Kaiser HMO anyone?

[shoe]

A year from now, DH and I must choose from one of three medical providers when he retires from his second career. If we were to choose Kaiser, it would save us nearly $300 a month and lessen our financial exposure since our out of pocket expenses would be minimal. Our concern is that the care would be substandard. We have heard that it takes a long time to get in to see the doctor if you are feeling bad. We both have chronic conditions. Does anyone have any experience with Kaiser? TIA

 

[chinaco]

I had them many years ago. I am pretty healthy so I did not use the service much. When I did use it (minor stuff)... it seemed OK.

But I agree with you... do your research. Try to find out by exploring current customers complaints.

 

[smileydog]

We went with Kaiser three years ago and it has been good for us. You have a few more hoops to jump through but they have common records between all doctors - which is nice. The care has always been good. Sometime we had to drive a bit further to go to a specialist. We are in the Atlanta area with quite a few Kaiser locations.

We were actually disapointed when our new retiree choices came out this year Kaiser was no longer a choice. We had just gotten used to Kaiser.

We signed up for a similar type plan called an EPO (Exclusive Provider Organization) - seems kinda like the Kaiser plan but with a network of doctors.

 

[shoe]

Smiley, when you needed to see a doctor, were you able to get an appointment without waiting long?

 

[smileydog]

No problem - if it is a routine matter it might be a week or so out. The only exception seemed to be dermatology which was about 3 weeks out.

You pick your primary doc and go through them for most situations (except gynocology and dermatology). We were previously on a PPO plan - it seems that getting an appointment is no better (or worse) with the Kaiser docs. One thing that seemed to be better was that if you have an appointment for 2:00 you rarely have to wait very long. I don't know if we just got lucky but that has held true in our area.

 

[KB]

I have been with Kaiser for the past 6 years and have had good care from them. I like the free flu shot every fall. My main complaint is that the billing is VERY slow for services other than routine office visits.

I had a series of Xrays in December and received the bill of my out of pocket expenses in October. Surprise!! I had Emergency room services in early April for which I have yet to received the billing.

I've been referred to specialists when needed. I have found that sometimes I need to wait a week to see my doctor, but can email her in the interim and get a response within a day or so.

The online access to lab tests is really great. They email when the results are in and you access your records online to get the results.

All in all, I need to manage my health care more than I did with my former company, but have good results.

 

[sailor]

Happy Kaiser customer in Georgia since 2002.
No concerns about quality of care comparing to other providers.
Least amount of insurance paperwork - none actually for last few years.

 

[shoe]

Wow, these replies are much more positive than I thought! We only have to sign on a year at a time and with the good reviews, combined with the $3384 we would save, it almost seems like a no-brainer. I am truly grateful for the observations. Thanks!

 

[bright eyed]

Have had Kaiser for 6 years and it is great for us. I love the all in one facility service - downstairs for pharmacy, upstairs for shots etc. I hated driving to separate places for blood drawing, prescriptions etc w/ the blue shield.

You just have to learn the tricks for same day care. I've always seen a dr. on the same day for me or my kids if you need it - sometimes you just have to drive to a further facility than your typical one. The facilities next to the hospitals usually have extra time for same day appts.

They also go out their way to save you money - so if your kid is sick and it's 6pm, they'll try to send to you to an urgent care clinic for a $5 co pay instead of emergency which is $100 for me at least...

Also, if you call the advice nurse at night, it helps you get a place earlier in line for same day appts.

We've also received physical therapy for our $5 copay, for my son when he had a knee injury...which was great!

We're a pretty low maintenence family - not sure how i'd feel if we had something major like cancer or a heart attack. I do have a friend who's father had open heart surgery and did well with kaiser's care, also had post op support groups etc. via kaiser which are usually very well run too.

You can always see the same doctor and choose your doctor...I've liked all the doctor's we've seen, even the ones that were last minute appts.

 

[Caroline]

I've been with Kaiser for about a grillion years through my employers. (over 20 now, I think). Couldn't be more satisfied.

