Kaiser Permanente - how does it work?
October 3, 2017 10:46 AM Subscribe
For the first time at work, we'll have an option to choose Kaiser as our health insurance carrier. There are a few points I'm not clear about and wondering if the green can help me out. I am in Eastside of Seattle in Washington State if it makes a difference.
1. If my understanding is correct - I can only go its all-in-one facility?
2. what happens if I travel and need medical help where there is no Kaiser facility?
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
1. If my understanding is correct - I can only go its all-in-one facility?
2. what happens if I travel and need medical help where there is no Kaiser facility?
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
We've had Kaiser for two stints, totaling around 3 years.
1. If my understanding is correct - I can only go its all-in-one facility?
Sometimes they have other facilities that are more focused. The campuses here (Portland) aren't all 'all-in-one' facilities, but some are. You're only allowed to go to Kaiser offices.
2. what happens if I travel and need medical help where there is no Kaiser facility?
They will reimburse you, this is largely a non-issue. Sometimes you'll need to fill out some paperwork, and as Fshgrl says, they'll just move you as soon as your stable to a Kaiser facility. This is largely the same as most other hospitals and insurance coverage.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
Depends on your plan. We've had both.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
Yes, for mental health, abysmal. They've been sued several times for not providing adequate mental health care. Like, every level of mental health care with Kaiser directedly exacerbated mental health problems that I had. Take this into consideration if you choose kaiser; you'll want to budget in worst-case scenarios for mental health care. It's really that bad. 6 month waits just to see a therapist, overbooked therapists. My wife worked for Kaiser in mental health and quit after 3 months because their practices are that bad (super unethical, and borderline illegal, so that's cool!).
People who complain about socialized medicine and 'long wait times' have clearly never had Kaiser insurance. We've had waits up to 9 months for non-urgent specialist care. God help your soul, you'll be on hold for hundreds of muzak filled years if you're in the position of needing something that Kaiser covers, but does not have in-house staff to do so. Getting sent out of network is a really, really, really hard process.
If you have any 'nonstandard' health care needs, you're boned. Healthy, childless 20 year old furnace.heart would have signed up in a hot minute, because he was only hospitalized for a motorcycle accident and preventative care. But, adding in family care and some specialized needs to that, we've switched out every chance we've gotten.
The dental care (separate from most medical plans, but it might be wrapped up into yours) is also really substandard.
posted by furnace.heart at 11:01 AM on October 3, 2017 [3 favorites]
1. If my understanding is correct - I can only go its all-in-one facility?
Sometimes they have other facilities that are more focused. The campuses here (Portland) aren't all 'all-in-one' facilities, but some are. You're only allowed to go to Kaiser offices.
2. what happens if I travel and need medical help where there is no Kaiser facility?
They will reimburse you, this is largely a non-issue. Sometimes you'll need to fill out some paperwork, and as Fshgrl says, they'll just move you as soon as your stable to a Kaiser facility. This is largely the same as most other hospitals and insurance coverage.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
Depends on your plan. We've had both.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
Yes, for mental health, abysmal. They've been sued several times for not providing adequate mental health care. Like, every level of mental health care with Kaiser directedly exacerbated mental health problems that I had. Take this into consideration if you choose kaiser; you'll want to budget in worst-case scenarios for mental health care. It's really that bad. 6 month waits just to see a therapist, overbooked therapists. My wife worked for Kaiser in mental health and quit after 3 months because their practices are that bad (super unethical, and borderline illegal, so that's cool!).
People who complain about socialized medicine and 'long wait times' have clearly never had Kaiser insurance. We've had waits up to 9 months for non-urgent specialist care. God help your soul, you'll be on hold for hundreds of muzak filled years if you're in the position of needing something that Kaiser covers, but does not have in-house staff to do so. Getting sent out of network is a really, really, really hard process.
If you have any 'nonstandard' health care needs, you're boned. Healthy, childless 20 year old furnace.heart would have signed up in a hot minute, because he was only hospitalized for a motorcycle accident and preventative care. But, adding in family care and some specialized needs to that, we've switched out every chance we've gotten.
The dental care (separate from most medical plans, but it might be wrapped up into yours) is also really substandard.
posted by furnace.heart at 11:01 AM on October 3, 2017 [3 favorites]
The primary limitation of Kaiser is that you can only go its facilities/providers. They are fairly extensive on the West Coast...although you should find out what happens if you need to go to the doctor in, say, San Francisco...I have a friend who had Kaiser through her family in Northern California, and she couldn't get medical care in Southern California because it was a different Kaiser sub-network.
Just like with all HMOs, if you travel and need to go to a non-Kaiser facility, you have to pay out of pocket. There may be out-of-network coverage, but it's likely only for emergencies and you will have a hell of a time getting them to cover it.
Generally, yes, copays (and coinsurance, if applicable) go towards the deductible. But you should check with your plan specifics.
Honestly, all insurance has terrible mental health coverage. Trying to find someone in your network is garbage, trying to get reimbursed for out of network is garbage.
Honestly, I also have the same feelings that furnace.heart does about Kaiser. I have heard horror stories about people not getting the care they need. My dad's barber was going into heart failure and my dad called Kaiser (my dad is a doctor, but not his barber's doctor) and had to threaten to report them to the medical board in order to get him in for an appointment. It's sort of a conflict of interest for the insurer to also be the medical practice. Private insurance is no picnic, but I don't get the feeling that my insurance company is trying to kill me.
posted by radioamy at 11:07 AM on October 3, 2017
Just like with all HMOs, if you travel and need to go to a non-Kaiser facility, you have to pay out of pocket. There may be out-of-network coverage, but it's likely only for emergencies and you will have a hell of a time getting them to cover it.
Generally, yes, copays (and coinsurance, if applicable) go towards the deductible. But you should check with your plan specifics.
Honestly, all insurance has terrible mental health coverage. Trying to find someone in your network is garbage, trying to get reimbursed for out of network is garbage.
Honestly, I also have the same feelings that furnace.heart does about Kaiser. I have heard horror stories about people not getting the care they need. My dad's barber was going into heart failure and my dad called Kaiser (my dad is a doctor, but not his barber's doctor) and had to threaten to report them to the medical board in order to get him in for an appointment. It's sort of a conflict of interest for the insurer to also be the medical practice. Private insurance is no picnic, but I don't get the feeling that my insurance company is trying to kill me.
posted by radioamy at 11:07 AM on October 3, 2017
If you ever need physical therapy, it is similar to the issues of long wait times, not actually seeing a physical therapist for more than a few minutes.
Kaiser is great if you're healthy. it is once you get sick that things go downhill. (In my opinion)
posted by CoffeeHikeNapWine at 11:08 AM on October 3, 2017 [1 favorite]
Kaiser is great if you're healthy. it is once you get sick that things go downhill. (In my opinion)
posted by CoffeeHikeNapWine at 11:08 AM on October 3, 2017 [1 favorite]
1. If my understanding is correct - I can only go its all-in-one facility?
The way Kaiser works is that you have to select a primary care provider. For non-emergency/urgent care, that PCP is your first point of contact in the Kaiser system for anything you need - they will have to refer you to specialists for anything, well, specialized, like podiatry, dermatology, etc. The wait times to see your PCP can sometimes be long (Mine, in Portland, takes appts about a month out), but once you get referred to specialty care, they're usually a lot faster.
