From: jge@ceti.cs.unc.edu (John Eyles)
Newsgroups: triangle.general
Subject: summary of responses on Kaiser Permanente (LONG)
Date: 21 Aug 92 16:45:04 GMT
Distribution: triangle

Recently I solicited opinions on the Kaiser Permanente HMO.

As promised, here is a summary of reponses.

Since my request, a number of additional HMO options have been
made available to state employees.

Also, not surprisingly, the employee costs of the options other than
the state health plan has risen considerably. (For employee-only, the
employee payment for Kaiser now exceeds the deductible for the state plan).

Summay follows:

*****************************************************************************

I've been going to Kaiser for about three years now and I 
really like it.  I like the fact that there's no big
deductible to meet, or insurance forms to worry about - 
you just have to pay $5 every time you go for a visit
and $5 for any prescription.  

I feel as if I've been pretty well taken care of there
and I haven't really noticed that they skimp on anything.
Just a few weeks ago they referred me to a cardiologist
for an ecocardiogram (which is not cheap I would imagine).
I don't think they would do something like that unless
they thought it was necessary - they are paying for it
after all - while a private doctor might go ahead and order
a test like that because he's not paying for it, you are!

One thing I didn't like at first was that I was seeing 
different doctors every time, according to whatever type
of problem I was having.  You could argue that that's 
good in the sense that you are getting someone who is 
a specialist in that field, but if you're used to seeing just
one family doctor who you know, you find the lack of that
a bit disconcerting at Kaiser.  However, Kaiser do assign you
to someone they call your "primary care provider," which is like
having your own personal doctor, although you may get referred
to others for particular problems.  So now I mostly go to this
one doctor who is very nice. 

I've never had any trouble making same day or next day appointments
for minor problems.  I've never had to use them in an emergency.
You can call up and talk to an advice nurse too, if you wish, which may 
eliminate the need for you to come in for something minor.  The only
thing I've had trouble scheduling was this once-a-year routine
gynecological exam.  The schedule for that seemed to get filled up
quite quickly for one month and I had to wait until the next month
to make the appointment - they only start making appointments for things
like that a month in advance or so.

Hope that helps.  If you have any more specific questions I'll try
to answer them.

*****************************************************************************

I have been very happy with the Durham-Chapel Hill Office.  I have a
premature baby and they've been very good about getting us the
specialists/medicines/machines we need.  (I think that's sort of
related to your question about medicines.)  You have to be an informed
and active participatant in your care, and maybe a little more
agressive than with a "regular" doctor, but that's my nature anyway.

The biggest drawbacks are that they practice out of Durham Regional, so
UNC is not used (usually).  And in quick/emergency/sick visits, you may
not get "your" regular doctor.  I haven't had any trouble getting an
appointment when I wanted one.  I also REALLY like their "advice nurse"
arrangement.  It means that you get to talk with someone reasonably
intelligent and get some immediate advice, with the promise of a call
back by the advice nurse and/or doctor if neccessary.

Let me know if you have any other questions, concerns, etc.

*****************************************************************************

I just moved into the area and got a job with a company that offers
either Kaiser or Managed Benefit Systems (a PPO, I think it's called).
I chose the Kaiser option mostly because my wife has had good luck with
HMOs, and because the flat rate of $5 per visit appealed to me.  I hate(d)
the thought of a deductible with a % copayment...

Anyway, I've only had the need to use their services once so far.
They seem to be a little stingy with same day appointments if you call
after the morning-call-us-for-an-appointment period.  I think their
appointment line opens up at 7:00am, so the scheme is this:

	1.	you get up & call at 7:00am, and get put on hold;
	2.	you wait a (seemingly) random amount of time (in my case,
		about 10 or 15 minutes, I think...  maybe not quite that
		long);
	3.	you talk to a nurse, who figures out which facility within
		their clinic you should get an appointment with (e.g. internal
		medicine, pediatrics, etc.) & who then makes the
		appointment for you.

If you miss the 7:00am window, you're only given a same day appointment
if its something they deem to be serious.  Also, you CANNOT make appointments
for the next day -- if you want an appointment for tomorrow, you have to
call them at 7:00am tomorrow morning.

That's my only real gripe about day-to-day stuff, though...
My visit was painless & quick, and the doctor was very friendly and
professional.

To get a physical, you have to call at the beginning of the month & get
put on their "physicals for the month" list.  I asked to be put on that
list during my visit (and even had the doctor order the lab work for me,
so I could get it out of the way during my visit), but haven't heard
any more about it (that was back in the middle of June).  I don't know
if I was supposed to have called them back or if they dropped the ball...

