Kaiser vs. Other Medical Networks
Related Page: Reviews of Kaiser Doctors & Hospitals
Parent Q&A
Yes, before I was married and could get on my husband’s insurance, I had to buy my own individual plan. I also did not qualify for any subsidies. I purchased an individual plan through Kaiser. I still have Kaiser now and I’m very happy with them. I also love my baby son’s pediatrician. I had bought the silver plan, and in retrospect I think I had bought the silver plan, and in retrospect I think either the gold or bronze plans are a better deal.
Archived Q&A and Reviews
Anthem Blue Cross vs Kaiser
March 2014
I have the opportunity to change from Anthem PPO to Kaiser this month. I have had a hard time finding MDs on Anthem who are taking new patients. I am not thrilled with my child's pediatrician for example but I am struggling to find a replacement. If we went with Kaiser we would be seen at Oakland or Richmond. I worry private practice is becoming unsustainable for many MDs and I wonder whether we would be better served by the coordinated care at Kaiser. My family is healthy now. But you never know.Should I make the switch ? Co pays and deductibles are not a problem, I just want good care and coverage in case of catastrophe. Thanks, Insured but Unsure
As a 30 year long Kaiser patient, I've seen it grow into what I think is the best health care around. I absolutely love the email system and I always hear back from my doctors very quickly- saves a lot of visits and phone calls. I use Richmond and San Rafael, the latter being a bit of a schlepp but not bad during the day- I followed my GP from Richmond and have found other great doctors there, too. I can wholeheartedly recommend Kaiser. Cece
Hi. I've had both a ppo and Kaiser over the years. I find Kaiser to be easier in that I never receive a bill saying only part of it is covered because someone or the procedure was not in network. I like my son's pediatrician a lot (both in Los Angeles and Santa Rosa). I like the mail delivery prescription service also. So, I've been happy with Kaiser. good luck. Kris
I can't compare, as I have been with Kaiser for years. But my family and I have had great experiences with Kaiser. In the last couple of years, they have expanded email consults, phone consults, and now video consults, which is particularly great if you have kids.
The new Oakland hospital will be state-of-the-art, but along with that are brand new building for a number of specialties. And their electronic medical records are great when you are seeing a different doctor for an urgent appointment--any Kaiser doctor across the country can pull up your entire record.
Twenty years ago, Kaiser was known as cheap, but not as good. They have really focused on improving quality, and have been recognized for it by California, Medicare, etc. Bryan in Oakland
Considering a move to Kaiser from Blue Shield PPO
Dec 2013
After many years of having a blue shield PPO for health insurance, I am contemplating switching to Kaiser. I have heard tons of good things about how nice it is to have electronic medical records, easy access to physicians via email, nurses on the phone, labs and docs all in one place, etc. Kaiser sounds great. My only hesitation is the following... how much will I be able to be in control of my healthcare? Earlier in life, I had two pretty significant health problems (thyroid disease and skin cancer) that were missed by primary care docs in an HMO who refused to take my concerns seriously and declined to order necessary tests or refer me to specialists. Problems that should have taken a few months to resolve instead took a few years and cost me plenty of anxiety in the meantime. It was a nightmare, and it is why I switched to having a PPO. But that was over a decade ago, and the HMO in question was NOT Kaiser. Still... my fear is that if I enroll in Kaiser (or any HMO, really), I will have less flexibility to consult with specialists and/or seek second opinions if I disagree with my primary care doctor. Are there any Kaiser subscribers or employees out there who can comment on whether or not that's a well-founded fear? Maybe times have changed and HMO's just aren't the same as they were a decade ago? Or maybe I should just stick with a PPO. Your insights would be very appreciated! Thank you. Curious about Kaiser
I've been a Kaiser member for quite a long time, and agree with all the positives you mentioned. I think your fears are unfounded. The key to making Kaiser work- of course- is finding a primary physician who you can develop a relationship and dialogue with, and that can take some work. I've had doctors retire on me or leave Kaiser and each time I've needed to find a new primary it's been a project. Since most doctors who've been with Kaiser long enough to establish a reputation are booked up, I just try out the available, newer doctors until I find one who feels right for me. I found my current doctor that way and have been with her for over 10 years. She offers me referrals to specialists as needed and is responsive when I request one, same with tests. Cece
Hi, I've been a pediatrician at Kaiser for quite a while. I think you'll find you'll be really happy with Kaiser, and that it's actually easier to see (or get advice from) a subspecialist at Kaiser than outside. Because it's an integrated system, it's very easy for general practitioners to consult with a subspecialist about a patient. You would still need to ''go through'' your primary care doctor for the referral, but that can often be done by contacting your doctor through an email or even a phone or (soon) video appointment. Often you don't even need to come into the office. Sometimes the primary care doctor only needs to get advice or answers to your questions from the subspecialist -- and because it's such an integrated system with an electronic record, it's simple for primary care docs to contact subspecialists and get an answer within a day for the patient (e.g. on tests to order, next steps in treatment, etc). Other times, based on the patient's problem, the primary care doctor can refer to the subspecialist directly, just based on an email or phone exchange. If you happened to be in the office with your primary care doctor, she can often do a phone consult with the subspecialist while you're there -- sometimes having a speaker-phone conversation between the subspecialist, your doctor and you takes care of everything in one visit. And finally, of course, it's easy for primary care docs to make an official referral for an appointment with the subspecialist -- sometimes even having the subspecialist see you the same day. My point of the first examples above is that, though you need to contact your primary care physician, there is a lot in place now to keep you from having to use your valuable time with unnecessary appointments. Most importantly, if you ever don't feel comfortable with your primary care doctor, you can always switch -- very easily. Kaiser Pediatrician
We've had Kaiser for about four years now and I love it. I think a lot depends on your primay care physician, but I feel like that's not a Kaiser-specific issue. Moreover, it's so easy to change primary care doctors under Kaiser, it almost doesn't matter. (I've changed my PCP three times in the last two years for purely logistical reasons and it was a piece of cake every time.)
I've had great experiences with my doctors and the overall system -- Very efficient. Very user- friendly. All of that said, apart from giving birth, I haven't really had occasion to ''test'' the system, so to speak. The one time I had a specialist-worthy issue (a strange rash on my hand that was itchy to the point of being painful) it was not life-threatening and had they just sent me away with a powerful steroid cream or something I probably would just have shrugged and accepted it. However, that's not what they did. I went in to see my PCP. She took one look at the rash, listened to my description, and decided she was out of her league. She called the dermatologist on duty and about ten minutes later the dermatologist was in my PCP's office with us, going over all of they symptoms again and giving me a diagnosis. I got an answer and a treatment in no time flat and was merrily on my way.
I had Kaiser growing up, too, and as a kid I had reasonably good experiences (again: great PCP/pediatrician). When I went out of state to work and had various other insurers and hospital experiences, they were all pretty run of the mill. Now that I'm back on Kaiser, I think if we ever have to move over to something else I'm going to have a really hard time. Kaiser is awesome. Arbequina
I had a lot of frustrations with Kaiser (SF) in the 1990s, and then I went out into the world of PPOs (out of the area, and then back in again), and had a mix of good and bad experience with providers but pretty much all stressful experiences on the administrative/coordination of care/bills side. I returned to Kaiser (Oakland) about 7 years ago, and found it to be a totally different place. Coordination of care is pretty much a dream, as is control of costs and administrative stuff when compared to the other things out there (in a terrible national ''system''). Unfortunately, my family has dealt with many health scares, some luckily not anything serious but several extremely serious. In all cases, tests and referrals were ordered immediately -- no exaggeration, as the doctors usually order them via computer while you're sitting on the exam table, or within 2 days after you email about symptoms. We have never had to fight to be taken seriously. We have dealt with specialists in so many departments, and there's no waiting for appointments. The Fertility Department even put me in a bit earlier than is protocol.
The only problem we encountered early on is when a couple of primary caregivers just weren't a good fit -- but it is so easy to switch doctors, and asking around at Kaiser, on list-servs and among friends yields oodles of great possibilities for who to switch to. If you call, you can get a list of LGBTQ-friendly providers too. The doctor that I've now had for years is such a stalwart, he once called me at 9:30 pm to tell me about that day's test results.
You'll find excellent doctors and nurses inside and outside of Kaiser. But in the American context, I just don't think PPOs can beat Kaiser on the issues you're concerned about. The effective way Kaiser runs things, it is to their financial benefit to address problems pro-actively. The preventative care / health education one-on-ones and classes are fantastic. I could go on... but I will stop here and strongly advise you to get Kaiser. It isn't 100% perfect, but it leaves my years of PPO care in the dust. No more PPOs for us
I have been with Kaiser since the mid 1970's. I am so glad that I have stayed with Kaiser throughout the years that it grew from a place where you could wait for an answer to a phone call for 30 minutes or more to the absolutely most efficient health care system imaginable. Having an integrated health management system is the best! Everything is available to all my doctors at the click of a mouse - all test records, notes of past appointments, emails back and forth between me and my doctors, prescriptions, ALL of it is right there. I have had excellent physicians. My primary care doctors have never hesitated to refer me to a specialist when I need one and appointments have been easy to get. There are no more endless waits on the telephone - I just log into my account and make an appointment. When I had breast cancer I had the best care imaginable. My oncologist, a Stanford trained MD, is just one of the smartest ever, and he answers emails within the hour. When my wonderful primary care doctor retired, I asked him for a referral to a new doctor and he gave me the names of several. This, I have found, is the key to selecting a good physician - ask the other docs at Kaiser. As you will be just starting out, get some referrals from this network (I LOVE Doug Crawford in Oakland). If you are not happy with your doctor, it is easy to switch. My oncologist told me that folks switch all the time when they find the match is not right - and Kaiser accommodates no questions asked. Each doctor has a limit to the number of patients on their panel, so if you do not get an opening with the doctor of your choice, you can get on a waiting list. Try Kaiser. You will not be sorry! I have watched friends try to manage their own care - getting records back and forth between different specialists, waiting endlessly for appointments, etc, etc.....and just shake my head. It could be so EASY for them! Barbara
I love Kaiser. When I first moved to Oakland about 15 years ago, I was warned against it. Everyone exclaimed how horrid it was! Perhaps it has changed. Because I've now been with Kaiser for about a decade and I've mostly loved everything about it. I birthed both kids at Oakland Kaiser and had a great experience (as much as something so intense and excruciating could be called ''great'' lol). Also, my dermatologist is fantastic (Dr. Ostrichier- sp?). He spotted the skin cancer with a mole I was concerned about and took immediate action. The only lame thing I have found is regarding my feet. I've wanted more help/advice about various skin issues (as well as some deep pain I had after gaining weight with pregnancy) and it was impossible to get the care I needed. It seems that Kaiser is only set up to deal with SEVERE issues and not really to help the regular patient ''thrive.'' But mostly my experience has been extremely positive. /happy kaiser mama
Have been a patient for over 20 years. Plenty of complaints but still with them. Someone whom can suggest a better plan I would listen too. patient patient
Kaiser is structured such that the physicians, the insurance plan, and the hospital administration are all actually separate companies, that are contracted to work together. Part of what that means is that the physicians are hired to be doctors, and they don't worry much about the insurance arm, or billing, or any of that--they get to focus on their patients. Kaiser lets you pick a doctor, and then change that doctor at any time. You can also make an appointment at any Kaiser facility, if you find one more convenient, or one is closer to work while another is closer to home. As you probably know, Kaiser is also opening a brand new hospital in Oakland next fall, and one in San Leandro (Hayward replacement).
My wife and I have had Kaiser for many years now, and we both have had instances where we wanted a second opinion. It may take a little pushing, but we both did get in to see a different physician. Her second opinion was great--caught an issue the original physician missed. My second opinion was the same as the first, but I was glad to have that evaluation. No matter what physician or group you are with, you have to really advocate for your own health. Kaiser has a lot of bureaucracy, but if you work the system, we have found you can get great care. Bryan in Oakland
Choosing healthcare plans - Kaiser or Aetna?
