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I’ve been with Kaiser for over a year after having been on One Medical which is aiming to go in the opposite direction (many small satellite offices with good tech and more personal private care).

For simple, routine needs Kaiser really does shine. Easy appointments, quick, good staff. We recently had a baby through Kaiser and pre-natal and post-partum care as well as the actual delivery was a fantastic experience. Much more so than the experiences of my peers at other non-Kaiser hospitals. Cost is all covered in employee plan.

BUT as soon as you encounter specific issues, Kaiser breaks. I’ve had persistent GI issues and was never able to find consistent specialists on Kaiser. I also lost coverage to my therapist as Kaiser only does group therapy.

Agreed. Kaiser does well for the vast majority of problems and for the averafe person, but anything specific, out of the norm, or challenging Kaiser fails. You sometimes need to see someone not in network and that's the main reason for insurance. Anyone really can help treat you for common ailments, but when something unique comes it's better to have the options to see the best in the field.

This happened to my family as well. My wife broke her ankle and is an avid amateur sports nut. She wanted to go see a top sports doctor (KP has none) and couldn't get KP to cover any of it. To pay out of pocket was anywhere between $20k-$30k. We ended up flying to the UK because it was cheaper and she had a trusted top tier sports injury surgeon she knew there.

Well that's how it works. If you want healthcare to work for everyone, you cannot expect that insurance will reimburse treatment from top doctors outside of rare conditions (where top doctors are the only doctors). Sport related injuries are extremely common. Why should an insurance reimburse an incredibly costly treatment when a normal treatment is good enough for most people? By definition, you cannot have an insurance that covers everyone but sends you to a top 1% doctor. What would the other 99% used for?

I'm not discrediting that notion. My point was to echo the sentiment that a closed-loop healthcare system has it's downsides when it hits edge cases.

For the record, I pay the same for healthcare from UHC now and it would cover the $25k cost for the specialist because they're in the UHC network.

Do you pay the same as an individual or through an employer?

When my wife left her job several years ago (but post Obamacare) and needed to get insurance on the open market, her Northern California Kaiser plan was roughly the same price as her employee group plan (inclusive of employer contribution). Not too long ago my sister purchased a Kaiser Mid-Atlantic plan on the open market, which was also reasonable with nearly identical coverage to the group plans I've had.

As far I understand, Kaiser is largely an outlier regarding rough cost parity between group plans and individual plans. I'd be surprised if UHC cost the same as Kaiser for the same coverage on the open market, but if you confirm then I'll have to update my assumptions.

Not sure about open market to be honest. I'm currently on COBRA (left a FTE position that had access to both). Will let you know in 9 months :)

Most of the "top 1% doctor" is marketing hype and BS. Reminds me of the "America's Top Doctors" ads you see on airplanes.

I don't know the kind of therapist you're going to but I was able to still see my therapist after I changed over to Kaiser. You might want to contact yours and ask if they're under the Beacon Health options plan. There are sometimes roundabout ways to get it done and I managed to do such.

You might be on the West coast. Kaiser does individual therapy on the East. Maybe your company isn't willing to pay for individual...

They do it on the west coast as well. You might be right that it's coverage related, but Kaiser in my experience let's you pay out of pocket for anything not covered. Could be that they don't do individual therapy for certain issues or simply can't due to staffing issues.

I'm with Kaiser Permanente (switched from a PPO) and have been for two years and I absolutely agree with your comment - in SF they have brand new world class facilities in the dog patch neighborhood near me and I can book and see a doctor and orthopedic specialist and get an xray and scan in the same day and in the same building, and be about $30 out of pocket all in. That is awesome health care.

Is it an HMO? Because those can bankrupt you if you go out of network...

It's a Health Plan. People go out of network in Kaiser all the time- basically, once Kaiser's default system can't handle you (complex organ transplants, advanced rare cancers, etc), they send you to a place like UCSF, and have negotiated the cost structure.

There's no guarantee KP won't bankrupt you, but it seems better than most.

If you voluntarily go out of network for non-emergency care, then yes, you pay a ton. If you have an emergency and go to an out of network ER, that is still covered (at least for plans purchased on CoveredCA) because of provisions in the Affordable Care Act. The billing may be a logistical challenge, but it should not bankrupt you!

