Is Kaiser good for babies/children's routine and serious care?
December 7, 2017 7:51 AM Subscribe
I am thinking of switching from an off-exchange plan to an on-exchange Kaiser plan for 2018 since I now have two more members of household (baby and unemployed husband who just immigrated to the U.S.) Most of the feedback for Kaiser in California is really good, but some say that Kaiser is only good for preventive/routine care and that it drops the ball or rations care for serious/catastrophic illnesses.
Everyone in my family is healthy with no chronic diseases. So far I don't have any serious post-partum issues, either. Nor does baby seem to have any problems. But down the road what if the worst thing possible happens and baby gets cancer or something? Is Kaiser good with really serious illness?
Everyone in my family is healthy with no chronic diseases. So far I don't have any serious post-partum issues, either. Nor does baby seem to have any problems. But down the road what if the worst thing possible happens and baby gets cancer or something? Is Kaiser good with really serious illness?
We found Kaiser (in OR, I've heard CA is different/slightly better?) to be particularly difficult to work with for anything that required specialty care. Mental health coverage was abysmal (which may not apply to your child, but it can), and other occupational-therapy related treatment for our kid was almost just as bad. Wait times to see certain specialists can stretch into the 6-8 month range, and to get referred out of network, you have to hustle for it.
In our case, they under-diagnosed a handfull of times, with different issues. It's not clear if this was so they didn't have to provide care or if it was just low quality diagnosis. We ended up paying out of pocket to see some specialists, because Kaiser wouldn't referr us out to the specialists we were pretty sure we needed.
One interesting thing about Kaiser in our region is that they don't do pediatric emergency care very well, and if you know this fact you can go to a couple other hospitals that are phenomenal and you get way better care for your kids in an emergency. But that's not widespread knowledge.
I know plenty of folks who like Kaiser, but they're by and large healthy with no health problems.
If you have minor specialized problems at all, I would avoid Kaiser.
posted by furnace.heart at 9:51 AM on December 7, 2017
In our case, they under-diagnosed a handfull of times, with different issues. It's not clear if this was so they didn't have to provide care or if it was just low quality diagnosis. We ended up paying out of pocket to see some specialists, because Kaiser wouldn't referr us out to the specialists we were pretty sure we needed.
One interesting thing about Kaiser in our region is that they don't do pediatric emergency care very well, and if you know this fact you can go to a couple other hospitals that are phenomenal and you get way better care for your kids in an emergency. But that's not widespread knowledge.
I know plenty of folks who like Kaiser, but they're by and large healthy with no health problems.
If you have minor specialized problems at all, I would avoid Kaiser.
posted by furnace.heart at 9:51 AM on December 7, 2017
Unfortunately, Kaisers differ regionally. If you're in Northern California, I'd highly recommend them. They do routine and serious care very well in Northern California and they're even doing much better with mental health care (a deficiency area in the past, though many plans across the board are terrible for mental health services.) If you're not in Northern California, you may want to respond with what region you're in and get targeted and recent info.
posted by quince at 11:46 AM on December 7, 2017
posted by quince at 11:46 AM on December 7, 2017
I was pregnant and had a child with Kaiser in Colorado and thought they did a really nice job of coordinating everything and handling all the routine care of delivery, post-natal and infant care, etc. I'm actually sad that we just had to switch our almost 1 year old's insurance to be not-Kaiser; I liked the straight-forward and comprehensive nature of their pediatrics program.
Seconding the statement that quality for Kaiser seems to vary a lot regional, so the answer to your question probably depends on where you live. I've heard good things about Kaiser in California.
posted by warble at 1:01 PM on December 7, 2017
Seconding the statement that quality for Kaiser seems to vary a lot regional, so the answer to your question probably depends on where you live. I've heard good things about Kaiser in California.
posted by warble at 1:01 PM on December 7, 2017
I’ve had Kaiser (N Cal) for years and have had good experiences with acute care needs — most recently an ER visit where follow up included a MRI and a bunch of other expensive diagnostic work. A good friend with a very high-risk pregnancy was immediately transferred to specialty care at UCSF as the experts with Kaiser paying for it all, including the extended time in the NICU for her baby. The key to Kaiser is learning how to work the system, using the nurse line, etc., and finding a primary doc you like. Some providers are great and others are really lousy, as in any plan.
posted by gingerbeer at 4:16 PM on December 7, 2017
posted by gingerbeer at 4:16 PM on December 7, 2017
Response by poster: I'm in Southern California (Inland Empire), but we could be moving up to LA or the Bay Area in 2018.
posted by KatNips at 9:27 PM on December 7, 2017
posted by KatNips at 9:27 PM on December 7, 2017
Response by poster: So how do you "work" the Kaiser system?
posted by KatNips at 9:28 PM on December 7, 2017
posted by KatNips at 9:28 PM on December 7, 2017
Everyone in my family is healthy with no chronic diseases
I had Kaiser and then not-Kaiser during my (Bay Area) pregnancy. Not-Kaiser was a huge annoyance: hard to schedule appointments, long waits, billing complications, short appointments, a sense that I was going to fall through the cracks if I didn't ask the right question, limited office hours, and 30-minute waits for return phone calls from the after-hours advice nurse. Kaiser was a well-oiled machine: convenient appointment times, a clear system of what I needed to do when, office visits that ran on time and had enough time for all my questions, easy access to a specialist to ask a question when one came up. Also, the advice-nurse hotline was so convenient to call when I had a question at any time of the day or night.
