Never had Kaiser insurance before. How do you like it?

[cantdrv55]

I'm hoping to retire next year right after I turn 58. I'll be losing employer provided HC coverage, which is all we know. My wife and I have enjoyed a PPO plan for 3 decades and now, because of cost all out of pocket, we're going to have to choose Kaiser.

My brother is a Kaiser doc and of course he swears by the organization. He said where else can you see your doc, get your blood drawn and get meds all in one building. I dunno though. Won't I feel like just another number? My current doc knows me very well as does the one specialist I see every quarter. Will I get the same attention from Kaiser docs? Can I see one next day without having to go to the ER? Also, our son has Down Syndrome and he sees a couple of specialists in addition to his pediatrician.

Please let me know your Kaiser experience. Thanks.

 

[Scuba]

My former employer offered both Kaiser and a PPO plan. I took the PPO, but many on Kaiser loved it. DH tried Kaiser when his employer offered it, but chose to go back to the PPO.

I think if you’re accustomed to Kaiser, there are lots of great things about it, but if you’re used to a PPO, it could be a tough adjustment. For me, I’d rather have choice. If I get diagnosed with a serious disease, I want to be able to go to Cedars-Sanai, Loma Linda, or wherever else I’m confident that I’ll get the very best care. And I want to be able to access the latest and greatest drugs.

I could be wrong, but for me freedom of choice is the most important attribute of my health coverage and one does not maximize freedom by going with Kaiser. However, YMMV. Kaiser has millions of satisfied customers.

 

[Irishgirlyc58]

I had Kaiser for about 24 years and absolutely love Kaiser.

Yes you can typically get an appointment the next day if needed. I’ve even had the experience with my pcp getting me an appointment that day for a serious issue.

You can choose your doctor and if you don’t like him/her then choose a different one right on line.
I’ve had a surgery, endoscopy for ongoing GI issues and melanoma. I’ve seen a physical therapist a couple of times.

On top of regular up keep.
Kaiser is great at prevention practices such as all your annual tests etc.
Prescriptions usually mailed a few days from ordering.
I agree with your doctor brother!

The only reason I gave it up is because I am actually out of the Kaiser service area. I’m in the Sacramento valley but too far for the coverage. I only qualified because my employer is in the service area. I had to say I understood that I was giving up on any home health care because of that and the older I got the more concerned I became about that.
Also, I’m planning to retire this year.

I actually looked into moving to be in the Kaiser coverage area. But then I wouldn’t be near my grandkids.
I love the grandkids more than Kaiser and I love Kaiser.

If you live in Northern California you might be familiar with Sutter Health- not a fan.

 

[savory]

I joined Kaiser after moving to one of their markets about 3 years ago. Prior I was PPO. I have also moved a bit so new doctors was a change I was use to.

I really like Kaiser. They are responsive and easy to deal with having everything under one roof. Their online communication is by far the best I ever used. For example, when I started blood pressure medication, I was able to enter my at home blood pressure monitoring in my chart. This was used in a televisit when I had some concerns. I also feel the idea that your doctor knows you is more of a comfort issue. They ultimately know your chart and what you tell them during the visit.

My initial worry and it nags me a bit is that for a significant procedure, I can’t shop around. Having said that, I really never felt comfortable with my shopping skills. And if my doc recommends another doc for a procedure, it turns out not to be too different from Kaiser. Except Kaiser has some skin in the game.

DW and I have received good care. Convenience and service is outstanding. Staff seems to enjoy their work and are well trained. Price is right.

 

[cathy63]

Some people love them, some hate them. I was born in a Kaiser hospital and have been a member most of my life. There were some times when they weren't an available choice, but I've always gone back to them when they were.

My current doc knows me very well as does the one specialist I see every quarter. Will I get the same attention from Kaiser docs?

This works the same at Kaiser as in a PPO. You will see the same GP and the same specialist every time and they will get to know you after a while, just like your current docs do.

You can usually see your primary care provider or someone else in their office within a day. When I broke my ankle a few years ago, I was able to get an appointment with my regular GP that afternoon. She sent me downstairs for x-rays to confirm the break, then put an air cast on the ankle, gave me crutches and ordered an appointment with orthopedics for the next day. The rest of my treatment was with the ortho dept and further appointments were made directly with them. If my own GP hadn't been available on the day I was injured, I could have seen someone else in her office or gone to Urgent Care.