2. what happens if I travel and need medical help where there is no Kaiser facility?
Your plan documents should tell you. In my plan, I pay $50 for office visits outside Kaiser's service area.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
Again, depends on your plan. My Kaiser has no deductible, the $15/visit and $15/prescription get paid every time, but beyond that I'm covered at 100% for everything routine.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
I have no experience with the mental tealth side, but my wife doesn't love it.
Also, as a general rule about Kaiser: the more you're willing to push and be your own strong advocate, the better your care will be. Do not accept their default stance of "quick appointment, quick diagnosis, move on to the next". Ask a lot of questions, push your doctor to come up with alternative solutions, and you'll be much happier with the care you get. Should it be this way? No, it shouldn't. But it is.
posted by pdb at 11:12 AM on October 3, 2017
The way Kaiser works is that you have to select a primary care provider. For non-emergency/urgent care, that PCP is your first point of contact in the Kaiser system for anything you need - they will have to refer you to specialists for anything, well, specialized, like podiatry, dermatology, etc. The wait times to see your PCP can sometimes be long (Mine, in Portland, takes appts about a month out), but once you get referred to specialty care, they're usually a lot faster.
2. what happens if I travel and need medical help where there is no Kaiser facility?
Your plan documents should tell you. In my plan, I pay $50 for office visits outside Kaiser's service area.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
Again, depends on your plan. My Kaiser has no deductible, the $15/visit and $15/prescription get paid every time, but beyond that I'm covered at 100% for everything routine.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
I have no experience with the mental tealth side, but my wife doesn't love it.
Also, as a general rule about Kaiser: the more you're willing to push and be your own strong advocate, the better your care will be. Do not accept their default stance of "quick appointment, quick diagnosis, move on to the next". Ask a lot of questions, push your doctor to come up with alternative solutions, and you'll be much happier with the care you get. Should it be this way? No, it shouldn't. But it is.
posted by pdb at 11:12 AM on October 3, 2017
Kaiser is great if you're healthy. it is once you get sick that things go downhill.
That's the rub. It's nice to go to have a one-stop shop for optometry, general health, etc. etc. and I basically go to Kaiser because I'm 35 and healthy and like the convenience. But, Personal Anecdote Number 1: my father had the same Kaiser doctor for decades. Several years ago, he was diagnosed with Stage 4 COPD, having never received a diagnosis for, say, Stage 1, 2, or 3 of said condition. It boggles the mind.
Referring to the same situation, I should say: it's my sense that Kaiser is great if a person wants their own naivete and personal health denialism channeled back to them in a feedback loop.
And then, Personal Anecdote #2: everything you've heard about mental health care there is correct, except that the reality on the ground is worse than you've probably heard. Kaiser essentially refuses to provide therapy to anyone who isn't suicidal. If, say, you're having a hard time coping, and just generally depressed, and going through some tough external circumstances, and you would benefit tremendously from a long-term relationship with a therapist, what Kaiser will do is have you come in for an intake, give you a bunch of questions, and send you home. Then they'll assign you to a therapist and make you an appointment. Then, when you come in for your appointment with your new therapist, said therapist will hand you a stack of photocopied pages about Buddhism and mindfulness. If you object, they'll say that if you're in a really tough situation, your therapist might say, "the Kaiser model is really not what we prefer to do as practitioners," and then you might be able schedule a set of 6 - 12 sessions with a therapist, but probably what you'd really benefit from is group sessions that they offer.
Speaking of which, Personal Anecdote #3: my mother went to Kaiser's group sessions, off and on, for years. I think she took from them what she wanted, which was a kind of watered-down CODA worldview which exempted her from any personal responsibility, and from the trouble of having to think of herself as mentally ill in any way. My mother, as everyone who was ever in her life knows, is a deeply mentally ill person, probably has a personality disorder, and remains an un-diagnosed Kaiser member.
posted by kensington314 at 11:23 AM on October 3, 2017 [1 favorite]
That's the rub. It's nice to go to have a one-stop shop for optometry, general health, etc. etc. and I basically go to Kaiser because I'm 35 and healthy and like the convenience. But, Personal Anecdote Number 1: my father had the same Kaiser doctor for decades. Several years ago, he was diagnosed with Stage 4 COPD, having never received a diagnosis for, say, Stage 1, 2, or 3 of said condition. It boggles the mind.
Referring to the same situation, I should say: it's my sense that Kaiser is great if a person wants their own naivete and personal health denialism channeled back to them in a feedback loop.
And then, Personal Anecdote #2: everything you've heard about mental health care there is correct, except that the reality on the ground is worse than you've probably heard. Kaiser essentially refuses to provide therapy to anyone who isn't suicidal. If, say, you're having a hard time coping, and just generally depressed, and going through some tough external circumstances, and you would benefit tremendously from a long-term relationship with a therapist, what Kaiser will do is have you come in for an intake, give you a bunch of questions, and send you home. Then they'll assign you to a therapist and make you an appointment. Then, when you come in for your appointment with your new therapist, said therapist will hand you a stack of photocopied pages about Buddhism and mindfulness. If you object, they'll say that if you're in a really tough situation, your therapist might say, "the Kaiser model is really not what we prefer to do as practitioners," and then you might be able schedule a set of 6 - 12 sessions with a therapist, but probably what you'd really benefit from is group sessions that they offer.
Speaking of which, Personal Anecdote #3: my mother went to Kaiser's group sessions, off and on, for years. I think she took from them what she wanted, which was a kind of watered-down CODA worldview which exempted her from any personal responsibility, and from the trouble of having to think of herself as mentally ill in any way. My mother, as everyone who was ever in her life knows, is a deeply mentally ill person, probably has a personality disorder, and remains an un-diagnosed Kaiser member.
posted by kensington314 at 11:23 AM on October 3, 2017 [1 favorite]
Nthing a lot of the above. I asked some time back about whether there's any way to get around their general practice of making therapy seem like only a thing for emergencies. The main thing they do for mental health is issue-specific classes, which I actually have heard are good.
But it really is good for physical health as long as you're basically healthy. I like my doctor a lot, have never waited to see him or felt rushed, and was thrilled the first time I went in to just cross the hall for blood work and go upstairs for a vaccination, then pick up my waiting rx on the way out. It's a well oiled machine for the basics.
posted by Smearcase at 11:30 AM on October 3, 2017
But it really is good for physical health as long as you're basically healthy. I like my doctor a lot, have never waited to see him or felt rushed, and was thrilled the first time I went in to just cross the hall for blood work and go upstairs for a vaccination, then pick up my waiting rx on the way out. It's a well oiled machine for the basics.
posted by Smearcase at 11:30 AM on October 3, 2017
I have Kaiser in Oakland, CA where they are well established. I work in health care and have a very good sense of how different plans work, and I LOVE kaiser. I think we should have socialized medicine, and it should be like Kaiser (with a couple caveats). I suspect there are some differences in Washington, but here, this is how it works:
1. If my understanding is correct - I can only go its all-in-one facility?
Yes, for most things, you go to the one Kaiser. This is great because you see the doc, go to the lab, get your x-ray, pick up your prescriptions, all in one place. All your providers in all specialties have immediate access to your full medical record. For some specialties, they have a specialist come by and see you right in your primary care appointment (for example, they have 'curbside' dermatology and a roving dermatologist can pop into your PCP appt and look at your skin complaint). For other specialties, I've never had to wait more than a couple weeks for an appointment. And the specialist and PCP communicate well because it's an integrated system. I've also never had trouble getting a referral to a specialist when I wanted one.