Since nobody in your family is sick, I would humbly submit that you might be better off with an HMO that is good at routine care since that's what you need now.
Also, before I switched, I used Kaiser to get therapy, a wrist X-ray, some ongoing specialty care, and treatment for getting poison oak all over my body, and all of that went smoothly as well.
posted by slidell at 10:00 PM on December 7, 2017
I had Kaiser and then not-Kaiser during my (Bay Area) pregnancy. Not-Kaiser was a huge annoyance: hard to schedule appointments, long waits, billing complications, short appointments, a sense that I was going to fall through the cracks if I didn't ask the right question, limited office hours, and 30-minute waits for return phone calls from the after-hours advice nurse. Kaiser was a well-oiled machine: convenient appointment times, a clear system of what I needed to do when, office visits that ran on time and had enough time for all my questions, easy access to a specialist to ask a question when one came up. Also, the advice-nurse hotline was so convenient to call when I had a question at any time of the day or night.
Since nobody in your family is sick, I would humbly submit that you might be better off with an HMO that is good at routine care since that's what you need now.
Also, before I switched, I used Kaiser to get therapy, a wrist X-ray, some ongoing specialty care, and treatment for getting poison oak all over my body, and all of that went smoothly as well.
posted by slidell at 10:00 PM on December 7, 2017
My parents have been with SoCal Kaiser for decades and it's been an almost entirely positive experience. My dad just had a rather complex eye surgery and now has 20/20 vision for the first time in his life. I know some good doctors who work there too. My parents are getting older and I love that Kaiser schedules followups and checkups for them so consistently. I feel like they're in good hands.
I do know one infectious disease pathologist who left Kaiser because he felt he lost a patient due to their unwillingness to pay for an experimental treatment he was certain would work. Likewise, they are not going to do the expensive, difficult new procedure on you if there's a cheaper procedure that works about as well. In short, if you want a doctor who is going to pull out every last stop to keep you alive when you get some rare disease, Kaiser is not where you go. But if you want the amount of medical care most reasonable socialized-medicine-type schemes would pay for in most first-world countries, for a reasonable price, Kaiser is the place to be.
You "work" Kaiser the same way you work any other system with gatekeepers: you don't take no for an answer. You be polite but firm. It certainly helps to be white, and male, and visibly non-poor and non-disabled. It certainly helps to know other medical professionals, and talk to them and sanity check diagnoses and treatments.
posted by potrzebie at 10:59 PM on December 7, 2017
I do know one infectious disease pathologist who left Kaiser because he felt he lost a patient due to their unwillingness to pay for an experimental treatment he was certain would work. Likewise, they are not going to do the expensive, difficult new procedure on you if there's a cheaper procedure that works about as well. In short, if you want a doctor who is going to pull out every last stop to keep you alive when you get some rare disease, Kaiser is not where you go. But if you want the amount of medical care most reasonable socialized-medicine-type schemes would pay for in most first-world countries, for a reasonable price, Kaiser is the place to be.
You "work" Kaiser the same way you work any other system with gatekeepers: you don't take no for an answer. You be polite but firm. It certainly helps to be white, and male, and visibly non-poor and non-disabled. It certainly helps to know other medical professionals, and talk to them and sanity check diagnoses and treatments.
posted by potrzebie at 10:59 PM on December 7, 2017
I have SoCal Kaiser, and I love it for the most part.
This summer, I broke my clavicle into 4+ pieces and required surgery. Even after weeks of PT, the whole thing cost about $500 and the only paperwork i had to fill out was “what religious people and family members should be call if the surgery goes real bad?”
The only real problem is closesly related to the biggest strength. Once you are in the system, and the system is followed, everything works like magic.
I broke my clavicle surfing and I was taken to a non-Kaiser trama center by ambulance. After I was discharged (no concussion, but surgery required) I had to walk into Kaiser ER to get things rolling on their end. Not super terrible, but extra work. Also, my surgeon was new to the Kaiser system, so he had hard time refilling my opiates because he couldn’t get a handle on the 2 factor authentication/authorization system Kaiser uses for serious drugs.
All in all, unless you really really like handling 100% of all medical situations, I recommend Kaiser.
posted by sideshow at 9:16 PM on December 8, 2017
This summer, I broke my clavicle into 4+ pieces and required surgery. Even after weeks of PT, the whole thing cost about $500 and the only paperwork i had to fill out was “what religious people and family members should be call if the surgery goes real bad?”
The only real problem is closesly related to the biggest strength. Once you are in the system, and the system is followed, everything works like magic.
I broke my clavicle surfing and I was taken to a non-Kaiser trama center by ambulance. After I was discharged (no concussion, but surgery required) I had to walk into Kaiser ER to get things rolling on their end. Not super terrible, but extra work. Also, my surgeon was new to the Kaiser system, so he had hard time refilling my opiates because he couldn’t get a handle on the 2 factor authentication/authorization system Kaiser uses for serious drugs.
All in all, unless you really really like handling 100% of all medical situations, I recommend Kaiser.
posted by sideshow at 9:16 PM on December 8, 2017
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If you can afford just about any other option, I'd recommend avoiding Kaiser.
posted by ernielundquist at 8:06 AM on December 7, 2017 [1 favorite]