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Question: I know Kaiser is limited geographically but why would someone opt for straight medicare and it's 20% co-pay when they could get something like I described, Kaiser Medicare Plus (Cost), provided it's available?
Lastly, does anyone know of procedures/places, that absorb the co-pay and do a procedure in exchange for just the allocated amount they will receive from medicare? I had, for example, a sleep-study who stated up front I would not have to pay anything if I got the procedure in their facility.
I'll answer Question 1. I live in Maryland and we have the same KPP Medicare Plus Cost plan. My sister, my friend, my mother and my father all have or had KP Medicare Plus Cost. First, my mother failed to get adequate treatment for her cancer because her NP did not read the radiology report in a timely manner. (The NP went on vacation and forgot to look at it when she returned. She DID apologize, though).
Second,my father's cataract surgeon misdiagnosed the wet macular degeneration in Dad's right eye and by the time he finally referred my father to a retina specialist my father had lost the central vision in that eye. The retina specialist gave my father injections for months and months (cha-ching!) until my father had a follow up at Kaiser. When my father's remaining eye was showing similar signs (on the OCT) the same cataract surgeon again failed to consider macular degeneration and wanted to schedule cataract surgery on his remaining eye. I requested a second opinion and he agreed to have Dad examined by one of KPP's other docs (from your side of town). Later that evening I decided this was crazy s$$$. No, just no.
I took Dad to Johns Hopkins the following day. It was at that time that we learned his right eye was severely scarred and that he would never regain vision in that eye. The remaining eye had active wet macular degeneration and needed to be treated immediately. Also, the retina specialist at JH advised him NOT to have cataract surgery in his remaining eye. I have no doubt that my father would have lost his central vision in his remaining eye if I did not step in and take him to Johns Hopkins (or another decent eye clinic).
There are other stories but I'll finish with this. The last time I looked KPs Medicare Plus Cost plan is scheduled to end in a few years. I don't know if a current member will have the option of switching to Original Medicare and purchasing a Medigap without underwriting. I would need that guaranteed because I would not want to be stuck with a Medicare Advantage plan.
Lastly, does anyone know of procedures/places, that absorb the co-pay and do a procedure in exchange for just the allocated amount they will receive from medicare? I had, for example, a sleep-study who stated up front I would not have to pay anything if I got the procedure in their facility.
Generally, it is against Medicare rules for a Medicare provider to waive copays. Many links on that issue, here:
Whether or not the provider will institute collection proceedings for the nonpayment would be the variable.
Quote:
Originally Posted by lenora
The last time I looked KPs Medicare Plus Cost plan is scheduled to end in a few years. I don't know if a current member will have the option of switching to Original Medicare and purchasing a Medigap without underwriting. I would need that guaranteed because I would not want to be stuck with a Medicare Advantage plan.
Your father should qualify under Guaranteed Issue Right #1:
Quote:
Guaranteed Issue Right Situation:
#1: You are in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.
You have the right to buy...
Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.
You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.
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Your father should qualify under Guaranteed Issue Right #1:
Since F is being discontinued in 2020, I would expect G will replace F in that table.
My father left Kaiser. He had additional insurance through his former employer (which I didn't know existed when I took him to Johns Hopkins.) I was providing another reason folks may need to be careful before enrolling in KPs Cost plan. In my roundabout way, I was questioning whether the Cost plan would be considered a Medicare Advantage plan in determining whether the guaranteed issue right would apply. Not surprisingly, you answered that question and I trust you are correct. Thanks.
Kaiser here is horrid. MY BIL was a physician here in Roseville
Then he moved out of state to work at another Kaiser which he said is MUCH better
Now he has his own practice
I'm a Kaiser member I go to the Point West Office near Arden Mall in Sacramento and I'm very happy with it. My Doctor is fantastic, he used to have his own practice & gave it up to go to work for Kaiser. The Doctor I had before him was pretty awful though, I always felt like he was playing candy crush on his tablet when he was talking to me.
But overall my experience with Kaiser has been good, I get the specialist referrals I need and feel like the care I'm receiving is adequate, they are much better than they were the last time I was a Kaiser member 30 years ago.
I'm a Kaiser member I go to the Point West Office near Arden Mall in Sacramento and I'm very happy with it. My Doctor is fantastic, he used to have his own practice & gave it up to go to work for Kaiser. The Doctor I had before him was pretty awful though, I always felt like he was playing candy crush on his tablet when he was talking to me.
But overall my experience with Kaiser has been good, I get the specialist referrals I need and feel like the care I'm receiving is adequate, they are much better than they were the last time I was a Kaiser member 30 years ago.
Can you green me his name? I am having issues that appear really serious right now (just did a post on it). I think they assigned me a Primary Care Physician already because I never responded when the kept asking me to pick one. So it may not matter. Thanks so much sleepy.
I've been studying up and was going to see if I could see a Doc at the Indian Health Clinic where I go, then get their opinion and learn of specific tests then visit the KAISER ER. Maybe I better go to Sacramento Kaiser ER because years ago, the Roseville one was bad (Per my BIL)
Can you green me his name? I am having issues that appear really serious right now (just did a post on it). I think they assigned me a Primary Care Physician already because I never responded when the kept asking me to pick one. So it may not matter. Thanks so much sleepy.
I've been studying up and was going to see if I could see a Doc at the Indian Health Clinic where I go, then get their opinion and learn of specific tests then visit the KAISER ER. Maybe I better go to Sacramento Kaiser ER because years ago, the Roseville one was bad (Per my BIL)
It says you don't accept private messages, but I don't think this constitutes an advertisement- trust me I don't get paid for it...so, his name is Garth Davis, I love him to death! If I have a question I email him and he gets back to me no later than the next day. He used to have his own practice in Vacaville, he's an internal medicine doc, very smart and pays attention when you talk unlike the old one who kept asking me the same questions over and over because he never freaking listened to me
It says you don't accept private messages, but I don't think this constitutes an advertisement- trust me I don't get paid for it...so, his name is Garth Davis, I love him to death! If I have a question I email him and he gets back to me no later than the next day. He used to have his own practice in Vacaville, he's an internal medicine doc, very smart and pays attention when you talk unlike the old one who kept asking me the same questions over and over because he never freaking listened to me
Thank you sleepy. I realize I really need an OBGYN though so won't likely be calling him.
Woke up and no blood. Even my body is starting to form nicely...from the exercise...very quickly
We will exercise 5 nights a week so I think that will keep the stress away thus the bleeding
But the bloating, something is off. need to get into seeing what that is, and the feeling there is a rock in my stomach along with that one incident of spitting up blood.
I forgot I clicked no private messages, I'll go unblock now.
Thank you very much for that name. I wrote it down just in case.
Thank you sleepy. I realize I really need an OBGYN though so won't likely be calling him.
Woke up and no blood. Even my body is starting to form nicely...from the exercise...very quickly
We will exercise 5 nights a week so I think that will keep the stress away thus the bleeding
But the bloating, something is off. need to get into seeing what that is, and the feeling there is a rock in my stomach along with that one incident of spitting up blood.
I forgot I clicked no private messages, I'll go unblock now.
Thank you very much for that name. I wrote it down just in case.
You can pick him as your PCP and still pick an OB/GYN just see who's accepting patients and google their name and check reviews
You can pick him as your PCP and still pick an OB/GYN just see who's accepting patients and google their name and check reviews
Good thinking, It's the evening I am at work and I am still OK! yahoo!!! But I'll still go see a Gyno for sure and eventually get my stomach thing checked out. That wasn't normal.
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