2. what happens if I travel and need medical help where there is no Kaiser facility?
If it's an emergency, Kaiser foots the bill. If you end up in a non-Kaiser hospital, they may transfer you to Kaiser if it's safe to do so.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
This depends on which Kaiser plan you have. For me, my preventative care is all free and copays cap out at a certain point.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
I love Kaiser quality. They can be rushed though. They have large panel-sizes, but I've found that some providers take their time better and you can always switch providers. Here anyway there is a large selection of providers to chose from, and you can specifically request a woman, an LGBT-friendly provider, etc if you want something specific.
In California anyway, their mental health services are poor - this is my biggest reservation. They have gotten in trouble over this and continue to offer inadequate services. They do have wait times and only limited therapy services. Having said that, I have gotten the assessments and evaluations and providers I've needed in their behavioral health programs, but often you have to take a class first or wait a while or make a pain of yourself to get it.
In conclusion: welcome to Kaiser. I believe they offer high quality, evidenced based care, with an emphasis on prevention. They integrate a broad range of services which is convenient and more safe for you as a patient. They have a few downsides, especially in mental health, but they have made some improvements to that recently.
posted by latkes at 11:41 AM on October 3, 2017 [2 favorites]
1. If my understanding is correct - I can only go its all-in-one facility?
Yes, for most things, you go to the one Kaiser. This is great because you see the doc, go to the lab, get your x-ray, pick up your prescriptions, all in one place. All your providers in all specialties have immediate access to your full medical record. For some specialties, they have a specialist come by and see you right in your primary care appointment (for example, they have 'curbside' dermatology and a roving dermatologist can pop into your PCP appt and look at your skin complaint). For other specialties, I've never had to wait more than a couple weeks for an appointment. And the specialist and PCP communicate well because it's an integrated system. I've also never had trouble getting a referral to a specialist when I wanted one.
2. what happens if I travel and need medical help where there is no Kaiser facility?
If it's an emergency, Kaiser foots the bill. If you end up in a non-Kaiser hospital, they may transfer you to Kaiser if it's safe to do so.
3. Doctor visit copay is $25. This is the amount that will go towards deductible?
This depends on which Kaiser plan you have. For me, my preventative care is all free and copays cap out at a certain point.
4. How's the quality and quantity of selections? I read that it's fairly horrible for mental health.
I love Kaiser quality. They can be rushed though. They have large panel-sizes, but I've found that some providers take their time better and you can always switch providers. Here anyway there is a large selection of providers to chose from, and you can specifically request a woman, an LGBT-friendly provider, etc if you want something specific.
In California anyway, their mental health services are poor - this is my biggest reservation. They have gotten in trouble over this and continue to offer inadequate services. They do have wait times and only limited therapy services. Having said that, I have gotten the assessments and evaluations and providers I've needed in their behavioral health programs, but often you have to take a class first or wait a while or make a pain of yourself to get it.
In conclusion: welcome to Kaiser. I believe they offer high quality, evidenced based care, with an emphasis on prevention. They integrate a broad range of services which is convenient and more safe for you as a patient. They have a few downsides, especially in mental health, but they have made some improvements to that recently.
posted by latkes at 11:41 AM on October 3, 2017 [2 favorites]
Oh, on the issue of acute illness: I watched my dad's experience when he had a stroke last year, both inpatient and follow up. Again, I work in a (non-Kaiser) hospital so I have something to compare to. I thought he got high quality care, all the appropriate tests in a timely fashion, and a safe and reasonable discharge process. Afterwards he got appropriate medical and physical therapy follow ups.
posted by latkes at 11:44 AM on October 3, 2017
posted by latkes at 11:44 AM on October 3, 2017
As an FYI, I would definitely try to get impressions of quality of care and variety of services from people who are using Kaiser in your area. The differences between the quality of care in Northern California, where Kaiser has a huge member base and there are lots of services and they attract very good medical providers, and other areas may be non-trivial. My mother is a medical professional and her assertion (in Northern CA) is that Kaiser's medical services used to be "pretty bad" but now are "good."
posted by vunder at 11:46 AM on October 3, 2017 [3 favorites]
posted by vunder at 11:46 AM on October 3, 2017 [3 favorites]
I have no experience with Kaiser's mental health support, but what people are writing here matches what I've heard from others.
Kaiser may be unique among health insurance companies in that there are lots of people who love them. I've used Blue Cross before, and it was fine, but I wasn't a "fan". I don't think anyone is a fan of Blue Cross. It's not the sort of thing you'd be a fan of. But there are Kaiser fans. There are actually people out there who dig Kaiser health insurance, who are like "Yeah Kaiser! Wooo!".
I use Kaiser and it's always worked well for me and when it does work well it works incredibly smoothly. Everything that can be done on-line is done online and everything that can't is well organized and straight forward and at that location.
posted by It's Never Lurgi at 11:47 AM on October 3, 2017 [1 favorite]
Kaiser may be unique among health insurance companies in that there are lots of people who love them. I've used Blue Cross before, and it was fine, but I wasn't a "fan". I don't think anyone is a fan of Blue Cross. It's not the sort of thing you'd be a fan of. But there are Kaiser fans. There are actually people out there who dig Kaiser health insurance, who are like "Yeah Kaiser! Wooo!".
I use Kaiser and it's always worked well for me and when it does work well it works incredibly smoothly. Everything that can be done on-line is done online and everything that can't is well organized and straight forward and at that location.
posted by It's Never Lurgi at 11:47 AM on October 3, 2017 [1 favorite]
(coming from the perspective of a fairly healthy 30-something using NorCal Kaiser)
2. I injured myself right before having to travel to an area with no Kaiser doctors and it ended up being shockingly hassle free. My specifics were that I needed a follow up appointment halfway through my trip and I was told to go to any urgent care to get X-rays, and have a phone appointment with my doctor. The non-Kaiser urgent care simply took my Kaiser insurance and I paid a regular $25 copay, no hassle/confusion/reimbursements.
Someone commented re: PT access upthread, and I'm incredibly pleased with how it's gone for me so far. The PT is one of the best health care providers I've ever had, and I've had no trouble whatsoever getting appointments. I've gotten booked at the end of the prior appointment and have no trouble getting dates/times I want.