Feb 2013
We're about to move to Berkeley from the East Coast and I am a bit bewildered by the health plan options offered to us by our employers. We can choose between Kaiser and Aetna, both of which offer HMO and PPO. Since I am not familiar with the area health care I don't feel equipped to make an informed decision.
If I understand correctly, Kaiser is a non-profit, and not only provides coverage but actual group practices. Those of you who use Kaiser, how does this affect your choices in PCPs, and specialist care?
Foreseeably we'd need a family physician, a pediatrician, and in a year or two, a CNM or OB for prenatal care and childbirth. I went the natural childbirth route with my first child, and it would be nice to do that with the second, to find a practice of OBs and midwives who are supportive of that, take our insurance, and have hospital privileges at a hospital that is well-equipped for that. Any advice on that?
HMO would be cheaper, BUT: In the past I have had experience with for-profit insurance companies such as BCBS, and when having a PCP was a requirement, it was a huge pain. The Boston area has a notorious shortage of PCPs and most of them don't take new patients. There might be a year-long waitlist, or you can easily find yourself stuck with one you don't like or has an office 40 minutes from where you live. Now this might be different Berkeley, but makes me cautious. In your experience, is it difficult to find a good family practice in the area? Has either Kaiser or Aetna significantly limited your choices?
Any other issues we should watch out for before signing on the dotted line? Of course we can compare terms and brochures, but there might be region-specific quirks we may not see from here. Vera
Love, love, love Kaiser. I mean, let's face it, none of the healthcare options is going to be perfect, but we have found Kaiser to be perfect for our family. Been with them for at least 15 years with no problems. Birthed my child at Kaiser Walnut Creek--his Pediatrician is in Walnut Creek--my Gyno is in Martinez--hubby's doc is in Walnut Creek. Easy, always there, great phone help, etc. V. Happy w/Kaiser
Go with Kaiser; it will be much less work for your poor brain with everything else you have to figure out iwth moving. It's much more of a full-service plan and everything is on one campus (if you go to Oakland) or easily accessible. You can pick your own physician if you want to knock yourself out, or you can just go with first available and chances are you'll like them just fine. Note that the ''good'' docs as recommended on BPN have been practicing longer and thus they get filled up. The docs w/availability are newer which in my opinion is a good thing (less set in their ways as some docs tend to get). Anyway, my whole family is very happy w/Kaiser for our whole range of needs (in specific response to one of your concerns, I had two natural childbirths at KP-Oak, attended by a doula. Worked out just fine.), which include a serious chronic health condition and a minor child surgery. We've seen a lot of Kaiser staff & facilities, obviously no place or person is perfect and there have been some bad experiences with the good, but we won't ever change willingly. Kaiser Mom
Hi! I had kaiser when I moved from the Boston area to the Bay Area 10 years ago. I love kaiser (I use Walnut Creek). They are amazing/no hassle. We picked an amazing pediatrician who always knew us and we could email (huge plus) with any questions. I also gave birth twice. It's so convenient. You need blood work, you go down the hall. You need a specialist, you get an appointment quickly. You never get bills. It's great. We recently switched to a ppo and I really dislike it. I keep getting bills, the advice for after hours pediatric is inconvenient.. I could go on and on.. Feel free to email me with any questions. Happy moving! Lindsay
I suggest you contact a health insurance broker regarding these questions. A broker can give you many options, including Kaiser, and inform you of the differences. In the east bay here, there is less and less difference between Kaiser and the other HMO's, they are becoming more and more alike. just found a new health plan
PLEASE, PLEASE get in touch with Ezra Herzog, of Integrative Insurance Solutions, ezra [at] integrativeinsurance.com Ezra is a licensed health insurance agent and can answer all of your questions and find you the best and most appropriate package for you. Good luck, June
Kaiser vs traditional HMO/PPO
Nov 2011
My employer can now offer Kaiser Medical to the employees. We can choose between Kaiser & the traditional HMO/PPO plans. I've never had Kaiser. Has anyone ever switched and wished they didn't? We liked the doctors we have on our HMO plan now and we don't have any serious medical issues. Ali
When I was growing up in SF during the 50s and 60s, Kaiser did not have a good reputation. That has changed completely. We switched to Kaiser less than 10 years ago and it is FABULOUS. we go to the Richmond Kaiser. Doctors email me back immediately when I have questions or concerns, there are 24 hour advice nurses available to talk you through your medical concern (which was wonderful when my son was young), and I have great docs! When we moved here, and had Blue Shield, all the ''good'' docs were full and I couldn't even find an ob-gyn. At Kaiser, I have a fabulous team consisting of a primary care doc, an ob-gyn, and a shrink; my son has a fabulous pediatrician. Kaiser docs DO NOT need to ask anyone or any insurance company for permission to do a certain test or make a certain decision---they can really practice medicine which is why so many good docs are moving to practice there. Happy Kaiser Patient
I have been with Kaiser for most of my life, with one break when I was with a PPO. Other than the fact that I found an OB/GYN that I loved while using the PPO, I was quite eager to get back to Kaiser when I had the opportunity. I don't have to worry about fighting my insurance company to cover services or procedures requested by my doctors. Kaiser is also more generous with prescriptions. I have really appreciated the changes I have seen over the years with Kaiser becoming more and more focused on preventive medicine and overall wellness. It is a model I wish more insurance companies embraced. MG
I switched to Kaiser last year and have been very happy.I like that everything is in one place and the doctors I have seen were all very good.Years ago when my daughter broke her arm we had to go to her doctor, then go somewhere in Oakland for an Xray and then we made a third drive for a cast.I was told that doctors like working at Kaiser as they have less paperwork to deal with-which means a better selection of high quality doctors.I usually go to Richmond but have been to Oakland which was good too.
I switched to Kaiser 5 years ago when it was added to the benefits of the company I was working for. I had never actually considered Kaiser, assumed it was HMO so bad, but there were a number of folks who had really worked hard to get it added to the benefits and so I thought I'd give it a shot. And I love it - great decision.
I love how everything is covered (no surprise fees like I had all the time with Cigna/Aetna). Kaiser really invests in technology and that makes life much easier. I can go online and email my doc / kid's doc anytime and they always respond within 24 hrs. I can also look up past visits, medication prescribed, everything I want.
At my 20 week ultrasound for my 2nd, the team at Kaiser found an anomaly. Super scary for me and they handled it so, so well. It's one of the benefits of Kaiser - everything you need is on campus. So I could go from one specialist to another without having to drive somewhere. My son had surgery at 8 weeks, everything went well, and lots of follow up afterward. I note this because I've heard comments that Kaiser being an HMO they are cost-conscious and will discourage/not allow certain procedures. So far that has not been my experience at all. love kaiser (and no, I don't work for them)
a CRUCIAL fact about Kaiser is that when you enroll, you waive your rights to a medical malpractice claim. You agree to Binding Arbitration when you sign up. No other HMO's do that. My firm does medical malpractice and it's surprising how many people call for legal advice with Kaiser and have no idea that they waived the right to sue them. This is definitely something you need to be clear about before you sign up for their medical services. works in medical malpractice
Pediatricians and Healthnet vs. Kaiser
Nov 2010
I've just returned to work after maternity leave, right in time for healthcare open enrollment. For the past three years I have been covered by Healthnet HMO. I was happy with them throughout my pregnancy. However, the cost of coverage has gone way up with the birth of my baby and I have an opportunity to cut our expenses by switching to Kaiser. But I'm really happy with our pediatrics office (Berkeley Pediatrics). I also love my OB/GYN, and would want to use her if we choose to have another child in the next few years. I'm a little nervous to be considering this change --- people seem to either love or hate Kaiser and I don't know which opinions to listen to. Most of my coworkers with Kaiser chose it for financial reasons rather than because they prefer it.
A change to Kaiser would be effective before the end of the year, and I'm not sure that I want my baby to change doctors so early (he'd be only five months old). He's still receiving his vaccine series, and his current pediatrician has been the one to see him and follow his progress since birth. Should I wait it out a year until my baby is older and then consider switching? The cost of that one year would be several thousand dollars. I keep thinking that if the care is equal, I could put that money towards retirement and college accounts (which we aren't funding as much as we should). If I do switch, which Kaiser has the best pediatricians and is convenient to El Cerrito? I would be picking between Richmond, Pinole, and Oakland. Pinole would perhaps be most convenient, but I have not been able to find many reviews of that office. All advice is much appreciated. nervous mama
I have heard from others who I work with who are also considering the HelathNet/Kaiser switch because of rising HealthNet prices.
I have been with Kaiser for almost 5 years. I moved from out of state with a three-month old baby. I had to get in to the Kaiser system within days of my starting work so my baby could continue to be seen on schedule, get shots, etc. Kaiser was fantastic. The patient office helped me find a pediatrician who could see her w/in a week. She was wonderful and was my daughter's doctor for her first three years (we switched when we moved and I had my 2nd baby).
There wasn't a step dropped when we moved into the system, and both of my daughters have had excellent care with Kaiser. Save your $$ for other things
We switched to Kaiser after 12+ years of our kids with pediatricians through various other insurance plans and have been very happy with Kaiser. I have zero complaints about the treatment, the availability or the level of care. My children now see different doctors based on gender and both have been terrific. The focus really seems to be on wellness care, but I have also found a willingness to support us in not pushing vaccines or antibiotics which is important for our family. Maggie
2005 - 2009 Reviews
Happy with Kaiser? I'm thinking of switching
Oct 2009
I am thinking of switching to Kaiser to save some money. I have never had Kaiser. When I was employed I had other health insurance plans and even since I have been self-employed for the last twenty years I have had HealthNet. The problem is that HealthNet keeps raising the premium every year. I am currently paying $435/mth just for myself and in December when I turn 45 it will go to $606 just because I will be in the 45-50 age bracket. It's killing me to pay these large amounts. For people who have Kaiser, how does it compare? I live in Hercules, so are some locations better than others? Thanks Scared to switch.
Yes, I've been a Kaiser member since moving to CA almost 4 years ago and I'm very happy with them. The biggest challenge is finding a doctor accepting patients who you click with. Once that happens, the rest is very simple and supportive of your health.
I live in Hercules too but my doctors are at Oakland. Partly because I work in Berkeley so its convenient for appointments, and partly because Oakland has all possible needs covered in one location. If you see your doctor and get referred, the specialist you need to see is in the same building or just across the street. Need lab work, ultrasound, etc? All taken care of in the same place and oftentimes on the same day. Even an on site pharmacy so your doc can order meds and by the time you walk to the pharmacy its ready to pick up.
Kaiser doctors don't have to deal with paperwork or preapprovals, so they're able to focus on care. My doctors are great at emailing me when I have questions, and fitting me in when they decide they need to see me. I've found Kaiser's philosophy to be on encouraging health as much as possible, so if you're interested in all the extras - classes, on line resources, etc, you can take advantage of them as well. Happy Kaiser member
I know you will hear a lot of mixed opinions here, but I love Kaiser - I spent most of my life with various PPOs that allowed me to see a fabulous pediatrician and then a great GP affiliated with Alta Bates. However, by the mid 1990's, they had stopped taking ANY insurance because of the hassle involved for them. That left me - even though I always had coverage - hunting every year for a new doctor or OBGYN, or God forbid a specialist, as there were constant changes in physician groups and Dr.'s accepting patients. I started getting my pap smears at Planned Parenthood because it was too hard to deal with hunting down an OB near my home or work with reasonable hours.
