Switch to Kaiser for med insurance?

[scottmandue]

Back in the day I was on Kaiser medical... it was ok but I didn't like the production line style of medical care.

I was on Pacificare and now on Blue shield and been with the same doc for a decade...

However instead of seeing the doctor I now see his nurse practitioner (who is hot but I don't feel as comfortable with her)

And this doc has got so popular that the office visits are getting to be an hour wait.

My parents and my wife are on Kaiser... parents are elderly and have had to go in for operations and i am very impressed with the treatment they get... wife just got a hysterectomy and the hospital/doctors were very good.

At 53 I'm as healthy as a ox but as I age I might need some work done and they seem to have a good network of doctors and facilities.

I would be particular interested in what the doctors here think.

BTW it is open enrollment at work and that is why I am thinking about this.

[artplumber]

It's reasonable care if you have garden variety medical issues or are not sick. In the past, people had very little time with the Doc, and Kaiser has lots of NP's & PA's as well, so you are not guaranteed seeing a physician.

In addition, they're still using 1st gen drugs in my specialty (with many subsequent better drugs available), and people that would meet indications for certain devices don't get them as often. Then there was an in-law, in-law that got transferred to 3 Kaiser hospitals (ER departments) in the LA area because 1st - couldn't figure out what it was, 2nd couldn't treat what it was, and 3rd - well, by then her life threatening illness had had a lot of time, hadn't it?

[Targa Me]

I am not a doctor, but I know this; here at work we have 400 plus employees and our health care options are either Kaiser or Aetna (which is a POS or PPO option) and almost all the employees go with Aetna. Others have had bad experiences with Kaiser whether its a billing issue or a medical treatment issue.
As stated above; if you have a garden variety medical issue the care from Kaiser can be reasonably good, but if you have something that requires more expertise you might be better with something else.

[gduke2010]

Check out Assurant health. I pay $224/mo and I'm 48. The deductable is a high $5000, but it pays 100% after that, no co-pay.

[Tobra]

That POS means point of service, just to clarify.

Kaiser is fine if there is nothing wrong with you and you don't need to see a specialist.

When I was in Texas got a kid through the ER who cut his foot in the lake, chunk of broken beer bottle, he was in town visiting his dad. ER rinsed it out, stitched him up and put him on the generic antibiotics. 2 days later he was back with a red foot, swole up tight as a drum. Did the I&D(drained it), got cultures and started him on some kick ass antibiotics. Cultures came back with some bug that the infectious disease guy had never heard of, relatively resistant. He flew back to his mom in Cali with a central line and IV antibiotics. Kaiser denied payment, said that we could have transferred him to a Kaiser facility for care, guess they thought a below the knee amp would have been cool for a 12 year old boy, nearest Kaiser hospital was like 1500 miles away.

I like Kaiser, one of their facilities is right up the street from me. I see lots of patients they won't care for that come and pay me cash. Patient has to pay cash for something their insurance should cover, so it is not so good for them though.

[scottmandue]

Hmmm... maybe I should stay on Blue Shield and shop for a different doc?

But really... isn't there horror stories with any med insurance?

I thought Kaiser had a good network of specialist and surgeons?

[artplumber]

Originally Posted by scottmandue

Hmmm... maybe I should stay on Blue Shield and shop for a different doc?

Tell your doc you'd rather see the doc. BTW what makes you less comfortable with the NP? Just not a doc? For most sore throat, high blood pressure... they are just fine, and more likely to early refer to a specialist than the general MD.

But really... isn't there horror stories with any med insurance?

It's not an anecdotal problem, but a systemic issue. They centralize what they have, so often a lot of delay getting folks to the right people. If you are not in critical condition, that's OK, less so, if you are sick right now.

I thought Kaiser had a good network of specialist and surgeons?

In general, the breadth of specialists' & their capabilities aren't as diverse/expansive as you would find if you could get anyone in your town. Remember, most non Kaiser physicians take any PPO insurance. If you are in a capitated plan, you might still be in a limited options specialist network. But it is a lot easier to go out of network on one of those plans than have Kaiser pay for someone/thing they don't do.

In addition, generally there are less options available to their medical staff to treat patients. And historically, Kaiser is no where near the edge, cutting or not

[Evans, Marv]

I live in the San Diego region and have been on Kaiser for a long time - actually can't remember how long. I do remember before that I had a plan where I chose a doctor, and that worked out OK until I got shuffled around to other doctors because mine had gotten loaded up with patients and farmed some out to other doctors. Plus testing and lab work was a cumbersome process. It was at that time I tried Kaiser. My take is that I don't have time to get all social with my doctor/medical provider every time I sneeze . If I have something fairly minor, I don't care if it's a physician's assistant or not, in fact I've found them and the nurse practitioners to be very good. If it's a production line procedure, that's fine with me because I'm in and out of there fast. I don't see why I need to get all warm and fuzzy with my doctor with something that's a standard procedure. If I want to see my doctor, who I've had for something like 10+ years, I get in to see him immediately on a walk in basis if it's important. Otherwise I get an appointment in a week or two. If I have something that needs attention, he refers me to a specialist right away. In July I had a hernia operation, and am completely happy with it. It was my second in 15 years. The only negative thing I can say is that they don't necessarily have the absolutely latest procedures in terms of fancy equipment in some cases. (In place of the standard colonoscopy, I asked my doctor about a scan for my colon, and he said they don't have that.) If it's a necessity that you have that though, I've been told they can farm it out to another facility. I like having a lab to go to that's convenient for lab work, and I like to be able to make appointments, view my medical history, and test results online. Maybe I'm just more comfortable with the system than other - or just not as picky.