Kaiser has both HMO and PPO plans, although depending on your employer you might only have access to the HMO (e.g. if they went with another insurer for the PPO).

Thus proving the inherent value of the network!

I'm new to the area and have Kaiser. Are you talking about UCSF Medical Center at Mission Bay?

The Kaiser facility is very close to that UCSF facility next to the 101 on Owens street.

I'm also a big fan of Kaiser, and can share a couple of anecdotes to illustrate why.

A few years ago when I was working for a startup and had insurance through United Healthcare, I came down with a high fever and then started seeing blood in my urine on a Saturday. My only option was to go to the ER, which I did.

In the ER I had blood and urine tests, which determined that I had an infection in my kidneys. I was treated with intravenous antibiotics, and sent home a couple hours later with prescriptions for a couple more drugs to take for the next week or two.

IIRC my total bill for the 2-3 hours I was there was around $6,000, of which my insurance covered about $1500 and I was left with a $4500 bill to cover out of pocket. I remember thinking at the time that such an event would be financially catastrophic for most people - I was fortunate that I could afford it.

My wife has been with Kaiser for many years. Last year my wife started experiencing chest pains, which turned out to be pulmonary embolisms (blood clots in the lungs). She was admitted to the ER as well, where they ran some tests and got her on blood thinners. This was followed up with lung capacity tests and a few other things. Like me, she was in the ER for just a few hours, then sent home with appointments for follow-ups.

Total cost for my wife was about $50 all-in.

The magic of Kaiser is that when the insurance and the provider are both the same company, there's no dispute over pricing. There are no fights over bills, and no surprise costs that weren't covered. We have deductibles with Kaiser, but almost all services are a low fixed cost, so we don't eat into those deductibles much at all. This is not the case with other insurance companies.

In my mind the Kaiser model is what the US should have as a national health care system, that's really good at covering the 95% cases at a reasonable cost, leaving people the option to go to other providers for specialty care if needed.

I'm with Kaiser and my favorite thing compared to the PPOs I've been with in the past is the integrated IT health records. Any doctor, specialists, ER, can see my whole history of ailments and drugs and lab test results. When my doctor orders up a specialist or a pharmacy I don't have to re-explain anything, it's all in the system. I'm sure it helps reduce medical errors.

They were the first 'big' client of Epic Software. Many other hospital systems around the US now use Epic, and have similar features.

The difference is when you're on something like BlueCross you have a "network" of hospitals and independent doctors and labs and pharmacies that you can choose from. But those are not on all on one IT system and a lot of times they have no way of communicating with each other. With Kaiser it's all vertically integrated under one company that can impose a system-wide IT system.

You may be amused to hear about the programming language they use.

https://thedailywtf.com/articles/A_Case_of_the_MUMPS

I've known two people who loved Kaiser until they had a serious issue. Not privy to a ton of the details, but it appears that they Kaiser is not immune to at least a divergence of interests with their patients when the figures get big.

I've been with kaiser my whole life. 3 open heart surgeries from 2 to 32, ongoing medical of all kinds (psych to phys). Kaiser was 2nd in the nation for cardiac care for awhile. I have had nothing but great experiences and have transferred to their Washington state system, which is basically the same, except the facilities and staff seem less sophisticated overall.

I've heard horror stories from all kinds of people with all kinds of insurers. For example, a neighbor of mine uses California Pacific Medical in Nob Hill. It's the hospital that caters to San Francisco elite. This past year his doctors mistook skin cancer on his eye for a sty for like 6+ months. He went back several times complaining before they caught their mistake. It's too soon to tell, but that serious issue may turn out to be a fatal one.

Doctors aren't magicians, and they make plenty of mistakes. More to your point, no respectable doctor is going to ignore the cost and time element. Nor should he. There's no such thing as a cost-free diagnostic or procedure, even when money is no object. Even the very best doctor the world has ever seen is working with scarce time and resources; namely, his own. There's no avoiding conflicting interests and goals of some sort or another.

