S/O of Expensive Health Insurance Thread...Kaiser

[Christine]

So, in reading the health insurance thread and all about deductibles, I was wondering how many of you use Kaiser.

I don't use it, but my DD who was booted off our insurance at 26 this past summer now has it through her employer. Her last employer did not offer it, so she purchased at catastrophic plan for which she paid about $120 a month for. Deductible so high and she was so poor, she didn't use it.

Her new employer offers 3 plans, all *roughly* the same price (Three levels of BCBS and Kaiser). All of the deductibles for the BCBS plans range from about $1600 to $2600. The Kaiser plan had ZERO deductibles and $20 copays. 100% coverage for hospitalization.

I told her to give a try for a year and she just has her first appointment a few weeks ago. It was impressive. We have several very good Kaiser facilities in our area. Several of my coworkers in the federal service choose to take it and have been more than happy with it. I remember everyone used to say "stay away from them" and "managed care, yuck!!" But the treatment she got for her first assessment is better than I've had in a long time with my regular health insurance.

Anyone care to share their experiences?

 

[morgan98]

People were more against Kaiser back in the day because of the fact that it is truly a closed network. However, because of that closed network right down to separate facilities, etc. they are able to control costs much better and that has become very appealing. Although, I have never used it personally, I know several people in healthcare that say that model works and is very good at delivering very efficient care. As with all things, some doctors are going to be better than others.

With the ever rising crazy costs of healthcare this is something I would most definitely not rule out in the future providing I live in an area with good coverage. Kaiser started as a West Coast thing so coverage was spotty on the East Coast. However, that has changed over the years.

 

[longboard55]

I take my brother to Kaiser. They make a big effort to do things smarter, a more efficient operation. Also they will not over medicate, just the opposite, they will always prescribe the cheapest. But in my brothers case who has a lot of issues, they make a big effort to keep him healthy, Overall its a good way to do things.

 

[Albort]

i have a few friends that have Kaiser because its employee sponsored. A few things ive heard is that sometimes, they make you wait for awhile. my friend said she wants waited like an hour in the waiting room before a doctor showed up. The other thing i was told that my friend said of all the times he goes to see the doctor, he never sees his primary doctor... i guess thats okay lol.

 

[Christine]

Yes, I was so impressed with what they did with my daughter last week. They addressed all of her issues, made her a second appointment the same day with a specialist she needed, got all her medication prescribed and they have now scheduled her for follow ups. These are all things she really needed to have done but was avoiding due to lack of money to meet the deductible. She couldn't believe the efficiency and how she didn't have to run three different places.

 

[Christine]

i have a few friends that have Kaiser because its employee sponsored. A few things ive heard is that sometimes, they make you wait for awhile. my friend said she wants waited like an hour in the waiting room before a doctor showed up. The other thing i was told that my friend said of all the times he goes to see the doctor, he never sees his primary doctor... i guess thats okay lol.

I think years ago I would have been very critical of this; however, what you've described happens to me with my own doctors these days. Didn't use to but things are not optimal anymore. I've even changed up providers and I find my care to be subpar these days.

 

[starry_solo]

I have had Kaiser coverage for many years. I only see my primary care physician for the yearly physical. If I'm sick and she's not available, I go with the first available appointment at my preferred location (one that's 5 miles away, versus the one that's 10 miles away) and see another physician or PA.

My family is all covered with Kaiser and they have been very good for us. First, through an employer sponsored plan, then to COBRA, then Medicare (for the parents and me when I was a kid covered under my parents' plan). Mine is covered through my employer. When I was employed by a firm that didn't offer Kaiser coverage, I still had an individual plan and got partially reimbursed every month through the employer (like it was $150-200/month, and I got $100 month back from the employer).

I will say, however, that my sister's former co-worker didn't have a good time with Kaiser (covered through employer). She complained constantly of pain in her abdomen area and was always pooh-pooh'd away. Turns out she had advanced colon cancer and died of it. And what was really weird is that she had colonoscopies which revealed issues and the doctor didn't put her on the repeat colonoscopies (every 1-2 years, versus every 5-10 years if nothing comes back).

 

[morgan98]

I think years ago I would have been very critical of this; however, what you've described happens to me with my own doctors these days. Didn't use to but things are not optimal anymore. I've even changed up providers and I find my care to be subpar these days.

I also think that the state of medical care has continued to change dramatically over the past several years. When people used to hear about Kaiser they heard about closed networks, waits, etc. Now we are also faced with this on traditional insurance. You have to wait for appointments, sometimes a long time, or a doctor you had been seeing may no longer be in network. Added to this is the ever increasing deductibles and out of pocket care. What had seemed like a questionable way to deliver care, seems reasonable in the current environment.

 

[tvguy]

My wife's company offers Kaiser.

THE GOOD: When you get care your bill will be zero or very little.
My brother spent 11 weeks in the hospital and rehab. Kaiser paid for everything except $50 for a walker.

