Kind of OT, but not: Why does everyone hate Kaiser?

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Submitted by TuVu on July 24, 2008 - 6:55pm

I'm posting this because the crappy economy in CA is affecting all sectors. Our kid is now having to get health insurance on her own (although we will be paying the premiums for the next two years). She is absolutely rejecting any possibility of Kaiser (even though where she will be living in the Bay Area is a whopping 0.2 miles from a major Kaiser).

I don't understand this. In the really olden times, when Kaiser first started as an HMO and I was a teen, I admit it was crappy. Imagine being 18 and having to walk through the entire waiting room with a very visible urine sample. Oh, the humanity.

In our late 20s/early 30s, we went back to Kaiser and it had improved immensely. You could choose your own doctor and you did, in fact, SEE your own doctor. Left Kaiser (on an individual plan) when one of us was offered a BC group plan. By the way, our kids was born at Kaiser on Zion. Not a bad experience.

Why does Kaiser have such a bad rap? Economically, it makes sense for our kid. We're at the point of saying "You'll get Kaiser and like it!" Opinions?

Submitted by Ren on July 24, 2008 - 7:00pm.

I'm independent and on a Kaiser HMO. Good price, and one of the reasons I selected it was because they seem to get good reviews. I haven't had to use it yet.

Submitted by TuVu on July 24, 2008 - 7:06pm.

Ren wrote:
I'm independent and on a Kaiser HMO. Good price, and one of the reasons I selected it was because they seem to get good reviews. I haven't had to use it yet.

Ren--

How old are you? Age range is okay. Our kid is 20. She will be living so close to Kaiser that you have to have a parking sticker to park on the street she'll be living on...fierce neighborhood group made sure of that.

Submitted by JPJones on July 24, 2008 - 7:29pm.

I had the same stigma about Kaiser from a long series of bad experiences in the 80's and early 90's. I have gone through several different health insurance organizations since then, mostly paid for by my employers, and I can honestly say that they weren't much better, and in most cases were much worse. My wife and budget (kids are expensive!) convinced me to switch back about 3 years ago and we were pleasantly surprised by their service and the accessibility of our doctors. They have improved by leaps and bounds over the run down old outfit they used to be. Their facilities, at least locally, have been streamlined. Their doctors are all accessible online via e-mail or their web site. Most lab test results can be viewed online as well. The list of improvements is extensive, with most of them being attributed to their recent transition to a completely paperless record keeping system.

If your kid is going to reside less than a mile away from a Kaiser hospital or major clinic, I think he or she might want to reconsider giving them a shot.

Submitted by Chance the Gardener on July 24, 2008 - 8:08pm.

Kaiser still has a BAD rep up north. Kaiser SFO is not equal to Kaiser San Diego. I totally agree that Kaiser down here is an excellent organization. Especially neonatal.

Submitted by seattle-relo on July 24, 2008 - 8:14pm.

I've had pretty good luck with Kaiser in San Diego. We I first moved here I had Health Net and I will say they were pretty awful. Why is your daughter so concerned about Kaiser?

Submitted by David J on July 24, 2008 - 8:18pm.

I grew up with Kaiser HMO in Los Angeles and stopped a few years ago. I couldn't stand them. It often would take months before being able to get a non-emergency appointment and the place was always overcrowded. Doctors were completely inaccessible.

I don't know how it is here in San Diego as I now have a PPO for insurance.

Submitted by TuVu on July 24, 2008 - 8:26pm.

seattle-relo wrote:
I've had pretty good luck with Kaiser in San Diego. We I first moved here I had Health Net and I will say they were pretty awful. Why is your daughter so concerned about Kaiser?

Hi, Seattle. She doesn't like that they are not into alternative therapies. She is going into the medical profession and doesn't like Alta Bates (Bay Area) for the same reason. As parents, we are hardening our stand: "This is what we can afford. Once you are a practicing professional you can choose -- and pay for -- whatever you'd like. For now, you'll have to live with Kaiser if you want any protection at all." As a couple, we are liberal, but I don't think we raised an "entitled kid." I think the Bay Area does the enviro-liberal thing on any kid who is smart and open-minded but only 17. She is still only 20.