At the end of the day people should be choosing healthcare based on objective criteria. More importantly, our social policies should be built around objective criteria. By objective criteria Kaiser is one of the very best hospital systems in the country. There's plenty to complain about, but it's the nature of things.

EDIT: I meant CPMC in Pacific Heights (Upper Fillmore), not Nob Hill. Judging by the people coming and going, Saint Francis on Nob Hill seems to mostly serve the Tenderloin.

Hence health insurance should be strictly separate from health care. A strong insurance body could even ensure proper competition in the health care space.

Ditched my BlueShield PPO for Kaiser and costs went down dramatically. There's tons of costs to be saved in healthcare and glad to see the private sector making an effort.

I tried applying to Kaiser and they rejected me for having a pre-existing condition which couldn't be helped given that I was born with it.

Good for everyone else, I guess. :/ I ended up moving back home where the government covers my treatments.

They are a business not an ONG.

US is a shithole country in relation to healthcare systems

Side note, but I really think pre-existing conditions should be covered by welfare, not private corporations who have the requirement of turning a profit.

isn't that illegal now?

The incident happened before the ACA, though insurers have found clever ways around it: https://www.theguardian.com/commentisfree/2016/oct/27/obamac...

the tactic doesn't involve denying coverage though. The poster above said he/she was rejected.

That was my understanding as well.

Kaiser is available up and down the west coast, having completed the acquisition of Group Health last year. https://www.seattletimes.com/seattle-news/health/kaiser-perm...

Second that. I was covered by Kaiser for more than 10 years. It really is a great provider. You just show up to a clinic and everything is there - all the specialists, doctors, labs all under one roof. They have all the records already, everyone in the chain can see each others notes, lab results etc.

Yeah with my plan I don't have access to outside doctors, so far however I didn't need them.

I had Kaiser for a while and loved it. One appointment and you get two doctor visits and blood tests done the same day.

That's pretty cool. I grew up with Kaiser, going to the one-stop-shop hospital in my youth. I didn't think much of it, it was icky and grey.

It wasn't until adulthood and having to navigate the fragmented world we have now, I realize how nice that was.

That and it was cheap(ish)!

I was with Kaiser for a long time because I never needed a doctor. When I did, I had to fire kaiser. They nearly killed me. Talking to my coworkers, it turns out this is quite common. They hire a lot of people that received their medical degree in countries with much lower standards. It's actually quite concerning how many people I know IRL that lost friends due to misdiagnosis by Kaiser. It doesn't help that you can't (easily) sue them. You agree to a non arbitration clause.

I see a lot of folks praising KP in this post and it's very concerning.

If you want to convince me, show me the relevant statistics. Medical errors are not unknown from other health providers.

I am not looking to convince anyone. I know what I experienced. My friends know what they experienced. That is more than enough for me to have left KP and to warn my friends regarding my experiences. I have advised various agencies of my experiences.

They're mostly based in California, though they recently acquired Group Health Cooperative (largest healthcare provider in Washington State).

They’ve been doing a big ad campaign in WA. Now I understand why.

Kaiser is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher than many of the other options that we have in our plan.

When you look at how Kaiser is structured, they should be cheaper. I think they're just pocketing the difference between the market rate and what their costs are.

I'm downvoting you because you stated this as if it is a fact for everyone. We're in a small group plan and paying about the same for Kaiser as we are for Blue Shield, not "much higher". So, I think here's it's more "your mileage may vary."

To be fair, Blue Cross/Blue Shield are usually highway robbery for terrible plans, so...

The whole thing is broken. A friend of mine is switching jobs and is going to forking over a third of her paycheck for COBRA until the new job enrolls her in their plan. Almost certainly, nothing will happen in that short time period, and she'll have wasted thousands of dollars. But if something did happen, and she didn't pay the extortion, sorry COBRA, she'd be up shit creek without a paddle and ruined.

She can wait until an incident happens and then activate cobra. You don't have to pay for it upfront.

This is not true of all COBRA plans. To be safe, she can delay premium payments a maximum of 45 days and still have coverage for claims that occur before the initial premium payment.

https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/...

This was really good to know, had no idea.

I think you can retroactively pay for COBRA, yeah?

