Changing from Kaiser to Blue Cross PPO

Kaiser v. High deductible PPO

Kaiser v. Alta Bates PPO

Kaiser v. Healthnet

Kaiser v. High deductible PPO

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

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

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 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

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

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 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

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

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 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

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

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 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

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

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

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.

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.