Submitted by seattle-relo on July 24, 2008 - 8:41pm.

I see...that's a tough one. Honestly it seems that most insurance companies are limiting coverage of alternative therapies...in fact, I think that Kaiser is better about authorizing OT and speech therapy for kids with autism than another CA leader like Health Net. It doesn't sound like she's entitled, she just trying to make a philosophical stand about the need for alternative therapies...ahhh, I wish I still had the same enthusiasm of a 20 year old :) Sounds like you and your husband are doing a great job raising her.

Submitted by Ren on July 24, 2008 - 8:43pm.

TuVu wrote:

Ren--

How old are you?

39.

Submitted by Aecetia on July 24, 2008 - 10:18pm.

My sister has been with Kaiser for years here in San Diego and is very pleased with it. You can e-mail your doctor, etc. I agree when it first started it reminded me of the Navy hospital, long waits and poor service. I undertand it has improved.

Submitted by CBad on July 25, 2008 - 12:44am.

Wow. She's 20, an adult, and you're going to pay for her health care for 2 more years. Her answer should be, "thank you." I would have been grateful for free band-aids and peroxide from my parents at 20-22.

Submitted by Shadowfax on July 25, 2008 - 1:42am.

they do seem to defend a lot of med-mal actions...but that could be because the statistical pool of patients is larger than other medical groups?

Submitted by CA renter on July 25, 2008 - 2:07am.

I was with Kaiser for 30 years, and there are some definite pros and cons.

IMO, distance to the nearest Kaiser hospital is key if you want to use their insurance. I'd say no more than 20 minutes, max if one lives in a city. You also don't want to be driving long distances just to get certain tests, etc. And you'll be doing that when you're sick.

The best part about Kaiser is that everything is in one place. If you go into Urgent Care/your doctor's appt., and they need to do labs, they can get the results back fairly quickly (in emergencies) because the lab is right there. Then, they can do any kind of test necessary to treat the problem right there, at that moment. Problem is, you'll only see that in emergency situations -- and they define what an emergency is.

Some possible options:

1. Pay what it would cost to get Kaiser coverage and let her pay for the difference between Kaiser and her preferred choice.

2. Go with Kaiser, and pay out-of-pocket for any "alternative" treatments. Either you or she can cover all or part of these costs. Maybe there's some kind of "flexible spending" account available for college students? Perhaps one of our more financially-savvy posters can address that.

Congratulations on your daughter's ambitions for medical school! Sounds like you did a great job with her. Good luck with your decisions!

Submitted by condogrrl on July 25, 2008 - 7:24am.

I was with Kaiser for many years (until one year ago). You have to know how to get around in their system, get a good primary care doctor, etc. I have no complaints except with orthopedics. The ortho docs may be good, but if you can never get an appointment with one of them, then it's irrelevant. I had an email relationship with my primary care doctor. He responded promptly to me, sometimes even on weekends and holidays. Kaiser is really good on preventative care. If I didn't now have orthopedic problems, I'd still be at Kaiser (San Diego).

Submitted by urbanrealtor on July 25, 2008 - 9:07am.

I grew up in Kaiser. My dad was a department chief there. That was in the bay area.
I spent a lot of time listening to complaints growing up from my peers and their parents.

So far as I can tell, the biggest issue is that they are a big company and work out of big office buildings and therefore are not as personal. You have to get a referral. They don't recommend holistic or alternative treatments. I once listed to a roommate explain to me how Kaiser had killed his father by taking him off a macrobiotic diet. Now I am of the opinion that eating organic sprout sandwiches was unlikely to cure his colon cancer but his frustration was that he did not feel listened to.