So...  The bottom line is that it's relatively cheap (& has a fixed cost),
and the care you get is good...  Their facility (building) is clean
and comfortable (not hospital-like).  On the down side, they serve a lot
of people, so the appointment system is a little cumbersome.  I guess, though,
that it does the job -- if you're really sick, you can come in that
same day; if you're kind of sick, you'll call back the next day
(or have someone do it for you).  If you're not all that sick,  you won't
bother to call back & they'll have effectively screened out a wasted visit.

I'm essentially satisfied, based on my limited experience with them...

Hope this helps at least a little bit...

*****************************************************************************

   Hi!  I've been on Kaiser for three years and think they're pretty good.
The only problem I've had is getting an annual physical appointment.  Granted
that's not a big deal but just a little annoying.  The great thing about
Kaiser that I like is the price of prescription drugs.  Only $5.00 for any-
thing (thus far for my prescriptions).  I think the co-payment range is
$5-7 for each prescription.  That helps us out a lot.  I like my doctor and
am pleased with the care I've received thus far.  I have not had anl
an emergency to date or needed an urgent or same day appointment so I can't
help you there.
  Just my 0.02 worth.

*****************************************************************************

In article <13673@borg.cs.unc.edu> you write:
|> I'm considering switching from the state health insurance
|> plan to the Kaiser Permanente HMO option.
|> 
|> I'm curious to hear opinions from Kaiser members in the area.
|> 
|> Particularly:
|> 
|> 1) how easy is it to get same or next day appointments for minor ailments

Pretty easy.  Mondays are tough, but other times generally are not.  You
won't usually see your primary care physician, just whoever has an opening
on their calendar.  I've seen pediatricians for knee pains,  etc.  I've
never felt this to be an imposition since I could always see my primary
care physician within a day or so if I wasn't satisfied with the visit
with the random physician.  I've also used the after hours emergency
number - I got the on call physician within minutes.  

|> 
|> 2) how chinzy are they ? for example, if a pretty expensive non-steriodal
|> 	anti-imflammatory works great for me for a chronic problem, how likely
|> 	are they to be willing to prescribe it rather than trying to make
|> 	me get by with aspirin, ibuprofen, or whatever ?

Hard to generalize, but I doubt that this would really be a problem.  I've
been suffering from chronic sinusitus for years now, and they've never
hesitated to prescribe any drug they thought would help.  They do generally
prescribe generic drugs to keep down costs and they will tell you to use
OTC medicines if they belive that is the appropriate treatment for your
malady.  The physicians I've dealt with have been quick to order medical
tests whenever it seemed appropriate - I've never felt that they were
scrimping on care to hold down costs.  

My family has had lots of treatment at Kaiser (2 broken arms, 1 birth,
1 Rocky Mtn. spotted fever, god knows how many visits for chronic
sinusitus, sinus surgery, chronic condromalacia (sp?), well baby visits, etc.
I've always felt that the Kaiser physicians bent over backwards to make
sure that we received the best possible medical care.  With few exceptions
(any large group practice is going to hire a dud occasionally, and to Kaiser's
credit, the physicians I thought were duds didn't last long),  I've found
the physicians at Kaiser to be excellent.  My family has been extremely
happy with the medical care we've received through Kaiser.

Now for the negatives:  First, their handling of medical records eats shit
with a spoon.  I've been referred to outside physicians and specialists
at other Kaiser offices and they _invariably_ loose some or all of my
records in transferring them between offices.  I no longer let them forward
my records - if I see a physician off site, I hand carry my records and
also take the x-rays or whatever back to Kaiser.  Sooner or later someone
is going to be seriously injured, miss critical treatment, or something 
similar because they screwed up the records, and Kaiser is going to be
sued to hell and back for negligence in handling records.  The second
negative is the Kaiser pharmacy.  It's OK when you call in prescription
refills ahead of time, etc., but if you try to get a new prescription
filled while you wait, you had better have a good book or your needlepoint
along to amuse you while you wait.  I've waited as long as two hours for
a prescription to be filled.  Half an hour is about average.  The pharmacy
is only open during hours that are very inconvenient for us working stiffs,
too.  You are SOL if you run out of some critical drug on a weekend.

In summary,  I really like Kaiser.  The excellent medical care is better
than I've ever had at any private family practice.  The price is eternal
vigilance when dealing with their bureaucracy.  I trust the Kaiser
physicians with my life, but I never trust their paper shufflers and follow
up on everything to make sure they correct their mistakes after they screw
up the records the first time or three.

