Considering leaving Kaiser - what's it like out there?

Open enrollment is coming up and I am considering transitioning my family's health care away from Kaiser, where we have been members for many years. Until recently I was super happy with my care at KP through two pregnancies and for myself. However, I have been frustrated with the lack of urgent care while dealing with sick kids. My questions are around what access to care looks like in other systems. A few questions on what non-KP physician groups are generally offering (specific practice recommendations also helpful): (1) Do most physician groups offer physician email messaging like Kaiser? (2) Are you able to get after-hours and weekend visits for urgent care? (3) What is the wait time on these types of visits? I would appreciate insights from families that have experienced Kaiser and other systems recently. Thanks!

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Thanks for putting these questions out to the BPN group. We are currently with Kaiser and our experiences have been quite similar. (Good prenatal and pregnancy care) and then it really fell off and has also been disappointing in the adult side as far as reaching our primary care physicians, specialists and getting additional screenings. 

We have very recently had experience with this. We were with Kaiser for 15 years, then forced to move to PPOs with first Cigna, and then Blue Shield, due to a job change. Now we are back at Kaiser. While I agree Kaiser has become more annoying over the last two years, being on the 'open market' for healthcare via the PPO plans was much worse! First of all, few doctors or practices are taking new patients. I had to call over 20 doctors to find one to take my teens, and that was only after begging. For me, it was even harder. I finally found a doctor who would take me, but she was a brand new physician and ended up leaving the practice a year later. We were with Marin Health which is affiliated with UCSF. They did not offer online appointment scheduling; you had to call between 9-5 M-F and wait on hold. Same-day and after-hours care was very limited and they said to 'go to an urgent care center', but those didn't always take our PPO insurance. I was excited about the PPO mental health care coverage, since it's so bad at Kaiser. Well, I called over 35 therapists listed as taking either Cigna or Blue Shield, and they all said they weren't taking new patients, and even if they were, they didn't work with insurers! And then the billing. So stressful. Marin Health used three different billing providers, so we got random bills from random places. The co-insurance and deductibles were confusing. My son went to the ER for a racing was $3600 for a five-minute visit with a NP. Thankfully, our $1500 deductible got waived because he got a Covid test during it. But it could easily have cost us $1500. I had a 15-minute Zoom intake appointment billed at $1800; our part was $180. Labwork was done at Quest, which sent insane bills I then had to get Cigna to repay. I was so happy to go back to Kaiser where the costs are fixed: $25 for an appointment, $150 for the ER, and all labs for free.

My kids are patients at East Bay Pediatrics, and they have needed quite a bit of last-minute or after hours care recently. Outside of main office hours, EB peds refers to an after-hours urgent care clinic. The few times we've needed that, we've had no trouble getting in to see a doctor. However, phone wait times to talk to someone and set it up have been significant (e.g., an hour on hold.) And most recently, we were seen at the urgent care clinic, but then info about our daughter's condition and prescriptions did not get sent back to her regular doctor in a timely fashion. So follow-up care was difficult and confusing; I felt like I was the messenger between the two doctors, which wasn't a reassuring feeling, because I didn't fully understand what my daughter's medical condition and options were.

Since covid, EB pediatrics has dramatically reduced the availability of "sick visit" time slots available. So when my kids have needed medical attention outside of routine check-ups, it has been really challenging. The few time slots they have are filled almost immediately. And then the other option is to get on the phone with the advice nurse and try to get an appointment that way. Phone hold times to reach the advice nurse regularly go over an hour. It's frustrating and exhausting.

Finally, you didn't ask about this, but I'll add that I had to book my kids' annual check-ups over three months ahead of time. We used to have Kaiser, and it was never this hard to book a doctor visit with Kaiser.

So... maybe it's just hard all around out there? I've been considering switching to a different pediatric practice so will be interested to read what others have to say.

We have One Medical for our primary care. I cannot speak to how it is for little ones because our kids are older teens, but we do really like it. On their app they have a video chat option... you can talk to a NP at any time when an urgent situation comes up. It's been a lifesaver for us. Our family recently went through COVID; the speed with which we got care from One Medical vs. how some elderly relatives were treated by KP was notable.

Doctors are not leaving the Bay area. Doctors love the Bay Area, as a place to live, and a place to practice. Since I am a senior with plain vanilla medicare I see whatever doctors I wish without restriction to a PPO or HMO. I have not met one yet who does accept Medicare Assignment, meaning I have no extra care other than the $120 annual deductible. There does seem to be shortage of general practitioners, but otherwise I have good specialists, and do not need a referral to see them. Hopefully someone with more expertise in the medical field will chime in with the PPO and HMO tips, because I am ignorant of their operations.

