Kaiser Insurance (HMO) advice?

[rjyoon]

I lost my job, so I lost my insurance (can't afford to COBRA). Fortunately, I just got married & got put on hubby's insurance. Unfortunately, it's Kaiser, and I think I'm going to have trouble seeing any specialists. I have an Interstim, so this could get interesting. Talked with some who've dealt with Kaiser before, and they told me that if I get too insistent about my health care, they'll send me for psych eval.

Does anyone have any tips on how to deal with stingy HMOs? I could use some help.

[tigger_gal]

I am sorry I can't help you, I have a ppom myself. All I can suggest is getting the company to send you all the info on there ins policies..

Brat

oh yea >>.. Welcome back great to see you

[classics]

I'm sorry you have Kaiser. I will pray for you. I don't mean to sound sarcastic, but I have had Kaiser in the past and was not happy. Several years ago I went through months of trying to get an MRI for my herniated disc in my neck. Some people love Kaiser though and I've heard it's good on the west coast.

[kadi]

I had Kaiser for 8 years, all before I got IC, so can't speak to how they will deal with that... But I did find that it was a very convenient system of medicine. Offices, labs & pharmacy all in the same building was super-convenient. AND - with the policy I had, there were no giant out of pocket expenses for things like surgeries or hospitalizations. (Unlike the PPO I now have-yeooww)

Your experience may be okay or even great. There is a really positive post about the Santa Rosa Kaiser in California on the California message board. And I know many people who've had excellent care of chronic illnesses at Kaiser-I am a teacher & most teachers in my district have Kaiser coverage. I hear way more good stories than bad.

Stay positive unless something specific happens, then don't be afraid to stand up for yourself & use the "Patient Advocate" office if necessary. They stepped right in when I had a problem with a doctor and quickly assigned me a new doctor at a different facility (actually the department chief) and I was quite satisfied with the outcome.

The good news is that you're already diagnosed, have medical records showing levels of advanced treatment, and already have the Interstim. I would think that already having those things will make them take your IC seriously.

Also I don't know where you live, but there are huge differences among the Kaiser facilities where I live. There are several in my area that are beautiful state-of-the-art facilities with pleasant professional staff and several that are pretty dismal all the way around. Don't assume all are the same, check them out for yourself & schedule yourself accordingly, if you can..

Wishing you good luck!!

[rjyoon]

I'm encouraged to hear that at least some have had positive experiences. I'm very glad that I'm stable right now, so I hope they'll cooperate with continuing what's working. I know they're going to try to get me to change medication, though, to meet their formulary, and then it will get tricky. I have so many medication side effects that I don't want to change what's working.

After six weeks, I still don't have my card, so we're having to get noisy about that, as I need to make my first appointment.

Good to know there's such a thing as a patient advocate office -- don't want to have to use it, but just in case...

Thanks for the help.

[jen_dahling]

Just saw a re-run on Oprah the other day about patient's rights and "when things go wrong in the hospital." It seems to be highly recommended to use the patient advocate for any hospital procedure. They are there for you and to help with anything from understanding your procedure, alternatives, insurance, and getting a second opinion. Who knew? I didn't. I guess some people put all of their trust in drs and hospitals and it's nice to know that there is an advocate to help navigate the system.
Jen