Kaiser vs Blue Cross

[SecondAttempt]

Planning ahead a little here. We have 2 health insurance options in retirement, Kaiser or HMSA (Hawaii's Blue Cross Blue Shield).

My partner has Kaiser and loves it. (Which means that's the way we will end up going so my research may be moot). I currently have HMSA. Neither of us have used health insurance for anything but routine and very minor things ever. I used to have Kaiser and my ex-wife used it for some sports-related injuries and grew to hate it. This was in part because she could only get treament locally, or at least in states where Kaiser has clinics.

In retirement we plan to travel both domestically and internationally and that may be a factor. Based on my research and reading of the plans for each, both cover emergency services worldwide. Urgent care is more questionable. HMSA seems to cover. Kaiser is more hedgy in how they describe coverage outside their service areas. Kaiser is more clear that they do not cover routine care out of their network. HMSA does seem to cover routine care worldwide after some pre-authorization or similar process.

I'm looking to hear people's experiences with both organizations in getting routine, urgent, and emergency care away from home. I'm sure both are good for major treatment in network and close to home.

 

[rodi]

We have had no problem getting urgent type care from Kaiser while travelling... But we called the appointment line to find out if they had a 'partner provider' at our location. Same with emergency service.

Like you, I'm in a mixed household.. Except it's my husband who dislikes Kaiser, and I'm a fan. We don't feel the need to have the same insurance providers. He has his (under Medicare) I have mine (Kaiser under ACA)

 

[Kerfuffle]

Kaiser is great if you are good with the lowest cost treatment, don't need to see specialists, and if you're someone who fits their mold exactly and don't require personalized medicine. Be ready to self advocate fiercely. I am leaving Kaiser this year for these reasons. I've said it before and I'll say it again, it's a very bad thing when your insurance company employs your doctor. Cost is all that matters to them.

 

[Brat]

I am on Kaiser Medicare Advantage and have had GEHA, both as a Fed retiree. I was recently diagnosed with breast cancer and have had NO problems choosing specialists for treatment. My surgeon ordered special PT, the radiation oncologist is a graduate of Harvard Medical School. My best friend is a retired general surgeon specializing in cancer surgery, also a Harvard Medical School graduate, I have sent him my test results. He says my care is per-protocol and consistent with what I would receive at the Cleveland Clinic (where he last practiced). My Kaiser surgeon told me that if I want reconstruction that care is available through Kaiser, don't hesitate to ask. The only specialist I have had an issue accessing, for a different concern, is dermatology and that is because those physicians are in short supply. Right now if I wanted a dermatologist for a simple issue I would pay for it myself because Kaiser wants your PCP to care for routine skincare.

I also had breast cancer treatment through GEHA and found it was a scramble lining up specialists.. there was no one to guide me through care options.

Might I go back to GEHA? Maybe, but right now Kaiser is providing very good care.

 

[RetiredHappy]

I had Kaiser in N. CA for 18 years before finding out how the alternative is so much better. If you don't need specialists or don't have something out of the ordinary Kaiser is fine. Drugs - they prefer to prescribe the cheapest drugs or better still, send you to buy OTC drugs rather than prescription drugs which actually treats your condition.

Dermatology, gastroenterology and allergy/immunology departments, I give them outright F grades. PCP and OBGYN were A grades for me.

For what they did to me for treatments or lack of, I would consider it malpractice.

My husband was given the cheapest generic drug for his condition. When we moved out of state, his doctor changed his prescription to a much better drug. I found a godsend allergist who stopped the 16 pillls of 4 overlapping drugs (16 times overdose by FDA recommendation) which Kaiser had me take but was not keeping my condition under control. The allergist replaced all 4 drugs with 1 drug and I was instantly better. I was miserable for several years and wished I never woke up each morning when Kaiser was treating me. Stay away from Kaiser!

 

[Brat]

..
Dermatology, gastroenterology and allergy/immunology departments, I give them outright F grades. ...

For what they did to me for treatments or lack of, I would consider it malpractice.

My husband was given the cheapest generic drug for his condition. When we moved out of state, his doctor changed his prescription to a much better drug. I found a godsend allergist who stopped the 16 pillls of 4 overlapping drugs (16 times overdose by FDA recommendation) which Kaiser had me take but was not keeping my condition under control. The allergist replaced all 4 drugs with 1 drug and I was instantly better. I was miserable for several years and wished I never woke up each morning when Kaiser was treating me. Stay away from Kaiser!