In general I've been very pleased with how all the disparate parts of my care work together. Everything was scheduled rapidly, everyone seems super informed on what the other practitioners are doing, and seem to genuinely work well together and document things well. I didn't have to spend much time/energy trying to figure out wtf was going on or dealing with scheduling hassles.
posted by soleiluna at 11:52 AM on October 3, 2017
2. I injured myself right before having to travel to an area with no Kaiser doctors and it ended up being shockingly hassle free. My specifics were that I needed a follow up appointment halfway through my trip and I was told to go to any urgent care to get X-rays, and have a phone appointment with my doctor. The non-Kaiser urgent care simply took my Kaiser insurance and I paid a regular $25 copay, no hassle/confusion/reimbursements.
Someone commented re: PT access upthread, and I'm incredibly pleased with how it's gone for me so far. The PT is one of the best health care providers I've ever had, and I've had no trouble whatsoever getting appointments. I've gotten booked at the end of the prior appointment and have no trouble getting dates/times I want.
In general I've been very pleased with how all the disparate parts of my care work together. Everything was scheduled rapidly, everyone seems super informed on what the other practitioners are doing, and seem to genuinely work well together and document things well. I didn't have to spend much time/energy trying to figure out wtf was going on or dealing with scheduling hassles.
posted by soleiluna at 11:52 AM on October 3, 2017
As you are looking for information, keep in mind that Kaiser in King Co. was until pretty recently Group Health Cooperative, a major health care provider in the Seattle area. It may be useful to look for some reviews of Group Health to get an idea of the quality of care.
posted by stowaway at 11:58 AM on October 3, 2017 [1 favorite]
posted by stowaway at 11:58 AM on October 3, 2017 [1 favorite]
I was a Kaiser member in NorCal until we moved. The two big things I used it for, in my late 30s-early 40s, were primary care and having a baby. My baseline for comparison with other US options is not super strong, since as a Canadian the US system mystified me for years. I was uninsured for part of my 20s, and had weird experiences with other insurers (in particular, fuck United Healthcare in Louisiana in the early 2000s, is my experience).
Choosing a primary care doc online was weird for me, like using online dating. The first doc I saw was really good and found I had a previously undiagnosed chronic condition. She was very diligent about getting me to a better place with this condition - regular check-ins, medication adjustments, etc. She consulted the appropriate specialist regularly and followed their recommendations. I never saw that specialist separately. A subsequent primary care doc was not as good a fit for me.
Obstetrics & gyno were great, up to and including the birth of the baby. I loved my OB, she talked to me like a real person and not just an instance of geriatric pregnancy (!!!!!). Labor and delivery was a great facility (brand new) and the care while we were there was very high quality. Our doula stayed with us with no questions, the nurses worked well with her and with us, etc.
I will say that they FUCKED UP with my lactation situation, which I didn't realize was happening until my kid was 7 weeks old and I consulted and paid for an outside specialist. I never even tried to get reimbursed for that. Their lactation people saw us once (baby was 2 days old), said things were fine, and then I disappeared from their view. This was not a great outcome.
They have you talk on the phone to advice nurses as much as possible before they will give you appointments. This was a mixed bag when the baby was little - it was good not to have to go in unnecessarily! But it was tough to have to convince people you needed to come in.
I would agree with other people in this thread who say that the degree to which you are your own advocate affects your level of care. I think this is terrible! But I am not sure any other insurer does it better.
posted by Lawn Beaver at 12:42 PM on October 3, 2017
Choosing a primary care doc online was weird for me, like using online dating. The first doc I saw was really good and found I had a previously undiagnosed chronic condition. She was very diligent about getting me to a better place with this condition - regular check-ins, medication adjustments, etc. She consulted the appropriate specialist regularly and followed their recommendations. I never saw that specialist separately. A subsequent primary care doc was not as good a fit for me.
Obstetrics & gyno were great, up to and including the birth of the baby. I loved my OB, she talked to me like a real person and not just an instance of geriatric pregnancy (!!!!!). Labor and delivery was a great facility (brand new) and the care while we were there was very high quality. Our doula stayed with us with no questions, the nurses worked well with her and with us, etc.
I will say that they FUCKED UP with my lactation situation, which I didn't realize was happening until my kid was 7 weeks old and I consulted and paid for an outside specialist. I never even tried to get reimbursed for that. Their lactation people saw us once (baby was 2 days old), said things were fine, and then I disappeared from their view. This was not a great outcome.
They have you talk on the phone to advice nurses as much as possible before they will give you appointments. This was a mixed bag when the baby was little - it was good not to have to go in unnecessarily! But it was tough to have to convince people you needed to come in.
I would agree with other people in this thread who say that the degree to which you are your own advocate affects your level of care. I think this is terrible! But I am not sure any other insurer does it better.
posted by Lawn Beaver at 12:42 PM on October 3, 2017
.I have a friend who had Kaiser through her family in Northern California, and she couldn't get medical care in Southern California because it was a different Kaiser sub-network.
This isn't true exactly. What is true is that for reason the NorCal and SoCal orgs act as different companies for some reason. So, if you were to move from Oakland to Los Angeles, you'd get a different Medical Record Number and new doctors, but you new doc could look up your old chart and all that. I moved back and forth from LA to San Jose, and for both moves I sent an email to my new doc and said "please xfer my prescriptions from my last doc" without any issues.
I've had Kaiser for most of my 37 years, and I love it.
To answer your #2: This summer, I injured myself surfing and I had to take an ambulance ride to the closet trauma center to the beach. (UCLA Medical Center). In the ER, the insurance person came around and took my Kaiser info and worked it out with them. I also got a separate thing from LAFD for the transport, and I filled out a website with my KP stuff. My total cost: $75 bill in mail for ER visit, $50 bill in mail for ambulance ride, the exact same cost as I would have paid if I were taken to a Kaiser facility in the first place.
I also needed surgery to fix up my vaporized clavicle. Since I was going under the knife, I had to fill out some paperwork to choose what kind of religious person who give me my last rites incase they killed me, but for the most part I paid $30 and had surgery.
I'm also doing PT, and I think it's great. The appointments are short, but for my kind of thing it's just: "let's test you out, ok do these new moves and don't do these ones, ok see you in two week". A longer appt would be a waste. They do have the big areas where people re-learn how to walk, but that's not something necessary for me.
Overall: If you love love love being in 100% control of every aspect of care, and don't mind the mountains of paperwork and medical billing that entails, then KP might not be for you. But, if you want to go into urgent care, pay $30, have X-rays, get a cast, get PT appts scheduled, pay $10 and pick your prescription, with only showing your kaiser card a couple times and never leaving the same building, KP is great.
posted by sideshow at 12:52 PM on October 3, 2017 [1 favorite]
This isn't true exactly. What is true is that for reason the NorCal and SoCal orgs act as different companies for some reason. So, if you were to move from Oakland to Los Angeles, you'd get a different Medical Record Number and new doctors, but you new doc could look up your old chart and all that. I moved back and forth from LA to San Jose, and for both moves I sent an email to my new doc and said "please xfer my prescriptions from my last doc" without any issues.
I've had Kaiser for most of my 37 years, and I love it.