 

[daylatedollarshort]

In our area, Kaiser seems like it must be the health plan choice of last resort. When we were members, the Kaiser ER typically had 50+ people queued up in the waiting room, while the non-Kaiser hospital ER in the same city would have 0, maybe 5 people on a busy night. We were seen at the non-Kaiser ER within 20 minutes for a poison ivy reaction, and never even fit in at all despite waiting overnight when one of our kids fell and had a possible head concussion. When we were employed and had to have Kaiser, one night I spent the entire night in the waiting room with one of our kids without seeing a doctor, it was so packed and backlogged. I finally left when the sun started coming up as I literally couldn't stay awake any longer, and had no hope of even seeing an ER doctor within the next 8 hours. The staff tried to block our way and force me to sign a document that stated I was leaving because I was refusing treatment.

Another time I called the minor injury clinic as I thought one of our kids might have a broken bone from a soccer injury. At first the nurse tried to tell me how to make a homemade splint until I said we paid good money for health insurance and had a hospital and clinic nearby, so I didn't think I should have to be my own field medic for the family. I mean even a doctor couldn't tell if there was a broken bone without an X-ray, so the whole conversation with the nurse and the homemade splint just seemed off the rails.

One of my relatives needed a complex, specialized surgery that could be fatal if not done right. Kaiser wanted to use a doctor who did maybe three a year. Luckily we were able to switch to a PPO plan and get a leading surgeon in that particular field who only did that surgery - hundreds per year.

Words truly cannot describe how much I loathe Kaiser. In our area it is almost like not even having real health insurance. I won't bore you with more stories but suffice it to say I have many more as well as some from friends. They are all along the same lines. But good luck with your own plan. Maybe your area will be better.

 

[Another Reader]

My mother used to call them "the witch doctors of Kaiser" 60 years ago. Back in the 60's and 70's, their pay scale was very low. No good doctor would work there. They found a way to streamline immigration of doctors from other countries, which became a major supply source for all providers. They invented the PCP model, which was designed to be the gatekeeper for specialist referrals and the PCP's were evaluated on how few they made.

They have treated their Covid patients very badly. Few referrals to specialists. There are now patient committees at some branches that were concessions to the many complaints filed. Meetings but no change.

Kaiser is now the sole provider for Medi-Cal services in Santa Clara and San Mateo counties. You can imagine what that is like.

Yep, "loathe" is the appropriate reaction.

 

[calmloki]

We snobird between Oregon and SoCal - both Kaiser regions. My primary care area is Oregon, in SoCal I'm a visiting member. It is valuable to me that the KP doctors north and south have instant access to my full charts and health records. KP paid bunches out of network to keep me ticking when they didn't have a KP specialist for an easily fatal heart issue. Prescriptions are mailed to me and in my hands within a couple days of my ordering them. We could save truly large amounts of tax money by moving to Nevada or Texas or even Arizona or New Mexico - but no Kaiser Permanente available. We're sticking with KP.

 

[stepford]

My wife is a teacher and the child of teachers and has been with Kaiser her entire life. I tried Kaiser briefly (for about 4 years) but changed to a PPO 20 years ago and haven't looked back. In comparing my wife's experience to my own I've found that:

Kaiser is much better at taking care of all the standard elements of care. They'll remind my wife of all the appointments she should make and tests she should take and schedule them automatically. I, on the other hand, need to stay on top of that myself.

When my wife needs to see a specialist there is a system of gatekeepers she must pass through and it can sometimes take several months before she actually sees the specialist she wants. I, however, can just call around and make an appointment directly. It can still take a while to be seen depending on the specialist's availability, but my wait time is more typically a few weeks (and as little as days if I broaden my search area).

As far as cost: Most things are free for my wife at Kaiser while I do 10-20% co-pays up to my deductible. In a typical year this makes my healthcare cost about $1K more than hers.

There are many other differences in the nuts and bolts, but that's the gist. If you want decent care that'll take care of all the obvious stuff then Kaiser does fine. If you want more active control of your healthcare choices then a PPO can be worth the moderate extra cost.

 

[RobbieB]

I've had Kaiser for 10 years now. Yeah, I've heard all the horror stories. My employer switched to them to reduce cost while I was still employed.

Much to my surprise I didn't get any horror. Now on Kaiser senior advantage which costs me $15/mo. Within 2 weeks of my covid vaccine eligibility tier I got an email saying I could schedule my shot. Also now scheduled my pneumonia shot too. Did ER visits during the covid times, no problem. Saw specialists, got xrays and annual blood draws.