I've never been part of Kaiser so can only speak to my experience with other insurers like Blue Cross or United. Every medical provider I've worked with in the last ~8 years has offered messaging service through something like MyChart, which is pretty easy to use. They offer proxy access for parents to see their kids' medical records and send messages to pediatricians. Bills are also paid through MyChart. My kids go to Berkeley Pediatrics and if they're sick I'm almost always able to get a same-day appointment if I call in the morning. After hours or on weekends, we go to the UCSF Pediatric Urgent Care (near corner of Ashby & Telegraph) which you can call for an appointment, usually within hours. For ER visits, it varies. Last spring I went to UCSF Benioff Children's ER in Oakland with my 3.5 year old, who had a broken collarbone. Was there for 7 hours (vast majority of which was in the waiting room) because sick infants kept coming in and bumping us down the priority list. Understandable, but still excruciating to wait so long. Another time my daughter had nursemaid's elbow and was in and out pretty quickly so it just depends on what's going on that day/night. Hope this helps!

I have had Kaiser in the past and now have Cigna. Unfortunately in 2021 I was very seriously injured so I’ve had a lot of interaction with the healthcare system over the past 2 years, and it has cost a fortune and been a complete nightmare. We will be going back to Kaiser the moment it is an option through one of our employers.

Since you asked about kids, my kids’ primary care providers (John Muir Health) have been booking 6 weeks - 3 months out, so anything that is not an emergency but that should be seen soonish has resulted in an urgent care visit even if it’s not urgent. Getting into a specialist takes longer - we waited 2 months for a dermatologist and I think 3 months for a GI specialist - both at UCSF.

Getting into urgent care is doable, though on one occasion by the time I was actually able to get into urgent care (waited 36 hrs) the doctor almost hospitalized my daughter because she had become so ill.

That kid needed an ultrasound. We’re in Berkeley, and the local outpatient radiology wouldn’t see kids on the weekend, so I had to either take her to the emergency room so she could get one in the hospital or drive her to Walnut Creek or San Francisco where they would see kids. Such stupidity.

When our kid has needed the emergency room at Oakland Children’s, I have waited hours. I once arrived at 8 pm and didn’t get out until 3 am — this was for a few stitches. In contrast at Kaiser Oakland I’ve never waited more than an hour upon arrival and even the time my kid needed a bunch of imaging and a GI consult, they had us out of there in 3 hrs with a follow up appointment scheduled the next day.

When I went to Kaiser, the amount I paid at check in was the fee. Now, the amount I pay is just the starting cost. Every time we go to the doctor, we end up with a couple bills for a not previously disclosed amount in the $300-$3,000 range. I never know how much it’s going to be.

Finally, you can get all your electronic health information in one place with Kaiser. Right now I have to login to four different MyChart accounts to see all my and my kids’ info. They’re supposed to be linked, but sometimes when I add a vaccine or something, it only shows up in one version. It’s incredibly annoying.

Kaiser has its own problems, but the logistics there are dramatically easier than outside of the system. I’ve never been sent all over the Bay Area for basic labs, imaging or specialists by Kaiser - everything is always in the same location. And the amount I pay is clearly communicated up front. If that kind of logistic thing is important to you, I would recommend thinking hard about switching. For us, the logistics of “normal” insurance have absolutely not been worth the stress. We can’t wait to go back to Kaiser.

Repeating an answer I gave to the poster below you with a similar question: A lot of people have quit clinical medicine. I work at a safety net clinic and we can't hire people. I was at an appointment at Kaiser yesterday and the doctor was saying they can't hire people either. It's not just doctors - the medical assistants who check your vitals and room you, nurses, front desk staff - it's all short-staffed. If someone has recommendations of practices or places where they've avoided this problem by all means, take advantage of that. But it's happening both locally and nationwide, so it's pretty widespread.

I had Kaiser for decades before moving to a PPO right before I had my daughter. After some trial and error, I now get my care through Sutter, which operates very similarly to Kaiser, and our daughter’s care through Berkeley Pediatrics. They use UCSF’s email messaging system, but it takes a couple of days to get a response to an email. It’s not a replacement for an appointment, whereas at Kaiser I could ask my doctor questions via email and get same day answers that avoided extra appointments. If you call early in the day, they often have availability for a sick kid visit the same day. We fortunately have not needed to use Urgent Care very often, but they are affiliated with the UCSF pediatric urgent care center should that be needed. We had to call one time. They paged a nurse who called us back awhile later. Overall, I’ve been really happy with our daughter’s care. The thing I like best is that our pediatrician’s office is not in a large medical center. It feels like a small family practice with all the benefits of being affiliated with the best pediatric hospital in the east bay.