*****************************************************************************

In article <13673@borg.cs.unc.edu> you write:
>I'm considering switching from the state health insurance
>plan to the Kaiser Permanente HMO option.
>
>I'm curious to hear opinions from Kaiser members in the area.
>
>Particularly:
>
>1) how easy is it to get same or next day appointments for minor ailments

It is very easy.  However, you must realize that if you want a same-day
appointment you will never see the same doctor twice.  This has proven
to be a real problem for me.  If you have lots of minor chronic health
problems, they will not realize that that is so--after all, how can a
doctor note that something is chronic if he only sees you once?  Even
for appointments scheduled well in advance, I have rarely had my so-called
"personal" physician--she is usually off on maternity leave.  I'm told
by other Kaiserites that that is unusual for advance appointments.

However, I have had, in the past, a very serious accident involving
emergency medical care (at Duke--it was the closest emergency room) and 
followup surgery (at Durham County, Kaiser's hospital).  They were great.  
They covered everything.  There was one small hassle after the accident
regarding followup care at Duke.  They wanted me to go to Kaiser for it.
I had to have the Duke doctor call them and yell at them to straighten
that out.  Kaiser really wants you to see their doctors since it is,
of course, lots cheaper for them.  You will have similar problems should
you ever want to see a specialist.  A Kaiser doctor must refer you to the
specialist, and, of course, you don't have any say as to who that
specialist is.

In addition, it took a VERY long time for Kaiser to pay Duke.  I got unpaid
bills for months.

>2) how chinzy are they ? for example, if a pretty expensive non-steriodal
>	anti-imflammatory works great for me for a chronic problem, how likely
>	are they to be willing to prescribe it rather than trying to make
>	me get by with aspirin, ibuprofen, or whatever ?

I don't know.  Our plan covers prescriptions at 2.00/per regardless of how
expensive it may in reality be.  So yes, they might be inclined to prescribe 
something cheaper.  This is just idle speculation, but it would make sense.

I have toyed with the idea of leaving Kaiser for quite some time now because
of the above-mentioned problems.  If you are a healthy person, I think it's
probably great.  Should you have problems, it is very hard to have any 
control over your care. 

*****************************************************************************

I have been a member of Kaiser Permanente in the Raleigh area
for over 2.5 years now, and in the Denver, CO area for 1.5 years
prior to that, so I would be happy to tell you whatever I know.

In general, I prefer Kaiser to my current alternatives for the
following reasons:
	1) My out-of-pocket expenses are lower than with other
	   alternatives.  This includes both the per-paycheck
	   cost and the per-visit cost.  The plan my employer
	   (BNR) participates in costs me $30 per paycheck
	   (biweekly), $5 for an office visit, and $5 for
	   each prescription filled at the Kaiser pharmacy.
	   This covers my entire family.  The office visit
	   and prescription costs for me are really important
	   primarily because my 2 year old has had many trips
	   to the doctor since his birth.
	2) I don't have to fill out forms.  As long as I
	   see a doctor at a Kaiser facility, I don't have
	   to fill out claim forms.  If I have to go somewhere
	   else (e.g. while traveling), claim forms are
	   necessary. but the process is very simple.
	3) Advice over the phone when needed.  There have
	   been LOTS of times with our child that we needed
	   to talk to a doctor or nurse, but wanted to avoid
	   the trip to the doctor.  Kaiser provides advice
	   phone lines staffed by registered nurses around
	   the clock (off-hours are to handle emergency
	   requests only).  This has saved us many trips
	   to the doctor and given us a lot of peace of
	   mind when we weren't sure we were doing the
	   right thing.

As to your specific questions:
1) How easy is it to get same or next day appointments for minor ailments?
	Kaiser provides what they call Urgent Care that fills this
	need.  Typically, you will be unable to see your regular
	doctor without an appointment scheduled in advance. 
	(For children, it is much easier to get appointments
	with their regular doctor if needed).  This seems to be
	one of the things that many people dislike about HMOs in
	general, but for my family it is not.  We don't care so
	much about seeing the same doctor each time, just that
	we see a highly-skilled, competent doctor;  and we do
	get that.
	Urgent Care is open on weekends and until at least 9:00 pm
	during the week for minor and not-so-minor ailments.
	(Try getting that from a regular doctor.)
	You typically call the advice line, and a nurse will
	help you decide if you can treat it yourself or should
	come to urgent care.
2) How chinzy are they?
	My doctor has asked me to try cheaper alternatives for
	effectiveness, but has never pushed this on me.  We
	then determined that the generic was just as good,
	but if this had not been so, I could have gone
	back to the name brand.
	My son has had a number of ear infections and each
	time, he has been prescribed very expensive antibiotics.
	We found quickly that most of the cheaper ones just don't
	get the desired results, and our pediatrician has never
	hesitated to give us the more expensive medicine.

