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Old 02-04-2011, 03:50 PM
 
Location: California
4,445 posts, read 5,168,213 times
Reputation: 9180

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I have had Kaiser in CA for several years now. I would recommend that you go to their site and look at the their doctors. In this area, it is extremely difficult to find anyone I can relate to. They claim they speak English but most of the time, there are huge communication problems which is not what you want when when it comes to your health care. One of many examples I could give; a man when to KP at their new facility in Santa Clara with shoulder pain. For three months he was treated for shoulder gout (yes, that is a new one for the medical books). Finally, he was lucky enough to get a smart advice nurse and by that afternoon, he was having stents in his heart. It might be different in CO but based on Santa Clara/San Jose experience, buyer beware.
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Old 02-04-2011, 05:53 PM
 
Location: western Centennial, CO
654 posts, read 1,756,408 times
Reputation: 301
One more thing about Kaiser. They have a formulary of drugs they cover. You can get anything but you will pay the full amount not the copay. Three times we have had a doctor (three different doctors) fill out the exception form such that a non-formulary drug is covered as a benefit and we paid only the co-pay.
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Old 02-05-2011, 01:40 AM
 
Location: Colorado
554 posts, read 1,305,418 times
Reputation: 948
I'm still up in the air on KP. I've never had experience with Cigna. With KP, they really took exceptional care of my parents in their time of great need. So, kudos to them for that. However, the co-pays and pharmacy costs are, IMO, pretty high. Both of my parents have KP plus Medicare for Seniors. So they do get help with stuff. I'd rather have Kaiser than nothing at all.

But when my sister had her gall bladder problem years ago, KP really dragged their feet on helping her and giving her proper care. She swears she was dying. It all worked out in the long run though. Just lately, a daughter of a friend was co-hearsed into entering the mental health facilities without her parents knowledge by a KP doctor. She did just turn 18 yrs old though. KP wouldn't let her own parents see her for 3 or more days. Her parents are meeting with their lawyer as we speak to sue them. It all got very complicated and I don't have any details other than that.
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Old 02-05-2011, 09:40 AM
 
Location: Colorado Springs
18,863 posts, read 8,860,357 times
Reputation: 18281
Quote:
Originally Posted by chilicheesefries View Post
...
My conclusion:
1)It depends on your doctor with Kaiser. We have never had any problems getting what we need at all.
2)Maybe it depends on how your insurance with Kaiser is handled - group, individual, etc. More risk to spread around in a group so they're more likely to give you the procedures?
The out-of-area scenario is one that people would be wise to consider. I had to go to the emergency room in Arizona once when I lived in the D.C. area, and although I can't say the payment situation was hassle-free, I was fully covered by KP.

And in terms of dealing with "your" doctor, back a while, again when I was in the D.C. area KP, I disagreed with my doctor on a particular medication, and she wouldn't prescribe the one I wanted. I did my research online, wrote a long justification for the drug I preferred, submitted a complaint. I fully expected to be turned down. Instead, KP approved my preferred drug and suggested a KP physician whom they though I would be more satisfied with.
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Old 02-05-2011, 12:49 PM
 
Location: California
4,445 posts, read 5,168,213 times
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My friend's dad went to S.J. Kaiser with a stroke. He was kept over night but during the night he called the nurses in three times trying to tell them that he was having another stroke. Each time they basically told him to shut up and go to sleep. When my friend arrive early the next morning she found him now paralysed on one side. Naturally, his medical records were altered when she tried to persue mediation - one can't sue Kaiser you know. There have also been local reports of about over medicating hospitalized adults and at least one infant causing serious injury and some deaths. My own doctors have told me to continue with cholestrol meds even when they put me into a zombie like state. The nurses confirmed for me that if I have serious damage because I follow the doctors instructions, it was still all my problem. Just since my last post I heard that some employers are now telling the employees that the huge employer based insurance rate increase which will take effect this summer is because of coworkers who smoke or have diabetes. Of course, insurance company greed isn't responsible. It seems like the insurance companies are working to create a divide between coworkers and also employers as it is easier for them to raise rates when individuals have no barganing power. It is getting nasty out there!
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Old 02-05-2011, 04:28 PM
 
5 posts, read 16,886 times
Reputation: 11
Thanks to everyone for your additional comments! It was good to hear everyone's out-of-network experiences have been, for the most part, postive. I will be traveling a fair amount in the future and wanted to make sure I wouldn't always be fully stuck with any emergency bills (though of course it all depends on the circumstances).

chilicheesefries, thanks so much for the in-depth information, especially pertaining to maternity and out-of-state care. It's helpful to hear how they handled these situations.

Heidi60 & Pierce2011, I completely understand where you're coming from and can see why you're not too keen on Kaiser. No one wants to hear you won't get treated when needed.

phetaroi, I'm happy to hear that KP listened and responded positively to your concerns.

I am self-employed so I am looking into individual policies. So far it seems the choices aren't all that great (high out-of-pocket and deductibles and high coinsurance) but I have to deal with what's available.
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Old 02-06-2011, 09:09 AM
 
Location: western Centennial, CO
654 posts, read 1,756,408 times
Reputation: 301
Quote:
Originally Posted by Pierce2011 View Post
I'm still up in the air on KP. I've never had experience with Cigna. With KP, they really took exceptional care of my parents in their time of great need. So, kudos to them for that. However, the co-pays and pharmacy costs are, IMO, pretty high. Both of my parents have KP plus Medicare for Seniors. So they do get help with stuff. I'd rather have Kaiser than nothing at all.
There-in lies the missing link in all of these discussions - costs, both premiums and co-pays. All my discussions are based on my group Cigna vs. Kaiser. Cigna has always had significantly higher premiums and used to have the same co-pay (assuming HMO here). Then the co-pays went up for Cigna but not Kaiser without a decrease in premium. For us Kaiser has lower premiums and lower co-pays then the alternative which is why we switched and we haven't had reason to be dissatisfied. My wife's work had a higher co-pay and higher premium verison of Kaiser! There's so many variations we can't talk about cost and do it any justice - your experience is high co-pays and pharmacy costs and mine is just the opposite with lower premiums to boot.
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