Kaiser Permanente versus BCBS (Burke, Woodbridge: insurance, loan, home)

[Nova Mom]

I have had Blue Cross Blue Shield for many years. I have many friends who really love Kaiser Permanente. Open season is coming up and I was thinking of possibly switching to Kaiser. I compared the cost and benefits of each. Kaiser's monthly premiums and copays are slightly less; it would save at most $250 per year. If I can get better health care and save a few bucks, that is fine. But, I am not willing to sacrifice quality healthcare to save a few dollars.

I would be using the Kaiser facility in either Fairfax or Prince William. What has been your experience?

Thanks.

[Mike from back east]

My wife and I would both say DON'T do it. We went to their Fairfax office which at the time was near Fair Oaks Mall, off of West Ox Rd.

Our experience with KP was not good. Their doctor turnover was always high and IMO too many mediocre docs to boot; if docs are too new or can't make it in private practice they go to KP.

Wife had a hairline fracture between a couple of toes, these often don't show up on an xray for a few days but KPs foreign GP (from a nation that does NOT respect women) told her to just go home, call for an appointment with THEIR podiatrist who had a six week waiting list for appointments, and wait it out. Oops, we had to go to work each day, so we went to a podiatrist up the street, got in the next morning (not six weeks later) and he wrapped her foot so she could walk and work.

I went to their Korean ENT in Falls Church who had no idea what Sleep Apnea was so he refused to treat me for excessive snoring. I didn't know about apnea either so I just sucked it up. A couple more years went by before I changed jobs and my new boss knew all about apnea and she told me to insist on a sleep study, which took about 12 weeks to get, but it confirmed severe apnea. But not before my heart was damaged by the oxygen deprivation that apnea causes.

My wife had a helluva time just getting pap smears. Get on a waiting list for months before even getting an appointment that was another 3 months out.

Then there was the wife's procto exam at Falls Church...we waited hours....their scope BROKE and they didn't have another one...told us we'd have to rebook, then all of a sudden, voila, they were able to borrow a scope from the next floor up... I can only wonder what was going on internally - were they arguing about loaning a scope to each other? Weird place. Bureaucracy run amok.

These are just a few of many such poor experiences.

When we first moved to COLO SPGS we kept KP for continuity sake. KP charged us $75 each to transfer our medical records. Really? Their provider here was a local doctors group, not one of KP's own clinics. Soon enough we got a letter from that doctors group telling us that they were breaking off their business relationship with KP because KP demanded that this group of doctors cut all of their fees and charges by 10% across the board, the same way WalMart bludgeons their suppliers to 'take less or we'll go elsewhere.' I'm so glad the doctors group told KP to stick it; that's when we switched to BC/Bs and have been SO happy ever since.

KP likes to skim the cream of the crop, offering low rates to big employers so they can get all those well educated professionals in the DC area who are too smart to smoke or take risks with their health which allows KP to not spend much to "deliver" care.

Their whole model is built around queuing people up in long waiting lines for appointments so that every last second of a doctor's time is used. In the airlines this is called overbooking. You get to their office and wait 15+ minutes to get into an exam room, then wait there for 15+ more for the doc to finally visit and then they apologize for being late because "it's crazy today" with emergency cases, etc. BTDT. SSDD.

Here's a link that may be of interest to you.

We're SO pleased with our BC/BS now that we've moved to Colorado, there's just no comparison, none.


EDIT to add: Oh yeah, the in-house pharmacy at Fair Oaks was another exercise in queuing up....wait in line for 3-6 people ahead of you to drop off an Rx, then take a seat and wait 15-30 minutes in a lobby like an airport waiting area, then when your name flashes on the electronic board you get in the pickup line and wait for 3-6 people ahead of you to get their Rx items. KPs mail order Rx was even worse, no way at all to speak to a human being in their Rx factory in Ohio.

I'm sorry Mom, but just about everything with KP still pisses me off, treated like a number, assembly line medicine at it's worst. I hope no one falls for that silly pack of lies about the USA having the best medical care in the world; maybe if one's rich and can fly up to the Mayo Clinic or Cleveland Clinic for cutting edge work, but the rest of us are not getting much to write home about and we pay 2x per capita of other nations and get poorer results.

History of KP and where the concept of making more money by providing less care came from.

[BT Lover]

I have to agree with Mike. KP is fine if everything you deal with is routine. But, the moment you need insurance for bigger things, you start running into problems. I suppose some people don't mind being treated like a number, having to call a call center for nearly everything, get approvals for nearly everything, but the point of insurance isn't for routine things because odds are, we will all have something to deal with that we need a specialist for now, not a month or more which was the problem many of my friends have and are dealing with. I like with BCBS and UHC which I have now that I just find a doctor and that is it. 99% of the time they reimburse more than they quote and I have had zero problems. I don't have to commit to specific doctors, I just see who is available. The longest I have had to wait for an appointment is a week. My friends with KP aren't so lucky with specialists. I think with healthcare you do get what you pay for. I don't like paying more but it has been worth it when I have really needed it.