You can enroll after an event and it'll be as though you had insurance the whole time. You'll have to pay for the retroactive coverage, but it's a pretty smooth way (assuming nothing happens) to avoid paying for COBRA while still technically "having coverage".

Though I think there's a time-limit on it.

>I think they're just pocketing the difference between the market rate and what their costs are.

This is baseless and not really possible.

Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.

> "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is."

When you can game the pricing you can always just slice 80% from an ever increasing pie.

That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated.

It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.

There is a whole lot of backscratching with the profiteers taking their cut of the 80%. That is why we get $30 Tylenol pills under the guise of "care".

Hospitals aren't charging insurance companies $30 for Tylenol and then paying insurance companies under the table if that's what you're alleging.

That's completely illegal and it's just too noticeable for them to do it large scale.

The OP was making a baseless claim because they didn't know what they were talking about, and you're now grasping at straws supporting their claim for some reason.

None of the stakeholders in American for-profit healthcare have any incentive to reduce costs so everything just keeps ratcheting up. Growth can't be achieved by increasing the population of sick people so the only other option is to raise prices. The insurance companies do benefit from this. They agree to cover the inflated pricing so that their 20% cut can be bigger. If ACA permitted rational price controls this whole problem would have been reigned in.

How does this have anything to do with

>I think they're just pocketing the difference between the market rate and what their costs are.

The OP had made a very specific claim about Kaiser. That Kaiser is reducing their costs but pocketing the savings and not passing them on to consumers.

I pointed out that there is no legal way for them to do that. You've made 3 posts and so far nothing you've said in anyway refutes that.

An allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...

And yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.

And immediately after, administration costs shot up to ooh, 15-20%...

Yes, I suspect it ends up as something of a perverse disincentive to control costs

They were already above that. Especially the not-for-profits (e.g. Blues) had to scramble to get under the cap.

There was a huge amount of waste in the system. 15-20% is a marked improvement.

Cancer care at Kaiser was outstanding. They may be spending the money on extra staffing and facilities, not just pocketing it.

The only place where I believe Kaiser falls short and gives the impression of pinching pennies is mental health care.

Is there any private non-university health chain in the country that does mental health well? Every contact I've seen with any acute mental health care system --- except at the University of Michigan --- has been a catastrophe.

Go Blue!

(Hope you’re feeling better)

My employer has a very good kaiser plan, basically I pay $15 for any office visit, and nothing for lab tests, etc. The total unsubsidized price is $1450/month for two people.

I don't know if $725/per person is good or not, but when I've looked around at other plan, I've found plans with far worse benefits (high out of pocket costs) for more money.

It's been a while since I've worked for a company that had Kaiser as an option, but my recollection was that it was more expensive too. The quality of care in a given service region might be higher, but there's a reason that they haven't completely taken over their market.

Kaiser is great compared to other US providers (although that's not such a high bar).

The issue I see is that they are very reluctant to refer you to specialists even when the issue seems way over the GPs head. And they are somewhat fast-food-ish. Go in, do whatever it needs to be done quickly, then off you go.

But still way better (and cheaper) than the competition.

Kaiser is almost a monopoly in Hawaii (only a handful of providers they haven't bought). Interests can diverge when they are the sole provider for both insurance and every health need. Example: hiring practices of cheap vs competitive doctors and staff. Anecdotally every doctor and nurse I know refuses to take their family there.

I really like the doctors at Kaiser. All very smart and caring. But their billing department is awful. I paid my bill every month but still got sent to collections multiple times. They would always recall it, but it was a giant pain in the ass.

KP was in North Caronlia in the 90's and if it wheren't for boneheaded mismanagement would have been completely dominant in the market there now. One of those other futures that slipped away in the night :(.

Kaiser Permanente has a huge presence in the Washington, DC area.

They are the main healthcare provider for a large swath of federal government workers in the DC area.

I love Kaiser. One stop shop for most things, easy, efficient, unified records. Highly recommended!

Agree that Kaiser is great for normal cases.

That said, it is terrible when traveling. It's almost as if they don't expect people to travel for more than a week at a time.

What do people do during long term travel?

Kaiser is also available in Colorado.

They're in Colorado