leave Kaiser for another carrier?

[Erin591]

Hello,

I am currently seeking specialists to work with my Father (dx MDS), who has been in and out (but mostly in) the hospital for the last 3 months.

He is being seen at a Kaiser facility, but I am increasingly interested in the specialized services of cancer centers, such as City of Hope or UCLA Cancer Center. Because of his current insurance he is not eligible to receive services at those sites.

I am looking to ask his doctors to send authorization for a second opinion from one of these sites, but am not holding my breath.

Has anyone left their insurance carrier mid treatment for another carrier? If so, what did this do to the premiums and copays? Is this a bad idea?

Would love any insight, friends.

Thank you

[sbk007]

It depends on the policy and it also varies by state. Is it individual insurance purchased by him or a group plan or Medicare/Medicaid. In NYS the Individual/Family insurance products that are sold now are much different than the policies they'll be selling in 2014. For 2014 They all have limited networks and none have an out of network option. For 2014 NYS insurance companies will offer the same Individual/Family plans and networks that are offered on the exchanges and their 2013 products will disappear for most Individuals/Familys. I don't know how it works in your state but in NY for 2013 if you have no insurance at all the state mandates the ability for anyone to purchase a policy from those ins companies that sell in NYS at anytime. Each company has a different network, and the premiums are 1500.00-2200.00 for an individual depending on the company. Once you have insurance the rules change and you must wait for open enrollment or a life event. There might be a way to get approval if your Doctor can convince the ins company that the out of network doc is unique and there are no comparable docs in the current plans network.

Please Note I am not a health insurance agent nor can I attest that the above is entirely accurate. Hope that helps a bit.

[BrianFlaigmore]

I have had Kaiser in the San Diego area for twelve years. Kaiser has some downfalls. It's tricky to work the system. But when AA rocked my world two years back they took good care of me. First with ATG then with a bone marrow transplant completely covered at City of Hope. I understand that you are dealing with MDS and may not be heading for a transplant, so I cannot comment on that. But, one huge advantage is their computer system for patient records and being able to email your doc.

With that being said I am looking at moving to my wife's insurance this month since I still have to drive to L.A. to see my BMT doc every couple of months.

If you have any questions, please fee, free to ask.

-Brian

[Erin591]

Originally Posted by BrianFlaigmore

I have had Kaiser in the San Diego area for twelve years. Kaiser has some downfalls. It's tricky to work the system. But when AA rocked my world two years back they took good care of me. First with ATG then with a bone marrow transplant completely covered at City of Hope. I understand that you are dealing with MDS and may not be heading for a transplant, so I cannot comment on that. But, one huge advantage is their computer system for patient records and being able to email your doc.

With that being said I am looking at moving to my wife's insurance this month since I still have to drive to L.A. to see my BMT doc every couple of months.

If you have any questions, please fee, free to ask.

-Brian

Thanks for your insight! I'm glad to hear that you received awesome care. it is so important! When you say covered at COH, do you mean that Kaiser was willing to authorize COH to provide services? I am really hoping that's the case... they're taking good care of my Dad but I do want to see what specialists outside have to offer as well.

[NLJabbari]

Hi Erin, We too are Kaiser members No. Cali. My son has been under their care since 2004 for SAA. Initially (at diagnosis) I took my son to Stanford Hospital for a second opinion. I paid out of pocket for the visit and Kaiser reimbursed me. To my knowledge, the ONLY other service they will pay for outside of Kaiser is any required treatment not offered at Kaiser (Like BMT) They sent us to Stanford for a BMT consult twice.

[BrianFlaigmore]

From what I understand is that the only services that they will authorize for City of Hope is a BMT. This covers the transplant, follow-up care to day 100. Then if you ever get sick and it is related to the transplant you can re-check in for care at COH. Sorry that my knowledge is limited to this.

-Brian