THE BAD: The premium is double what the next most expensive plan is. The price difference for a family of 4 is more than the $5,000 deductible the cheaper plan costs.
In my brother's case, his hospitalization was the result of them not catching and property treating a minor infection that spread through his entire body.


And my mom was an RN, and she had a very low opinion of Kaiser patient care. They paid nurses more than another other hospital, but the patient to RN ratio was higher.

 

[mom2rtk]

I used to work in marketing for a staff model HMO very similar to the Kaiser model. I'd give my right arm to have that coverage again.

The doctors are in a group practice. They aren't required to think the same way or treat patients the same way. If she sees one doctor and doesn't like them, she should be able to choose a different one next time. I'm sure they have good and bad doctors on staff, just like in private practice.

 

[disneyhand]

I have been with Kaiser for over 30 years. I have always had excellent care and am completely satisfied. When my primary care doctor that I really liked retired a few years ago, I didn't hit it off with the 1st replacement doctor. All I had to do was say I wanted someone else, no problem changing. I think the longest I've ever had to wait for an appt was about 15 minutes and it was due to a patient emergency. We are contemplating moving out of state in a couple years and I dread the thought of losing my Kaiser

 

[VandVsmama]

If you are a run-of-the-mill patient with nothing out of the ordinary wrong with you and you don't get sick very often other than the normal cold or occasional flu, Kaiser is just fine.

But anything else? Forget it. All of my examples are from Kaiser in northern California. We have a relative who has a close family member who is a senior executive with Kaiser in southern California and that relative's parents have Kaiser and THEY get top of the line care...well, because the parents' son is a senior So Cal Kaiser exec.

Kaiser screw up #1:
I had an allergic reaction to an antibiotic that I was taking for a sinus infection. Developed a fever, horrible hives & rash all over my body, and it felt like my throat was starting to close up. DH rushed me to the local Kaiser emergency room. They had me walk across the street to a clinic, where I waited 4 hours to be seen. Once I finally did see a doctor, they were really concerned about my airway and my ability to breathe (since I really couldn't). But nobody ever gave me a breathing treatment, put me on oxygen, gave me a steroid injection or anything. Just "here's a prescription for Prednisone" and instructions to go home. It was horrible.

Kaiser screw up #2:
My grandmother had all the symptoms of a stroke. Sudden muscle weakness. Couldn't walk. Couldn't stand up. Somehow my mom got her to the Kaiser ER. Doctors examined her and told her to go to the clinic because she wasn't "that bad." So she went to the clinic. A family practice doctor saw her and told her to go home and rest and to take an Alleve and let them know the next morning if the severe back pain and muscle weakness didn't get any better. The next day, she had to be sent to the ER by ambulance, where they finally ran some tests and learned that she'd had a stroke in her spinal column. My grandmother pretty much never walked again after that. She could shuffle around but she lived the rest of her life in a wheelchair. All because the Kaiser ER docs couldn't be bothered to run a CT scan on her back.

Kaiser screw up #3:
This happened to a close friend of my sister. We'll call her Jane. Jane's mom and dad had Kaiser. One morning while showering for work, Jane's mom had a massive heart attack, thought she was going to die. Called 911, they raced to the Kaiser ER, which was NOT the nearest ER to them. It was a 20-25 min drive from their home. They got to the Kaiser ER. Docs examined her and told her that she was too sick for their ER, that she'd have to be medivac'd via helicopter to the county trauma unit at the county hospital a 30 min drive away (but <5 min by helicopter).

But there was nowhere for the helicopter to land because there were too many cars parked in the ambulance parking area. And the ambulance drivers wouldn't move their ambulances. Nor would any of the regular car owners move their cars either.

So they had no choice but to drive her to the county hospital. Except now the county hospital wouldn't take her because of other traumas they were dealing with, so they didn't take her to the county hospital. By now, they figured out that Jane's mom had experienced an aortic dissection. The same thing that killed actor John Ritter. It was a miracle that she was still talking.

1 of the ER nurses told Jane, "Oh my! This is too stressful for me. I'm going to go get a cup of coffee." And the nurse left.

Now Jane's mom was sick enough that she had to be sent to Stanford Medical Center but again, no helicopter because of nowhere for it to land and this hospital didn't have a heli pad on the roof of the hospital. So Jane and her dad had to say their goodbyes to Jane's mom and the doctors told Jane and her dad that Jane's mom would probably die en route to the other hospital, so prepare to have to identify the body when they got there to Stanford Medical Center.

Jane's mom was stuck at that stupid Kaiser ER for over 90 minutes before they finally sent her off to Stanford in an ambulance. During the 90 minutes of total ineptness, Stanford had called in their top heart surgery team and everybody was there at Stanford hospital on stand by ready to rock and roll.

Once Jane's mom arrived there, Jane said that it was like night and day difference in terms of the quality of care. Stanford ran like a well oiled machine. The Kaiser hospital let her mom sit there waiting to die while they did literally nothing to help her. Jane's dad was so distraught that he threatened to call the police and drive his wife to Stanford himself.

