a repeat of that experience.</p>
<p>Thank you everyone. One thing I noticed when I did their online quote system is they noted that premiums may go up in July due to maternity being required (mandatory change in all healthcare insurance programs), so I’ll wait and re-assess then to see how much more the premium will be.</p>
<p>There’s a brand new (less than 2 years) KP facility within a few miles from where I live.</p>
<p>And, yes, this is for self-insured, individual policy.</p>
<p>Thanks for all the tips, they’re invaluable. Another one of the reasons I love the CC boards!!</p>
<p>"Edgar Kaiser is running this Permanente deal for profit. And the reason he can do it … is all the incentives are toward less medical care, because the less care they give 'em, the more money they make. … The incentives run the right way.</p>
<p>Nixon: Not bad.</p>
<p>The next day, Nixon announces the establishment of HMOs, saying, “I want America to have the finest health care in the world. And I want every American to have that care when he needs it.”</p>
<p>Above is from Sicko. The Internet is full of info concerning denied patient care under Kaiser and its huge profits.</p>
<p>My sister lives in Northern Ca and they love love Kaiser. Something that bothered me but didn’t bother her was that when she was pregnant she saw a OB in her area but for delivery she had to go to the Kaiser hospital in San Francisco and have her deliveries by Dr’s that she had never met.
Interesting that your BC Anthem plan doesn’t cover well visits. Our Blue Cross PPO covers well visits including Pap and mammograms. I am also in Ca and we have an individual family plan.
My SIL has worked for Kaiser off and on for 20 yrs in management. She doesn’t go to Kaiser for her health care. Her first job was with another health care company and she liked her care and has continued with that company as her insurance carrier. She is insured through my brother’s company.
I have heard that at least in Ca that Kaiser attracts a lot of smart female MD’s. Women who do not want the expense and time committment of having a private practice.</p>
<p>This was known to be a bacterial infection? The reason for asking is that antibiotics are commonly asked for even when they would do no good (and could do harm) for non-bacterial infections.</p>
<p>One of my friends was a pharmacist with KP for many years. She & her family opted to pay extra & have BCBS because she knew too many bad things had happened while she worked for KP. Others of my friends work for KP–some have KP for their healthcare while others opted for BCBS. Don’t believe Anthem serves HI, or if so they have a miniscule market share.</p>
<p>Our BCBS does offer wellcare and preventative care. Have not had problems getting the care we want or need, including consultations in other states covered by our BCBS. All labor & delivery & maternity costs were well covered by our BCBS–we paid the regular $15/visit co-pay but nothing at all for labor or delivery (except having to pay for H to have a disposable coverall to be there for delivery). Read policies – inclusions & exclusions carefully. </p>
<p>Some of the support group members with supplemental O2 say they can’t get the O2 provider who contracts with KP to provide enough O2 so that they can leave their dwelling. This causes them to dangerous things like going without the O2. Not sure whether they aren’t “squeaky enough wheels” or if it is other issues.</p>
If you alert Kaiser ASAP, they will generally approve emergency transport & treatment at a non-Kaiser facility. If you ask for permission first rather than forgiveness after the fact, they are usually pretty accommodating. I had to submit a bill for out-of-area emergency treatment (for the ski accident) 3 times before it was finally approved. Each time I reminded them that they had approved treatment at the time of the accident.</p>
<p>As for poor PT, Kaiser has good & bad therapists like any other provider. If the quality of PT is poor, ask for a different therapist. DH went through several therapists before he found someone who knew the correct way to treat vertigo.</p>
<p>Receiving good care through Kaiser is all about being the “squeaky wheel.”</p>
<p>I’m a Kaiser member going on 15+ years now with a short period in the middle when I was a BCBS member when I went on my husband’s plan. I have always been very happy with the care my family and I have received. I wasn’t dissatisfied with the care I received through BCBS, but it’s different because you get the actual care from the doctors, not BCBS. What I didn’t care for was after we had our son and had to begin paying out of pocket for things such as immunizations, and we had excellent coverage through my husband’s plan. I really appreciate the preventative care model that Kaiser espouses.</p>
<p>I have read the other posts about being an advocate for your health if you are a Kaiser member. I would say this is the case nowadays, no matter what health plan you have. People need to speak up for themselves if they aren’t happy with the care they are receiving. There are lots of options out there. They key thing is to be vocal and involved with your own care.</p>
<p>Kaiser’s model varies in different parts of the country. In California, they own & operate hospitals. Out here, they either contract or have some kind of operating/sharing agreement with hospitals that are part of other systems.</p>