To answer your #2: This summer, I injured myself surfing and I had to take an ambulance ride to the closet trauma center to the beach. (UCLA Medical Center). In the ER, the insurance person came around and took my Kaiser info and worked it out with them. I also got a separate thing from LAFD for the transport, and I filled out a website with my KP stuff. My total cost: $75 bill in mail for ER visit, $50 bill in mail for ambulance ride, the exact same cost as I would have paid if I were taken to a Kaiser facility in the first place.
I also needed surgery to fix up my vaporized clavicle. Since I was going under the knife, I had to fill out some paperwork to choose what kind of religious person who give me my last rites incase they killed me, but for the most part I paid $30 and had surgery.
I'm also doing PT, and I think it's great. The appointments are short, but for my kind of thing it's just: "let's test you out, ok do these new moves and don't do these ones, ok see you in two week". A longer appt would be a waste. They do have the big areas where people re-learn how to walk, but that's not something necessary for me.
Overall: If you love love love being in 100% control of every aspect of care, and don't mind the mountains of paperwork and medical billing that entails, then KP might not be for you. But, if you want to go into urgent care, pay $30, have X-rays, get a cast, get PT appts scheduled, pay $10 and pick your prescription, with only showing your kaiser card a couple times and never leaving the same building, KP is great.
posted by sideshow at 12:52 PM on October 3, 2017 [1 favorite]
FWIW, Kaiser in WA state is re-branded Group Health. I have a friend who works for Group Health, and Kaiser left them alone when they bought them out, they are now considered a 'region' of Kaiser. This means that, for example, you may be able to keep the PCP you have. I used to have GH and loved it - none of my employers have offered them in years. They generally get good grades in WA state. I don't know about mental health services in this state.
posted by dbmcd at 1:16 PM on October 3, 2017
posted by dbmcd at 1:16 PM on October 3, 2017
I've had Kaiser for a long while now, and it's true that their mental health care is substandard. When I had depression for the first time in my life, I was able to get an appointment with a psychiatrist promptly, and got on some meds (covered), which definitely helped. But individual therapy appointments were 6 weeks apart! Maybe if I had exaggerated my symptoms or some such nonsense they would have done more. I ended up paying out of pocket for private therapy ($130 a visit, now) but it was worth every penny. I think they might have offered some group sessions, but I was embarassed about being depressed and could afford private care, so... Obviously when you feel like you're hanging on by a thread is the absolute worst time to be advocating for yourself, but I've never heard from anyone who really liked their insurer's mental health care.
One of the incredible things about Kaiser is the 24-hour nurse advice line. You can call, from anywhere in the world, and talk to a nurse and they will consult with appropriate doctors, even specialists. They don't do after-hours urgent care, but the advice line has kept me out of the hospital on at least a couple occasions. Sometimes you have to wait ten minutes to talk to a nurse, which can feel like an eternity if you've just cracked a bone in your toe, but in general there is very little waiting and it's a miracle service.
On the converse side, it can be very difficult to get in touch by phone with a person, especially your Primary Care Physician. (I've had excellent luck "emailing" my doctor, though.) The phone number on your card only connects with the aforementioned advice line. Even when you call a specific department of a specific facility, the phone is often answered by someone in an entirely different facility. So you rarely talk to the same person twice, and getting the direct number of an individual is like finding the holy grail. They all have access to your complete medical record, though. If you want to build a relationship with specific staff members, it's a nightmare.
Another downside is that often the services you want are located physically far away. We don't have a Kaiser hospital within 40 minutes, for example, and that goes for garden-variety specialty services. In my immediate facility, they only do primary care, pediatrics, X-rays/blood workd, and pharmacy. So if you need, say, cancer treatment, you're looking at a 45 minute drive each way. But, and this cannot be emphasized enough, the person you see will have done literally thousands of whatever you are there to have done. One of the main reasons doctors choose to work for Kaiser is that they get to do 100% patient care since all the administrative stuff is taken care of. Kaiser is also big on evidence-based medicine, so you tend to get the most up-to-date treatment, which is often not the case with doctors in private practice. Part of that is that they don't do tests and treatments unless they've been shown to be beneficial, which I am all for, but sometimes people just want that test or shot anyway.
Emergency care out of network is a non issue. We had friends who needed life-altering emergency care and Kaiser paid for it all to be done at a non-Kaiser facility with the necessary expertise. The billing for all of this was definitely a lot of work.
So basically there is a "style" that Kaiser has, and if that fits you, Kaiser is great. The basic stuff is handled with extremely high efficiency and quality. A lot depends on what style of care you like. All health insurance has gatekeepers, they just take different forms. No insurer is going to call you up and recommend you come in unless they have a very good reason to think that it will save them money, such as flu shots. Unfortunately this means that a lot of chronic disease goes untreated, but that's not Kaiser's fault so much as a monetary reality that people will consume more health care if you make it easier for them to do so. Telephone and Skype appointments apparently don't save money, since people who wouldn't have dragged themselves to the office are willing to make a phone call.
posted by wnissen at 1:25 PM on October 3, 2017
One of the incredible things about Kaiser is the 24-hour nurse advice line. You can call, from anywhere in the world, and talk to a nurse and they will consult with appropriate doctors, even specialists. They don't do after-hours urgent care, but the advice line has kept me out of the hospital on at least a couple occasions. Sometimes you have to wait ten minutes to talk to a nurse, which can feel like an eternity if you've just cracked a bone in your toe, but in general there is very little waiting and it's a miracle service.
On the converse side, it can be very difficult to get in touch by phone with a person, especially your Primary Care Physician. (I've had excellent luck "emailing" my doctor, though.) The phone number on your card only connects with the aforementioned advice line. Even when you call a specific department of a specific facility, the phone is often answered by someone in an entirely different facility. So you rarely talk to the same person twice, and getting the direct number of an individual is like finding the holy grail. They all have access to your complete medical record, though. If you want to build a relationship with specific staff members, it's a nightmare.
Another downside is that often the services you want are located physically far away. We don't have a Kaiser hospital within 40 minutes, for example, and that goes for garden-variety specialty services. In my immediate facility, they only do primary care, pediatrics, X-rays/blood workd, and pharmacy. So if you need, say, cancer treatment, you're looking at a 45 minute drive each way. But, and this cannot be emphasized enough, the person you see will have done literally thousands of whatever you are there to have done. One of the main reasons doctors choose to work for Kaiser is that they get to do 100% patient care since all the administrative stuff is taken care of. Kaiser is also big on evidence-based medicine, so you tend to get the most up-to-date treatment, which is often not the case with doctors in private practice. Part of that is that they don't do tests and treatments unless they've been shown to be beneficial, which I am all for, but sometimes people just want that test or shot anyway.
Emergency care out of network is a non issue. We had friends who needed life-altering emergency care and Kaiser paid for it all to be done at a non-Kaiser facility with the necessary expertise. The billing for all of this was definitely a lot of work.