Thats a legitimate gripe (though I am not sure how it can be safely addressed).

However, I am willing to (as I suspect most consumers are) forgo seeing my specific physician in favor of seeing someone today or right away.

What are other gripes people have?
I am curious to hear.

Submitted by jennyo on July 25, 2008 - 11:42am.

I have had Kaiser for over 10 years and I think they are OK if you never really need to use them, or if you are in need of serious medical procedures/treatment. That said, switching is too much of a hassle and I have had PPOs before that didn't seem any more efficient.

My husband and I have had a few bad Kaiser experiences, once he almost sliced his finger off while greasing his bicycle chain and while Kaiser was great in keeping his hand intact, they left a staple in his hand which later got infected and required additional outpatient surgery. A couple years ago I had a bicycle accident and could tell my elbow was hurt pretty bad. They took x-rays and told me it was OK, a soft tissue injury and that I should make sure to flex my arm frequently to work it out. 5 days later they called me and said that the chief radiologist had looked at the x-ray and that a bone in my elbow was fractured, and that I should not move it, and should come in immediately and get it set. Only it was memorial day weekend so the soonest I could get in was Tuesday (this on a Friday). That was annoying. Another time I had a bad cough, and I was getting ready to go on a trip to Paris, so I went in and the doctor just told me to take sudafed. The cough got progressively worse, and basically ruined my trip. When I got back they diagnosed it as whooping cough, which is highly contagious. Poor people on the 12-hour plane ride with me...

BUT, all of my friends who've had babies with them absolutely rave about it, including those who Kaiser provided midwives for (which I would consider semi-alternative medicine). Another friend had lifelong epilepsy and was able to get, through Kaiser, experimental treatments that essentially made the epilepsy disappear. And a very close friend of mine with Cystic Fibrosis had a double-lung transplant 2 years ago at age 40 which has completely changed her life, courtesy of Kaiser.

I think every health-care-providing bureaucracy is going to have its problems and inefficiencies and some percentage of customers is going to experience them.

Submitted by TuVu on July 25, 2008 - 5:57pm.

I just wanted to thank everyone for their advice and experiences. I am going to have my daughter read this thread. Jennyo--what you said about midwives is right. I think Kaiser was ahead of its time on that front. When I was pregnant more than 20 years ago, the system at Kaiser was you alternated your monthly (or whatever it was) checkups between your OB/GYN and your midwife (both were employed by Kaiser). The midwife -- and I loved her -- happened to be on duty the night our baby was born. She delivered the baby.

Submitted by paramount on July 25, 2008 - 11:04pm.

I think Cigna is the new poster child for HMO horror stories.

Submitted by AK on July 26, 2008 - 2:22am.

When I was a kid in the early '80s my mother worked for an HMO run by the Blessed Daughters of Charity. Now THAT was one sorry HMO. We were overjoyed when they were bought out by Kaiser.

I'd have to agree with those who say that Kaiser quality varies wildly by region. Somehow services and facilities seem to be best in areas with predominantly healthy, affluent demographics ... When I was lucky enough to live in those areas, I had great experiences.

But in the end I suspect Kaiser's rep is largely a hangover from its roots as a health plan for blue-collar unions and civil servants.

Submitted by TuVu on July 26, 2008 - 1:15pm.

paramount--

Yep. I just started with a new dermatologist I really like and her receptionist said, "We take everything but Cigna."

Also, a year or two ago, a friend who got insurance through her professional group, said Cigna raised rates across the board in California(didn't matter your age) to about $1,350/mo in San Diego to about $1,600/mo in L.A. and that was just for an INDIVIDUAL in an HMO. The PPO people really got screwed. I can't even imagine how high those premiums must be now. Rumor was/is, Cigna just wants out of California.

It just infuriates me how nearly impossible it is to get an individual policy in CA if you have any sort of pre-existing condition (even migraines). And the endless hoops we are having to jump through even for a healthy 20-year-old...something has to change.