My first appointment at Kaiser was a same-day one I made because I was flu-ish and thought I was pregnant. I wasn't, but it turned out I had cancer (found during the routine breast exam during that appt), and because of the way that Kaiser is structured, I was scanned and biopsied within days, asked for and got a second opinion amazingly fast and was on chemo within weeks. I had fantastic doctors, nurses and caregivers who were kind and compassionate to me and my family, and have been in remission for 6 years.
I realize that everyone's experience is different, but in terms of whether or not I would have access to great doctors without the hassle of an insurance company getting in the way of my treatment, I couldn't say better things. Also, because I was on the pure HMO plan, the entire experience cost me about $20 out of pocket.
Honestly, I joined Kaiser because I thought I was going to lose my job 7 years ago and we could get it through my husband. Since then, I have seen the light - there are plenty of doctors to choose from at Kaiser, their profiles are online, and it's much easier to tell whether they have openings. You can do most everything online - schedule appts., refill prescriptions, e-mail your Dr. and get test results.
You are always going to be frustrated by health care the way it is currently set up in this country. Kaiser's system is different, and it has made a huge difference where it counts for me and my family. loving kaiser
Me and my family of 4 have been on Kaiser for last 5 years and I have had them before that. They have been great for us. I know there have been some negative stories but I think maybe they have improved? In any event. They are super convienient, good doctors, good system overall. They also have lot's of different programs now that make it affordable even if you're buying on you own. lisa
I have nothing but positive things to say about Kaiser Oakland. I felt a bit concerned switching from my Blue Cross plan but the people at Kaiser are extremely efficient, competent and warm. And if they're not, you have a mechanism to complain. Lisa R
We are former HealthNet members who are VERY happy with our switch to Kaiser. While we loved our pediatrician at East Bay Pediatrics, our employment changed and Kaiser was going to be a much better deal for us. I had misgivings about Kaiser, having been a member when I was a kid and young adult, back in the days when it did not necessarily always attract the best physicians. Well, these days, Kaiser seems to be the practice of choice for talented, caring physicians who really want to focus on patient care. I have two friends who have chosen to pratice medicine at Kaiser precisely because of the emphasis on patient care and the relative freedom from paper-pushing, insurance management hassles.
We've really benefited from the Kaiser focus on prevention and early intervention, the personal attention, the availability of advice 24/7, and access to specialists when needed.
We love, love, love our daughters' pediatrician, I adore my primary care doc, they are genuinely caring and really smart and thorough. We've unfortunately had to be high consumers due to a a series of illnesses, in my case requiring surgery, and my husband and daughter have had to see specialists for various reasons. We have had nothing but outstanding care.
Of course it helps to be informed, advocate for yourself, use the Kaiser website to find out more about the physicians and services available, but the training of the advice nurses and the doctors and support staff mean that very little falls through the cracks. I wish everyone in the country had a Kaiser level of care.
Oh, and we go to Kaiser Oakland, but have used the facilities at Richmond (which are excellent, but neighborhood is dicey after dark), and in San Rafael, Santa Rosa, and Walnut Creek - the latter three much more suburban/plush than Oakland, I suppose, but the quality of care does not vary. (And the nice thing is you can choose to go wherever you prefer...) =Big Fan of Kaiser =
In my opinion, Kaiser can work well for most people. It also seems to work well for really sick people, for example SF is supposed to be good for cardiac surgery. It also seems to work well for people who have been in the system from birth and are tapped into how to work the system and have good primary doctors. They have some truly excellent individuals at Kaiser. But if you are in the middle, if something starts to go wrong, and you don't have an excellent doctor, in my experience things can be maddening and worse, there is no where else to go. It may not be common, but after our bad experience we heard other bad stories, and you also can google them if you wish. We decided to leave Kaiser for a PPO. anon
I was a long time private insurance user who switched to Kaiser about 12 years ago. I have been very happy at the services we are able to get. Referrals to specialist are no problem. Like any other insurance or health care provider, you still need to be your own advocate. But our pediatrician has been great at helping us get services for our daughter even when the services are outside of the Kaiser system. I you live in Hercules, they have a new facility at Pinole which is brand new and has very good doctors who transferred there from other facilities. Juliet
i love love love kaiser! they always seem to keep impressing me! i have had them all my life, and while they werent the best when i was a kid their new ''thrive'' campaign for the last several years has really made a difference. i find all their doctors to be great, open minded and lovely people. i go to the richmond facility which is clean, and easy to park. it makes so much sense to me to have it all in one place and the fee policy is so simple, nothing to figure out. i hated when i briefly had blue cross that i could never figure out where to go or how much it would be that i ended up never using it. lovin' kaiser
Hi - I've been a Kaiser member on and off for many years. I am very happy with them. During the ''off'' times (always due to Kaiser not being offered by my employer), I've always wished I could go back to them. Maybe I've been lucky, I think Kaiser gets a really bad rap. I've always had great service, been able to get to the doctors I need quickly, etc. I like that everything I need is in one location and the records are shared across the departments. You can change doctors easily if you don't like the one you initially pick (you can shop around). You do have to advocate for yourself and, sometimes, be a bit ''pushy'' to get what you need - but I've found that to be the case with other insurance providers as well. I have used the San Francisco and Walnut Creek facilities. I'm not sure about other locations. Happy to answer questions if you have specific info you are looking for. jaia
Just had to chime in on the Happy With Kaiser bandwagon. I had Kaiser in the eighties and hated it. Hated the service, the hoops I had to jump through to get service, and most especially, I hated my doctor. Then, after being out of Kaiser for 15 years, I returned because that's what my husband's job was offering. I couldn't believe the difference. My non-Kaiser doc had just identified a breast lump about 6 weeks before I made the switch and I was in the midst of trying to get my Blue Shield PPO to approve the follow up tests and an appointment with a breast cancer specialist who didn't have anything available for months, etc. Everything was taking forever and I was freaking out. I switch to Kaiser, got to see the specialist the next day, walked downstairs to have the tests, etc. The lump turned out to be benign but the care throughout the process of determining that was amazing -- and fast. And they continued to monitor my breast health more actively for several years afterwards.
I love my own doc, my kids' pediatrician, and the fact that I can get referrals to services instantly. I had a weird arthritis like virus -- got occupational therapy for my hand pain. Need an eye exam -- walk over to optometry. Routine tests, here's your lab slip, go on over. So easy! And of course, the H1N1 vaccine is available to Kaiser members who qualify, while there are shortages everywhere else.
They are also open to alternative treatment including acupuncture (now available to Kaiser members).
The caveat -- you must find a doc you like. If you don't like your doctor, try another one until you find one you click with. Your primary care doc is your interface for everything else, so you must have someone you trust who will advocate for you.
Last thing -- I know a lot of Kaiser docs and they love working there because there's no insurance company breathing down their necks. A friend who does recruiting says it's easy pickings pulling docs from outside into the kaiser system -- they like that they can spend more time with patients, refer to specialists or for tests as they see fit, and never deal with paperwork. satisfied customer
Kaiser vs. Aetna or Blue Shield/Blue Cross
May 2009
Hi, My Healthnet rates are going up 25% next year and my company contribution is only increasing by 5% so I am considering switching healthcare plans. The other companies offered are Kaiser, Aetna and Blue Shield/Blue Cross and I am totally at a loss as to which one to go with! (and that's not even getting into the whole HMO vs PPO plans...) This is the first time I have ever decided to dive in and do the research (I've been lifelong Healthnet member until now) and I feel a little overwhelmed. I am leaning towards Kaiser since that is what my husband and daughter will be switching to later in the year, but I've heard mixed reviews. I would love to hear about experiences with the above companies to help me narrow down my options. Thanks! Joanna
Dear Joanna- I used to be VERY uncertain of Kaiser and somewhat smug about my insurance carrier allowing me to go to a nice private practice in Lafayette. That was until my grown daughter had emergency surgery through Kaiser. They literally saved her life on the operating table. I had always understood why my neighbors who were doctors went to Kaiser- reasonable working hours, all the office work left to proper staff, etc. But what I didn't understand until my daughter was saved was that THE BEST are going to Kaiser because they want to be free to do what they trained to do. The last straw for me was when my fancy private practice didn't have the flu vaccine available for three years running and I had to go down and sit for three hours at the public health clinic in Richmond to get immunized. Trust me you'll appreciate what Kaiser does- it leaves physicians to practice medicine and clerical staff to balance the books. Susan
Kaiser definitely has its problems--I hear about them everyday from patients at SF General who had Kaiser and were misdiagnosed, mistreated, etc. That much being said, any healthcare system is a giant bureaucracy and if your husband and daughter are going to be in Kaiser, it might be easier for you to be there, too. I have Kaiser--if anyone in your family gets sick, make sure you advocate for yourself, do your own research, etc. Try to find a doctor for each person that you really like--keep searching until you find that person. I did for my son, and it's made a world of difference. anon
We switched to Kaiser a few years ago, due to money concerns. I go to Kaiser San Rafael and my husband goes to Kaiser San Francisco. (I don't know about Kaiser in the East Bay.) We've been very impressed with the quality of care, and far more satisfied than we were under our prior PPOs. Most important is picking a good primary care doctor. Some reasons care is good: an outstanding medical record system (yes, it makes a big difference) and the ease of contacting your doctor. Plus you can ask the Kaiser nurse questions 24 hours a day--no more leaving a message Friday night and hoping to hear back before you expire on Sunday. Flu shots are free and prescription refills really easy. I'm glad we made the switch. Lola
I've been a Kaiser patient for about 25 years and definitely recommend Kaiser. Most of that time I lived in the LA area and had great experiences delivering both of my kids at Kaiser, received really good care for a variety of my family's health problems, had great experiences with different kinds of surgeries at Kaiser, and watched a friend in his mid 40s get excellent treatment after having a heart attack. No health care system is perfect and Kaiser does have its problems, but when talking to friends with other insurance I've found that I've had fewer problems with Kaiser and gotten the same and at times better quality of care. I've never had a problem seeing a specialist and when it's been important, appointments have been made quickly. I've found that the key is getting a good primary physician and developing a good relationship with that doctor. I moved to Oakland last year and chose a great primary physician and ob/gyn, partly thanks to great recommendations from BPN. !
My husband just had arthroscopic surgery on his knee and it was totally succesfull and it cost us $15!
The other thing to consider is that it makes life much easier if the whole family uses the same health insurance. That way you get to know that system, can share experiences with doctors and have your records in the same place. Reva
My family (myself, husband, 3yo, 10mo) are on Kaiser and we love it. We live in Rockridge so are close to the Oakland facility. I love that all the medical professionals and pharmacy are at one (albeit large) location. We've been with Kaiser for a few years and have been happy the entire time. We love our pediatrician and I delivered my 2nd son at the Oakland hospital - great experience. I love the investment Kaiser makes in technology - I can email my docs and they all respond within 24 hours. When my youngest had a medical issue that required specialists they could all pull up his info quickly and even view the ultrasound test/videos online. Highly recommend. loving Kaiser
Kaiser HSA Plan
May 2009
I have not had Kaiser as health care provider, nor a HSA before. This plan seems to be a better financial option than a traditional HMO. Is there a disadvantage in terms of coverage (services) to it? Please let me know, if you have experience with this kind of plan - positive and negative. Elisabeth
I've been a Kaiser member for years and recently signed up for their HSA. I had done a lot of reading about HSAs, and given the medical system that we have, it seemed to make sense financially, especially since we're a pretty healthy bunch. Kaiser also has an arrangement with Wells Fargo as the custodian for the funds, which appears to be a good deal in that WF doesn't charge a maintenance fee--other institutions do. You get a WF debit card and you can use it for other medical expenses.