You will not wait long for your appointments either, very efficient. I'm usually in within 10 minutes of arrival. I've sat in PPO waiting rooms for well over an hour.

Very happy overall with Kaiser, not planning a change.

 

[rodi]

I grew up with Kaiser and have had it when I've lived in Kaiser areas.

Like any insurance - your primary doctor is the key. If you don't like your doctor within Kaiser, change doctors. I've had the same doctor for 20 years now and she's great.

They have some great specialists. And attract some very good doctors by offering opportunities for specialty work, research, and good work/life balance. The pediatrician that my kids recently aged out of (Used the same Dr. for almost 20 years between the two boys) loves NICU work... Kaiser gave her the opportunity to do 2 days a week of NICU and 3 days of clinical work. Her clinical practice had 5 other pediatricians in the same office unit - so there was always coverage. (Similar to non-Kaiser multi-doctor practices.) I had many talks with her about what she liked about Kaiser - the nicu and hours/vacation were her quick reply. She loves to travel - and she likes to spend time with her own family. She said she rarely worked more than 45 hours/week. (Unusual for many doctors outside of Kaiser.)

My husband was not a fan - and is on a PPO. He had a disagreement with his primary about whether a procedure was needed (dr. wanted to try less invasive stuff before surgery). Rather than changing doctors, he changed insurance. Oh... and the other treatment WORKED.

For broken bones (did I mention I have sons) - we just went to urgent care - who would x-ray, cast, and refer to ortho for follow up. When older son took a baseball to the face - we had multiple specialists for the orbital fracture. When he had an ameloblastoma discovered by his dentist - they immediately took him into the maxilo-facial surgical department. Didn't have to see primary - just emailed the x-rays to the pediatrician who referred him immediately. The surgeons who did the surgery were excellent.

Same son just got on his own insurance because he's moved out. He chose Kaiser because, even though he's in a different county, he knows his ameloblastoma records will transfer - and he may need more followup.

 

[pacergal]

We currently have Kaiser. I wanted to try it out for a year or two before we left employee insurance and go to Medicare, "just to see".
Have been on it two years and I must say, I am very impressed. (I am an RN, so 40+ years experience within a medical system, so know what to look out for)
We were able to choose our PCP, have had excellent care. They have embraced an EMR system that is so responsive. I have had virtual visits, electronic visits--so nice to not have to go into the office! Ordering/receiving prescriptions are a breeze, getting three months mailed at a discounted cost is nice. Both DH and I have been able to get specialty referrals with out a problem via PCP contact, either in person or EMR.
I love the fact that my entire medical/dental/vision care is coordinated and all in one Electronic record. They are very proactive in preventative care and will call or email when we are due for anything.
The wait times in office have been less than 15 minutes, where it was not unusual to be waiting in my previous PCPs waiting room for an hour.
We plan to sign up for Kaiser Advantage Medicare when the time comes.

One thing I do think is important is to be your own advocate. This goes for any care anywhere, but especially with a bigger system like Kaiser. We haven't had to push for referrals, as I can put the need in medical terms for both DH and I, but I can see where it might be more difficult if you didn't.

 

[rodi]

One thing I do think is important is to be your own advocate. This goes for any care anywhere, but especially with a bigger system like Kaiser.

Totally agree with this!!! Not just Kaiser - any insurance system.

 

[Mr. Tightwad]

Been with Kaiser 20 years or so. They have certainly treated me good. Had blood drawn a couple days ago. I was in and out in about 4 minutes. I couldn't believe it. I'm having a CT scan today. I made the appointment yesterday. How's that for quick service? And I'm in the big city.

The best part for me is that GF is a family medicine DR at Kaiser and gives me insider information and tips, but I was satisfied with Kaiser before I met her.

 

[RetiredHappy]

I had Kaiser in N CA for 18 years. My last PCP and OBGYN were the best. The issue was with the specialists. They could refuse to see you or simply discharge you even though you have an ongoing problem. My PCP was my advocate but his hands were tied. There were also specialists which were incompetent. I was prescribed 4 types of duplicate medications, each of the medication 4 times over the FDA daily dosage limit and my illness was still out of control. I was overdosed by 16 times for more than 10 years. My quality of life was so bad that I was suicidal. I was suffering so much and really did not want to wake up in the morning. We happened to move out of state, and my new PCP sent me to the best immunologist in our area and he stopped me on these medications and replaced with one medication and my medical condition immediately became under control. I looked up the medication and it is listed as a Tier 2 drug for my condition and to be prescribed if Tier 1 drugs don't work. I asked my new doctor why did my Kaiser doctors not prescribe me with this drug. He said simply - They just don't know. I won't go back to Kaiser if I ever move back to Northern California. Having choice of specialists is critical as we get sick and older.

