Hi Everyone,
I am wondering if anyone has Kaiser Permanente as their health plan and if so, how likely Kaiser is to refer you out of state to someplace like Mayo if Kaiser does not have the ability or resources to conduct a procedure? We will be in the marketplace for a choice next year (January 2020). We have been happy with Kaiser up until now but if seems that they may be limited in what they can do going forward. Thanks everyone!
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Jump to repliesI had Kaiser and was happy with the treatments I got there. They are professional, the facility was new and they are also very organized. I was not impressed wth my MO there, but she didn't specialize in PCa. They did have a regional PCa specialist originally from UCSF that was very good and I was able to consult wth her when I needed to.
From what I know, it's pretty much impossible to get anything outside of their system. I've also heard they are very reluctant to refer you out for a clinical trial, but I don't have first-hand experience with that.
Thanks! We have also had good luck so far in Colorado but there are treatments that my husband may need in the future that I know Kaiser does not do. Our oncologist is general and there is not a regional pc specialist but we have been lucky so far to consult with a pc specialist at both Mayo and Anschutz (University of Colorado). We have not had a problem with referrals to clinical trials, Kaiser gave my husband two so far. Best of luck!
Good to know you got the referrals.
I don't know how Kaiser works but usually you have to call and get preapproved for a treatment or to see a doctor that is out-of- network. At least that is how it works for other health insurance companies. If you do see a doctor out-of-network you may end up paying something for the treatment. Check your policy is see what it would cost to see and out-of-network institution.
Thanks! I think Kaiser is a bit unique in that they kind of function like Southwest Airlines (very individual). We don't really have an out of network. If our oncologists refers us supposedly it should work but talking to both Mayo in Rochester and Anschutz here in Denver, they both have said that Kaiser is difficult. That doesn't mean that it can't work, but migraines with insurance companies is something I'd like to avoid!
I have been associated with Kaiser in Denver for 48 years. The first 30 as a Pediatrician on staff and the last 24 plus as a patient with prostate cancer. Your plan makes a huge difference. If you are on Kaiser Medicare Advantage then the rules for outside referrals change. In any event part of Kaiser's success is to provide as much care internally so that costs are controlled. It is never going to be an open ticket to go outside to the provider of your choice. It will always be closely monitored and limited.
CU Denver(Anschutz) has many good urologic oncology services available locally but it is hard to get referred out if the service can be provided internally. At one point I went out for a second opinion on my own dollar, but once it was established that I needed something not offered internally it was paid for.
Right now all oncologists at Kaiser see all cancers though some are becoming more informed about certain cancers and provide in-house expertise.
Locally Kaiser has had some big financial challenges the past year so they are scrutinizing all outside referrals very carefully. There are some painful changes in staffing going on but not with physicians and especially not subspecialty care. A Union strike also looms but it is fueled by the national unions. It will settle locally but employees are being misled by some information.
I am a Frequent Flyer at KP right now and would never consider a change.
Thanks! Your information helps a lot! One of the procedures that I think my husband may need in the not to distant future if enzalutamide and then Radium-223 fails is proton beam or cyberknife to his calvarium. As far as I can tell, Kaiser does not have the ability to perform this and we may need a referral to someplace that can.
I have no answer for you. Kaiser has been more than good for me. But after Xtandi (going on 25 months, psa .1) and then provenge and Ra-223, where do I go? Chemo again, rechallenge with Xtandi, and then what. Wise of you to think of things before end of year decisions. There must be someone at Kaiser that can answer a direct what if question. Wishing you the best.
Thanks Monte1111! Perhaps we can present the "what if" question to our oncologist and see what he thinks. After all, he would be the one requesting a treatment outside of Kaiser if he felt that it would be advantageous. He probably has experience within the Kaiser system to know what is approved and what is disapproved. Best of luck!
I agree with Monte. Best to ask questions in advance. If you are on Medicare it really helps. I have been on Xtandi since January with good results. It costs $10,000 per month and my co-pay is $10 for a months supply.
Proton beam is available somewhere in Denver but will be scrutinized since results have not shown it to be a lot better than most available radiation therapy. Clinics and hospitals with it are trying to push for its use to pay for a major investment gamble.
Very wise to check with your oncologist and ask for an internal referral to a Radiation Oncologist to discuss options well in advance.
Good luck and good wishes.
Bob
Thanks again! Unfortunately we are not of Medicare age as of yet. The proton beam or cyberknife thoughts are because my husband has numerous Mets on his skull and the radiation oncologist said he didn’t want to conduct radiation in that area because of the brain being so close. He is about to try xtandi and then Xofigo when the xtandi fails. Perhaps the xtandi and or Xofigo will bring the Mets to a stop! Zytiga and Docetaxel worked in the past. Best of luck to you!
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