Send a letter to the Medical Director of the Kaiser org that treated you with specifics and your patient ID. Let me assure you that they would take your concerns seriously. It doesn't matter whether or not you are a current patient, they want to know of weaknesses in their care. Your drug problem should have been caught by their pharmacy software, for example.

 

[RetiredHappy]

Send a letter to the Medical Director of the Kaiser org that treated you with specifics and your patient ID. Let me assure you that they would take your concerns seriously. It doesn't matter whether or not you are a current patient, they want to know of weaknesses in their care. Your drug problem should have been caught by their pharmacy software, for example.

... Regarding the drugs - the allergist asked me to get all OTC drugs so their software never caught it. Each time I saw her, she said to me that I was not taking enough drugs because I still had symptoms and to add more... more...

 

[Brat]

Still, write the letter. The allergist needs to be held accountable.

 

[Kerfuffle]

... Regarding the drugs - the allergist asked me to get all OTC drugs so their software never caught it. Each time I saw her, she said to me that I was not taking enough drugs because I still had symptoms and to add more... more...

Yes, they love prescribing OTC drugs for sure. Anything that doesn't cost them money is the best. I feel so disgusted when I think back at the substandard care I've gotten over the years, and my husband and I are excited to get away from them. We keep mentioning to each other how we will soon be able to see a doctor who isn't wholly controlled by a cost-saving computer system.

 

[RetiredHappy]

Still, write the letter. The allergist needs to be held accountable.

It has been 5 years, I think it is going to be a waste of my time. That allergist could well be out the door by now. My PCP knew what I was taking as well and how miserable I was. I asked my current allergist why Kaiser had not given me the medication which I am now on - which is actually a tier 2 drug for my condition when tier 1 drugs fail to treat. He said "They just don't know." I was overdosed 16 times on tier 1 overlapping drugs. The moral of the story is that when you are stuck in a HMO system, your care is only as good as the doctor who is treating you and you don't have a choice to look elsewhere.

 

[Another Reader]

60 years ago, my mother called them the witch doctors of Kaiser... No real doctor would work there because of the low pay scale was her belief. Misdiagnoses, inappropriate drug prescriptions, babies lost because inappropriate obstetric care, no second opinions, the list is endless. The PCP was a Kaiser invention - the gatekeeper to the specialists. Run!

 

[RobbieB]

I love Kaiser, Kaiser rocks!

 

[daylatedollarshort]

In our area Kaiser is truly horrible, almost like barely having any health insurance at all. The ER wait might be 50 people on a given day, while the local non-Kaiser hospital would have no wait or maybe 1 or 2 people in the waiting room.

I spent all night in a Kaiser ER once for a kid with a possible head concussion and we never saw a doctor the whole time, the wait was so long. We ended up leaving in the early morning hours to just make an appointment with our regular doctor, since it was the next day already and we weren't even close to being seen. Then, to add insult to injury, the ER staff tried to insist I sign a statement saying I was refusing treatment. Once off Kaiser, we had a kid have a bad reaction to poison oak on a holiday when the urgent care was closed, and were seen with no waiting and pleasant staff in the ER at the non-Kaiser hospital.

For a specialized, major surgery we went to one of a handful of expert surgeons in the country and our non-Kaiser insurance paid for most of it. Kaiser wanted to have a surgeon that did maybe three of those surgeries a year do the operation. If you can afford to not have Kaiser, at least where we live (maybe other areas aren't as bad), it isn't worth risking your life or the life of a loved one to save a few bucks.

 

[daylatedollarshort]

Yes, they love prescribing OTC drugs for sure. Anything that doesn't cost them money is the best. I feel so disgusted when I think back at the substandard care I've gotten over the years, and my husband and I are excited to get away from them. We keep mentioning to each other how we will soon be able to see a doctor who isn't wholly controlled by a cost-saving computer system.

That sums our experience. When I called the advice nurse once for a possible fracture with one of the kids from a sports injury, she first tried giving me instructions on how to make my own splint. I had to point out that since we paid for medical insurance, we were entitled to an appointment and examination from an actual doctor.