As far as care, there's no difference, but it's not always clear what you have to pay for and how much. So far in my experience, you do not pay for preventative care--basically annual checkups and mammograms. But lab tests can add up, and I wonder if the doctors have been told that some members are now paying individually for these tests. For example, a battery of lab tests used to be $10, but now I pay for each test separately, which added up to about $250--surprise, surprise because I was sent a bill rather than pay before the tests. I think some of the billing issues are because the program is relatively new at Kaiser. The staff is not fully informed on all the payment rules and it's such a different model from what they've been using, but those problems could change with time.
As far as Kaiser in general, as for any plan, you want to find doctors that you like--and Kaiser has a lot of good ones (I've been pleased)--and then be a squeaky wheel if you need to get your problem escalated. I do really like the ability to make same day appts (even on weekends, so no emergency room), especially in pediatrics, and the advice nurses who are available beyond 9 to 5.
Kaiser high deductable HSA plan - confusing!
April 2009
My husband has been self-employed for two years and we have had the high deductible HSA insurance plan with Kaiser. In the last year, he has had numerous medical issues such as bad back, eye problems and infections. Needless to say, it is making a dent in our tight budget!!
My question is regarding billing and/or reducing our bill. First of all the bill is so confusing! I have no idea whether we are being charged correctly or not. There seems to be an arbitrary amount for an office visit, for example $540 for an opthamological exam. Then, an adjustment of $100 (which he paid at the time of the appointment); then ''Contractual adjustment'' amount of $370. When he went for a second opinion regarding his eyes, we were charged a different amount: $170 for the office visit then another $300 for ''visual field exam'', again with all sorts of contractual adjustments.
I have several pages worth of these line items, charges and adjustments. I haven't paid the most recent bill yet until I get this figured out! How do I know that we are being charged correctly? How do they come up with these seemingly random amounts? I have never seen a list of ''prices.''
My second issue is whether there any way to get some of these charges reduced? A friend has told me that HMOs will bill their High Deductible members (i.e. mostly out-of-pocket) more than they would charge members who are covered by their employers.
Is there some way to deal with all of this that I don't know about, i.e. seeing someone in Member Services or calling a certain department? Please help!
Thank you!!
P.S. We had Kaiser when my husband had insurance through his previous employer and we were very happy with it. Of course we never saw a bill, just paid the $15 co- pay for each visit. So I don't have a problem with the medical care, just the insurance part of it. --dazed & confused about Kaiser
Funny you should bring this up. I called Kaiser this morning about my latest bill. I have to do this practically monthly--- you're absolutely right, the bill is pretty much impossible to decipher even if you're college educated and good with numbers! I can't imagine what they're thinking. Today I suggested it would be far easier for me to be checked in for the appointment and charged nothing, and then receive the correct charge in the mail, rather than a perfunctory charge which is then manipulated up and down before I finally get a piece of paper telling me what I still owe. So far they have not made a mistake, but I, like you, want to be able to understand and approve the billing before paying it. It also irks me that they have no idea what the real charge will be at the time of service. A doctor once wrote a prescription for my daughter that would have cost over $3,000 with no warning that it was expensive. It was only because I was concerned about side effects that I found out the cost. I was contemplating a minor surgery and was given a very broad price range but no one could tell me how much it would really cost for the surgery, anesthesia, day in the hospital, etc. I wish we could pass our comments on to Kaiser (anyone listening?) and get their attention. heidi
Here are some very general guidelines from a medical biller: - An examination, an injection (including the injectable and the administration of the injection), an office visit - all of these are procedures and are likely to be billed.
Some procedures have levels of complexity that are billed at different rates: e.g., a visit for a cold is less complex than a visit with multiple complaints, injections, diagnostic procedures, etc. All procedures have criteria of medical necessity that the doctor must document as they are subject to audit. Each specialty will have a different set of procedures that they bill. Variation in charges can result from differing scopes of examination, differing procedures being performed and different contracts with insurance companies, in-network vs. out of network status, your being a new vs. established patient, the visit being a consult vs. an office visit. There are a hundred variables. If you have questions, ask their billing person.
- Every doctor and every practice has contracts with a number of insurance companies (with the exception of Kaiser doctors who are generally contracted exclusively with Kaiser). Each contract has, among other terms, a fee schedule that defines what each doctor agrees to accept as their fee for particular procedures. If you see someone who is not contracted with your insurance, then they are considered ''out of network'' which can subject you to higher out of pocket costs. Say your doctor bills for a moderate complexity office visit. They bill insurance $200. The insurance company would allows the contracted fee of $125 and the doctor writes off the $75 difference as an adjustment. With a high deductible plan, you can expect to pay that $125 until your deductible is met. Some procedures are considered bundled and so the doctor may write off the entire amount. Other procedures may not be covered at all and you can expect to be billed for that. A given doctor will have the exact same allowed or contracted amount for a procedure whether the patient has a High deductible or no deductible plan. You pay more because you have a higher deductible. - Most coverage definitions, exclusions, coverage levels, copays, co-insurance, etc. are outlined in your policy summary. It is your responsibility to know what your coverages are. - If you don't understand your bill, call the number on the bill. That's part of their job. A Medical Biller
I am an employee at Kaiser Permanente as well as a BPN subscriber. I'm very sorry that you are having difficulty with your deductible plan, and wanted to offer some suggestions: 1) Call this number for assistance to walk through your bill and get explanations of charges: 1-800-390-3507; 2) To help estimate the costs of services that are subject to a deductible in advance, you can see a sample fee list at http://www.kp.org/treatmentestimates; 3) If the service you need is not on this list, call 1-800-390-3507 and a representative will help you estimate the cost of service before your appointment. Finally, if you need help paying for your medical services, you may be eligible for Kaiser Permanente's Medical Financial Assistance Program (MFAP). You can get more information, including an application, at http://www.kp.org/mfa. I hope this information is helpful to you.
Affordable Kaiser insurance for self-employed?
Jan 2009
Can anyone advise me on getting affordable Kaiser insurance if I'm self-employed? Up to now, I've been covered under the Cobra and Cal-Cobra plans but those options have expired and I need to apply for my own coverage--are there any umbrella groups for self-employed individuals with families that offer cheaper rates? I've heard Costco, for example, offers group rates but I'm not sure they offer Kaiser. Any info would be greatly appreciated! anon
I haven't heard of any umbrella groups for Kaiser, but Kaiser offers many different types of plans for individual/families. Just go to their website and type in your info for quotes on their plans. You can choose from a lower monthly with a deductible or a higher monthly with low co-pays and no deductible. It just depends on your needs. anon
Hi - did you check the Kaiser website? I was just looking at it myself last week, for my 23-year-old son. There are a lot of different options, and they tell you exactly how much everything costs. You can add on dental and/or vision, too. The Kaiser website is really the best source of information for this. Did my homework
You should just go online at KP.org and look at the various plans available for your age group. My husband is self employed and adding him to my employer plan was costing us over $500/month for Kaiser. He signed on as an individual for $330/month for very similar coverage. I don't know what their turn down rate is, my husband had been a Kaiser member on my group plan and they knew he rarely had been to the doctor but had outpatient surgery about 18 mos. prior to his signing on as in individual and it went through with no problems. been there
In my opinion, Kaiser is the best ''bang for the buck,'' plus I like the one stop shopping when I have multiple appointments, looking up lab results on line, etc. If you go to their customer service, I think they can give you a quote and comparison of their plans. I have been working with a very nice consumer advocate for health care who can help you with a comparison of most plans. If you ended up buying a plan through her, it is apparently the same price as what you would pay direct with Kaiser (so they pay her a commission, I am guessing). Her name is Claudia Burtis, 408-353-6871. Please tell her Kathryn Levenson (AFLAC) referred you. kathryn
Blue Cross HMO or Kaiser
Dec 2008
We need to choose a new health care plan from my husband's new employer- we have two teens. We're switching from a PPO that gave us a lot of freedom, but not without cost. One option, Blue Cross PPO, seems unpopular/inflexible from notes here and Berkeley Pediatrics where we've gone for many years doesn't take them. What about Blue Cross HMO? Most of our doctors are on that plan. The alternative is switching to Kaiser. Advice comparing the two would be very helpful.
I would definitely sign on for Kaiser coverage. I have been a member of Kaiser since birth and as an adult I have had other health coverage in addition to my Kaiser coverage. I greatly appreciate the ease and freedom of my care under one roof. Vs. needing to find a physician that I like and that takes my current insurance. Finding a physican you like is important, and it is easy swapping primary care doctors during your time at Kaiser if need be. Getting labwork and diagnostics is simple, as they are all in the same location, even vision care with great benefits. We currently go to Kaiser Walnut Creek, a beautiful facility, and we have chosen adult medicine doctors and pediatricians to our liking. I respect that Kaiser invests in preventive care measures. Putting the power of good health first and foremost in the hands of the patient. Kaiser is great. A happy Kaiser patient
I haven't used Blue Cross HMO, but I have to say that I'm a huge Kaiser fan. No figuring out crazy bills, everything's in one place. You just have to find doctors that you like (and there are many to choose from and they're not too hard to get appointments with). Communication is easy (e-mail, etc.). Once you get used to the system, it is super easy to use and I've been very happy with them. Good luck! Kaiser lover
Forced to switch to Kaiser
Nov 2008
Due to state of medical insurance in our country we are forced to switch to Kaiser. Does anyone have good rec for pediatricians (I need a male and a female), a gynacologist, and a primary care doctor. I've always been scared of Kaiser, but have heard its fine as long as you find a good doctor. Any ideas? worried
Forced to switch to Kaiser? Wow, that's something I haven't heard in a while. I had Kaiser as a child, switched to private insurance as an adult and now have been happily back at Kaiser for 7 years. We (husband and two children) have had an amazing level of care, love our doctors and had nothing but top quality care from specialists we have seen. In my opinion, you are lucky to have Kaiser. anon
I actually LIKE Kaiser. Everyone is in one place, there's ample supply of docs (you can try out different people without any hassle or worry about records transferring). The specialists are on-site and you don't have to go researching like crazy for recommendations for good ones or haggle your policy/type of insurance, etc. You have to learn the system for sure but once you do it's reliable and predictable. My son was diagnosed with a debilitating and life-threatening condition at Kaiser Oakland and I swear by those pediatricians. The pediatric specialists are all exceptional top to bottom (and believe me, we see them all!). Happy and healthy at Kaiser since 1975
I think Kaiser can be fantastic if you have good doctors. Certainly no more of a pain than regular insurance! Good luck! anon
Kaiser Insurance While Out of Country?
Oct 2007
Has anyone had Kaiser insurance and needed to use it while out of the country? I am writing to find out whether you were able to get the medical care you needed and whether it was reimbursed. We have the option of continuing Kaiser through Cobra while in South America and are unsure whether we should or whether we should just get travel insurance. We will be gone for 6 months. Thanks. anon
I didn't need to use it, and maybe you already know this, but before I traveled to Europe 2 years ago I got a packet from Kaiser that explained how to use it abroad and contained forms. Cece
I know this is not exactly what you were asking, but I highly recommend emergency evacuation insurance for an extended stay in Africa. We lived in Uganda for 18 months (original commitment was only 6 months, so beware ''African time''!). I had an ectopic pregnancy and had to be emergency airlifted to Kenya (ruptured en route). It saved my life. At the time we had Blue Shield through Mass. General Hospital (which covered our medical bills). Can't speak to the Kaiser issue. scjones sarahcjones [at] mindspring.com
Kaiser insurance worked for us in Paris, where my husband nearly lost consciousness in a restaurant two years ago. We went to a private hospital - the American hospital in Neuilly - and paid them there for treatment. Kaiser reimbursed us, I think in full - anyway, the major portion of the bill, relatively quickly, when we got back. But you will be gone for 6 months, and that is a different deal! Happy Kaiser member - so far
Fortunately we haven't had to deal with a medical emergency while out of the USA, but we have experienced administrative issues with Kaiser when we have needed information from them. For instance, I did not realise that my husband and I had to have separate logins for the Kaiser website and I incorrectly assumed that I could view both our profiles when I logged on to their website. At the time, my husband needed proof of medical insurance for a visa while we were out the country & Kaiser REFUSED to fax us the information to an international number because it was against their policy. We were able to make a plan with the help of some friends in the USA (lots of expensive telephone calls at strange hours due to time differences). I thought it was very short sighted of Kaiser. We do much travelling to Africa and emergency evacuation and medical treatment would cost a lot of money - probably way too much for us to pay out of pocket before submitting a claim to Kaiser. I am thinking of switching to a more internationally friendly medical plan. Frustrate with Kaiser Admin.
