Anyone have Kaiser Ins and how do you rate it?

Jackster51

My insurance co is not offering coverage in CA next year so I have to find a new plan. I have heard different opinions on Kaiser so thought I'd check in here with you ladies and gents. As insurance companies go, if you have Kaiser, do you like them? Thanks in advance!

exbrnxgrl

jackster,

I have been a Kaiser patient for many years, including bc diagnosis and treatment. My experience has been very positive. Here are the pros and cons, IMO

Pro

Convenient, centralized care, especially if you use one of their larger campuses. Everything I have needed, from PET scans, to surgery, labs, pharmacies, all doctors and even a weekly farmer's market are all in one location.

All of your records are available to all of your service providers with a few clicks of a mouse. No waiting for docs to send/receive records or results.

In the same vein, their patient portal is great. I have never waited more than 24 hours to get results of any tests or scans, ever.

I go to their Santa Clara campus, which is a fairly new facility. They also have a great relationship with Stanford and participate in research .

I have never had to get pre-approval for any procedures or scans my oncologist has ordered. If my onc orders it, I get it.

Not that I was happy to be there, but the hospital was great (as far as hospitals go). All private rooms, not too awful food, emphasis on maintaining a quiet, healing atmosphere.

Emphasis on health and wellness. Many classes and lectures on staying well. They are big on preventative care.

I have had some wonderful docs and a rare few who weren't . It was fairly easy to change docs within their system. I also love all of the caring, compassionate nurses, sides and techs who work in the oncology and infusion departments.

Cons

You can only see doctors within the Kaiser system. Second opinions, third opinions? Sure, as long as they are with Kaiser docs. This really bothers some people. I will be honest and say that it really didn't bother me, but it bothered my family. My brother generously paid for second opinions that I had at Stanford. My Kaiser onc and Stanford onc knew each other and communicated well. Still, I would have been fine with a second opinion from a Kaiser doc.

In my experience, and this goes beyond oncology, they really try to go the least invasive routes when it comes to tests, procedures and prescription meds. Some people think their approach is not agressive enough, but really , do you need an MRI for a hangnail? Or, must you always leave with a prescription when you see the doctor ?

It's a bit difficult to get the name brand of most meds as they are gung ho on generics. This hasn't been a problem for me, but I understand it can be for others. BTW, most of their pharmacies sell a wide variety of OTC medicines, supplements and other health care items at very good prices.

Overall, some consider Kaiser to be too mass market (their docs are salaried) and there is definitely a Kaiser way of doing things. You know this going in to it and if that bothers you, then don't choose Kaiser.

Please remember that there are many plans on Kaiser so my experiences may be affected by what my plan covers or doesn't cover. I have no deductible, great prescription coverage, etc. It's also my understanding that not all of their facilities are equal. I went to a different Kaiser campus for a few years before I switched to Santa Clara. I like Santa Clara much better.

Good luck with your decision making.

Jackster51

exbrnxgl, thank you for such a detailed run down!! That is all very useful information. Lots to consider for sure. I'm happy to hear they have been a good fit for you. Thanks again!

peggy_j

exbrnxgrl, regarding second opinions, your brother took the recommended approach, of making sure you got a second opinion from a doctor from a different medical practice. (to eliminate any barriers or biases related to their workplace)

FWIW, Stanford, is no longer in-network for a lot of insurance companies, like Blue Shield. This was new effective 2017, I believe. Looking to 2018, Blue Shield will jack up their deductible for out-of-network doctors (from 9,800 to 20,000 for an individual policy. Yep, you have to pay that much before your insurance pays a nickel to your out of network doctor. And Stanford's office visits are crazy expensive. )

I guess all of this is to say that...PPOs may not offer nearly as much flexibility as they used to. ;(

exbrnxgrl

Hi Peggy,

Not sure I understand your point (haven't had my coffee yet). The op was asking for opinions on Kaiser. As an aside I mentioned Stanford, because I was fortunate enough to have a family member pay for my second opinion . There was no worry about networks, expenses etc. since it was a purely cash transaction. I was and still am a Kaiser patient

peggy_j

ex, sorry. I wrote that late at night so maybe I was tired too. I know you we're discussing Kaiser. You made the point that you can only get second opinions if they are another Kaiser doc. My points were

1) the conventional wisdom for 2nd opinions is to try to find a doctor outside the same medical practice (so in this case, outside Kaiser) So if this is important to a patient, as you said, then Kaiser might not be her choice or she may need to pay out of pocket. (When I called Stanford earlier this year to get a second opinion on my osteoporosis Tx, i was shocked that an office visit was >$800! Admittedly, it's a longer first-time appointment, but if I preferred Stanford's approach, could I afford to be treated by that doctor?)

2) however, today PPOs seem to offer fewer in-network doctors than in the past.

I guess for me, this adds up to

A) how important is it to have a wide choice of doctors?

if it's important, can you find a PPO that actually offers many options? I found, for example, on the ACA plans, only one lists my current oncologist as in-network.

C) so even though Kaiser may be limited to their own docs, this limitation may not be as great as it was in the past.

Is this more clear? I hope so. Sorry for being confusing----not my intention at all.

exbrnxgrl

Thanks, Peggy

PauletteK

I have been lurking this thread for awhile, i heard kaiser is getting better and I have so many friends and friends joined Kaiser now. I was thinking once I reached 65 might be I do that also.

MargoChanning

I was moved to Kaiser due to work benefits changes after being on PPO's for decades. I've had mixed experiences; the gyn I saw was very good and understanding of SE's from aromatase inhibitors. The MO I was assigned, however, is a blood cancer specialist and has not been able to engage in discussions of AI's or ongoing risks, etc. I've been trying to determine who might be a breast cancer specialist but the pcp I asked said "breast cancer is very common so all the oncologists specialize in it". If that was true, the MO should have been able to answer my questions. I'm still trying to find out if there is someone on staff with more BC experience but hard to find this information.

Also the last several months I've been trying to get in to see someone to look at a continuing and worsening knee problem; the pcp (who retired last month) told me to go to urgent care. Not a good solution for a chronic problem and I don't want to spend 8 hours in a clinic to see a nurse practitioner when I should see an ortho. So I called the appointment center and asked to see any available pcp at my location. So far I have been scheduled for and then cancelled by Kaiser, 3 appointments in the last month. They call the night before and tell me either the doctor is not available or is overbooked.

The pcp I chose after the first one retired is apparently overwhelmed due to the retirement of the other doctor and can't see me until December, which is why I asked to see anyone available. I never had these kinds of issues with PPO.

exbrnxgrl

I think that there are good and not so good experiences with any medical practice. I did not like the mo I first had at Kaiser. My RO was sympathetic and easy to talk to. He made an appointment for me with another mo and I've been with her ever since. Though I have been very happy with them, 6years of NED at stage IV, not everyone will be

Jackster51

Thanks everyone for your opinions and I welcome more. It's so silly - IMO - that we have to figure all this out! On top of earning a (fake) medical degree in breast cancer!

Meg101

Jackster - I highly recommend Kaiser. Over the years I have had a variety of providers. Kaiser has been by far the most professional, efficient, and caring provider of all. Their doctors actually care about their patients. They are not practicing medicine just to make money. They truly care. I'm thankful to be with Kaiser now that I have breast cancer. BTW, I use the facility in Woodland Hills, CA (Los Angeles area).

Jackster51

Awesome Meg! Thanks for that