 

[RetiredHappy]

60 years ago, my mother called them the witch doctors of Kaiser... No real doctor would work there because of the low pay scale was her belief. Misdiagnoses, inappropriate drug prescriptions, babies lost because inappropriate obstetric care, no second opinions, the list is endless. The PCP was a Kaiser invention - the gatekeeper to the specialists. Run!

Regarding pay - fast forward, Kaiser is probably the best pay master in all health care systems in California. I am doing quite well myself in retirement but I envy the financial compensation that my RN and MD friends that are getting at Kaiser now and in their retirement.

 

[Bamaman]

We had Kaiser HMO many years ago--when my Ford insurance had $5 office visits and $2 prescriptions. They were fine for the sniffles and minor ailments--with quick appointments in their office.

At the same time, my wife suffered with a "female" problem for 3-4 years that never got solved. It was almost like the Gynecologist was being paid by what procedures he was NOT performing. He just wasn't a first class physician.

We had the chance to switch over to Blue Cross Blue Shield conventional health insurance. It took one office visit for the new doctor to diagnose my wife's problem and a 1 hour outpatient surgical procedure. Problem solved.

We pick our physicians and concur with them on what hospitals we use. My wife continues to have some pretty serious medical problems, and she's had the absolutely best of care on Plan F with AARP-United Healthcare. We've yet to receive a bill of any kind.

Medicare Advantage is heavily advertised on television, and we receive call after call from telemarketers. That alone is enough to make us question the program. But we often see Advantage physicians to be graduates of foreign medical schools. And not all hospitals are created equal, and one of the good hospitals with 1,700 physicians in their practices refue to accept any Medicare Advantage patient.

 

[CindyBlue]

I have had nothing but great care from Kaiser. I have had Kaiser all my life except for about ten years in the 90s when I was on Blue Cross through work. Blue Cross was hard to deal with - I spent half my time trying to find and make appointments with a doctor or a specialist. I have never had that trouble with Kaiser. Right now they (and most if not all hospitals, I'd imagine) are slammed with covid issues, so I've had to wait longer than usual lately for an appointment with a specialist, but it has never been more than three weeks and usually much less.

When we both got Covid last year, Kaiser was on it right away. Someone called daily to check on us, and they sent us boxes of supplies.

When my hubby practically sliced off his leg last year during the height of the pandemic, we were in the wound clinic every week for about four months, and they carefully taught me every step about how to care for his wound every day at home for in between visits. I sent all the information to a daughter of a friend of ours who is a wound specialist in Nevada, and she concurred with everything the Kaiser wound clinic was doing - she said she was very impressed.

But my appreciation for Kaiser mostly stems from the wonderful care they gave my mom for the years and years she was dealing with ulcerative colitis (from which she ultimately died), and their care for my dad while he was in the nursing home for about a year last year, and then during his last days when he got covid and passed. The care was everything we all could have hoped for.

 

[RetireBy90]

I'll add one more to the Kaiser side. We have had Kaiser through DW school system, then through my employer, and now through Medicare. For many years we didn't have any real problems so provider didn't really matter. Then DW got diagnosed with breast cancer. She elected for mastectomy. Surgery and reconstruction went well. They sent her to an outside plastic surgeon for the reconstruction at no cost to us. Then she had appendix while out of Kaiser area in Mississippi and recently had to visit emergency room while out of area in Texas. All treatments have been great. She had to change PCP a couple times over the years but found a good doctor she can work with well. I was recently on Tricare awaiting 65 for Medicare and have been happy to get back on Kaiser. We pay Medicare and $50/month for Medicare Advantage Plus each, so $100/month. No plans or discussions about leaving. One big thing we see with friends on other plans is they have a provider they like and is not part of Kaiser. If you have a network of providers that you want to keep you will need to look to Blue Cross or other. If not, and we don't then Kaiser finds good people to keep us healthy.

 

[mountainsoft]

We've been with Kaiser for at least 25-30 years and have been quite happy with them. I can usually get an appointment within a day or two, and most situations are dealt with quickly. I have never had an issue getting prescriptions, though I rarely need anything. And they mail prescriptions right to our house so we don't need to go pick them up. Kaiser dental is a little harder to schedule with, but medical has been great.

I did have a weird rash on my leg many years ago. It took a few visits with my primary doctor and a biopsy to figure it out (no specialist referral), but once she knew what it was it was cleared up quickly.

During COVID I exchanged many emails with my doctor to get my blood pressure under control. That all went well, including trying different prescriptions until I found one that worked with minimal side effects.