 

[Kerfuffle]

I detest Kaiser. With all my heart. We're currently with them and have been for the last decade or so, and we'll be switching as soon as we can. I think the deal with Kaiser is that you are very much a number, and are very much treated as one, especially depending on the doctor you get. I know from working with the organization through one of my clients that their determination to cut costs is unreal... the lengths they will go to just to save a penny is crazy. And I think when you're a patient, you have to be happy being treated by whatever their computer algorithms say, which will always be the lowest cost treatment available. This might work fine if you're a perfectly average human who the algorithms were written for. It's the walmart of healthcare, and if you don't mind bureaucracy and being treated like a cog in the machine, it'll probably be fine. If you do need anything done that the computer doesn't want you to do, you'd better be prepared to self advocate with an intensity that gets exhausting.

 

[daylatedollarshort]

Kaiser is now the sole provider for Medi-Cal services in Santa Clara and San Mateo counties. You can imagine what that is like.

Yep, "loathe" is the appropriate reaction.

Ah, that explains a lot. Kaiser being the sole Medi-Cal (California's Medicaid) county provider explains why there were so many poverty stricken looking people packed into the ER waiting room when we had Kaiser, yet no or barely any waiting at all when we switched to a PPO plan and could go to the non-Kaiser hospital in the same town. Since all ERs have to provide care to anyone, I was wondering why the people who looked like they might not be able to afford health insurance didn't just go to the other hospital, too. Our county must have had a similar Medi-Cal arrangement when we were Kaiser members, and Kaiser didn't have enough staff to support the volume of patients.

 

[Scuba]

I had Kaiser in N CA for 18 years. My last PCP and OBGYN were the best. The issue was with the specialists. They could refuse to see you or simply discharge you even though you have an ongoing problem. My PCP was my advocate but his hands were tied. There were also specialists which were incompetent. I was prescribed 4 types of duplicate medications, each of the medication 4 times over the FDA daily dosage limit and my illness was still out of control. I was overdosed by 16 times for more than 10 years. My quality of life was so bad that I was suicidal. I was suffering so much and really did not want to wake up in the morning. We happened to move out of state, and my new PCP sent me to the best immunologist in our area and he stopped me on these medications and replaced with one medication and my medical condition immediately became under control. I looked up the medication and it is listed as a Tier 2 drug for my condition and to be prescribed if Tier 1 drugs don't work. I asked my new doctor why did my Kaiser doctors not prescribe me with this drug. He said simply - They just don't know. I won't go back to Kaiser if I ever move back to Northern California. Having choice of specialists is critical as we get sick and older.

Your last sentence says it all to me. Glad many are happy with Kaiser but I’m not going to make any decisions that limit our choices. I’m perfectly capable of keeping good health records for myself, managing my own preventive care, and coordinating care among docs. What I’m not capable of is knowing how to best treat a serious illness or knowing what more expensive drugs might be available if I can afford them. I will worry about cutting costs if I need to. I’d rather have my healthcare provider focused on giving me the best possible care options and allowing me to decide the best cost/benefit option for me.

 

[RetiredHappy]

Your last sentence says it all to me. Glad many are happy with Kaiser but I’m not going to make any decisions that limit our choices. I’m perfectly capable of keeping good health records for myself, managing my own preventive care, and coordinating care among docs. What I’m not capable of is knowing how to best treat a serious illness or knowing what more expensive drugs might be available if I can afford them. I will worry about cutting costs if I need to. I’d rather have my healthcare provider focused on giving me the best possible care options and allowing me to decide the best cost/benefit option for me.

+1. My husband was prescribed the cheapest generic drug for his medical issue while he was in Kaiser. When we moved, his new PCP switched him out to a much better but more expensive drug.

 

[daylatedollarshort]

In studies of expertise, including doctors and surgeons, it takes 10,000 hours of deliberate practice to make an expert. We all may be one car accident or a latent genetic defect from needing specialized major surgery. With our relative's surgery from my previous post, we went to one of a handful of experts in the country for a specialized surgery. We had to pay around $4K extra out of network for the surgeon over what the PPO would pay, but the hospital he operated at was in our PPO so we just had the max out of pocket to pay for hospital costs. I feel like that was a small price to pay to have a real expert with 10,000+ hours of practice for a serious operation, instead of just using someone Kaiser has on staff with maybe 50 hours practice in of the same type of specialized surgery.