After being a happy Kaiser member for 22 years, a recent experience has made me feel the need to warn others about their ''out-of-area'' coverage. My daughter is a first year college student - she was injured this summer and her Kaiser docs said that she would need follow-up in the fall (and wrote this in their notes). They were aware that my daughter would be out of state and said that she just needed a referral to get treatment at school. So we were pretty shocked when we later asked for the referral and they refused. We have appealed this decision at both the local and regional Kaiser level and it is now before the Independent Medical Review Board in Sacramento. The docs at Kaiser are now lying to cover themselves, saying they never talked to us about an out of state referral, etc, etc. So Kaiser's deal is: if you have an emergency ''out-of-area'' they will pay. If you break your leg the day before your trip, or are diagnosed with a disease and need follow-up, they will not cover it. It doesn't matter if it is medically necessary or if your doctor has recommended it - they will not authorize it. If anyone at Kaiser suggests that they will, get it in writing. They are, very unfortunately, looking out for their bottom-line and not always for their patient's health and best interest. And trying to get the truth out of them has been a bureaucratic nightmare. Talk to someone in member services before you go on your trip and make sure you understand what will be covered.
2004 & Earlier
Changing from Kaiser to Blue Cross PPO
January 2004
We are considering changing our health insurance from Kaiser to a Blue Cross PPO plan with a high deductible. Kaiser has raised our premiums quite a bit, and we would save a significant amount of money on premiums if we do. I wondering about people's experiences with Blue Cross, if they are able to find providers and if they have had trouble with getting medical services approved. I have looked on the website and have not found info about Blue Cross. Thank you
We learned to avoid Blue Cross --even the PPO -- when we discovered how many doctors wouldn't accept it, and how many were closing down their relationships with Blue Cross. For years now, we have had the Blue *Shield* PP0, with a high deductible. Many doctors take it and we have had no problem getting approvals for what our docs want to do. anonymous
We have had Blue Cross through my employer for the past two years. Prior to that we had Blue Cross through my husband's employer. Know that every blue cross plan is a little different. So, for example, doctor's visits that are completely covered under my current plan were not necessarily covered by my husband's. Your best bet is to look at all the small writing in your plan proposal and to call their customer service department with specific questions. Try to predict what you might need to have done and ask if they will cover it. For example: ''Will you cover an ultrasound for my 20-week pregnancy check-up?'' ''Does your prescription plan cover all drugs prescribed or only those prescribed by my primary physician?'' ''Can I see any physician on the list or do I need to get approval from my primary care doc first?'' Good luck
I have the Blue Cross PPO plan with the $2000 deductible. I have an individual plan; I don't know if it is better with a group plan. I wish -- oh how I wish -- I had switched to Blue Shield before I got pregnant. Blue Cross PPO pays very poorly to pediatricians and so a bunch of very good Berkeley pediatricians won't take BC PPO. I've not had any problems finding physicians for me -- OB, oncology, etc. -- that take BC PPO. Good Luck
I've done benefits for many many years. The really short version is, a PPO plan is always a good idea if you want flexibility in your choice of doctors and services, but you will have to pay some part of the visit or service depending upon the PPO (i.e., 100% innetwork/80% out, etc.). I'd say Blue Cross is fine, they have some of same annoying internal procedures as any other PPO. Just be sure you follow the plan summary and pick physicians in the Blue Cross network for maximum coverage. The good news is, you'll notice when you make an appt at a physician's office, the clerk will perk up when you say PPO instead of HMO. sharon
You may remember my posting from a couple months back when my husband's company dumped our carrier (HealthNet) & had to choose between Blue Cross HMO, Blue Cross PPO & Kaiser. After reading all of the helpful responses & asking around, we signed on with Kaiser & are SO-O-O-O glad we did!
What's right for you probably depends on your situation. If you're young & healthy & don't have any prescription medications, don't visit the doctor very often, don't have kids AND/OR you have specific doctors outside of Kaiser whom you know & trust & really want to work with, then Blue Cross PPO could be a good choice, since most doctors in the area seem to accept the plan. Back when my husband & I were young & self- employed & didn't have kids & couldn't afford anything else, Blue Cross PPO worked out great for us.
But overall, I recommend sticking with Kaiser. The monthly savings on your premium may not be worth the higher deductibles, copayments, & costs for prescription medications if something changes in your life like a pregnancy or the onset of some other condition that requires more doctor visits than you were counting on.
Also, if you're used to the way Kaiser coordinates your medical care, keeps track of your medical records & prescriptions, & generally has basic stuff like flu shots in stock so you can just walk in & get one, etc. you might find other Healthcare providers to be a major hassle. Unless you know a doctor around here, picking a primary care physician is like closing your eyes & randomly pointing to a name in the yellow pages. In my experience with other healthcare providers, including Blue Cross, Aetna & Healthnet HMOs & PPOs, the right hand never seems to know what the other hand is doing or what's covered & what's not, etc.
Good luck! Elisabeth
I've had a Blue Cross PPO on and off for 15 years or so and it's worked well for me. They've covered a few knee surgeries and the associated bills without any problems. Currently, I have a Blue Cross PPO plan through work. My wife was insistant on a PPO plan (rather than Kaiser or an HMO) so we could go to any doctor we wanted. We've had no problems with choosing/finding doctors and services. No problems with getting procedures approved (like sonograms and other baby-related tests). They even cover a few visits for accupuncture each year.
A few caveats, however. Double check to see if the doctor(s) you want to see accept Blue Cross. For example, the doctors office I've been going to for years (Alta Bates Medical Associates in Berkeley/Orinda) does not accept the Blue Cross PPO (at least as of my last visit a few months ago). This means I must pay for services up front, then get reimbursed from Blue Cross at their rate, which means more out-of-pocket expense to me than just the co-pay.
Also, take a close look at the fine print. Look at the exclusions to make sure you're covered for everything you want to be covered for. Also, you will have a co-pay each visit, and a deductable up to a point, and a portion of the bill after that. Look at your typical demand for medical services in a year and figure out your total out of pocket expenses. Frankly, I'd be surprised if it was less than Kaiser's total cost (at work, Kaiser's monthly premium is a few hundred dollars less than the Blue Cross PPO with a 2000 deductable). For us, the choice and flexibility of the PPO is worth the cost of the PPO. Bob
Blue Cross has seemed to work fine for me. I've had it for about 5 years and they have always been right on with payment for any treatment that i've had. There are a few caveats to this: I have an HMO which Brown & Toland manages. I have had more problems with Brown and Toland and none to speak of with Blue Cross. I can use a vast array of doctors, many of whom are excellent and very caring practioners. good luck
Kaiser v. High deductible PPO
Feb 2003
Anybody out there had experience with a high-deductible health insurance policy? My husband and son need new insurance (we just had a terrible experience with Alameda Alliance that left them uninsured for two months, without our knowledge) and we're trying to decide between a Blue Shield high-deductible plan, coupled with a medical savings account, and Kaiser (I'm covered by SHIP). The deciding factor is whether they can expect to meet Blue Shield's $3400 deductible and/or the $5000 yearly out of pocket maximum (including premiums, the most they'd have to pay per year is about $7400). My son is 15 months old, and has had the usual ear infections and colds, but no major problems. My husband is also relatively healthy. How much have other families typically had to pay in a year? Do you hit the max? The information on the archives specifically compares a high-deductible plan to a high-priced HMO, but how do the yearly costs of such a plan compare to Kaiser's ~$330/mo? Thanks for your help. Katy
In our family, my son and I have the high deductible Blue Shield plan and my husband has Kaiser. We've only been doing this for eight months, but so far the Blue Shield plan is cheaper. My son (age 3) has gone to the doctor exactly once (knock wood) for his well-child visit. I've gone a few more times than that, and just had to pay for an x-ray out of pocket ($200) but that still doesn't bring me close to reaching the deductible or the cost of Kaiser. The savings vs. Kaiser are modest, but even if the costs were identical I'd probably choose to go with Blue Shield because I was never happy with Kaiser when I was there. My husband, on the other hand, has always liked Kaiser and since his health requires a bit more intervention and an expensive prescription drug, it made sense to go with them. If you go the high deductible route, make sure to find out what your doctor and pediatrician charge for office visits. There are huge variations -- one doc I saw charged $145 per visit, my current doc charges $45. You should explain that you're paying cash, and ask if they offer discounts to patients who pay at the time of service and thus don't have to be billed. Many docs do and those who don't should (to read about this approach, visit www.simplecare.com). nelly
We have had the $2000 deductible Blue Shield plan for the whole family for about 8 months. For my 1 year old son, my husband and I the premiums are less than $200/month for medical and dental. We have had to pay a co-pay of $50 for every well-baby visit and a co-pay of $10 for prescriptions and that is it. They even pay for half of a prescription that my previous Blue Shield HMO plan didn't cover at all, which saves us an additional $65 per month. We are pretty comfortable with the choice, and are working to have a back-up fund to cover the deductibles in case of a serious medical problem, but we are all pretty healthy and so we expect to not have to worry about it. If there was a serious problem, most hospitals would set up a payment plan so we would not have to pay a huge chunk of money all at once. I believe it is worth it for the lower premiums and much greater choices in doctors, being able to keep my son's pediatrician and all of our own doctors. I guess it is somewhat of a gamble, but we are saving so much compared to our old plan (which was about $585/mo!!) that we decided to take the risk and bank the difference. Laura
I've had both a high deductible PPO plan and a Kaiser plan and personally preferred the PPO. High deductibles are best if you can afford the monthly fluctuations in medical expenses, and medical spending accounts help smooth that. There is no need to ''insure'' regular and expected expenses like well baby care. However, I would caution you that most PPO plans have a lifetime maximum while HMO plans do not. A maxium of $1 million is typical and believe me, is easy to hit if something catastrophic occurs. I've been there. insurance wise
Go with Kaiser.
Initially I had some reluctance to sign up for Kaiser imagining I'd get little more than substandard treatment and impersonal service. Instead we opted for a high deductible health plan. BIG MISTAKE.
While my husband and I were both healthy it was fine (ie until we had to go to the doctor). There are routine visits that should have been covered from 3 years ago that Im trying to get the company to pay for. Over the course of this time premiums have increased and coverage has decreased. We've gone from paying 30% out of pocket to 40% out of pocket.
But when things really became a problem was when my husband developed colitis. Now not only do we have to pay huge deductibles for expensive procedures, we're stuck with this plan. Unless we lie about this new ''preexisting condition'' no other insurance will cover him.
Im still healthy and managed to escape to Kaiser and I couldn't be happier. I get full service coverage for a flat rate that wont change if I develop a chronic problem. The care has been amazing, beyond what I ever got from a private physician. anon
Kaiser v. Alta Bates PPO
November 2002
It is open enrollment time and we need help deciding between staying with Kaiser care or changing to a PPO that would place us in Alta Bates if we were hospitalized. We have long been with Kaiser but we were very disturbed by how Kaiser treated my parents after they became ill (one with cancer and the other with Alzheimers). The care at Kaiser Oakland was very poor. I realize this general subject has been covered before but mostly on birthing and outpatient care. Kaiser is clearly convenient. But I am wondering about people's experience with hospitalization and more serious illnesses. Thanks!
