Anyone ever beat Kaiser?

SuddenlyWornOut45 wrote:
Never used kaiser, Ive heard a lot of bad stuff about them. Arent they out West a lot? Kind of like one of the original HMO health insurance companies?

Eric

I don't work for Kaiser. I don't have Kaiser coverage, though Kaiser is available to me currently. Those are my disclaimers for my comments. I work in HR and manage benefits for almost 400 employees. Kaiser did start in Northern California. It is a very popular plan in California, both Northern and Southern, and it has extended to some other states. Kaiser is the number one ranked health insurer in California.

My company is contemplating going to a self-insured plan. We haven't done so is because our Kaiser penetration is so high. When I offer jobs to people, many will ask simply if we offer Kaiser? The loyalty to Kaiser is like nothing I've ever seen.

Healthy people love Kaiser, and they do handle some chronic conditions like asthma well. But G-d help their members who get old, have unusual neurological or cancer illnesses, or don't fit neatly in their by the book protocols. They are all about the protocols, and if you don't fit in the box you're out of luck. Very few of their doctors seem to be able to think for themselves, and they like to do everything in group classes.

DH is having memory issues that are putting his job jeopardy, but he can't be evaluated by a neurologist until he attends a class. They will spend 2 hours telling him memory loss is a normal part of aging (he's not even 60) and that he should get at least 8 hours sleep a night (he does) exercise regularly (he does) and eat right (he does). Only then will be ever be evaluated. Hopefully he will still have a job after waiting over a month for the group class and who knows how much longer to see a specialist.

4 of his first cousins have had cancers and tested positive for BRACA II, but when he asked for testing, first he had to take a class bent on discouraging him from getting tested (we have 2 daughters!), and they made it so difficult to schedule the testing that more than a year has passed and he will need to take the damn class again to get on the schedule for testing.

These are the minor things. I'm livid at the hoops I have to jump through to see needed specialists for me and my daughter's multi-system genetic issues. I would be here a week describing all the fun and games, I work around them whenever feasible.

Janknitz wrote:Healthy people love Kaiser, and they do handle some chronic conditions like asthma well. But G-d help their members who get old, have unusual neurological or cancer illnesses, or don't fit neatly in their by the book protocols. They are all about the protocols, and if you don't fit in the box you're out of luck. Very few of their doctors seem to be able to think for themselves, and they like to do everything in group classes.

DH is having memory issues that are putting his job jeopardy, but he can't be evaluated by a neurologist until he attends a class. They will spend 2 hours telling him memory loss is a normal part of aging (he's not even 60) and that he should get at least 8 hours sleep a night (he does) exercise regularly (he does) and eat right (he does). Only then will be ever be evaluated. Hopefully he will still have a job after waiting over a month for the group class and who knows how much longer to see a specialist.

4 of his first cousins have had cancers and tested positive for BRACA II, but when he asked for testing, first he had to take a class bent on discouraging him from getting tested (we have 2 daughters!), and they made it so difficult to schedule the testing that more than a year has passed and he will need to take the damn class again to get on the schedule for testing.

These are the minor things. I'm livid at the hoops I have to jump through to see needed specialists for me and my daughter's multi-system genetic issues. I would be here a week describing all the fun and games, I work around them whenever feasible.

Jan, thank you for saying this. Your assessment of Kaiser is spot on. Most of the folks I know who love Kaiser are healthy individuals whose main health needs are wellness and preventive services, and or who tend to have common conditions for which there are established protocols. Like you I need a good neurologist for a poorly understood and hard to treat condition and I've had no luck at Kaiser trying to get a neuro doc on board to help. Also, here at the Northern CA Kaiser in my area my primary has never referred me for a bone density screening (even with a parathyroid history), and I didn't get referred for a skin cancer screening until I got skin cancer a couple of months ago. I'm 61.

Pre-existing conditions have made it impossible for me to get out of Kaiser for many years so I am grateful that I'll be able to switch plans in 2014. Yes Kaiser is efficient -- pharmacy, lab, docs all in one place, electronic communication system, etc., and I think that's why they get ranked so high in the HEDIS reports. But if you need care outside of the box Kaiser can become your worst nightmare. Even the good docs at Kaiser -- and there are some good docs -- are working in a system that can tie their hands in terms of what they can offer patients. And all the pre-requisite classes before you can get care... I guess I could be here for a week too Jan! So just thank you, it was validating to read your post.