 

[cantdrv55]

The difference between Kaiser and PPO available to us, a family of three, is $20k (Kaiser) and $40k (Blue Shield PPO) annually. Tough decision?

 

[RetiredHappy]

I realized I could have answered one of your questions. Yes, you can see your PCP the following day but you must learn the tricks of the system to ensure that you get in when you need to see your doctor. Their urgent care is also very good, and is open 7 days a week. So if you need to see your doctor the same day and you cannot get it, the nurse on the phone can help get you into their urgent care clinic the same day.

The other question, only you can answer is if you want to pay the difference of $20K a year. I have complexed medication issues and I pay off-exchange non-subsidized private individual plan which costs me alot more than going to ACA. I need to see the best specialists and they do not take ACA plans. I pay more because I need to and it is a priority for us. We also pay an annual membership fee to have a concierge doctor as our PCP.

 

[Bamaman]

My wife and I were on Kaiser Permanente for years. And for years, she suffered with some nagging "female" problems. We learned how to work their system, and it worked well for the "sniffles" for our young child.

But if someone needs serious medical care--something expensive--it's like the primary care physician is on a budget. He won't be quick to refer you to a specialist if it's going to be costly. It's like his salary is based on what he's not spending on his patients cumulative.

After we went on conventional insurance, a new doctor solved her problem in a 1 hour outpatient procedure. And to think she suffered for years with Kaiser.

You don't want to get really sick with them picking up the tab. Your care won't be first class.

 

[Rambler]

Kaiser is great for regular run of the mill care. I was able to get everything done that needed to be done in one building, even down to the pharmacy. Then, I came down with prostate cancer. My urologist estimated that it was too serious for radiation and that the prostate needed to come out ASAP. We discussed it and her suggestion was to go with the old school open surgery, as opposed to waiting for the one Da Vinci surgical robot available in the area (all of Northern California…which was surprising to me). The surgeon in our portion of the group had performed all of 100 surgeries with the machine, one every two weeks, for the preceding several years. The earliest I could get the Da Vinci surgery was at least 9 months out. But as I said, mine was on the more serious side, and he opinion, as well as the second and third opinion was that it needed to come out “now”. But, the gold standard for prevention of incontinence and erectile function is the DaVinci. So I looked around and found a top doctor in NYC who had done 7000 Da Vinci surgeries. I looked into whether or not Kaiser would pay for it since they didnt have state of the art available in our area. Of course, they wouldn’t. But, continence and freedom from ED was of serious importance to me, being only 55 at the time. And, when my dad had the open surgery, he lost so much blood that he almost died on the table…had to be jump started a couple times. At 85, he has been incontinent for 25 years. So, I chose to pay for the Da Vinci surgery myself…not cheap, but if you look at how much my dad has spent on incontinence supplies for 25 years, it isn’t too bad.

TLR, if you suspect you may have serious illnesses in your future, and want gold standard care without having to seek and pay for care elsewhere, maybe choose a non-kaiser option. I loved the convenience, but hated that I was paying tens of thousands per year on health insurance and deductibles, but could not get the best care when I had a serious illness.

 

[RetireBy90]

Been with Kaiser 20 years or so. They have certainly treated me good. Had blood drawn a couple days ago. I was in and out in about 4 minutes. I couldn't believe it. I'm having a CT scan today. I made the appointment yesterday. How's that for quick service? And I'm in the big city.

The best part for me is that GF is a family medicine DR at Kaiser and gives me insider information and tips, but I was satisfied with Kaiser before I met her.

DW and I have been with kaiser since 94. I was off for 2 years after I retired and went on Tricare till Medicare this year.
I’ve received great care, but forget me only minor care. DW had Brest cancer and they took care of everything including non-Kaiser plastic surgeon for reconstruction. The plastic surgeon was rated as best in DC area by other surgeons. Then she had apendix removed while in Mississippi, non-Kaiser state, and they covered everything. DW sees them about once a month for this or that, and neither of us would leave. DW had to change PCP once, now very happy with all female doctors. She had a swollen jaw and lip last week, one call to advice nurse she was told to come to urgent care and saw a Dr in about 10 min and was treated for about 4 hours all good, (she is good now). All for $35 copay.