Submitted by TuVu on July 26, 2008 - 1:29pm.

AK wrote:
When I was a kid in the early '80s my mother worked for an HMO run by the Blessed Daughters of Charity. Now THAT was one sorry HMO. We were overjoyed when they were bought out by Kaiser.

I'd have to agree with those who say that Kaiser quality varies wildly by region. Somehow services and facilities seem to be best in areas with predominantly healthy, affluent demographics ... When I was lucky enough to live in those areas, I had great experiences.

But in the end I suspect Kaiser's rep is largely a hangover from its roots as a health plan for blue-collar unions and civil servants.


Could be right. My parents worked for San Diego Unified and my dad said that, at that time, Kaiser was considered socialized medicine to some extent. They didn't care. Children of the Depression, they chose the Kaiser option because it was CHEAP.

I am laughing again at my humiliation about having to carry a small see-through container of urine from the Kaiser bathroom through the throngs of people in the waiting room to the lab. "What's your problem?" my mom growled at me. "EVERYONE pees!" That's the beauty of aging. I now wouldn't have a qualm about my urine sample parade (and, of course, you don't have to do that at Kaiser anymore). In fact, I'd probably stop and ask people stuff like, "What do you suppose the absolute clarity of this sample means? What color is normal?"

Submitted by stockstradr on July 26, 2008 - 10:07pm.

Oh, yes, the misery of Kaiser Permanente? (The “Permanente” is Spanish for a system of “permanent” denial of care.)

I have so many stories for you. Where to begin?

Back in 2003, without asking friends their opinion, we chose Kaiser from our employer’s plans.

You see, I didn't know. I was naive.

The next day at lunch, sitting with a dozen fellow employees, I was asked, "So which health care provider did you select?"

I replied, "Kaiser"

I saw stunned faces looking back at me, then laughing faces. Then pity.

Then one of them asked, "You don't know about Kaiser, do you? You must not be from California?"

I'm thinking, "Uh oh"

Now, years later I understand. I have a hundred stories of our desperate attempts trying to squeeze a few drops of health care from the hard lifeless rock that is Kaiser. Our friends have a thousand more. I'll just bore you with just one typical true story. You'll get the idea.

I had a strange tumor coming out my back. It was the size of a squashed tomato. It was big. It was scary. After two months of waiting for an appointment with a Kaiser “doctor,” here's what happens during my appointment.

The doctor looks at my tumor and then he gets out the 3-ring Kaiser "book" which is a book of rules about denying patient care. It was clearly written by the bean counters at Kaiser, to save Kaiser millions by denying patient care, through use of various rules that disguise the process of denying care.

The "doctor" holds the book and then gets out his little tape measure. He says, "Well, it is only 3.7 inches long"

"Here at Kaiser, any tumor needs to be at least four inches long or Kaiser won't operate, or even do a biopsy."

"I can't give you a referral to a Kaiser surgeon"
"Your five minutes are up. I have more patients to see today."

I'm thinking to myself, "Kaiser does NOT have doctors. Kaiser has robots with medical degrees, heartless, mindless robots which are programmed to systematically deny patients care."

After several more appointments and phone calls, and three weeks more of waiting, finally, my doctor says, "Well, we have a program where a nurse can remove small tumors like this?"
I’m thinking to myself, "A friggin' NURSE is going to cut a four inch hole in my back and remove this tumor? NO WAY!"

I was pissed. I was DETERMINED to squeeze a few drops of damn health care from the dry lifeless rock that is Kaiser.

I needed a respected advocate. I scheduled an appointment with a professor of surgery at UCSD Medical Center La Jolla. He looked at this bulge on my back and said, "This has got to be surgically removed!"

I told him what Kaiser said. He looked at me with understanding eyes that have heard this story before from a hundred patients who had come to him after denial of care by Kaiser.