I'm a Kaiser member and usually use Richmond Kaiser. The few times we've needed emergency care at Richmond and Oakland we have been taken care of immediately (my kids, and myself). I've heard other nightmare stories about people waiting and waiting. We've NEVER had to wait in emergency or when I needed an urgent care appt in Richmond. I once had an extreme emergency...an eye injury. In Richmond they sent me immediately to Oakland where the optholmologist was waiting for me...this was a Sunday evening. The waiting room was full and I was taken right in. The Opth. never rushed us.He treated me with care and compassion and assured me that I wasn't going home till he was satisfied that my situation was improving.Over the next month I was there a lot having my eye checked. Ultimately I had surgery.. I was assured the eye surgeon was the very best...I felt well taken care of and listened to. The surgery was a success. The nurses were absolute angels.
I think part of my success at Kaiser is being a bit pushy when I call for information or appts. If you wait for them to ''get back to you'' it may not happen. It's a frustrating system to work with sometimes...who has 1/2 hour to sit on the phone?, but it's worked for us. I ask a lot of questions, ask for referrals, ask who is best for what I need and I don't back off. (I do this for general appts and info, not when anyone is in an emergency situation). My biggest frustration right now with Richmond is that I'm trying to switch doctors to one in Women's Health Care. About 5 or so of the Drs. I requested are not taking new patients.
Recently my husband tore a tendon in his rotator cuff. Going through Richmond meant waiting, getting no answers and more waiting. We called a friend who is an OB nurse in Oakland...she referred us to someone in Orthopedics....my husband was seen the next day and had an MRI a week later (as opposed to the 3 weeks away appt. in richmond).
So, I guess part of what I'm saying is you have to learn how to get around in the system. Knowing someone on the inside is really helpful. Good luck, you may need it. I have no experience with Alta Bates but I have heard both good and bad stories about them as well. (Maybe more bad stories lately). June
I have been in Alta Bates twice, once for the birth of my daughter and once a year before when I was an inpatient for 2.5 weeks. I have to say that both times I was quite pleased with Alta Bates. I had major surgury there and I felt that I got excellent care by the nurses and staff. However, I think a lot depends on your docter. The thing you might consider though is the cost. I also had a PPO that paid 80% of my surgury, etc. I had a hospital bill (including all procedures and docters bills) of about $150,000 that I ended up having to pay about $4000. This is different than the Kaiser system, where you would just have an inpatient copay. However, all said it was worth it for me and I didn't have to deal with the red tape and hassle that Kaiser is famous for. karna
My husband just spent nearly a month at Alta Bates with complications of a gall bladder surgery, and I've had three babies there. What I can say unequivocally is that Alta Bates is a great place to have a baby. For general medicine and extended stays, I think we have a more mixed review.
The Emergency Room is, in general, a snapshot of hell. Rick entered the hospital both times through the emergency room, and it is a very busy place with a very wide range of ailments and clients served. He ended up waiting nearly eight hours the first time, mostly because he was quiet, once medicated, and didn't have an advocate. To be sure, he was not imminent danger from a gall bladder attack. I observed on arrival there that they were very busy after a friday night in Berkeley... There was a client screaming in one corner, and a naked woman walking through the ER. He got admitted to the hospital within about a half an hour of my arrival. Lesson #1: Bring an advocate to the ER. The second time, I went with him, and he had been called in ahead by the surgeon and was *really* sick (jaundiced, beginnings of peritonitis). He still ended up waiting about an hour in the waiting room, until I asked the triage nurse what we should do if he fainted in the waiting room. They then found him a gurney in the hallway. They put an IV In his arm and sort of left it, and it ended up backing up, which was very scary. It was a particularly busy day, Veteran's Day, so some of this is understandable.
He got a reasonably nice room, by himself for the first stay of five days, sort of the luck of the draw. The second longer stay, he had two different roommates, one a very nice man, the other in later stages of dementia, so difficult. The nursing, by RN's on the whole was good, though they were very understaffed. We saw this in the length of time that it took for him to get pain meds... Often 45 minutes would go by before he would get them after a request. Unfortunately, AB is staffing difficult to staff shifts not with their regular, quite high quality nurses, but with registry nurses who are unfamiliar with their procedures, and don't always have much of a stake in taking care of the patients as they might. This was particularly evident at the 12-8 shift. I got several calls from my husband in the middle of the night after he had called for help unsuccessfully from the nursing staff.
Much of the routine care is done not by the RN's but by the medical assistants/lvn's. In this group there is a very, very wide range of skill and motivation. There were some very lovely and dedicated women who clearly cared deeply about their work and carefully came in and checked that everything was allright, emptied his bile bag and urine bottle quickly and carefully. There were some very inexperienced and less dedicated ones, who did not. For some one who had an increased sensitivity to smell, the urine bottle sitting on his bedside table for more than an hour was a big problem, especially when he was supposed to be trying to eat.
Other things we noticed as a problem: 1) Cleanliness: I don't have very high standards, but every day in the room, I would be cleaning up. I cleaned up bile off the floor nearly every day. I picked up bits of medical waste (bloody bandaids, tops to syringes, etc) off the floor every day. The bathroom was not cleaned once in the whole time he was there (nearly a week in a room shared with another elderly gentleman), except for the times I cleaned it.
2)Transport took an inordinate amount of time nearly every time that he used it. After his last procedure he waited nearly two hours in recovery for transport, despite repeated calls by the nurse manager on the floor, the nurse, etc. The surgeon finally took pity on me waiting in his room (long after day care had closed) and went and got him herself. Once during a radiologic visit, my husband finally decided to leave himself, since he had been waiting for an hour and had visitors waiting for him. They are just too understaffed in that area.
3)Poor coordination of care. This is something that I think Kaiser does very well, and Alta Bates has more difficulty doing. Each doctor was an independent contractor. My husband saw a surgeon (Catherine Forest), a GI guy (Narayan) and a radiologist. The doctors didn't always communicate well, and there were some real issues that came up as a result of that. There was no standard protocol, which Kaiser definitely has. The Radiologist wasn't an employee of the hospital and had to be called in to do a test on a Sunday. The test had actually been ordered for the day before, but they couldn't get anyone in. He also found himself in the hallway on Sunday morning hearing the radiologist say ''I don't have time to do him today, you techs can do that''. Not exactly what he wanted to hear.
In any case, my husband came home, and is improving. Of course, he had an infection that had to be treated, a not unusual thing to happen after a stay in the hospital. So, I guess alls well that ends well.
I have some opinions about the care of the doctors, but it's not relevant to the particular question being asked. Myriam
Kaiser v. Healthnet
July 2002
My family's been using Healthnet for the past couple of years, and like our doctors, but we're considering switching to Kaiser since Healthnet's costs are going up (my employer would cover us 100% for Kaiser; Healthnet would cost us an extra $300/month out of pocket, which isn't impossible for us, but not easy either.)
I've read the archive posts on this subject, but they were scanty and a bit outdated. I'm particularly eager to hear from people who've *recently* gone through pregnancy/childbirth with Kaiser, especially anyone who had a high-risk pregnancy and/or who had a c-section.
One of the archive posts said pregnant women see rotating nurse practioners instead of their own doctor, and are delivered by residents. Is this true? Can you still deliver at Alta Bates? Do Kaiser doctors cut corners in terms of more expensive tests or procedures? Are all the ''good'' doctors unavailable to new patients?
I've heard some scary things and don't want to put my family's health at risk, but we could sure make good use of an extra $300/month (like getting some housekeeping help!) Thanks for any input, positive or negative!
I don't know how helpful this will be to you, as my son was already 15 months old when we switched from HealthNet to Kaiser... but I am *very* happy with the switch. My only regret was leaving our wonderful pediatrician here in Alameda (and now Kaiser has a small office & pharmacy here!).
I have had no problems with doctors (got several recommendations first), appointments, and tests. The lines for the pharmacy can be long, but there are other, smaller pharmacies you can use, and the refills-by-mail are easy and convenient.
I've been very pleased. I'd be happy to answer any further questions privately. Jennie
I have had Kaiser since I was a child and highly recommend it. I had a baby last year and while I have other (very premium) insurance through work, I have paid for Kaiser out of my pocket b/c I am so familiar and happy with it and wanted to have my baby at a Kaiser facility. I didn't have a high-risk pregnancy but did have a few things come up that I was immediately seen and treated for. I saw an ob/gyn in Hayward throughout the pregnancy but decided to deliver in Walnut Creek after touring WC, Hayward and Alta Bates l I actually was admitted for false labor to Alta Bates and felt my care was outstanding but when I went back for the actual tour, it was packed and chaotic and Walnut Creek was more appealing (although I would have felt totally confident to deliver there). When I went into labor, WC was very busy and chaotic but I was taken wonderful care of. They welcomed my doula and lots of family too throughout the loooong labor. I know there are a lot of Kaiser bashers out there but I have to say, I have had good and bad experiences with other health plans and doctors over the years and find that Kaiser is simple, cost-effective and caring. When I have been unhappy with a doctor, I simply switch, just like I would on any other plan. My mother had some health issues that stumped Kaiser drs. and her test results were sent to Stanford for further analysis. I have never felt short-changed or that doctors were trying to curb costs in all the years me and my family have had the care. I decided to test my other insurance out and have a private pediatrician for my baby. While I love him and am very happy with her care, I do miss not being able to show up in a same day urgent care clinic like I could at Kaiser for the occasional ear infection. I would be happy to talk to you if you have other questions Nicole
I have positive and negative things to say about Kaiser.
When I was a Kaiser member, I saw a nurse practioner every other time. I liked my doctor and my nurse practitioner so that wasn't a problem. The NP can spend more time with you. I live in Fremont and had all my appointments there. With my second pregnancy, there was most definately more visits because of eclampsia. They monitored me very closely.
As far as I know, if you belong to Kaiser, you deliver at Kaiser. You also get whatever doctor is on call when it comes time to deliver. As for cutting corners, I have a lot of negative nasty things to say about Kaiser, but maternity and birth are not included in them. When I was finally able to get out of bed to go see my baby, I had to grab the wall for support due to dizziness. They made me stay another day because the nurse told my doctor. The Hayward hospital where both of my children were born had the highest infant survival rating in their NICU at the time my daughter was born. They took excellent care of both myself and my daughter. I was there for two weeks, my daughter for four. There was nothing lacking in maternity. In Fremont, Dr. Coplan was my pediatrician. He was also excellent and good with the kids. Kaiser excels at babies and kids.
However, adult care is not as good. A lot of the nurses do not have English as a first language and don't communicate well in it, a fact that can really disillusion you if you speak English as a first and only language. It isolates you more in an already isolating situation. My mother-in-law died while in their care due to their lack of care. The injuries she came in with were not life-threatening, but their care gave her life-threatening conditions which killed her in 19 days, all while under their ''care'' (care being they'd rather clean up the bed when they have time than take the time to walk you to the bathroom). Their excuse was it was the wrong time of year to get sick (two days before Christmas she fell and broke her shoulder). They tried to make us take her home without even seeing if she could stand up on her own (she couldn't) or finding out why she fell in the first place. Once we proved our point they were forced to keep her and then promptly farmed her out to a cheaper facility after being exposed to pneumonia. She already had symptoms and we told them so, but they said everyone had those symptoms. They ignored us, told us we would be responsible for the bill if we interfered. We found a place close by and they said they had room, but Kaiser intervened and said they had no room. They refused to place her close enough so we could visit her every day. The place they sent her to was three hours away one way, too far for us to check on her progress everyday. The care there was no better and she ended up in a coma on an ambulance in the middle of the night to Oakland emergency (We refused to let her go back to Hayward). By the time she got the care she deserved at Oakland, it was too late. She was so septic her body could not fight the infections. My mother-in-law died for the price of a hospital bed. And then they turned around and tried to bill us for morphine shots alledgedly given to her three days after she died. That went on for several months before they didn't dare call us anymore. So that's the bad story.