If you have other specific questions, I'll do my best to answer.

*****************************************************************************

I have had very good luck with Kaiser.  The biggest problem has been
turn-over in doctors.  I'm on my 3rd one in 5 years.  As far as appt's
for minor problems.  If you call at 7:30 in the morning, they can
sometimes squeeze you in, but there's no guarantees, particularly if
it's  specialist.

I also know of some folks who have tales of woe trying to get
appointments or get a problem resolved.  A lot has to do with whom you
get as a physician.

I can't answer the drug question.  I have very specific prescription
needs so there's no generic alternatives.

Hope this helps.

*****************************************************************************

I have excellent experiences with all aspects of care with Kaiser.  We use
the West Raleigh branch.  Wife has had 2 major operations, with one being
spinal related which took a lot of investigation to uncover the problem
(growth on vertebra into the spinal cord, which required MIR scan to discover,
and other was emergency surgery for multiple fractured ankle).  Have been
with them since 1985.

*****************************************************************************

We find Kaiser sufficient to cover our needs. Some anecdotes:

  They allowed us to pick between 4 treatments, one of which was $375
  PER VIAL (which contains 2 shots, but we could only use one of them)
  and would require 6 vials of medicine. This was a special case (not
  everything is 0% co-payment), so we would have had to have paid $75
  per vial if we could have found another person willing to buy the
  rest of each vial... In general, though, if a need is present and no
  alternatives are available, they will pay, in our experience. As for
  your expensive medicine, you could simply ask them before you
  switch.

  My wife just had a minor but invasive surgical proceedure, sometimes
  viewed as elective. Our above-premium cost: $0.

  I cut my thumb with rusty metal and they gave me an appt immediately
  (I was bleeding profusely)

  I had an emergency on a weekend and had to go to Durham County
  hospital -- I waited for over 3 hours for a 2-minute exam to rule
  out a serious condition. A private doctor might have been more
  convenient.

They may make you wait UP TO 2-3 days for minor conditions, especially
around X-mas and in summertime, when they are swamped with patients
and have staff on vacation, respectively. I have been known to have
gotten an appt in 1 day for cold symptoms. Prepare to wait up to an
hour past your appt time to see the doc. I think that this is because
they get emergency cases during working hours, but we've been going
there for 2 years and the delay was only about 15 minutes when we
started with them. Draw your own conclusions, or better yet, ASK them
what the delay is and why it has been on the increase...

Some of the docs are exceptional, and others are absolutely horrible.
The good thing is that if you don't like your doctor, you can switch
(we did). You get a primary doc who knows your entire medical history
and knows you personally, and he or she can refer you to others for
treatments outside his or her training.

Medication is dirt cheap during working hours, and slightly more
expensive ourside working hours (if you need them in an emergency from
a pharmacy.)

Note that Kaiser has been around since the mid-40's (!) and, although
longevity is not an accurate indication of quality, I think that it
says something about Kaiser. 

*****************************************************************************

>>>>> On 9 Jul 92 18:58:50 GMT, jge@ceti.cs.unc.edu (John Eyles) said:

John> I'm considering switching from the state health insurance plan
John> to the Kaiser Permanente HMO option.

I think HMOs are a good option for relatively healthy people who only
need to see the doctor for regular physicals and minor illnesses.

John> I'm curious to hear opinions from Kaiser members in the area.

I've been a member for about three years, and have been satisfied,
although their appointment system leaves something to be desired.
It's such a pain to hear a recording say crap like: "Thank you for
calling Kaiser Permanente.  Our office is currently closed.  If you
have a serious injury or a life threatening problem, please press '1'
now.  If you'd like to make an appointment, please call back during
our regular office hours."  This isn't an exact quote, but you get the
picture.

Also, it's possible, if not likely, that you'll be assigned a "Primary
Care Provider" who's a physician's assistant rather than an actual MD.
Again, for minor illness, this isn't a big deal.  For someone with a
chronic illness or serious ailment, I'd say that a personal physician
would be best.

John> 1) how easy is it to get same or next day appointments for minor
John> ailments

I've never been able to get a next day appointment (at the
Durham/Chapel Hill office on Rt. 54).  My experience has been that you
must call the same day, typically early in the morning to get an
appointment.  You can usually get a same day appointment without too
much hassle, though.  I don't know why they do it this way, but maybe
they figure that if you're really sick, you'll go to their
emergency/night care areas.

