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Old 02-20-2014, 10:57 AM
 
10 posts, read 52,111 times
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HI there,

We are moving to Sacramento in July. Husband is going in two weeks to start, kids and I will follow after school is out. We have to make a medical plan selection soon.

I lived in So Cal for 20+ years, and we moved to NJ 10 years ago. At the time Kaiser scared the crap
out of me with people's horror stories.

Can anyone tell me about either plan, but especially Kaiser. The ins the outs, good and bad.
Thanks so much!
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Old 02-20-2014, 11:16 AM
 
Location: Carmichael, CA
1,933 posts, read 2,726,978 times
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I've had Kaiser here for years, as do many co-workers. Nearly everything is online now--appointments, test results, lots of preventative help. Lots of free or nearly free classes. 24-hour nurse advice line that has a doctor available if need be. If something serious happens, you can generally get a same day appointment. You can email your doctor anytime and generally get an answer within 24 hours.

All in all, they have a huge network that they manage very well. I've been concerned about the influx of new patients in January as they were one of I think six Affordable Care Act providers here, so I'm expecting a bit of confusion as they all get absorbed. (A number of years ago they took a huge number of Sacramento MediCal patients, and there was the same blip as it all got worked out.)

Yes, Kaiser used to be horrible--I had it when it was, and left. Compared to then, it is totally different now--I think a case where they looked at everything to see why they were losing patients and made the changes.
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Old 02-20-2014, 11:44 AM
 
10 posts, read 52,111 times
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Good to know, CB. Thanks. I am concerned, but I did do a little digging. Seems nothing good to say about Anthem, at least the on-line reviews.

I play a lot of tennis and tore my meniscus a couple of years ago. Had surgery here in NJ by the NY Jets Orthopedic surgeon and the results were fantastic. I maintain now with gel injections, 1 per week for 3 weeks and repeat every 6 months and so far it is keeping a total knee replacement at bay. Believe me you don't want just anyone coming at you with THAT needle, let me tell you. With my guy, it's really a piece of cake.

But the good news is that I just read that the Sac Kings now use Kaiser as their main medical team. Very good news. I have
an appt with my NJ Ortho next week, and I will hand him the article I printed out with the 3 main knee guys pictured for the Kings. Chances are, with all the networking these guys do, my doc may know one of them.

Thanks again. Glad to hear they have improved. Anyone else have any thoughts, I would love to hear.
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Old 02-20-2014, 12:18 PM
 
1,321 posts, read 2,083,670 times
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I've had only positive experiences with Kaiser, though they're relatively limited. I'm a healthy youngin' but did have one issue that required a trip to the ER. It wasn't as fast as it could have been, but I was impressed by how thorough they were (which was a little surprising, since it's not like they're fleecing the insurance company--they ARE the insurance company), and then ultimately amazed at how little I paid for a doctor visit, trip to the ER, and all the associated work. I have a co-worker with a severely autistic daughter, who says that Kaiser has been really great to work with. Another friend's son had leukemia and had a great experience with Kaiser Roseville (he's better now--even has all his hair back).

The only drawback for me is that all their facilities are scattered in the 'burbs, and are nearly impossible to get to without a car (and I generally bike to work downtown). Kaiser of Northern California gets high marks from folks like Consumer Reports. If external reviews make a difference, you might find that issue of CR at a local library.

Forgot to add: Good luck on the impending move and to your husband in his new location!
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Old 02-20-2014, 12:52 PM
 
10 posts, read 52,111 times
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Great stuff, Ryuns. Thanks
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Old 02-21-2014, 07:46 AM
 
Location: Sacramento
5,057 posts, read 7,263,515 times
Reputation: 3492
Quote:
Originally Posted by 1kelkat View Post
Good to know, CB. Thanks. I am concerned, but I did do a little digging. Seems nothing good to say about Anthem, at least the on-line reviews.
that's not entirely true. FYI, Anthem used to be Blue Cross of California. I had their coverage for years until I changed jobs. I received excellent service and easy access to any provider I wanted, even the top notch providers/facilities in the area. Some of the best orthopedic surgeons in the areas are non-Kaiser. I saw one of the Kings orthopods last year for a medial meniscus tear. Most of the top MDs are affiliated with local sports teams. There are lots of options in Sacramento.

I'm a RN & I still hear horror stories about Kaiser. Of course, there are horror stories about all healthcare companies/systems in the news. One of my previous jobs was oversight/regulatory aspects of healthcare so I investigated these types of complaints

I think it really comes down to the type of system you prefer. A closed system where you can only see receive care within a network (Kaiser), or an open network with many choices. Anthem also has the closed option network, but it doesnt operate in the same way as Kaiser. I think there are ways to work with each system to get what you need.

I prefer open networks, and I would never personally chose Kaiser. People either love the model (kaiser vs PPO-HMO option) or hate it.