I don't really care what doctor I have, as long as they are competent and friendly. I just don't see a doctor often enough to care. Unfortunately, turnover seems high at Kaiser and many of my favorites moved to other positions.

While the local Kaiser office is actually closer than non Kaiser doctors, their hospital is a good 45+ minute drive away. So that's kind of a pain for anything serious. Thankfully, we can still go to the local hospital for a true emergency.

My mom has PacificSource. It's OK too, though there have been a couple of issues with procedures that were deemed "out of network" even though they were prescribed by an in network doctor. I don't have to worry about any of that with Kaiser.

Unless something major changes, we are planning to go with Kaisers Medicare Advantage when we retire. Stick with what works...

 

[Goldendoodlebug]

In the 80s-90s, I had insurance through HMSA in Hawaii ( was it called that then? I don’t remember). It was fine, don’t really remember any problems but I was young and did not use medical services much.

I have been on Kaiser since ~1997 and have nothing but good things to say about it. My husband has had many health problems and Kaiser has covered it all. He had lymphoma and we did not have to worry about any bills. He was hospitalized for High blood pressure and received great care.while we were in Las Vegas he had back problems. He needed an ambulance to get to the hospital and spent about 12 hrs there. It was not a Kaiser hospital but we did not receive a bill or have to fight them about covering it.

My MIL had Kaiser and she received such good care. After hospitalization they sent her to a rehab facility that had a Kaiser Dr. on site. They put her on hospice, hospice care was covered. I don’t think all of the hospice nurses were the best, but that happens in any large system.
Any time I read about people fighting with their insurance companies to get procedures or tests covered I’m glad I have Kaiser.

One critical advance is medical records. Since all of Kaiser practitioners are in the same system, they all have access to your medical record. Less chance of overprescribing and care is coordinated
.

 

[pacergal]

Kaiser--either most folks love it or hate it.
We switched a couple years ago,, so far love it. No problems getting referrals, specialists have done the same things and ordered the same labs/tests DH and I had when on other insurance and PCPs.
The docs I've seen have been vey informative, thorough in their care.

Have worked in the medical field for over 35 years, believe me, your insurance company, no matter what it is, is running your care, what they will and won't pay for, what your doc needs to do in order to get "premium bonus payments" back behind the scenes that you don't know about! All part of the medical home model.
Not saying it's bad, just that your doc may not be as "individual" as you think.

 

[Brat]

Remember that medicine is a human endeavor. Non-Kaiser physicians make mistakes as well. I know because my daughter's FIL was an officer of a malpractice insurer.

Kaiser NW has many more health care provider applications than they can employ. Physicians love working for Kaiser because they have family-friendly schedules. Their pay is market rated and their fringe benefits are higher than almost all practice groups. My providers are 'Fellows' in their field of practice. One of my specialists is a Harvard grad.

 

[YB88]

My wife and I were with Regence Blue Shield for some years until out of the blue they told us they were no longer going to write individual policies in our state. We switched to Kaiser because we're confident that since they have lots of infrastructure and employ the doctors, etc, they're not going to suddenly stop offering service here!

Overall the experience has been great with them. In general I find that the people there are great, whereas the admin is mediocre. I can live with that. We're just in the process of switching to their Medicare Advantage plan, and it's been overall seamless.

 

[RetiredAndLovingIt]

60 years ago, my mother called them the witch doctors of Kaiser... No real doctor would work there because of the low pay scale was her belief. Misdiagnoses, inappropriate drug prescriptions, babies lost because inappropriate obstetric care, no second opinions, the list is endless. The PCP was a Kaiser invention - the gatekeeper to the specialists. Run!

Maybe then but I don't think now. Kaiser nurses and doctor are on the high end of the pay scale according to my daughter in law who is a nurse. You also need to have some experience before they will hire you.
It's truly a delight to go to their facilities and be seen on time by nurses that are friendly and organised. I can get my labs and blood work all done at the same place and I'm out the door within an hour or less of my appointment time. They just run far more efficiently that private physicians office that I've used over the years.
Of course YMMV but at least for now I plan to stay with Kaiser for a long time, I have no complaints.

 

[Brat]

FYI regarding the claim that Kaiser providers choose the cheapest option: My provider is recommending a treatment that costs $22,000 MORE (based on my research online) than the alternative.