As for ''good'' doctors, it all depends on your personality. My doctor has since retired and I am no longer a Kaiser patient. I stopped seeing them since the death of my mother-in-law. If all you are looking for is for your kids and future babies, by all means find a good Kaiser. A lot of the facilities have evening and weekend clinics for those after hours ailments one often has to deal with when one has babies. I personally have never heard anything bad about Kaiser in relationship to babies and kids, just adults. If you're fairly healthy or of a temperament to fight for your rights, you should do alright at Kaiser. Just remember your rights and don't be afraid to insist on them. anon
I just delivered my second child via repeat c-section through Kaiser Oakland at Alta Bates in March. I have been a lifelong Kaiser patiend (was borh at Oakland Kaiser) and have NEVER felt that my family's health was compromised.
FYI, all OB/GYN patients from Oakland and Richmond Kaiser go to Alta Bates for in patient care. Kaiser only pays for the cost of a double room in the postnatal unit. If you want a single Alta Bates will bill you for the difference. It is close to $300/day. Kaiser covers all the other costs though.
To address your concerns directly. Yes, with most pregnancies the prenatal apts are with NPs. With this pregnancy since I was going the repeat c-section route the dr set me up for the ''MD Prenatal Clinic'' so that I could get to know the different drs who might be on duty to perform the c-section. If I had been considered high risk I would have been seen in this clinic also. I always saw a dr until the last month when the apts were harder to get, and they bumped me to the NPs. That was fine with me, I figured the high risk moms needed the apt more than I. I couldn't see my regular Gyn, she doesn't do prenatal care. I was in the MD clinic so I could meet the drs, but the receptionists generally try to schedule you with the same dr (or NP) every visit and so I saw the same OB for most of my pregnancy. (I only didn't when I asked to have a different Dr.)
Yes, residents do most of the deliveries at Alta Bates. There is always a supervising OB around though. With my first son I saw several residents, although there was one who primarily took care of me during my stay. With this pregnancy my c-section was scheduled so I only saw the resident when she went over the forms with me immediately before going into the ER. With both deliveries my c-section was performed by both an OB and a resident. I didn't find it problematic in anyway. Hope that info helps. Rose
I had my baby at Kaiser (Walnut Creek)last summer. I had a great N.P. (low risk pg) who I saw every time I went for my appointments. I had many ultrasounds (at each appointment after the first one) so I could monitor my little one. I loved that! I ended up needing an emergency c-section after a really bad labor that sort of stopped after I dilated (loooong story), and the doctors and midwives and nurses in labor and delivery were all very wonderful...great bedside manner, really listened to me and didn't seem to cut corners at all. They kept me informed and gave me options that didn't seem to be limited by cost. I was not thrilled a bit with the maternity nurses, they were really bad...but the lactation consultant was great. Our pediatrician at Kaiser is also great.
I have no experience with Healthnet, I've only been in the bay area for 5 years and have always had Kaiser here, and an HMO when I lived up in Seattle. I've had great experiences with HMO's...you just really have to shop around to find a doctor you like. Mom of a 11 month old born at Kaiser
I changed from Healthnet to Kaiser just before my latest high risk pregnancy. Kaiser is extraordinary. They sent me straight to Larry Newman, Perinatologist, whom I saw for every visit every two weeks. He was outstanding. Unlike Healthnet, where I had to argue for tests, Dr. Newman encouraged me to tap into every available resource, and the beauty of Kaiser is that there is no insurance administrator saying otherwise. I delivered by c-section last July at Alta Bates under the care of an extremely competent staff doctor (not a resident). I had sent information about my son's rare condition a few weeks before his birth. Absolutely every nurse and every doctor who came in contact with my son had read my instructions and respected them. Each doctor spent a lot of unhurried time with us. We spent time in the NICU at Alta Bates. The docs and nurses there were also outstanding.
This was my fifth pregnancy, so I'm coming from a broad base of experience when I say that hands down Kaiser is absolutely outstanding. I'm also very happy with our pediatrician and the follow up care we've received. Good luck. Anonymous
I have Kaiser, and my partner had Kaiser and switched to Healthnet. In addition, I am a medical social worker and am pretty familiar with both systems. There are pros and cons to Kaiser.
Kaiser was great with my preganacy ( I conceived with the help of the fertility clinic in San Francisco), and I saw my OB for all visits except for urgent care. I followed her when she moved in my 7th month of pregnancy to Redwood City Kaiser, and when I needed an unexpected c-section, they paged her and she came in early and did it! I also have a great primary practioner and ask her for any and all referrals to specialists. You can choose to deliver anywhere in the Kaiser system, including Alta Bates, Kaiser Walnut Creek etc. The lactation nurses are fabulous! My pregnancy was not high risk, but I hear they do a good job with that.
For our daughter, we got recommendations for pediatricians and were assisgned to our second choice. We like her, and we like that we go to Children's for emergencies. They seem quite pro-active around children's care.
I also like the conveince of their urgent care system and hours for evening/weekend apointments and on-site pharmacy, although hold times are bad.
That being said, I travel to San Francicso (where I work) for my primary care, because the two previous doctors I had left, and reassigment was challenging at best. We had huge drama and mismanagement for my partner's breast cancer, enough that she switched health plans never to return.
I also see patients who are admitted emergently to where I work who have Kaiser. Kaiser is the most aggressive health insurance in terms of tranfering patients back to their own hospital, and definitely more concerned about money then family wishes (i.e. will transfer a patient to Marin even if they live in Oakland if Oakland is full), and they offer less in-patient rehab.
All in all, if you can get a primary care person you trust, and don't have any need for specialty care, its fine. In fact, more conveint than Health Net for flu, allergies, eye glasses etc. But if you have some crisis (like breast cancer or a car accidient) you definitely give up your choice of seeking the ''best'' in the area. If you choose Kaiser ($300 is a lot of money), just be prepared to be an educated advocate if there is something out of the ordinary. Stephanie
I have a 15-mo old, and I started out that pregnancy with Kaiser through my employer. We switched to another insurance through my husband's employer when I was about two months along because they paid 100% of the monthly premium (as opposed to mine, where we had to pay about $300/month). It seemed like a great idea, but it ended up being a huge mistake. I did have a personal doctor, who I saw for all my appointments, but he was not on call when we went into labor, so a doctor in his practice (who I had never met) ended up delivering my daughter. I also had some risk factors (over age 35, possible Rh incompatibility,Group B Strep), and ended up having an emergency C-section. I delivered at Alta Bates, and I have no complaints about the care I received. But the post-delivery, namely the bills, have been a nightmare!!!!! We got bills from at least five different places (Ob, Pediatrician, hospital, lab, State of CA), which we still have not straightened out.
I haven't delivered with Kaiser, but I do know that Kaiser patients deliver at Alta Bates (at least Kaiser Oakland patients, I can't say for sure about other Kaiser offices). We're expecting again, and are using Kaiser. I'm looking forward to everything being billed through one place, so that if we owe anything at all, we'll only have to deal with one bill. As far as having a personal doctor goes, I see the same Nurse Practitioner for all my appointments. I know she probably won't deliver my baby, but the same thing happened with my first. So far, I feel that the quality of care I've received is comparable to what I got with the non-Kaiser doctor. We'll see how the delivery itself goes... Anonymous
I had similar worries about switching from HealthNet to Kaiser two years ago. I couldn't imagine leaving Berkeley Peds or my OB/GYN (Hank Strietfeld), whom I'd seen for 20 years. As a matter of fact, I continued paying out-of-pocket for office visits to these providers even after we'd signed up for Kaiser. Then one day I decided to try Kaiser out when my daughter was ill at 6:00 PM. I called Kaiser and we had an urgent care appointment for 7:00 that same night. I was stunned to have been given an appointment in the clinic that night and was immensely impressed by the lovely pediatric clinic, state-of-the- art equipment, the fact that we were seen at exactly 7:00 PM (no waiting!), and by the excellent clinical care. I braved the switch to Kaiser's OB/GYN clinic and was equally impressed. Bottom line:
1.The outpatient clinical care is excellent and much more integrated than non-Kaiser care (it's one system, so the specialists, hospital, pharmacy, primary care are coordinated).
2.The physicians are supported by an impressive clinical support system and protocol (I feel that my physicians are top-knotch and the fact that they are part of a large group of Permanente physicians really enhances their clinical expertise).
3. Pediatric care is the best! I have never felt in better hands--24/7. Every time my daughter has been sick, she has been seen within 1-2 hours of our calling by wonderful, caring pediatricians. The urgent care system (which has appointments in the regular clinic til 10:00 PM and in the E.R. after 10:00) is awesome and makes you feel really supported. Alos, Kaiser pediatrians do not rush to prescribe antibiotics for any ailment; I really appreciate their clinical approach.
4. The call system has been greatly improved in the last five years. When you call an advice nurse, you do have to wait, but I've never waited more than five minutes. The advice nurses are fantastic.
5. If anything, I would say that we receive more care than I did outside of Kaiser. When I call an advice nurse if one of us is not feeling well, more often than not we are advised to come in ''just in case''. I never, ever have felt that I receive less care/services than I have needed.
5. A friend of mine is a Kaiser member who has ovarian cancer and is receiving a $1,000 anti-nausea drug (which a friend of hers was denied by HealthNet). She is constantly saying that she feels so grateful she switched from HealthNet last year because of the rapidity with which her cancer was diagnosed and is being treated. She feels that the Kaiser system is really holding her and that had she been with HealthNet, she would have had to navigate through the specialists in a way that would have felt daunting. (On the other hand, a friend of a friend felt that she did not receive state-of-the-art cancer treatment with Kaiser; experiences will vary, as they do between non-Kaiser physicians.)
6. Kaiser is particularly renown for its state-of-the-art protocol and clinics to treat chronic diseases such as diabetes, asthma, etc. They advise other countries on these clinical protocol, which are widely respected.
7. You can choose your personal physician, who follows you. It is true, of course, that the popular physicians' practices are often closed to new patients (as is true outside Kaiser). But you can wait for them to open up, while still being in excellent care from the newer physicians. I was actually very happy just seeing whatever urgent care doc happened to be on call, though they kept urging me to sign up with a personal physician.
8. Kaiser is non-profit fully integrated health care delivery system; HealthNet is a for-profit HMO that contracts with physicians and hospitals for care. The CEO of Kaiser recently said that Kaiser has a ''mission dividend'', not a stock dividend, which distinguishes Kaiser from the for-profits. Kaiser's mission is to deliver affordable, quality care.
I work for Kaiser in a health policy position. Much of my work involves evaluating benefits and products that are offered to members. I often have Kaiser physicians working on my teams to assist in clincial assessments of policy decisions made. I have been extremely impressed by the level of concern every physician I have worked with has over quality and access to care. While business people within the organization are feeling compelled to become ''more competitive'' (read: less rich in benefits in order to compete with the other HMOs), the physicians consistently argue for staying true to the commitment of ''Permanente Medicine''--with its high quality and ready access for a broad range of members. In this day when everyone is concerned about the bottom line, it is truly inspiring to hear the Kaiser physicians deeply concerned about quality and affordable medicine.
You do hear scary stories about bad care at Kaiser--which is why I was so loathe to become a Kaiser member (even after I had worked here for a year). I didn't want second-class medicine for me or my family. But I have seen no evidence of bad care; quite the contrary. The one ''bad'' story I know of personally is from my manager at work, who had frustrating experience with Kaiser, waiting for her carpal tunnel surgery to be scheduled. I'm sure you'll hear other stories, but they happen everywhere, unfortunately. Kaiser's may be more highlighted because it is both a delivery system and an insurance company--so it's easier to identify.