Last edited by caligirlz; 02-21-2014 at 07:54 AM..
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Old 02-21-2014, 08:47 AM
 
Location: Shingle Springs, CA
519 posts, read 1,202,309 times
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I have Anthem PPO. I have never had a problem with them paying claims. I have my choice of doctors and I'm willing to pay more out of pocket for services for my wonderful doctor. I've had about 4 surgeries in the past decade while on Anthem and everything has gone smoothly - and there is a cap on what you have to pay out of pocket. It's worth it to me for peace of mind. I can be anywhere (and have a kid in college out of state) and have no worries about my insurance being accepted.

I agree with caligirlz, it really depends on what kind of system you prefer.
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Old 02-21-2014, 03:46 PM
 
10 posts, read 52,111 times
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Thanks, Cali and Ducky. I am concerned about not being able to see my doc of choice. Right now we have United Health Care and they are excellent. Cali I am really picky re my orthopod. Like you I go to a local sport team guy. But I just saw where the Sacramento Kings are now with Kaiser -- looks like since last year.

The complaints I read were of Anthems poor customer service and payment. Not the physicians. Interestingly Kaiser costs more than Anthem in this company plan. And I too am concerned about traveling, and where to go when there is Kaiser in th area.

Cali, could you give me the name of your Kings Orthopod? I would like to look him up.
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Old 02-22-2014, 12:08 AM
 
Location: Sacramento
5,057 posts, read 7,263,515 times
Reputation: 3492
Quote:
Originally Posted by 1kelkat View Post
Thanks, Cali and Ducky. I am concerned about not being able to see my doc of choice. Right now we have United Health Care and they are excellent. Cali I am really picky re my orthopod. Like you I go to a local sport team guy. But I just saw where the Sacramento Kings are now with Kaiser -- looks like since last year.

The complaints I read were of Anthems poor customer service and payment. Not the physicians. Interestingly Kaiser costs more than Anthem in this company plan. And I too am concerned about traveling, and where to go when there is Kaiser in th area.

Cali, could you give me the name of your Kings Orthopod? I would like to look him up.
Keep in mind that more people are going to complain online annonymously, especially if they can't successfully work the system, they will vent online. United Heatlhcare has an office in Sacramento. Is there any way you could keep their coverage?

If you take Kaiser, you will not be able to see any doctor outside the Kaiser network, except, if they do not have a specialist available. That is the downfall of signing up for a highly restricted HMO model. Given my medical history of 2 back surgeries, and the mm issue, I would never choose that option. I HATE HMO's. I've had an HMO in the past and my 2nd back surgery delayed for months due to jumping through ridiculous hoops with the PCP. Never again. Last year my insurance changed, and the PPO costs increased, but the HMO option became more restricted. The only HMO option was through Hills Physicians, an IPA and their limited network. I've worked with Hills, and I knew their network could not handle the influx of patients. This year, the severely limited network is no longer being forced upon the employees, as there were many complaints. But for a long term Kaiser member, they'd have no problem with that level of control because they are used to it. I choose the HSA PPO. It has a higher deductible, and higher costs, but again, I can go anywhere, and I can go to Sutter which is my preference. Many insureres are leaving Sutter out of their networks as they are the most expensive in NorCal, and one of the higher rated systems. With Anthem, you can go to Sutter, Mercy (Dignity Health), or UCDMC physicians/hospitals. With Kaiser, you go only to Kaiser.

I saw Dr David Coward at Sac Knee. David Coward, M.D. | Sacramento Knee & Sports Medicine | Sacknee Opps, I see he is not a Kings physician. But he is one of the top ortho's in Sacramento, and when I asked the doctors I work with for recommendations, his name was always mentioned. Dr David Weber is another good one. Dr Guy Guilfoy is also highly recommended. Dr. Guilfoy

I was just looking online at other top orthopods, and I see a lot of MD's at UCDavis Medical Center which makes a lot of sense to me. This is actually the 2013 list >> Best Doctors - Sacramento Magazine - December 2012 - Sacramento, California

Interesting, I found another article that says UCDMC has been the King's physicians for 2 decades >> https://www.ucdmc.ucdavis.edu/medica...rtnership.html
So, I suspect the change in team docs has to do with the change in ownership, or costs and not necessarily quality.

Ok, I found the article. Kaiser is the team physician for the 2013/14 season. http://www.nba.com/kings/news/sacram...dical-provider
"Kaiser Permanente has been a health care provider for employees of the Kings organization for 20 years, and this partnership expands the long-term relationship with the team by actively supporting the total health needs of Kings players. As the greater Sacramento region's leading health care provider and a sponsorship partner for the season, Kaiser Permanente will also work closely with the Kings organization on a wide range of community health initiatives. Additionally, Kaiser Permanente will sponsor the Kings annual Rhythm 'N Rims event in downtown Sacramento on Oct. 13, benefiting 15 regional nonprofits. "
Yes, there is always a reason why contracts change, and it is not always related to quality. Usually more so to money....


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Last edited by caligirlz; 02-22-2014 at 12:33 AM..
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Old 02-22-2014, 04:56 PM
 
11 posts, read 23,730 times
Reputation: 10
I have Anthem, my husband has Kaiser, I would go with Kaiser. We have the same PPO coverage, but his seems to cover so much more than mine.
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