He says, "Here is what we'll do. I know the head of surgery at Kaiser. I'll call him up and embarrass him by telling him another story about how a patient at Kaiser isn't getting care. He'll do something about it. I will also write him a letter on your case."

I'm thinking, "Now THIS is a doctor, one who understands the meaning of being a true ADVOCATE for patient care."

That appointment at UCSD was not covered by my Kaiser insurance. Of course not. It cost me $300. It was worth it.

Two days later a Kaiser nurse calls me up and explains she schedules appointments for a Kaiser surgeon. A month later my tumor was removed from my back...and the Kaiser surgeon was excellent, very talented, because she was selected by the UCSD doctor from La Jolla!

This is a classic story about Kaiser. It is typical because it reveals that Kaiser is a machine that exists to deny health care, because Kaiser is a corporation focused upon making money by denying care. Only the few patients like me are able to squeeze some health care from that cold lifeless machine, because we are RELENTLESS in fighting the Kaiser machine, in finding the twisted path to getting at some mediocre level of health care from Kaiser. And we have the financial resources, and the smarts to know how to work the Kaiser system.
But, it is exhausting. We could only take a year of it.

Now let me talk about Sharp, and UCSD. The smart money, or at least the smart, in San Diego understand you get great health care in San Diego from either Sharp Memorial or from UCSD Medical.
We spent three years getting our care from Sharp. The first time I visited Sharp, I found myself thinking, “I must be dreaming. I don’t believe this kind of conscientious, quality medical care even exists any more.”

At Sharp I had doctors actually invite me into their OFFICE and sit me down to discuss my condition for 30 minutes! Impossible you say? Sharp is a world apart from Kaiser. Sharp hires doctors who are top 20% in their class. Who do you think Kaiser hires?

Get a clue about Kaiser. Open up your eyes:

http://articles.latimes.com/2002/oct/11/...

http://www.usatoday.com/news/nation/2006...

http://cbs5.com/investigates/Kaiser.live...

Submitted by CA renter on July 27, 2008 - 12:31am.

Unfortunately, I can confirm that there are a number of cases just like stockstrader's.

I know of three people who had cancer, but were not diagnosed in time because Kaiser refused to order necessary tests. All believed they had cancer before being diagnosed, and requested testing. All were refused. All died (two were young, in their 40s).

One time, I was taken by ambulance to a North County hospital in the middle of the night, and they determined I needed a blood transfusion. They stabilized me and called Kaiser, but couldn't reach anyone. Finally, hours later, they got in touch with a person at Kaiser who said I had to be transported to Zion in order to get a blood transfusion. They refused to let the North County hospital do it (the drive can take over an hour).

We changed our insurance two days later, and will never return again.

Kaiser can be good if you get the right people, but they can kill you if you don't.

Submitted by TuVu on July 27, 2008 - 5:08am.

stockstrader and CA renter,

Thanks. Reading these experiences have convinced us to buy her a Blue Shield PPO plan, even tho it's more expensive than Kaiser. We are with Sharp and only regret there is no Sharp for our daughter in the Bay Area. Three times in the last year (twice for me, once for our daughter) our Sharp primary care physician has ordered us to get blood work to see how new meds are affecting us. We tend to procrastinate on stuff like that, and the doctor would have her nurse hound us by phone to get it done. This resulted in an odd combination of emotions in me: I was both infuriated and impressed.

We were not with Kaiser very long. I do remember, however, having to work the system to get an immediate (same day) appointment, such as exagerating symptoms. At Sharp, you simply say, "I need to see someone today" and they will accommodate you, even if it's with a physician's assistant, which is fine by me.

Submitted by no_such_reality on July 27, 2008 - 8:13am.

Kaiser was an HMO early when Americans weren't used to HMOs. Americans were spoiled with go anywhere, never see a bill health insurance provided by their employers. That's the root of the complaints.

Since then, Kaiser has on occasional given itself a black eye with organ problems etc.

