Your experiences with Kaiser...

kittycarr

Considering a POS plan with them with DH's work. $60/mo

No deductible, no coinsurance, unlimited payout

Copay - $10/$20

ER - $75

Outpatient procedures - $25

Inpatient care - $0 for 90 consecutive days

External prosthetics - only mammography bras, urological and ostomy supplies (and i'm aware of the law regarding reconstructive surgery for a mastectomy)

Um, what else...prescription coverage is good.  My concern is for specific care for if you get cancer, I want a full limitations and exclusions guide that I am waiting for from DH's employer and the external prosthetics scare me.  If I get a disease or have an accident that results in the loss of a limb or two, I have to pay in full for that??  Is this where Aflac comes in??

 

 

 

kittycarr

And until there is the big benefits guide as to what's what, I won't know anything about specific coverage and treatments regarding cancer.  What happens when we get cancer? 

Even though what I stated above is good coverage, if customer service blows and they think everything is not necessary and refuse to cover stuff, then it's not worth it.

JOEBunny

My uncle has had them for 20 years.   He has a serious chronic condition and they have done a good job of treating it.  He uses crutches, but has all his limbs, so not sure if they would pay for that or not.

KoriBrett

aflac doesn't cover limbs.  I work at a place that makes limbs, and I have aflac, so I know that at least LOL  They pay a set $ amount toward a specific event but do not take the place of ins. coverage for a limb.  Aflac does have a cancer coverage policy and an accident policy, but would cover nowhere near what a limb would cost for a lifetime.

What about internal prosthetics, like if someone needs knee reconstruction?  The external prosthetics, it sounds like they just quoted you about DME instead of O&P (durable medical equipment, orthotics & prosthetics).

kittycarr

There is a separate section of coverage mentioning dme's - is that what external prosthetics are?

KoriBrett

Technically, DME can be anything from crutches to a new boob to a new leg to a colostomy bag.

Check out anything that says DME or O&P on it, it's a broad category.

JillShari

I am a physical therapist who worked in hospital for many years and I HATED Kaiser.  They had their own case worker which meant that for me to request further therapy either at home or in a rehab, they had to concur or they did what they wanted to.  If I needed crutches or a walker or sometimes I actually wanted them to have both (one for stairs, other for level surfaces)...I had to clear it through them and that was tough.  Instead of inpatient rehab somewhere, they'd often say, but we can get a commode chair and home nurse/therapist out to see them tomorrow...good enough??  Actually...NO!

When I worked in a nursing home, we had one Kaiser patient.  She was youngish and had had both knees replaced...she should have gone to acute rehab (more aggressive), but she didn't (more expensive).  She lived on her own in a townhome where she had a flight of stairs to enter and then 2 more flights to her bedroom/bath.  They told us to notify them as soon as she could do 1 step, then she could be sent home.  (We had a dilemma indeed and had to decide if we practiced stairs and didn't write it down or notify them when she did any)  They said it was a "social" issue not a medical one.  And how was she supposed to open the door for the home nurse/therapist etc????

So.... as a therapist I hated them and knew that I would NEVER use them if given the choice.  Sure they are cheaper, but I didn't agree with the cost saving measures.

kittycarr

Kori - That's exactly why I want that exclusions and limitations book to look at first.

But why would there be two separate columns for dme's and then another for ext pros?  Ext pros to include mammory bras, ostomy and urological supplies?  That raises a red flag...