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    I hate kaiser!

    hi

    well i haven't been active in a while.....
    been busy, moving to the states and all....

    and i have to say, health care is, in many ways, worse here than in palestine.
    at least my husband got the catheters, gauze, jelly, first aid solution for free there! true, there were things lacking, but sheesh! this is ridiculous

    i am paying $330/month for his insurance, and every appointment has a co-pay, every prescription has a co-pay, and most of the things he needs are considered "over the counter" and thus aren't covered at all.

    they only give him 4 catheters a month (he doesn't re-use catheters), and nothing else! no gloves, gauze, jelly, first aid solution....


    but the thing that has really got me peeved is this:
    he was referred to the urologist by the primary care doctor, to talk about his bladder program.....

    so we went to the kaiser urologist a few months ago, and my husband asked him about catheters and urinary issues and etc. then he asked about fertility - what the urologist thought would be a good method to try. well, the urologist didn't really answer the question, but he said, if you bring in a semen sample we can test it for you.

    my husband never did bring in a sample, but now, several months later, we get this bill from kaiser for $85 for a "fertility consultation"! As if what that urologist did was some kind of consultation?!@

    and when i called customer service to ask about it, the woman said, "when your husband asked about fertility, the type of appointment changed to a fertility consultation. much like if a mother brings in a baby for a well-baby exam, which has a $0 co-pay, but then the baby turns out to be sick, then it is no longer a $0 co-pay. But the doctor doesn't know what the patient's plan covers, the doctor is just there to help."
    to which i replied, "and you, obviously are NOT here to help." and hung up.

    maybe that was rude, but i just find the whole thing so crazy - that by asking a single question you get charged $85 -- even though the doctor didn't even answer the one question!

    sigh.

    maybe we should just go back to palestine :
    “Our lives begin to end the day we become silent about things that matter.” -- Dr. Martin Luther King, Jr.

    #2
    Kaiser

    Yes Kaiser has many weaknesses. However, you need to ask to be referred to a physiatrist. The Dr should be able to authorize all the catheters and in many cases this includes gloves, etc. With HMO's you need patience and the ability to
    "work the system to meet your needs.".......This is easier said than done. Good luck.
    In the dime stores and bus stations, people talk of situations, read books, repeat quotations, draw conclusions on the wall. ......Bob Dylan

    Comment


      #3
      tried that....

      Originally posted by Nirvana
      Yes Kaiser has many weaknesses. However, you need to ask to be referred to a physiatrist. The Dr should be able to authorize all the catheters and in many cases this includes gloves, etc. With HMO's you need patience and the ability to
      "work the system to meet your needs.".......This is easier said than done. Good luck.
      went to the physiatrist.....no dice.....went through kaiser's appeal process to get more catheters and everything else....APPEAL DENIED.

      so much for that......
      “Our lives begin to end the day we become silent about things that matter.” -- Dr. Martin Luther King, Jr.

      Comment


        #4
        Originally posted by symmetry
        ... i have to say, health care is, in many ways, worse here than in palestine. ... at least my husband got the catheters, gauze, jelly, first aid solution for free there! ...

        ...several months later, we get this bill from kaiser for $85 for a "fertility consultation"! As if what that urologist did was some kind of consultation?!@
        "when your husband asked about fertility ... the doctor doesn't know what the patient's plan covers, the doctor is just there to help."
        to which i replied, "and you, obviously are NOT here to help." and hung up.

        maybe that was rude, but i just find the whole thing so crazy - that by asking a single question you get charged $85 -- even though the doctor didn't even answer the one question!
        sigh.
        The American system of healthcare is so very broken.

        So sad ... it would appear that you only asked for a $100 question (from Jeopardy) they probably have $200, $300 $400 and $500 questions. >>> said with lots of sarcasm.

        As for the doctor being there to help you and doesn't know how the Kaiser sytem works >>> he/she knew enough to write down that single question so that Kaiser could get a co-payment/consulation from you.

        Did you ask to speak with their ombuds person? It is worth a try to get a better answer.

        I could have moved to the USA many years ago and this was a key reason why I did not move.

        Sorry you are having these difficulties and I am sure things will get better with some additional time.

        William

        ... rolling since 1989
        ...

        BE NICE!It's free

        P.S. ~ I have "handicapabilities"

        TWITTER: @MacBerry

        Comment


          #5
          Just wondering why you picked Kaiser??? Of all the HMOs I have found them to be the least disability friendly. Yes, you can appeal, but it is very difficult. Can you change to a different insurance (and if possible NOT an HMO)???

          Medicare and the VA also restrict catheters (to 4 and 8 per month respectively). Why doesn't he reuse catheters? It is perfectly safe if properly done.

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #6
            Symmetry

            How long have you had this insurance policy? And you really can't expect them to pay for catheters just because you don't want to clean them to reuse.