The main benefit in my mind is one-stop-shopping, as mentioned earlier. Regular doctor, gyn, tests, pharmacy, specialists, physical therapy all in one hospital. Parking is a bit of an issue but where isn't it?

No matter what doctor I'm seeing he / she can call up my complete record and review it -- I don't have to remember everything myself and the Dr. doesn't miss anything someone else did.

Another thing I appreciate is automated notices of what I need to do next -- is it time for a mamogram? They let me know. Every time I visit I get a printout with a list of dates when I had standard tests, and when those tests are due again. These include cholesterol screening, pap, tetanus shot, etc. etc. When I turned 50 they sent me a little kit in the mail to take a sample and test for colon cancer.

I like the advice nurse too -- I call and she / he reviews symptoms and either suggests i come in or directs me to more resources, gives me self-care advice, etc.

I'd be really disappointed if my employer stopped offering Kaiser.

 

[clifp]

I couple of years ago US News did a ranking of HMOs, Kaiser was consistently near the top of the list, although satisfaction did vary considerably depending on location.

Its worth trying to find some survey's to see how Kaiser is ranked in your area.

Most Kaiser have spent considerable resources computerizing their records it really helps increase the quality of the care.

Facilities like the advice nurse and the urgent care facility, really help alleviate the occasionals hassles of long waits for specialists.

 

[Life_is_Good]

Many years ago, I had Kaiser coverage and was very satisfied, BUT....
there was one horror story that I knew about first hand.

A (young) coworker came down with a horrible disease and Kaiser doctors were not able to identify it. She almost died. She transferred out to a local university hospital where the disease was identified as Guillain-Barré syndrome. She eventually recovered and returned to work about a year and a half later. I suppose that could happen anywhere??

 

[bright eyed]

I couple of years ago US News did a ranking of HMOs, Kaiser was consistently near the top of the list, although satisfaction did vary considerably depending on location.

Its worth trying to find some survey's to see how Kaiser is ranked in your area.

Most Kaiser have spent considerable resources computerizing their records it really helps increase the quality of the care.

Facilities like the advice nurse and the urgent care facility, really help alleviate the occasionals hassles of long waits for specialists.

There are regional differences, so I think it's good to hear what may be weaknesses in your area. But I am in between two or three service regions and have easy access to any of them should one have better care for whatever condition you may have...

For example, some Kaiser hospitals have midwives do the delivery, while others have dr. residents do them, I much preferred the midwives! so you can make a decision to go to a specific facility for that occasion...

 

[Texarkandy]

Had Kaiser for five or six years back in the 90's - we were ok with them for routine stuff until we had a really bad experience with them over a major medical issue - after that experience we said Never Again!

I'm fortunate to have a variety of plans to choose from under FEHB & for as long as it's available we'll stick with insurance that allows us to go to an out of network provider when we want/need to & they'll still pay 70%. It's no longer an issue of just $ with us, but control over our own health care decisions & providers.

 

[yakers]

Happy with Kaiser for 25+ years, DW had her own medical coverage and chose to use my Kaiser for a serious cancer surgery. Great coverage for my kids. Just saw the cardiologist, very pleased with the process.
The one thing to remember is although they have good doctors they have more gate keepers and structure which you need to navigate around or through. And one other major point that can be a weakness is how you are covered while traveling away from their coverage. I remember being sick on travel and just needing some medicine and the only option is an emergency ward. Just something to think about.

 

[shoe]

I can't thank you all enough for your candid answers regarding your experiences with Kaiser. I wish there was someone here in NE Ohio to give me a local opinion. The Kaiser office is literally a mile and a half up my street with a hospital about 8 miles away. Hmmmmm......

 

[bright eyed]

There might be a local yahoo group or craigslist where you can ask the question? You might find a local oriented chat room - sometimes city-data has conversations like that...