John> 2) how chinzy are they ? for example, if a pretty expensive
John> non-steriodal anti-imflammatory works great for me for a chronic
John> problem, how likely are they to be willing to prescribe it
John> rather than trying to make me get by with aspirin, ibuprofen, or
John> whatever ?

I've heard from a co-worker that they can be chintzy (sp?).  His kid
gets the same illness yearly (ear infection?) and he knows that the
standard treatment isn't enough, and that something stronger is
required.  But the Kaiser people refuse to prescribe the stronger
medicine to start with.  They will only prescribe the standard stuff,
have the family wait a few days until they're sure it's not working,
and return for another visit for the stuff that they already knew was
required.  This used to cost only the time, discomfort and $$$ for the
extra prescription.  Now our company's plan requires a $5 payment for
*every* visit, so every extra visit, even just for getting a new a
prescription, costs $$$.

This kind of co-payment really sucks!  I got a physical last year and
had to get a special type of TB test because I was born in Hong Kong.
Supposedly, I most likely got some innoculation that can test false
positives on Tyne tests.  Of course, this alternate test requires a
second visit to check results (a two second visual inspection by a
nurse) while the usual 4-pin Tyne test can be checked visually by the
patient.  This year, it'll cost me $10 while it cost zip last year.

*****************************************************************************

In article <13673@borg.cs.unc.edu> you write:
>I'm considering switching from the state health insurance
>plan to the Kaiser Permanente HMO option.
>
>I'm curious to hear opinions from Kaiser members in the area.
>Particularly:
>1) how easy is it to get same or next day appointments for minor ailments
>2) how chinzy are they ? for example, if a pretty expensive non-steriodal
>	anti-imflammatory works great for me for a chronic problem, how likely
>	are they to be willing to prescribe it rather than trying to make
>	me get by with aspirin, ibuprofen, or whatever ?
>I'll summarize if there is interest (certainly seems like there would be).
>Thanks for your responses; I'll anonymize them in my summary, upon request.
>John Eyles

We have been with Kaiser for three years now and think that it is
great.  For my first two years here we used the PCP plan through BCBS
but they dropped it so we switched.  The main reason that we have it
is because of the kids.  We went through a period where they were at
the office at least once a week.

Our oldest daughter uses a special RX lotion every day for her dry
skin and we have had no problems with them trying to "push" something
else on us.  When she needed it she has seen a dermatologist (outside
referal before they had there own).

We are very satisfied and would never switch back unless the state
keeps cutting back and the cost of Kaiser get to high.  At first we
paid $2.00 for RX's and $0.00 for a visit but now it is $5.00 for a RX
and $5.00 for a visit.  This was caused by the increase in costs and
the state didn't want to pay more/pass on to the employees a increased
cost so we got reduced coverage.

*****************************************************************************

In article <13673@borg.cs.unc.edu>, jge@ceti.cs.unc.edu (John Eyles) writes:
>1) how easy is it to get same or next day appointments for minor ailments

In two years, I never had a problem.  But you may have to wait as much as
an hour, typically more like 30 minutes.

>
>2) how chinzy are they ? for example, if a pretty expensive non-steriodal
>	anti-imflammatory works great for me for a chronic problem, how likely
>	are they to be willing to prescribe it rather than trying to make
>	me get by with aspirin, ibuprofen, or whatever ?

I found them anything but chinzy.  To my taste, they really seemed to overdo
some things, such as sending you to a specialist.

*****************************************************************************

In article <13673@borg.cs.unc.edu> you write:
|> I'm considering switching from the state health insurance
|> plan to the Kaiser Permanente HMO option.
|> 
|> I'm curious to hear opinions from Kaiser members in the area.
|> 
|> Particularly:
|> 
|> 1) how easy is it to get same or next day appointments for minor ailments

	Tough
|> 
|> 2) how chinzy are they ? for example, if a pretty expensive non-steriodal
|> 	anti-imflammatory works great for me for a chronic problem, how likely
|> 	are they to be willing to prescribe it rather than trying to make
|> 	me get by with aspirin, ibuprofen, or whatever ?

	If it isn't significantly better then tough luck. They're actually
	not bad here, though they'd prescribe 3 ibus and make you pay for
	them rather than prescribe 600mg Motrin and pay for it themselves.
	Also, they have a "preferred" prescription drug list. I couldn't
	get a decongestant I liked because it wasn't on the list. Check
	things like this first.