But otherwise, it basically boils down to rationing and much like the recent protest in LA by the Armenian community, boils done to someone isn't going to get the additional treatment they want to try because it just doesn't make cost effective sense.

Submitted by evolusd on July 28, 2008 - 8:36am.

Kaiser here in San Diego has been nothing but great for our family. I had ACL (knee) reconstruction and it went perfectly - I'm 100% now and had a great surgeon. My wife had our first baby last year at Zion and it was great as well. When I have an appointment, they are always on time or even early. I couldn't ask for much more.

I think some markets aren't as great as San Diego, so she may want to ask friends/colleagues up in SF how their experiences have been.

Submitted by DWCAP on July 28, 2008 - 9:34am.

My GF had to switch to kaiser from UCSD due to job change. Hasnt had a single problem with them, cept that her BC pills are not covered. That sucks, but the quality of care has been just fine.

Submitted by ocrenter on July 28, 2008 - 10:00am.

Hasnt had a single problem with them, cept that her BC pills are not covered.

this and very similar issues is the main reason why a lot of people don't like kaiser, but it is also the reason why medicine should march toward something like the kaiser model if we are to save ourselves from cost over runs that will eventually BK this country.

let's take the birth control pill Seasonale. cost per year is $740/person. if you use generic pill like microgestin, cost per year is $100/person.

if you can just get 1500 women to use generics like microgestin instead of Seasonale (which essentially does the same thing), you've just SAVED $1 MILLION.

in the typical medical world, woman watches Seasonale TV commercial, goes to her doctor (who just got treated to lunch by the Seasonale rep), she asks for Seasonale and gets it. Great, she gets to have a period every 3 months now. Terrific. She pays a slightly higher brand name co-pay, but everybody carries the burden of her desire to have less frequent periods.

in the Kaiser world, woman goes to her doctor, who tells her SHE has to pay the $640 difference. She opts for the generics. she continues to get monthly periods. But 1500 women later, we save $1 million.

that is the Kaiser difference, it saves us from ourselves.

Submitted by nin_sis on July 28, 2008 - 10:01am.

Had surgery at Kaiser Zion in 2000. It was considered elective although it was either surgery or antibiotics for life. I chose the surgery. Had a great experience the 4 years I had my insurance there. I was able to change my GP, because I didn't like her, to another that was great. Then I was able to easily get a referral to a specialist and was under that physician's care for 2 years post surgery. Didn't have one bad experience...unlike my horrible experiences with Scripps Green hospital. They were truly the worst. Now I'm with Sharp (for 5 years) and they too are great.

Good luck!

Submitted by UCGal on July 28, 2008 - 3:16pm.

I have Kaiser. It is as good as any HMO I've had. All HMO's (and a lot of PPO's) require you use a network doctor to get full benefits... the difference is Kaiser is closed network - so the network doctor is an employee of Kaiser.

I saw them waste no expense on my mom's multiple cancer surgeries and chemo. She had excellent care.

Same with my dad.

My younger son was born at Zion - I loved the midwife pre-natal care and midwife delivery.

If you don't like your primary, it's easy to change them. I happen to like my primary.

My kid's pediatrician is great. I've grilled her about what it's like to work for Kaiser, she likes it because she gets hands on clinical plus gets to work on her specialty - neo natal... they set up her schedule to allow both. And her hours are much more regular than elsewhere.

I also like that they don't have blanket, one size fits none, policies about what surgeries are covered, etc... I was/am considering a surgery that is a bit more radical than guidelines, do to a familial cancer risk. I was told that as long as my doctor agreed, it would be covered. (They cover a similar surgery, for non-cancer related reasons, without problem - that was my basis for for discussion with the surgeon.)

But - You will not get private rooms, or high end treatment like you might at other hospitals. The recovery rooms for OB sucked and I was glad to go home in less than 24 hours after my son was born. The care was good -but having my roommate's loved ones chatting and visiting 24/7 made recovery less than fun and I was happy to go home.

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