[CornersLow]

BCBS to Kaiser? Are you kidding? Not many people willing to trade a Rolls-Royce for a Kia.

[ChristineVA]

I have to agree with the others. Kaiser works fine if you are very young, very healthy, and only need VERY routine care. Once you go beyond that, you can really get into trouble. I have several coworkers who have either had Kaiser themselves, or they have family members that have it and it is NEVER a good story.

For a savings of $250 per year, that's not worth it. Now, if you were telling me it saved you $5,000 a year and you were very young, I'd probably give it a thought.

[Mike from back east]

BT, you remind of one more incident.... for the short time I was with KP here in COLO I had to have a nuclear stress test for my heart issues. The Cardiologist needed to do one more step in the process and he had to personally stop what he was doing and call KP to get their approval for this extra step. Simply nuts.

In the state of VA people are not allowed to sue an HMO for malpractice, even in cases of gross negligence, because KP and their lobbyists got that passed into the laws in the state of VA.

KP's phone tree was dreadful to use too.

[rute boye]

WOW! I have used Kaiser for over thirty-five years and have never had any experiences even remotely close to what is described by the above posters. I've used the centers at Fair Oaks, Falls Church, Springfield, Burke, Woodbridge, Pennsylvania Ave, and even North Capitol, and have had generally very positive experiences. A few details:

- I'm 61 years old and in generally good health, but have had my share of health issues over the years.
- I have have had several surgeries including a turmor removal and a rhinoplasty.
- I've had several hospital stays, including one stay of two weeks with a life-threatening case of pneumonia.
- You get "one stop shopping" with laboratories, radiology, vision services, and a pharmary at all of their centers, each with a discount over conventional out-of-network sources.
- You can choose your own primary care doctor, and switch if you don't like the first one you chose (without having to give a reason.)

My wife had BCBS for many years and she finally let me talk her into trying Kaiser for a year. She has been extremely happy with them ever since. I'm really astounded to hear of all the negative comments given above.

[jillybean720]

Kaiser failed to diagnose my type 2 diabetes in its early stages. I wasn't diagnosed until I switched insurances and went to a new doctor, where I was diagnosed at my very first appointment. When I had KP, I was morbidly obese, and they turned every single appointment into a weight issue. No, my obesity did not cause my cold/flu/ear infection...I would not recommend KP to anyone. As soon as I got different insurance and was able to go to a non-KP doctor, my quality of life improved.

[patriot201]

I have had Kaiser for many years now and have been VERY, VERY happy with them.

There have been a few doctors who have been absolutely awful, but they are the exception, not the rule. I had the same percentage of terrible providers when I had other insurance as I have had with KP, though.

With Kaiser, as with most healthcare, you need to be a good self-advocate. If you don't agree with a provider, ask for a second opinion! That's wise in any healthcare situation, though.

I have never, ever waited more than two weeks for a "routine" appointment. Podiatry is the only department where I've had to wait forever, and have had less than a stellar experience.

[sullyguy]

We use BCBS PPO and have for a decade at least - though the most expensive of the employer's medical offerings, we wouldn't change a thing. We've never had to worry about visiting whatever doctor we've wanted to visit (though, admittedly, all those doctors in whatever specialty have ALL accepted BCBS - there are doctors, of course, who do not (*)). If we =want= to see a foot doctor, we go see a foot doctor - no referrel necessary (as of yet) - and WE choose the doctor to visit. The copay has been creeping up over the years (I believe it's $20 now) but other than that, we rarely have to pay any charge ourselves.

We're definitely hooked on personal - as WE like it - service.

============

(*) Some doctors don't accept some insurances - or any, for that matter.

The difference between billed charges and mandated-by-insurance charges are shocking - not unusually there can be a 10:1 difference - the physician's office bills the charge as, say, $100 and the insurance company says $10...and the physician's service ACCEPTS that reduced charge. And it happens over and over and over again. Same thing with lab costs.

We've never run into a physician's office that does NOT accept BCBS over the aforementioned decade; perhaps we were simply lucky with our choice of doctors.

Only one time have we run into a situation where an office did not accept insurance (using a different PPO-like insurance) - that was an orthodontist. In that case we weren't really interested in the office anyway for non-economic reasons but, near the end of our "Hi, how are ya!" visit the staff cheerfully exclaimed "We don't accept insurance however we will completely fill out the paperwork for you so you can send it into your insurance company!" without bothering to mention that the charges they would be billing were literally thousands of dollars more than others we had "interviewed" AND also unmentioned was the pure fact that the 10:1 ratio of billed-to-accepted-by-insurance would smack us upside the head when we would have attempted to recover our upfront payments to the orthodontist - that is, the charge would have been, say, $5000 (where others charge $3000) and the insurance company would have paid $1500...