Needless to say, their family are not big Kaiser fans and will never use Kaiser ever again.

Nor will I. It's cafeteria medicine. And that's not a compliment. Luby's Cafeteria of medicine.

 

[mom2rtk]

What good are the other plans if high deductibles keep her from seeking care?

 

[dotfurio]

I HATE Kaiser. I know lots of people who swear by them and I've heard good things about the Kaiser hospitals, but locally we only have clinics and they are terrible.

When I was an x-ray tech we had the local Kaiser contract. They treated the symptoms, not the problem. One example that sticks out with me is a guy who had chronic leg pain, went through two years of bs (pills, psych eval, pain management stuff) before they finally checked his arteries in his leg and they were so blocked the only treatment option was surgical.

On a personal note, they once told me to continue taking diet pills despite having heart palpitations. They told my dad his liver ultrasound was fine because they failed to read the second page of the report which stated cancer throughout. She went into his hospital room and told him his liver looked great. I had to tell her she didn't read the conclusion on the report. He had had a form of cancer that routinely spreads to the liver four years before and despite recommendations to do screening liver ultrasounds every 6 months they NEVER did ONE. He had been having abdominal pain for over a year and they didn't do a single scan. He died within a week of the ultrasound.

If you are healthy and can strongly advocate for yourself it's probably fine, but for anyone else I wouldn't recommend Kaiser.

 

[low-key]

I had them many years ago, didn't have to many problems, in fact only one (a miss diagnosed kidney stone) but I was young and seldom went to Doctor, I have no facts to back what I'm about to say but it just seems to me, if you were a good Doctor you woudnt get in a group like Kaiser, they offer you protection for malpractice, but the best who are confident in there ability dont end up there

 

[Araminta18]

We have Kaiser, and have had them for 5 years or so. We live in northern VA, so we're only talking about the DC/MD/VA situation, but we love it. Love having everything in one place, *love* being able to schedule everything via the app and get our prescriptions mailed to us. I really love the advice nurse, and being able to make appointments with urgent care. We've never really had to wait a long time to be seen or anything. And as far as price, they are one of the cheapest, if not the cheapest, plan my employer offers, and basically it's just been a fantastic experience all around. But Kaiser in this area is generally really good. We don't have any chronic health problems, but my coworker had lupus, and she really liked Kaiser too, especially being able to keep in contact with her doctor via email. But basically, we have had the same type of great experience that your daughter has.

 

[kdonnel]

My family and my in-laws had Kaiser for years. It was great while everyone was healthy. Once the in-laws started having health problems, Kaiser SUCKED!!!!

Kaiser has very specific procedures the doctors must follow that greatly lengthened the time my father in law spent in agony with a spine issue that ultimately was solved with surgery. To get that surgery took months of being forced to try drugs that did not work. Multiple trips by ambulance to the hospital and finally my wife and her brother putting their foot down and demanding Kaiser have someone read the MRI instead of sending him home because he was on step 30 of their 100 step treatment plan.

We had similar issues with my wife’s second pregnancy and the mandated Kaiser treatment plan for pregnancy.

The best was when my mother in law almost died on a cruise and ended up in Mexico having emergency surgery. When back in the US the in laws filed a claim with Kaiser. The bill was $30,000. Kaiser told them they should have negotiated a better rate and reimbursed them $1,300.

The final straw was when Kaiser started billing for multiple co pays for each doctors visit. If my mother in law asked a diabetes related question and a kidney disease related question during the same appointment they would receive a bill for a second co pay a couple weeks after the appointment. Kaiser then sent my in laws a bill for $600 for uncollected double co pays for the prior year when Kaiser decided to audit the medical billing from the prior year.

At the beginning of the next year they switched to a different option and have been much happier.

In short if you are healthy Kaiser is great. If you have a major health problem you don’t want Kaiser.

 

[Christine]

Interesting stories and good to hear them all. Like Araminta18, we are in the DC/MD/VA area and it seems like the Kaiser here might be very well-rated (thankfully)

Someone upthread talked about going to a Kaiser ER. Not sure if that's their own ER. They don't do that here. You go to a regular ER, get assessed, and if it's not a Kaiser contracted hospital then they transport you to the hospital with the Kaiser contract.

One of my coworkers has had it for years and her son has severe Crohn's Disease and her daughter has Type 1 Diabetes. She said it has all be very well managed. Her son had to pick another insurance when he became employed and they didn't offer Kaiser. He has been on BCBS for 3 years and she said his "care" is going downhill because he's not being "managed" as he was a Kaiser. They were just about forcing regular exams for him and now that he's sort of on his own, it's sliding. He's having trouble finding a good specialist without a wait time of 3 months for an appointment, and so on.

My other coworker's mother had great care through a whole breast cancer diagnosis. She was elderly and her only hiccup with the system was that the closest hospital to her was not a Kaiser hospital. So as she got older and had other issues, she was always being transported from the closer ER to the Kaiser hospital, which for an older person was fairly unsettling.