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Kasier HMO Vs Aetna PPO

Joined
28 October 2009
Messages
815
Location
SoCal
I have done some research but most say stay away from Kaiser, but I am in SoCal where there are many Kasier facilities now. I am 28 years old so knock on wood that I don't think I will have to visit the doctor very often.

Coverage I prioritize most:

- Emergency Room / (Car Accidents)
- Chiropractic Specialty Doctors
- Sport Injures, x-ray, MRI, etc..
- Routine check up, blood test, etc..

Which one would you choice and your opinion? I am leaning toward Aetna (High) PPO.

 
Hi Hugo! I live in Orange County and am on Kaiser. I am happy with them but it depends on where you live. When I was in Los Angeles County (Acton, using Lancaster and Palmdale facilities) I wasn't nearly as happy with them.

I pay $25 per visit, $10 for blood tests and X-rays. My medications are usually $10/month, each, to me although my Enbrel shots (for RA)cost Kaiser over $1,600/ month. I have rheumatoid arthritis so I see my RA doctor about every 6 months but only go to my primary or a substitute for him/her, when I'm sick or broken, which is not often at all.

I can't really tell what your monthly premiums are with those options. If I got cancer I think I'd be more relaxed with Aetna than Kaiser. Otherwise, I've been happy with Orange County Kaiser.
 
I'm a long time Kaiser member (NorCal) and love them! I come from a medical family (dad OBGYN, mom nurse) so I know good medicine when I see it.
Choose your plan carefully. Talk to them if you have questions - they have a great call center.
Most important, choose your primary-care Doc carefully. I had to go through two before I found one that worked best with me. They are the gateway to the rest of your care.
 
I suggest that you visit Kaiser Anaheim. You will be surprised how tremendous Kaiser has improved over the years.
 
People say Kaiser has worse doctors, long & tedious process to get a specialist.

I have Kaiser and actually a lot of the friends that I went to college with who became doctors went on to became Kaiser doctors! Kaiser has become extremely competitive and offers a certain work/life balance that a lot of Doctors now are seeking. My overall experience with them has been extremely positive, you just need to find a Primary Care Physician (PCP) that works well with you. Some are anal and take a lot of convincing to refer you to specialists. Other PCPs refer you out without you even having to ask. It's easy to switch your PCP if you don't like them too. I think you do it online now (or just call them).

Things I've learned being with Kaiser off and on over the past 15 years, it is important to have your PCP in a convenient location to you. Those locations can usually do Pharmacy refills, basic X-Ray and blood work. My PCP is on my way to work.

ALSO, I found it is very important to have a full Kaiser Hospital close to you because all additional services are there (MRI, CT Scans, Physical Therapy, Mental health and other specialty doctors offices). I live in West LA and the West LA Kaiser hospital is only 10 minutes away.

For your priorities:
- Emergency Room / (Car Accidents) - If you're ever in an emergency situation you go to whatever hospital is nearest (regardless of Kaiser or not). Kaiser's policy is to reimburse you fully if it is truly an emergency). For Urgent care you must go to Kaiser facilities.
- Chiropractic Specialty Doctors - Kaiser has specialty doctors, physical therapists and physical medicine doctors. From my experience, I have not seen any Chiropractic services through Kaiser and generally the Kaiser insurance does not cover chiropractic care.
- Sport Injures, x-ray, MRI, etc.. - Kaiser is good, but these services are usually only offered at the full Kaiser hospitals (except basic X-Ray).
- Routine check up, blood test, etc.. - This is all done at Kaiser PCP locations which are scattered all over the place. In LA and OC you shouldn't have a problem finding them.

My last bit of advice, my Ex was under my Kaiser insurance and she "threw out her back" one day. She basically couldn't stand up, but was fine laying down. It took about a week to get an appointment with her PCP, another 2 weeks to get a spine specialist after that, then 3 more days to schedule a MRI. Turns out she had a huge herniated disk in L5/S1. In cases like this, it's almost always better to suck it up, pay the higher deductible and go to Urgent care or the Emergency room. You could end up waiting a few hours but at least you'll get a MRI right away instead of 3 weeks. But the service we received from this experience was nothing short of exceptional (once we got in to the doctors).
 
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