A long time Kaiser member here. I was forced to move to Cigna for 2 years and as soon as I could, I went back to Kaiser. Kaiser is not perfect but their primary care system is very efficient and lab tests, x rays, etc. are all quite convenient. Specialists are a hit or miss but I believe they are obligated to schedule a specialist appointment within a certain time window, so no 2-3 month wait. Kaiser mental health is a joke. We have accepted that we have to pay out of pocket for my weekly therapies. When I switched to Cigna, it took 3 months to see an endocrinologist for an existing condition involving a brain tumor! And the doctor’s mri order was denied so they had to resubmit the order. Again, for a brain tumor! It was nice to be able to request reimbursement for mental health costs but everything else was less efficient and less convenient. With Kaiser, I do feel that I have to advocate for myself very strongly and ask for tests and things, but when I do, I get them. Just the other day, we were at ER and the tech was going to bandage up without any antibiotics so I had to remind them and ask “should we put some antibiotics on the wound?”  For people who are less vocal about their care, I can see Kaiser not working out for them.  As I write this, I realize health system for us mere mortals is not great. People who use One Medical or Forward type premium services seem to be happy…

I feel like the healthcare system is so broken but overall I'm glad not to be with Kaiser anymore.  I left in 2020 for Anthem Blue Cross.  I wouldn't call it smooth sailing since then but on balance I'm glad I switched and really appreciate having options and not feeling stuck with whatever is offered through Kaiser.  I found a great pediatrician's office for my daughter where I get quick responses and have access to UCSF urgent care, which has been fantastic with COVID and general health questions.  I'm in Marin so that may not be helpful for you but I didn't have a problem getting her in.  It took me some calling around to get my own GP.  The person I got ended up closing her practice, but I found a new one I like who was recommended by a friend.  I also have a great OBGYN, both through MarinHealth.  MyChart operates an email your doctor service like Kaiser and my GP has an urgent care where I've gotten same-day appointments and good access to things like COVID tests.  The email response times aren't as fast as the ones I had with Kaiser (varies with the doctor for sure) but I can call the office and get help.  I had psychotherapy covered for a while but it was definitely hard to find therapists willing to take private insurance of any kind.  I am now paying out of pocket for a therapist I really like.  The paperwork and billing stuff involves more admin on my part but for now I'm willing to deal with it for the choice and flexibility.    

We did the reverse of what you're proposing - we had Blue Shield for years and then switched to Kaiser 8 years ago when I changed jobs. While I agree with other posts that things have declined in the past 2 years, my mom is not with Kaiser and she's experiencing the same thing, so I think longer wait times for appointments, etc. is across the board. I would definitely not switch back. With Kaiser we can email doctors and get responses, make appointments online, and everything (doctors offices, lab, radiology, and pharmacy) are all under one roof; it's SO much more streamlined than non-Kaiser providers. So, that's my 2 cents.

I can offer my perspective from "both" sides.  I am a provider in a big university medical center and both myself and my family are Kaiser patients (including pediatric care).  I have found that communication with and access for appointments is easier at Kaiser.  I am in the primary care setting myself, (in adult medicine) and I know the environment well in terms of access for specialists, acute care, and primary care follow up.  Kaiser is most certainly more responsive to calls, urgent messages and non urgent messages and generally seems to have much better availability than the private/HMO/Sutter/UCSF local organizations for urgent appointments and short term follow up.  I am always impressed by how fast my own PCP gets back to me, and can say the same for my husband's and children's providers.  While we may have to wait to be seen by the person we are assigned to on short notice, typically we can get urgent appointments in a timely fashion with a covering clinician. Someone else wrote in about folks who work in healthcare leaving the industry--this ranges from providers (MDs, DOs, NPs, PAs, CNMs) to support staff (Medical Assistants, Call Center Folks, etc) and everything in between. I think it is absolutely true to say that things are indeed tough all over and I would caution against assuming you will be able to easily find an open practice with easy access for urgent and routine appointments outside Kaiser.  Our system is under tremendous stress right now-between Covid, which is still causing a hit and need for urgent appointments and care, RSV, Influenza, etc.  Also, with Covid, many providers and other health care workers cannot come to work when they are infected=reduced access and support.  In my office we have had one-two providers and staff out any given week for the last year.  Good luck! 

I left Kaiser five years ago for Blue Cross PPO and I'm glad I did it.  Kaiser is good for primary care, and if you are young and healthy overall.  If you happen to have a serious medical condition, Kaiser is not a good place to be! With Blue Cross PPO, I have access to many top notch hospitals, including UCSF and Stanford. Kaiser doesn't provide much mental health support and therapy, which Blue Cross does. The only downside of a PPO is that you have to shop around and call for doctors, but then you can go for the best!