I do know that member satisfaction surveys show high regard for outpatient care and less satisfaction for inpatient care. Kaiser takes these surveys seriously and is under constant self- improvement.
I can't speak to obstetrical care; I had my baby before joining Kaiser.
I don't believe that you would compromise your family's care by switching to Kaiser. It think you will be wonderfully surprised by its excellence. --Linda
My sister has just taken a job with Kaiser (in DC, not here) as a hospitalist. They did a lot to recruit her as a top-knotch infectious disease doctor, and have set up a situation for her which she is happy with. The last internist that I had that I really liked went to Kaiser Oakland, and an acquaintance who is an excellent internist just went to Kaiser Oakland. Kaiser seems to be recruiting excellent, experienced doctors from private practice. My sister is happy because she doesn't have to fight with insurance companies anymore, and can do what is right for the patient, not what is proscribed by the insurance company. Nearly all of the parents that I know who have used Kaiser Pediatrics are very happy with it. They particularly like the after-hours urgent care clinic that they can go into without a lot of trouble, the really excellent pediatricians that they choose and the ability to get outside experts if they need it. I have been reasonably happy with my current insurance, but am thinking about changing to Kaiser because I am sick of the revolving door my primary care doctors have. Anon.
I can relate my experiences with Kaiser (I've never been covered by Healthnet), having had my first child in November 1999 and the second in November 2001. Both times I had a C-section. Let me try to address your specific concerns, based on my knowledge.
Kaiser patients who are not high risk are seen by nurse practioners during their pregnancy. I saw the same nurse practioner for all my visits--and I saw the same nurse practioner during my second pregnancy. If you are classified high risk, then you see one of the doctors who specializes in high-risk pregnancies. I felt very comfortable with my nurse practioner. In fact, when she had concerns about the baby, she scheduled my next apppointment with the high-risk doctor.
Yes, residents do deliver the babies and do C-sections. Both times, residents did my C-sections--and did an excellent job. No complications and I was happily out of the hospital in 2 days (you can stay longer if you want). Residents are always under the watchful eye of an attending physician in the operating room and you can always request to speak to the attending doctor while in the hospital (I did!). Also, when complications did arise during my first pregnancy, I was treated by the high-risk doctor from then on. During my second pregnancy, I simply asked to see the same doctor again and was able to get his opinion about the progress of my pregnancy.
I wouldn't say that doctors cut costs by not doing tests--just the opposite. After two miscarriages, it was recommended that my husband and I go in for genetic testing. Although my husband was skeptical (he thought we'd just had bad luck, and he was right), we had blood tests and chromosonal analysis. Later, during my first pregnancy, the doctor recommended repeating a test when my husband wanted a second opinion about the results. I think the doctors and nurse practioners are quite proactive in recommending tests and procedures. Unlike some HMO's, by the way, decisions about tests and treatments are made by the doctors and patients and do not have to be OK'd by anyone else.
All Kaiser patients deliver at Alta Bates--that's standard procedure.
Although you might have heard some bad stories about Kaiser, Kaiser does consistently well in consumer satisfaction surveys. Check out Consumer Reports (sorry, I don't remember the date). They recently did a review of HMO's across the country, and Kaiser got high marks in quality of care and patient satisfaction. Alison
I have been with Kaiser for 10 years now with generally good results. In particular, I have found excellent pediatric care at Kaiser Oakland. I also had a C-section at Kaiser San Francisco. The chief surgeon in OB/GYN delivered my child (unplanned C- Section), and I had the same nurse practioner throughout my pregnancy. I even saw a genetics counselor during the pregnancy. If you go the Kaiser route, you need to be vocal about your care, get a personal physician RIGHT AWAY, come prepared with questions and GO BACK if situations do not improve. Kaiser is a wonderful place for immediate care. Although my pediatrician, Gail Udkow, is great, I love the extended care hours for the problems that arise after 5 that are not emergencies. I also like the option of seeing any physician when I have an urgent need. You will not have the paperwork hassles that you do with Healthnet,and your claim will not be turned down. The biggest problems with Kaiser come when you don't have a permanent physician. My husband has chronic health problems, and he considers his personal dr as his advocate. He has been referred to specialists at Kaiser without problems. I know there are horror stories about Kaiser, but as a former employee of a group contracted to coordinate medi-Cal patients conversion to HMO's I learned that Healthnet was one of the worst for denying claims. Be prepared and informed; you'll do fine. Bennett
Nov 2001
Re: considering pregnancy
I would strongly recommend any insurance other than Kaiser, and the more choices offered to you by the insurance the better. Kaiser does some things really well but their system has extreme weaknesses (e.g., rarely seeing your own doctor for same day appointments). In my family, Kaiser has missed serious medical problems because no one was one the case -- each dr. seen on the fly took each instance of the problem as a single event and no one looked at the chart to say Woah, we have a serious pattern here. I think the problem is not incompetent doctors but a problem with the system and I find I am so happy with being able to call my doctors office and see HER *every* single time.
Another weakness in Kaiser is pregnancy -- my understanding is that at Oakland you are seen by nurse practitioners throughout your pregnancy and are delivered by residents. This was my experience until I left Kaiser, very happily, the first moment I could. I LOVED getting to know my non-kaiser doctor over my pregnancy and having the chance to get to know those who would be delivering, and know they had lots of experience.
Also, I found many (all?) the good doctors at Kaiser aren't taking new patients and while that can be a problem on the outside too, you will be able to find someone that people recommend who is available.
Also, for the person who wanted to know about UC Care and where to deliver, I have UC Care and there is no problem delivering at Alta Bates -- it depends what hospital your doctor/midwife is affiliated with.
Is Kaiser health care really worse than the private doctors, and would it be better to pay an extra $163 a month to stay on Health Net?
As for private doctors being better... phooey! I have been a Kaiser member my entire life and have had very few bad experiences. I have seen many of my friends with private doctors pay a ton of money for services and having a hard time getting in to see anyone, getting advice, etc. As you can see, I am a fairly passionate Kaiser supporter. Good Luck! Linda
I think the difference between using HealthNet and Kaiser is much less clear than it was a number of years ago. In many ways Kaiser is a much more compelling choice since it is more predictable and in many ways more convenient. This is absolutely true for pediatric care... They have evening clinics, so you don't have to wait until the morning with a ear infection, and in a minor emergency you can go to their ED instead of Children's Hospital. Ironically, it's much, much better to use Kaiser than CHO for little emergencies, since it's less bureacratic, and the waits are far shorter for kids who are not super sick. I never got the impression as a Kaiser member in their pediatric clinic that my child was not quite sick enough for them to deal with, which I have gotten every time I have taken my little ones to CHO.
I think if you are good at dealing with Kaiser and can hook up with a good doctor you can can absolutely first rate care there. It's easy to get referrals, and (usually) relatively hassle and paperwork free. Their formulary is good (about the same as the HN and PC)
A story about Kaiser and a friend's very ill child: Diagnosed with a brain tumor quite early by a Kaiser Hayward pediatrician. They referred out to UCSF because that was the best place for his care. They received top notch care, paid absolutely nothing and the child is now reasonably well. These folks have nothing but wonderful things to say about Kaiser.
I have had great care at the Oakland site. I will state that I now prefer Kaiser to Healthnet. Healthnet gave me huge hassles regarding speacialists. Billing became a nightmare. At Kaiser, if you have a personal physician, you can have excellent treatment. I like the fact that it is not a hassle to see another physician if it is not an emergency but still a serious condition. With Kaiser, however, be vigilant, and don't take no for an answer. Personally, I love Oakland's pediatric staff, particularly Dr. Gail Udkow. I think that Kaiser is worth the money. No paperwork, fewer hassles, a decent prescription formulary. The keys are to have a personal physician and to be able to accurately describe symptoms. Bennett
I live in Oakland, and both of my children have gone to Kaiser Walnut Creek Pediatrics since they were born. (I myself have seen a nurse practioner at the Oakland facility, but have only recenlty switched from Health Net, so I don't really have an opinion about it.) I have nothing but great things to say about it. Whenever I have called about a concern, I have been offered an appointment within an hour of the call. All of the physicians and nurses have been wonderful, as is the facility. The only draw back is that the tunnel can get backed up, which has made me question my decision to drive to Walnut Creek when I could just as easily go to the facility in Oakland. However, as soon as I remember how happy I am with our pediatrician, I realize I made the right choice.
I, too, had a bad impression of Kaiser; however, now that we have been members, I could not be happier and would not change. People I know that have private insurance have to wait much longer for appointments, sometimes days just to have their kids' ears checked. Kaiser is always open, and at least for urgent care, you never have to wait. They also have advice nurses, 24/7. I think it is wonderful for kids. Jenny
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 heart...it 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!
We have only had Kaiser, so can’t speak to other places. I just wanted to provide a counterpoint for those who say Kaiser is not good for serious medical conditions. My husband has a serious medical condition (brain cancer) and has had for 13 years. My husband is scanned and meets with his doc every three months, and Kaiser has even flown him to other places for clinical trials - no expense. He has gotten several treatments, including new and cutting edge ones. While UCSF docs are known to be top notch for his condition, many people we know with the same condition but seen at UCSF have to haggle with their insurance to get scanned regularly and don’t seem to see their doctor as often. Our Kaiser doc meets regularly with docs from all over the Bay Area and country and has the same information UCSF does at his fingertips. Ultimately what I’m trying to say is that we have gotten excellent care for something very serious at Kaiser and because Kaiser is so streamlined we have not had trouble getting care that is needed or had to make calls to ask for coverage etc which would be immensely stressful kn our situation. . The care has been organized and high level.
Both my parents had cancer, one treated at UCSF and the other at Stanford, and our experience was horrendous at both. Unfortunately, neither of my parents made it. Every scan, every chemotherapy, particularly newly FDA approved ones, etc had to go through an insurance approval process, which delayed therapy etc. UCSF and Stanford physicians were difficult to reach and the wait time for appointments as well as at the office was challenging, sometimes my mom waited 2 hours in the office to see her oncologist. The physicians didn't feel obligated to respond when you messaged them with questions, even if rarely. Often, we got residents who provided care, and they rotated monthly in the clinic so whenever my parents came to the office, we were seeing a different resident who didn't know my parent and we had to go through the whole history and details of the reasons for the follow up visit! The whole "reputation" idea we associated with UCSF and Stanford was way overblown.
I am a senior with Medicare and a Blue Shield supplement. I recently had neck surgery at UCSF and could not have been happier with the service I had before, during, and after the procedure. I use their MyChart portal, and my questions are always answered promptly. Additionally, my next steps are planned out quickly, thoroughly, and understandably. I've also been happy with my Sutter doctors, finding it easy to schedule appointments, see test results, and communicate through their portal.
We left Kaiser years ago because they couldn’t manage my acute asthma attacks. We went with Blue Cross and then my husband’s company moved us to United Healthcare. I loved Blue Cross. I love being able to find my own doctors and specialists. It’s made a huge difference in my health and my children’s health. Years ago, I herniated a disc overnight. I had been recommended an amazing pain management dr. When we both realized I wasn’t improving, he sent me to a neurosurgeon in Fremont at Washington Hospital. My niece drove me. She lives in Palo Alto. She was so impressed with Washington Hospital. Said that care was better there than Stanford where her mother and older sister had to go to. Washington Hospital’s staff was so welcoming and helpful. I never felt like a number and the establishment never felt like a factory. This was back in the 2914-2015 school year. I adored my neurosurgeon and their office. They cut through all the insurance crap and called me the day before my planned surgery to say we were ago. My poor husband was in shock , but rolled with it. The whole surgery and post-op care was amazing. The overnight care was amazing as well. I truly recommend leaving Kaiser.