5 ms·

This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network

This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.

mdorazio 7y ago
... what if you don't make it to a Kaiser emergency room? The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
- henryfjordan 7y ago
  Kaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.
- laurencerowe 7y ago
  My experience has been fine with Kaiser for an out of network ER visit, I just got charged the standard copay. CA law seems to specifically protect those of us on HMO plans: https://www.sfchronicle.com/bayarea/heatherknight/article/SF-General-s-insured-patients-suffer-further-13543542.php https://www.sfchronicle.com/bayarea/heatherknight/article/SF... """ Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
- ianmcgowan 7y ago
  My wife had an emergency, which ended up with removing one of her ovaries. Kaiser was pretty insistent about transferring her from the closest ER to one of their facilities (which was stressful), but after that the treatment was awesome. After a some major surgery and a few days recovering the bill was completely covered. Kaiser isn't perfect, but they're the closest thing to a reasonable health-care system I've seen in the US. Agree that there are worse models for how to do healthcare, within some of the constraints of the US system.
sprucely 7y ago
Kaiser is great for critical care and general practitioner stuff. But they do most of their cost-cutting in specialty care; the stuff that is rare or tends to not be easily diagnosed while having a major impact on patients' quality of life. Just lookup lawsuits and Kaiser mental health.
- borkt 7y ago
  Also terrible with mental health from what I hear.
- henryfjordan 7y ago
  There is an art to navigating specialist care at Kaiser for sure. Personally I don't think you are likely to have a significantly worse experience at Kaiser than you would with the average Dr, but you will also never have the _best_ experience. You do have to know when to be pushy and when to demand a different specialist. That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
- smsm42 7y ago
  Same experience here: routine care is ok, emergency care is great, hospital also pretty good, but trying to get them to refer you to proper specialist and figure out what's wrong when you yourself don't know it (e.g. not a cold or broken leg when it's obvious but kinds of conditions where you may need to ask several specialists to figure it out) is a long uphill battle and they are very reluctant to cooperate. It's a bureaucracy which likes doing what they know and hates complex cases and exceptions.
- chillacy 7y ago
  I get the general feeling that KP tends to under-prescribe care, but other doctors definitely over-prescribe care. That's what the financial incentives are for each anyways.

mdorazio 7y ago

... what if you don't make it to a Kaiser emergency room? The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...

henryfjordan 7y ago
Kaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.
laurencerowe 7y ago
My experience has been fine with Kaiser for an out of network ER visit, I just got charged the standard copay. CA law seems to specifically protect those of us on HMO plans: https://www.sfchronicle.com/bayarea/heatherknight/article/SF-General-s-insured-patients-suffer-further-13543542.php https://www.sfchronicle.com/bayarea/heatherknight/article/SF... """ Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
ianmcgowan 7y ago
My wife had an emergency, which ended up with removing one of her ovaries. Kaiser was pretty insistent about transferring her from the closest ER to one of their facilities (which was stressful), but after that the treatment was awesome. After a some major surgery and a few days recovering the bill was completely covered. Kaiser isn't perfect, but they're the closest thing to a reasonable health-care system I've seen in the US. Agree that there are worse models for how to do healthcare, within some of the constraints of the US system.

sprucely 7y ago

Kaiser is great for critical care and general practitioner stuff. But they do most of their cost-cutting in specialty care; the stuff that is rare or tends to not be easily diagnosed while having a major impact on patients' quality of life. Just lookup lawsuits and Kaiser mental health.

borkt 7y ago
Also terrible with mental health from what I hear.
henryfjordan 7y ago
There is an art to navigating specialist care at Kaiser for sure. Personally I don't think you are likely to have a significantly worse experience at Kaiser than you would with the average Dr, but you will also never have the _best_ experience. You do have to know when to be pushy and when to demand a different specialist. That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
smsm42 7y ago
Same experience here: routine care is ok, emergency care is great, hospital also pretty good, but trying to get them to refer you to proper specialist and figure out what's wrong when you yourself don't know it (e.g. not a cold or broken leg when it's obvious but kinds of conditions where you may need to ask several specialists to figure it out) is a long uphill battle and they are very reluctant to cooperate. It's a bureaucracy which likes doing what they know and hates complex cases and exceptions.
chillacy 7y ago
I get the general feeling that KP tends to under-prescribe care, but other doctors definitely over-prescribe care. That's what the financial incentives are for each anyways.