 

[Brat]

I used Kaiser NW for all years I lived in their service area... starting in about 1946 through about 1996. A child patient, a new mom patient, middle aged patient. They were great. I was covered in college although I was out of their service area. Both kids went to college in the N. CA service area so coverage was seamless. I loved the urgent care centers as when I returned home from work it seemed that the kids often needed attention.

I had one child who was accident prone. A physician on their staff lived across the street, she would take him to work with her for follow-up exams.

My OB was Dr. Roger George who delivered quints when they were rare, in the early 70s. His wife helped the family care for the babies, after he retired and she died the family asked Dr. George to live with them so that they could exchange the courtesy of care.

The son of my former boss returned from Belize with breathing problems. Kaiser consulted with CDC and diagnosed a lung fungus which was treated.

Errors happen in any system, health care is a human system after all, but in my experience they often go the extra mile.

 

[harley]

DW and I have Kaiser (Mid Atlantic). Been with them for almost 30 years. I am very satisfied, even though over that amount of time you would have a few issues with any system. But we've learned how to manage them. I know how to push for a quicker appointment, even same day if I need it. DW discovered that they have alternative therapies (accupuncture, chiropracty, etc), they just don't advertise it and you have to push a little.

They took a definite dive downhill about 15 years ago when they merged with Humana, bringing in a large number of additional patients without significantly upgrading their facilities. But that eventually evened out.

Many people make a big deal about not having your own personal physician, but DD had the same pediatrician for 18 years, and he was also DGDs pediatrician while she was still under our plan. I've had the same doc for about 5 years, abd he's done pretty well with my diabetes.

We moved out of the area and were freaking out over having to change plans after all that time. I have to admit that being able to keep the coverage was a factor in our deciding to buy a townhouse back in Northern VA, although it wasn't the driving reason.

Then again, I recommended Kaiser to a coworker, and he and his wife hated them and switched plans after a year. So YMMV.

 

[free4now]

Interesting to see how many good words there are for Kaiser. My experience was so-so, after being with them for a couple of years. It really helps to think of them as the biggest beauracracy that you will ever deal with. They were always rotating in new doctors with little experience and poor bedside manner, so you just develop a "trooper attitude" of going back over and over until your issue is resolved. The good thing about Kaiser is that there isn't anyone who knows enough to stop you from trooping in until your issue is resolved, so you do end up getting resolutions to most issues. I was talking about this with some friends who have Kaiser and they concurred that it's all about just going back over and over until you find someone who takes your problem seriously. If you are someone who is skilled at fighting wars of attrition, Kaiser will likely work well for you.

 

[ziggy29]

I had it when I lived in California, and I loved it -- and miss it.

There are drawbacks. Appointments for routine care may take a little longer. You are limited in the facilities you can use (at least for non-emergencies). The care, in general, seemed a little more hurried and impersonal than it can be elsewhere.

But these pale in comparison to what I liked about Kaiser. First, no claim forms, no pay up front and wait to be reimbursed, none of it. Since we moved out of CA and lost the Kaiser plan, this has sometimes been a hassle. Second, if a Kaiser doctor feels something is medically necessary, it's covered. No preauthorizations from insurance bureaucrats counting beans rather than treating patients. My wife had maxillofacial surgery in 2000 -- often not covered and something many insurance bureaucracies would fight -- but she saw the Kaiser maxillofacial surgeon who looked at X-rays and said it was necessary (it was something like a $20,000 procedure). And that's all it took -- he says it's necessary, it's covered.

I'd jump at the chance to take it again if they were in TX and there were facilities reasonably close by. Having said all that, I haven't had Kaiser since 2003, so I don't know if they've declined since then.

 

[Brat]

Every health care orginization has it's isues, there is no heaven on earth. We now live in a 'upscale' community served by a non-HMO clinic affiliated with a major hospital. We have had a lot of turnover of internists, husband gets very frustated. The younger ones are very good and the older ones are.... well, just our kind of physicians. We hate to see any of them leave. The reality is that they are having a tough time finding a balance in their professional lives.

Life is not for the meek, HMO or not, for physicians or patients.