So basically there is a "style" that Kaiser has, and if that fits you, Kaiser is great. The basic stuff is handled with extremely high efficiency and quality. A lot depends on what style of care you like. All health insurance has gatekeepers, they just take different forms. No insurer is going to call you up and recommend you come in unless they have a very good reason to think that it will save them money, such as flu shots. Unfortunately this means that a lot of chronic disease goes untreated, but that's not Kaiser's fault so much as a monetary reality that people will consume more health care if you make it easier for them to do so. Telephone and Skype appointments apparently don't save money, since people who wouldn't have dragged themselves to the office are willing to make a phone call.
posted by wnissen at 1:25 PM on October 3, 2017
I had Kaiser when I lived in the SF bay area, and it was great, primarily because they are a dominant network there with tons of specialists/subspecialists/facilities and I was young and healthy and it was very inexpensive from a use perspective (premiums about same, but copays much less). I got sick once when I was traveling and there wasn't a Kaiser nearby, and it wasn't easier to navigate that process than say, BCBS would've been. Many health insurance plans have 24 hour nurse advice, so I don't think that's particularly unique. I was able to see things like dermatologists without horrific waits, but that was a while ago and maybe it's changed.
I now live in smaller city outside of Portland. My neighbor and I both had cancer diagnoses a few years back. I had BCBS and my neighbor Kaiser. I got far quicker (ten days from diagnosis to Pet/CT scan and chemobeamo), and more modern treatment. My neighbor got what I'd call the minimum standard of care and had to drive about 90 mins each way to get it vs. me being able to select a local provider if desired. Mine cost more in copays due to the plan deductibles and out of pocket limits, but my treatments delivered a better outcome. He had more time away due to driving and out of pocket for things like gas.
I interviewed for a local job once and asked what the worst thing about the place was. Uniformly it was "we only have Kaiser insurance," but it was an older crowd outside of Portland so YMMV.
Compare the available facilites/practitioners and their location compared to yours (e.g. do they have mental health or oncology or endocrinology or whatever near you? If not, how far are you willing to drive, and how likely to need specialty care?). Compare premiums and total out of pocket limits (my copays for BCBS were fixed plus a percentage up to $6000 a year - I got sick at the end of the year and between Dec. and Jan. had to drop $12,000 out of pocket.) if something major happened. Check drug formularies to see if they cover anything you take, and what the alternatives are if not. Prioritize according to your unique needs and circumstances.
posted by OneSmartMonkey at 2:26 PM on October 3, 2017
I now live in smaller city outside of Portland. My neighbor and I both had cancer diagnoses a few years back. I had BCBS and my neighbor Kaiser. I got far quicker (ten days from diagnosis to Pet/CT scan and chemobeamo), and more modern treatment. My neighbor got what I'd call the minimum standard of care and had to drive about 90 mins each way to get it vs. me being able to select a local provider if desired. Mine cost more in copays due to the plan deductibles and out of pocket limits, but my treatments delivered a better outcome. He had more time away due to driving and out of pocket for things like gas.
I interviewed for a local job once and asked what the worst thing about the place was. Uniformly it was "we only have Kaiser insurance," but it was an older crowd outside of Portland so YMMV.
Compare the available facilites/practitioners and their location compared to yours (e.g. do they have mental health or oncology or endocrinology or whatever near you? If not, how far are you willing to drive, and how likely to need specialty care?). Compare premiums and total out of pocket limits (my copays for BCBS were fixed plus a percentage up to $6000 a year - I got sick at the end of the year and between Dec. and Jan. had to drop $12,000 out of pocket.) if something major happened. Check drug formularies to see if they cover anything you take, and what the alternatives are if not. Prioritize according to your unique needs and circumstances.
posted by OneSmartMonkey at 2:26 PM on October 3, 2017
I've found that wait times are pretty bad most places on the west coast. It's about 3-6 months to get into an ob-gyn here and a friend was recently handed a 14 month wait for rheumatologist. That's with regular old fashioned insurance. And without any coordination or follow up at all.
posted by fshgrl at 3:41 PM on October 3, 2017
posted by fshgrl at 3:41 PM on October 3, 2017
I have five kids and have had us all covered by Kaiser for 10 years. I love it. I haven't had the long wait times for specialists (usually it has been about a week) and haven't needed their mental health services.
posted by tacodave at 3:43 PM on October 3, 2017
posted by tacodave at 3:43 PM on October 3, 2017
This is an edited version of my answer to another Kaiser Permanente question:
In my experience with Kaiser gynecology and chronic pelvic pain, I got so frustrated that I started sobbing, and the doctor insisted that I have a psych eval ("so tearful").
Kaiser is good at health promotion education and preventative care, but if you are seriously affected by an undiagnosed conditoin, they prefer to defer substantive treatment until you are at death's door (either physically, or, frankly, from suicide because you can't take it).
You absolutely must be firm. I've found that they tend not to be particularly bright, either, for people with so much higher education, and you absolutely have to tell them what you EXPECT them to do.
Rest of my answer to today's question:
A KP doctor handed me the form for ordering tests and said, "What should I check off?" Uh, dude, you're a doctor, amirite?
This is in Washington, D.C., 1998 or so. From what I hear, things haven't changed.
posted by jgirl at 4:01 PM on October 3, 2017
In my experience with Kaiser gynecology and chronic pelvic pain, I got so frustrated that I started sobbing, and the doctor insisted that I have a psych eval ("so tearful").
Kaiser is good at health promotion education and preventative care, but if you are seriously affected by an undiagnosed conditoin, they prefer to defer substantive treatment until you are at death's door (either physically, or, frankly, from suicide because you can't take it).
You absolutely must be firm. I've found that they tend not to be particularly bright, either, for people with so much higher education, and you absolutely have to tell them what you EXPECT them to do.
Rest of my answer to today's question:
A KP doctor handed me the form for ordering tests and said, "What should I check off?" Uh, dude, you're a doctor, amirite?
This is in Washington, D.C., 1998 or so. From what I hear, things haven't changed.
posted by jgirl at 4:01 PM on October 3, 2017
I have Kaiser in Oakland, CA, and I am definitely a fan, despite having a rather serious medical condition. (Caveats -- I don't have any mental health issues, so no experience with that, and I haven't had to seek any emergency care out of network to date).
Yes, you go to their mostly all-in-one facilities only (in the Bay Area they are often referred to as campuses, as they consist of multiple buildings clustered together, at least in Oakland and Redwood City). But it's fabulous. Need bloodwork? The lab is downstairs. Need to pick up meds? The pharmacy is downstairs. PCP referred you to a specialist for something? They're in the building next door. Minor problem you just need to talk to your doc about? Phone appointments have no copay (at least on my plan, and I think for everyone), and you can usually get one quicker than an in person appointment. Want to get a flu shot while you're already in for something else? Stop off on a different floor.
For me, there has been literally no submitting of claims or any of the horror stories you hear from people trying to get their insurance companies to cooperate with their health care providers. Everything just works. I pay my premiums and co-pays, and Kaiser bills itself and pays itself for everything else.
Admittedly, I have really good care largely due to the fact that I have a great primary care physician. It's rare that I need to wait more than a week or two to see her. She takes my concerns seriously and respects the fact that I'm an intelligent person who researches stuff and asks a lot of questions.