            Comment


              #7
              Beef

              Sym: To me it seems your beef is with your doc who coded the consult as being for fertility. Your insurance is only following her/his coding, paying the doc's fee and billing you for co-pay.

              Stay Strong,
              Hardy Sole
              You C.A.N.
              Conquer Adversity Now

              Comment


                #8
                Happy to be Canadian!

                Comment


                  #9
                  I agree with the nurse on the choice of insurance, was this your only option? Mine covers a lot more.
                  T7-8 since Feb 2005

                  Comment


                    #10
                    Kaiser Problems

                    Just curious, what region of the US is your Kaiser in?
                    I'm in Northern Ca region and thru the Kaiser DME, I'm eligible for 5 self contained disposable mentor caths per day. Kaiser has a contract with Shield Health Care and I am authorized 150 cath's per month. Kaiser is paying 100%. My insurance is thru Cal Pers and this may make a difference.

                    Also, I have a friend using the Va at Palo Alto, and he's receiving comparable quantities. He's also told me that he can reorder supplies on-line with no hassles.

                    You need to be relentlessly persistant. Good luck.
                    In the dime stores and bus stations, people talk of situations, read books, repeat quotations, draw conclusions on the wall. ......Bob Dylan

                    Comment


                      #11
                      Originally posted by Nirvana
                      Just curious, what region of the US is your Kaiser in?
                      I'm in Northern Ca region and thru the Kaiser DME, I'm eligible for 5 self contained disposable mentor caths per day. Kaiser has a contract with Shield Health Care and I am authorized 150 cath's per month. Kaiser is paying 100%. My insurance is thru Cal Pers and this may make a difference.

                      Also, I have a friend using the Va at Palo Alto, and he's receiving comparable quantities. He's also told me that he can reorder supplies on-line with no hassles.

                      You need to be relentlessly persistant. Good luck.
                      No question, Shield Health Care is a top-rate provider/vendor. I order by phone (althought on-line is available) and never have any problems.
                      "The world will not perish for want of wonders but for want of wonder."
                      J.B.S.Haldane

                      Comment


                        #12
                        Originally posted by Nirvana
                        Just curious, what region of the US is your Kaiser in?
                        I'm in Northern Ca region and thru the Kaiser DME, I'm eligible for 5 self contained disposable mentor caths per day. Kaiser has a contract with Shield Health Care and I am authorized 150 cath's per month. Kaiser is paying 100%. My insurance is thru Cal Pers and this may make a difference.
                        I'm with Norcal Kaiser, as well. My GP is the one that did the prescribing: one intermittent catheter & 35 condom catheters per month, and two self-contained disposable per month. Shield works very well.

                        The cost is more the particular health plan rather than how you got it. The really annoying thing is the 20% $2000 cap on DME... A real pain when buying a wheelchair...

                        Raccoon
                        4/6/97, car accident, C5. http://raccoon-kathleen.blogspot.com/

                        Comment


                          #13
                          Maybe there is hope to reform healthcare.

                          The state government is taking some insurance companies to court in Massachusetts for failing to cover health benefits and services required by Massachusetts law.


                          Attorney General Martha Coakley filed an amended complaint in Suffolk Superior Court against MEGA Life and Health Insurance, Mid-West National Life Insurance, and their parent company; HealthMarkets, Inc., raising serious new allegations about unfair and deceptive trade practices. Specifically, the Attorney General's complaint alleges that the insurance companies violated state law by misrepresenting the provisions of their policies, failing to cover health benefits and services required by Massachusetts law, disclosing personal health information about insured consumers to third parties, and illegally requiring self-employed individuals and small businesses to pay fees to join associations to gain access to small group insurance. The Attorney General's action seeks to stop the alleged unlawful practices, to require that MEGA and Mid-West pay refunds and restitution to harmed Massachusetts residents and substantial civil penalties and costs to the state.
                          http://www.medicalnewstoday.com/articles/80553.php

                          William

                          ... rolling since 1989
                          ...

                          BE NICE!It's free

                          P.S. ~ I have "handicapabilities"

                          TWITTER: @MacBerry

                          Comment


                            #14
                            Sym

                            I notice you didn't answer my question on how long have your husband had this insurance. I think you know why I asked it. If I remember correctly, your husband is from palestine and not an American citizen. He came here with a pre existing condition so why would Kaiser pay for his medical care do to his injury. If i'm wrong correct me

                            Comment


                              #15
                              Originally posted by TheRainman
                              Sym

                              I notice you didn't answer my question on how long have your husband had this insurance. I think you know why I asked it. If I remember correctly, your husband is from palestine and not an American citizen. He came here with a pre existing condition so why would Kaiser pay for his medical care do to his injury. If i'm wrong correct me
                              What does one's citizenship status have to do with coverage?
                              Daniel

                              Comment

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