I never used kaiser and never heard a single good thing about them. Im glad they are out West and not here on the East Coast. They sound very bureaucratic and sound like "canned medicine," AKA one size fits all medicine. Like military Tri-care medicine or something like that.

Eric

Erik, that's a good assessment, I call it "big box" medicine. A lot of people like big box stores like Costco until you really need some personalized service. Then it stinks!

I should add that I work with seniors, and kaiser treats them like dirt I could tell horror stories for weeks.

And their diabetic care is mired in conventional wisdom, they don't have a clue.

I call it "canned medicine." One size fits all medical care. The managed care outfits love canned medicine. The military loves canned medical care, dont ask me how I know that. The VA likes canned medical care.

Im sure if we ever get one payer system in this country (socialized medicine) "canned medicine" will become the norm for everybody but the truly wealthy who can afford to pay out of pocket for everything.

Medicaid is "canned medicine."

I prefer individualized medical care. Individualized medical care focused on ME. In North Carolina, two hospitals in Charlotte have started a "concierge" medical care system where you pay like, $2500 a year extra than whatever your insurance pays and you get real time on with your doctors. Its like old style, pre-managed care, individualized medical care. The doctors actually spend time on your situation and your case. The doctors in the concierge program are limited to like, 300 patients a year. Doctors in the same hospital system otherwise handle like, 3000 patients a year. In other words, if you are not in the concierge medical plan you are getting canned medicine.

kaiser reminds me of that, from rumor and stuff Ive read.

Eric

Janknitz wrote:Erik, that's a good assessment, I call it "big box" medicine. A lot of people like big box stores like Costco until you really need some personalized service. Then it stinks!

For What Its Worth Kaiser here in Northern Ohio is selling out. They lost to much money here. It is cheaper insurance cost per pay.
And it is fine if you are healthy, but if something goes wrong with your health you are in big trouble. In recent years they have closed their hospital here and sent patients
to the Cleveland Clinic. The down side is when you are released from the hospital you still have to go to their to their doctors. I don't know of any one that had much luck
with them.

Re: Anyone ever beat Kaiser?

Chancellor Max von Baden did.

LMAO

If something goes wrong with your health and kaiser does not pull its load, WTF good is kaiser good for then? Besides making a ton of $$$ for their kaiser executives? Sounds like white collar fraud and racketeering to me.

Eric

Bill44133 wrote: And it is fine if you are healthy, but if something goes wrong with your health you are in big trouble.

I have had lots of different insurance. Am N.Ca Kaiser now so personal experience not rumor or hearsay. Am I always happy with Kaier? NO. But that was also true with Aetna, Blue Cross, Blue Shield and other national health insurance carriers
If you have no DME coverage you do not get benefits re DME. Like no car insurance in a wreck...gee no coverage...No Surprise.
Kaiser has processes, I found BlueCross BlueShield, Aetna and every other health insurance company also have processes.
Advice: take someone with you to see doctor. This person can verify your symptoms are real, double check your communication is clear, concise, and understood; as well as document what the doctor is telling you. Take a smart person. Witnesses are good if you are not getting what you need.
Use the patient advocate person Kaiser has on each site. Kaiser tries to use evidence-based health/medicine. They also know about malpractice and want to avoid it. Kaiser does care what it's doctors do, Blue Cross/Aetna really do not review physician practices.
No insurance system is perfect, Kaiser has flaws.... but OMG what I saw with my parents care with BlueCross/Shield was HUGELY worse. Cannot talk to Kaiser outside N.CA Kaiser but I choose Kaiser after years of other coverage.

Oh yeah, I forgot to mention that it took me more than FIVE YEARS to finally get a colonoscopy from Kaiser when I had a first degree relative (my father) who died of colon cancer. They ask me when he was diagnosed, and since he was over 65 when diagnosed they figure the risk of getting colon cancer before age 65 is no greater than the regular population. But they did not take into consideration the fact that my dad had stage IV cancer when diagnosed, and if colonoscopies had been routine in those days he probably would have been diagnosed at age 55 instead of age 65.

They STILL waited until I turned 50 to do any testing, and then only wanted to do a sigmoid and an occult blood screening.

All this from a "health maintenance" organization.