When I had back issues that turned out to be brain issues, she got me in for an MRI within a couple weeks, and I had my brain surgery (serious, but not an emergency) less than two months later. It would have been quicker except that I requested the delay to accommodate my work schedule.
The only issue for me is that the adult neurologists/neurosurgeons are clustered an hour away from me (which is why I know about the Redwood City facilities), and this is relatively minor, since they are great with email and phone appointments, and I only rarely need to go in person.
My ongoing care has been great, with good coordination between my various doctors. I have at least 4 specialists I follow up with at least once or twice a year, and I'm very happy with all of them. I did have a dud of a PCP at first, but I just switched and it was not an issue at all.
posted by ktkt at 5:13 PM on October 3, 2017
Yes, you go to their mostly all-in-one facilities only (in the Bay Area they are often referred to as campuses, as they consist of multiple buildings clustered together, at least in Oakland and Redwood City). But it's fabulous. Need bloodwork? The lab is downstairs. Need to pick up meds? The pharmacy is downstairs. PCP referred you to a specialist for something? They're in the building next door. Minor problem you just need to talk to your doc about? Phone appointments have no copay (at least on my plan, and I think for everyone), and you can usually get one quicker than an in person appointment. Want to get a flu shot while you're already in for something else? Stop off on a different floor.
For me, there has been literally no submitting of claims or any of the horror stories you hear from people trying to get their insurance companies to cooperate with their health care providers. Everything just works. I pay my premiums and co-pays, and Kaiser bills itself and pays itself for everything else.
Admittedly, I have really good care largely due to the fact that I have a great primary care physician. It's rare that I need to wait more than a week or two to see her. She takes my concerns seriously and respects the fact that I'm an intelligent person who researches stuff and asks a lot of questions.
When I had back issues that turned out to be brain issues, she got me in for an MRI within a couple weeks, and I had my brain surgery (serious, but not an emergency) less than two months later. It would have been quicker except that I requested the delay to accommodate my work schedule.
The only issue for me is that the adult neurologists/neurosurgeons are clustered an hour away from me (which is why I know about the Redwood City facilities), and this is relatively minor, since they are great with email and phone appointments, and I only rarely need to go in person.
My ongoing care has been great, with good coordination between my various doctors. I have at least 4 specialists I follow up with at least once or twice a year, and I'm very happy with all of them. I did have a dud of a PCP at first, but I just switched and it was not an issue at all.
posted by ktkt at 5:13 PM on October 3, 2017
Best answer: If your current level of coverage is what you would describe as:
** "excellent" or "above average" insurance - you will likely be disappointed by the lack of flexibility with getting specialists, but satisfied by the price. You will likely be pleased by the organization and seamlessness of their systems.
** "average" or "below average" - you will likely LOVE the transparency and ease of getting care, as well as the price.
If you need mental health specialty care, you will be unhappy. (To be fair, I have had excellent insurance in the past and still paid for therapy out of pocket because my excellent insurance wouldn't cover it.) If you need primary care or PT, you will be satisfied with Kaiser.
I've had great experiences with Kaiser (NorCal and SoCal) my entire life until last year, when they failed to catch my husband's appendicitis for 2.5 days and he ended up in the hospital for 3 weeks after the rupture. However, it's possible that that could have happened anywhere, and the care he received after the rupture was high quality. So, we took Kaiser again even after the experience.
posted by samthemander at 6:31 PM on October 3, 2017 [2 favorites]
** "excellent" or "above average" insurance - you will likely be disappointed by the lack of flexibility with getting specialists, but satisfied by the price. You will likely be pleased by the organization and seamlessness of their systems.
** "average" or "below average" - you will likely LOVE the transparency and ease of getting care, as well as the price.
If you need mental health specialty care, you will be unhappy. (To be fair, I have had excellent insurance in the past and still paid for therapy out of pocket because my excellent insurance wouldn't cover it.) If you need primary care or PT, you will be satisfied with Kaiser.
I've had great experiences with Kaiser (NorCal and SoCal) my entire life until last year, when they failed to catch my husband's appendicitis for 2.5 days and he ended up in the hospital for 3 weeks after the rupture. However, it's possible that that could have happened anywhere, and the care he received after the rupture was high quality. So, we took Kaiser again even after the experience.
posted by samthemander at 6:31 PM on October 3, 2017 [2 favorites]
I worked for KP in the Northwest region in the past and had their health insurance. I had an ER visit on Guam, and Kaiser paid the whole thing, no hassle, I was much relieved.
I had a fine experience getting physical therapy there, as has a friend. Friend has also been a frequent-flyer ER / urgent care user, and has gotten good care (which I've seen in person). I really appreciated KP's focus on evidence-based medicine, although some clinicians explain this poorly and come off as impersonal or gate-keepery. They also have well-developed online systems for viewing test results and making appointments, although this is becoming more common. I was also happy with the dental care I received, but I didn't get anything beyond a cleaning.
They have had some problems moving from a premium-only model to having copays and deductibles and there was some billing confusion. This was 5+ years ago now, so hopefully it's sorted out. They've also made large investments in improving patient experience (hospital improvements, service initiatives) and I saw noticeable positive change in the time I was there.
I have heard nothing but bad things about their mental health coverage.
posted by momus_window at 8:41 PM on October 3, 2017
I had a fine experience getting physical therapy there, as has a friend. Friend has also been a frequent-flyer ER / urgent care user, and has gotten good care (which I've seen in person). I really appreciated KP's focus on evidence-based medicine, although some clinicians explain this poorly and come off as impersonal or gate-keepery. They also have well-developed online systems for viewing test results and making appointments, although this is becoming more common. I was also happy with the dental care I received, but I didn't get anything beyond a cleaning.
They have had some problems moving from a premium-only model to having copays and deductibles and there was some billing confusion. This was 5+ years ago now, so hopefully it's sorted out. They've also made large investments in improving patient experience (hospital improvements, service initiatives) and I saw noticeable positive change in the time I was there.
I have heard nothing but bad things about their mental health coverage.
posted by momus_window at 8:41 PM on October 3, 2017
I just remembered that a friend also had a horrible time getting mental health care with Kaiser. She wasn't having a crisis, she just wanted to talk to a therapist. They finally got her in to see someone, and then was told that appointments would be monthly. Monthly! Every therapist I have ever seen has been weekly.
posted by radioamy at 8:55 PM on October 3, 2017
posted by radioamy at 8:55 PM on October 3, 2017
My parents have been fairly happy Kaiser people since the early 90s in Socal. My dad's had several pretty involved surgeries there, and my mom gave birth to two of her kids there. They got a rep in the early days for really skimping on treatments; these days it's much better. My dad loves that they are on top of all the medications he's taking and all the specialists he needs to see. If you happen to be near a big Kaiser hospital it's really a pretty great deal. When we were kids they had 24 hour urgent care. I remember going in at 2am once with an ear infection. As a parent, the idea that I could do anything other than "give them some Tylenol and call first thing in the morning" sounds pretty amazing.
