PPO to Kaiser - Should I Change?

[Astro27]

Hey all, in the 15 some years I've had crohn's I've ALWAYS had a PPO insurance policy. The main reason is out of fear of being told I can't see a certain doctor or use a certain medication, so I've just always stuck with PPO coverage.

Here's my dilemma; I'm starting Remicade tomorrow and my out of pocket coverage @ 10% is going to be about $350 per infusion. Next year my yearly $500 deductible resets, so you can see that I'm going to be spending a ton of money over then next couple of months. My second issue is that I don't like my current doctor. Every time I need a medication refill his office has some problem getting it filled, and I've currently been out of Asacol for about a month because they can't get their sh*t together.

So I'm basically at the point where I'm okay with a new doctor, and because it's that time of the year when I can change my insurance premium I'm seriously considering going with Kaiser. Everyone I've talked to loves Kaiser, however, none of them have Crohn's disease so I don't know how much weight I should give their opinions.

Can anyone with experience using Kaiser give me your honest feedback? Do you like it, hate it, or are you neutral? Any horror stories, or specific differences I should know about? The only doctor I ever see is my gastro and it seems like I always have a $400 bill due at anytime for some test or procedure I had to have done. At the end of the day I want the best coverage, but $350 per infusion and an incompetent gastro doc are making me wonder if Kaiser would be a better choice for me.

 

[my little penguin]

Do you have remistart ?
It covers your portion of the copay .
Not income based
Then you are only left with a very small amount
But insurance gives you credit for the full copay against your deductible .
Once you hit max oop then your infusions are free for the year .
We plan on spending max oop for ds plus monthly premiums to figure out total cost for the year .



http://www.remistart.com

 

[Clash]

No info on Kaiser but when you started remicade did they mention Remistart to you. It's a patient assistance program from remicade makers and it it NOT financially based. If you have commercial coverage then you should qualify.

While my son was on Remicade I think we paid 248.00 a year out of pocket.

Here's a link, it would work with PPO or Kaiser

http://www.remistart.com/

 

[Justanothercp]

I have had Kaiser forever. They manage my Crohns, I've had one resection and get Meds including Remicade through them. I really like Kaiser, and like you, I don't ant to change, going so far as to turn down jobs that didn't offer Kaiser insurance. I've had different copy's depending on how good the insurance coverage was through employer. Kaiser, like all other insurances, has recently started charging more for a pit of the specialty tier Meds.
What part of Calif do you live?

 

[Astro27]

I haven't heard of Remistart, but I would think that I would have been told about it because I went back and forth quite a bit due to the high cost. I'm assuming the location I'm going to isn't part of the Remistart network, according to my doctor's nurse the nearest infusion center is about 50 miles away. I live in southern California, the IE area. I'm guessing the lack of options is likely why it wasn't mentioned, but I'll call tomorrow.

There doesn't seem to be a wealth of gastro docs in my area, so I'm a little curious who Kaiser would send me to. How does that work exactly? If you don't like the one you get can you change? Is it hard to also get a nutritionist?

 

[Lisa]

Here is information on the remistart program.....it is not location based.

http://www.remistart.com/for_patients/patient_rebate_program_for_remicade.html

 

[Astro27]

Any personal experiences with Kaiser? (please keep this thread on topic)

 

[pdx]

My 13-year-old daughter has Crohn's disease, and we have Kaiser insurance. (Full disclosure: my husband is a Kaiser physician.) I think that all the Kaiser regions run independently, so our experience in Oregon may be different than yours in So Cal.

I've always been very happy with with our Kaiser coverage, especially this last year as we've gone through my daughter's diagnosis and treatment. Her GI is fantastic, which is fortunate, since she's the only Kaiser pediatric GI in our area. (There are more choices for adult GI's.) I like that whatever her GI recommends doesn't need to go through insurance approval (things like MRE's, Remicade dose increases, or antibody testing). Everything is very seamless, from making appts to filling prescriptions. I feel like we jump through many fewer hoops than people on PPO plans.

My daughter's out-of-pocket maximum each year is $600, and we hit it in January, so we haven't had to pay anything out of pocket since then (and she's had 2 hospital stays, Remicade, Entocort, and 6 months of EEN supplies, along with all her GI visits).

The one area where I feel Kaiser does a poor job is with mental health coverage.

 

[Cross-stitch gal]

I switched from kaiser to PPO in 2013 after having them since I was born. I had some alright doctors and some not so good ones. Just remember if you go with kaiser that once you pick a doctor, you're stuck with them whether good or bad. My last GI wasn't very good and there weren't very many to pick from in comparison to PPO. I'm thinking that for me, I'd rather stay with PPO.

 

[teeny5]

I have Kaiser and love it! Never had an issue, billing is easy. Coverage can vary. For me lab tests are free and office visits $25, but all that depends on what plan you pay for. What is nice is if I see my regular Dr then go see my GI they each can look up tests the other one ordered easily...no explaining things over and over to people. They have an online thing you can use to refill prescriptions, email your Dr, request and appointment, or look at test results. I am in southern California...My GI is in Riverside.

 

[BigBoss]

I live in soCAL, and I have had kaiser for the last year, there are alot of really good things about them as someone mentioned, the whole online thing, with the ability to email your doctor, make appointments, get lab/test results the moment that your doc does. Those are all very cool. I don't recall being stuck with the Dr. you pick once you pick one, I have requested new Dr.s before, but it may be different from one kaiser to another? Anyhow, my biggest gripe with kaiser, is the pain management area, for me, I have been unable to achieve remission, and pain meds drastically help my quality of life, or my situation, however you want to look at it, but they are more than reluctant to look outside the box. The fact that not all crohn's patients have the same symptoms or that not all patients respond to the same treatments, or just that not all people are the same.
I did meet the most amazing surgeon/MD I have ever come across at my facility. He did my 6hr resection surgery and did an amazing job. The most human and caring doctor I have ever met without a doubt. He is the main reason I am still considering staying with Kaiser. I just find it hard to deal with the whole idea that if something helps you feel better or more comfortable, that you can't have it, as they also have a no marijuana policy at all, no ifs ands or buts. That isn't a deal breaker for me necessarily, but it just goes back to the whole thing that you can't take something even if it helps you feel better.