[cantdrv55]

My brother is a Kaiser doc and I sell medical instruments. We have lots of discussions about this. He is one of two specialists for a Kaiser population of 43,000. Of course not all need to see him but still. He said he cringes whenever someone mentions Yelp because he knows someday, someone is going to give his department a bad review for long wait times at the office, long wait times to get an appointment and very short time in front of him or his colleague.

[mikester]

We had an Aetna PPO for a couple of years and had been on various PPOs for a few years prior to this year.

We simply got completely burnt out on the PPO billing issues - I could rarely tell when or if something was actually my part of the payment or not. Plus the Doctors would 'balance bill' us and my understanding is that with the negotiated rates with the insurance companies - they weren't supposed to do that. They could and did send me to collections regularly and I'd have to fight it.

BURNT OUT!

Though I will say that we had good experiences with Aetna as a whole and the fact that my employer dropped them was also a big motivating factor. Blue shield was our new PPO option and we had already had bad experiences with them in the past. Kaiser was an option, we had heard reasonably good things about their pediatric care so we decided to experiment with it this year.

My wife has really liked it for the kids; we had a very personal relationship with our previous pediatrician so leaving that was a tough call. The Doctors my kids are seeing at Kaiser - they see the same one every time are very good. The big plus is, we pay $20 when we get there and that's it (well, that and parking). Wait times are almost non-existent to see your regular Doctor - lab work and specialists however are a different story.

I'm really concerned with travelling care - Kaiser is very localized and I have heard plenty of horror stories of Kaiser not being reasonable about emergency care at non-kaiser facilities.

I got an eye infection in Florida earlier this year and I called them and they said it didn't sound like an emergency but I was having trouble seeing because of it. I needed to be able to drive. I ended up just going to a local eye doc and he gave me some drops and I paid cash. I really didn't mind that but it made me think.

So...so far so good. I think that on our next trip I'm going to purchase a travel policy from my state farm agent for good measure to hedge my bet against kaiser. Short term policies like that shouldn't be that expensive.

[scottmandue]

Hmmmm well,

My parents go to Kaiser Harbor city CA, major things have been mom's colon cancer (total recovery), dad's esophagus cancer (he lost a lot of weigh and I have heard of a new procedure that may have been better for him), and dad crashed on his moped and crushed a couple vertebra.

Overall I feel like they got very good care and the facility in Harbor city is very large with a lot of services.

Wife is in Beaverton (stop snickering!) OR and the facilities in Beaverton and Portland are very nice. She had her hysterectomy at the Clackamas OR Kaiser that was also very large and very new, she is recovering well and her doc seemed like a good guy.

RE: My nurse practitioner, she is nice and I don't mind seeing her... I pretty much just go in a couple times a year to get my blood work done to check my cholesterol and sugar so no biggie there.

More bugged by the long wait at my current doctor's office than anything else, but maybe i will get that wherever I go.

I thought as long as you had medical insurance you went to the closest ER?

[RWebb]

ask you regular MD about this - they don't have the same perspective as a patient, but you will no doubt get some good info

[Tobra]

Balance billing is illegal if the doctor is contracted with the insurance company, report it to the appropriate authorities.

You go to the nearest ER whether you have insurance or not if you need to. After the fact, the insurance company may say it was not an emergency and refuse to pay, that is what happened in the case of the severely infected foot. The patient is responsible for the bill, that is on the papers you sign when you check in. If the provider is not contracted with the insurance company, no agreement is in place ahead of time, and the provider is not obligated to accept whatever they deign to pay.

[red-beard]

My brother in law died of cancer in 2001 of a really agressive bone cancer. My sister worked very closely with Kaiser and they did an awful lot to help him. It was pretty much a terminal condition but they did everything they could.

She recently did what I've done which is go to a $5000 deductible and a Health Savings account. She is so much happier being a good consumer. We get the negotiated prices of Blue Cross, and the largest nationwide network, no "Co-Pay". It really is Insurance. Small stuff, we pay. A big issue, it will kick in 100% after the deductible.

[Rloop]

I would never go back into Kaiser, maybe OK if you are healthy, but I had a bad experience with Kaiser (Fairfax County, VA).

My first wife died at age 34. She was breathing hard, weak, went into Kaiser 3 times over a 3 week period. Each time they suggested she was dehydrated. Two days before she passed, we went in for another check out, we went on a weekend as I figured we would see a different set of doctors, and maybe one of them would figure out what was going on. Turns out she had a clot in her calf that traveled into the lungs and ended her life, all this from the autopsy.

Hard for me to think the systems and processes at Kaiser work well enough to recomend someone subject themselves to Kaiser when you really need them. As the OP phased it, production line style of medicine -- well it isn't what I want when the things get serious.