I also know multiple doctors who worked or currently work for Kaiser. The consensus seems to be that Kaiser is a great gig if you want medicine to be more of a job than a lifestyle, if that makes sense. You give up a decent amount of autonomy - Kaiser really does have essentially "death panels" that will tell you you're not allowed to pursue an experimental or potentially costly treatment if they don't think its likelihood of success is high enough to make it worth the risk. I know one doc who quit over that. However, I also know a handful of longtime Kaiser physicians who love it. They see their classmates from med school having to deal with malpractice insurance, all the day to day overhead of running a practice, forming partnerships, all the accounting, schmoozing investors when they need new equipment - all that is out of a Kaiser doctor's hands. ALL they have to do is treat patients. You can show up and really treat it like any other white collar job. I mean, they definitely still have call. But all the extra crap - I mean, I know docs who went back to school for MBAs so they could feel like they were running their practice correctly! - that's all just entirely taken care of by experts.
+1 to the reports of crap mental health coverage, though.
posted by potrzebie at 9:00 PM on October 3, 2017
I also know multiple doctors who worked or currently work for Kaiser. The consensus seems to be that Kaiser is a great gig if you want medicine to be more of a job than a lifestyle, if that makes sense. You give up a decent amount of autonomy - Kaiser really does have essentially "death panels" that will tell you you're not allowed to pursue an experimental or potentially costly treatment if they don't think its likelihood of success is high enough to make it worth the risk. I know one doc who quit over that. However, I also know a handful of longtime Kaiser physicians who love it. They see their classmates from med school having to deal with malpractice insurance, all the day to day overhead of running a practice, forming partnerships, all the accounting, schmoozing investors when they need new equipment - all that is out of a Kaiser doctor's hands. ALL they have to do is treat patients. You can show up and really treat it like any other white collar job. I mean, they definitely still have call. But all the extra crap - I mean, I know docs who went back to school for MBAs so they could feel like they were running their practice correctly! - that's all just entirely taken care of by experts.
+1 to the reports of crap mental health coverage, though.
posted by potrzebie at 9:00 PM on October 3, 2017
+1 for Kaiser being incredibly convenient so far for preventative care and minor injuries.
posted by value of information at 11:43 PM on October 3, 2017
posted by value of information at 11:43 PM on October 3, 2017
Wow. After reading most of the posts I must be in an alternative Kaiser universe. I think having a pro active PCP makes all the difference in this kind of system. They are the ones that grease the wheels. I admit having to wait for dermatologist appointments but every time I complained about that my PCP requested an immeadiate appointment and I was seen within a week. Knowing how your PCP's appointment system works is very important in getting an appointment otherwise it can be months to see her face to face. I see her about once a year and then rest of the time communicate through email. She responds within 24 hours but usually by the end of the day.
As far as mental health. I emailed my Doc about feeling depressed and wanting to try meds and possibly therapy. She submitted a referral. I called the nurse care line and was interviewed by a nurse. I wasn't suicidal or in crises, just depressed. I was immeadiately approved for 8 visits, $20 copay. I was just recently approved for 20 more visits. I can see how the therapist would not be a good fit for lots of people but he is the perfect fit for me right now.
Kaiser is not perfect but coming from a rural area with just original Medicare I can tell you that I feel like I am in medical care Heaven.
Research the PCP options. I looked up my five pics on line. Read their profiles. Researched any lawsuits. I love my PCP. Her practice was closed but I got in anyway. Call even if they say they aren't taking new patients.
Good luck.
posted by cairnoflore at 2:15 AM on October 4, 2017
As far as mental health. I emailed my Doc about feeling depressed and wanting to try meds and possibly therapy. She submitted a referral. I called the nurse care line and was interviewed by a nurse. I wasn't suicidal or in crises, just depressed. I was immeadiately approved for 8 visits, $20 copay. I was just recently approved for 20 more visits. I can see how the therapist would not be a good fit for lots of people but he is the perfect fit for me right now.
Kaiser is not perfect but coming from a rural area with just original Medicare I can tell you that I feel like I am in medical care Heaven.
Research the PCP options. I looked up my five pics on line. Read their profiles. Researched any lawsuits. I love my PCP. Her practice was closed but I got in anyway. Call even if they say they aren't taking new patients.
Good luck.
posted by cairnoflore at 2:15 AM on October 4, 2017
I love Kaiser and was a member for over 31 years before I moved out of their area.
I am not sure that you understand the concept-pay/deductible situation.
A deductible is something you have to pay before any insurance kicks in. I have a plan with Providence Health right now with a $6000 deductible. I am paying $ 234 per MD appt and am into my Physical therapist for over $1000 this month alone. Once I meet the deductible, I can have the very nice $50 copayments for the rest of the year.
Both deductibles and co-payments go towards meeting the annual Maximum-Out-Of-Pocket "MOOP." Once you MOOP out, visits are free.
Prescriptions are a whole different matter. They are billed in a completely separate system.
The above goes for most health insurance plans in the US.
posted by SLC Mom at 4:50 PM on October 4, 2017
I am not sure that you understand the concept-pay/deductible situation.
A deductible is something you have to pay before any insurance kicks in. I have a plan with Providence Health right now with a $6000 deductible. I am paying $ 234 per MD appt and am into my Physical therapist for over $1000 this month alone. Once I meet the deductible, I can have the very nice $50 copayments for the rest of the year.
Both deductibles and co-payments go towards meeting the annual Maximum-Out-Of-Pocket "MOOP." Once you MOOP out, visits are free.
Prescriptions are a whole different matter. They are billed in a completely separate system.
The above goes for most health insurance plans in the US.
posted by SLC Mom at 4:50 PM on October 4, 2017
I've never had a problem getting Kaiser to pay for out of area expenses as long as I went to an emergency room or an urgent care. There's a number on the back of the insurance card where you call and let them know about the visit. That's it.
If you are in an area that has a Kaiser facility available, you need to apply for a medical record number for that specific service area. You can only do that Mon-Fri while customer service in your home service area is open. So if you get sick on the weekend, you're out of luck unless you happened to think ahead and get that number before you go.
Plans vary quite a bit, so I would check on the specifics of your plan.
For what it's worth, I've been with Kaiser Southern California for 8 years and am very pleased.
posted by Sunnyshe at 11:21 AM on October 6, 2017
If you are in an area that has a Kaiser facility available, you need to apply for a medical record number for that specific service area. You can only do that Mon-Fri while customer service in your home service area is open. So if you get sick on the weekend, you're out of luck unless you happened to think ahead and get that number before you go.
Plans vary quite a bit, so I would check on the specifics of your plan.
For what it's worth, I've been with Kaiser Southern California for 8 years and am very pleased.
posted by Sunnyshe at 11:21 AM on October 6, 2017
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2. It'll be covered but they will transport you asap to a Kaiser facility no matter how inconvenient or far away it is.
3. When I had Kaiser yes but I don't know anymore.
4. No experience with this but typically if you have normal medical problems they are very good. If you need to see a very focused specialist or want out of the box treatment options not so good. The coordination is really nice though.
I would go back to Kaiser in a heartbeat. I've been dealing with the lingering effects flog a weird viral illness and trying to coordinate amongst all the variosi specialists I've been sent to is maddening
posted by fshgrl at 10:52 AM on October 3, 2017