patrick.net

One thing on your to-do list should be to bring in your blood pressure monitor and show your own readings. High BP (although not high when treated) was one of the automated reasons that I had to pay HIPAA rates.

I have had Kaiser before and I agree that scheduling appropriate follow-ups was not their strength.

Did you do the yearly physical yet or did you only go in for specific problems? I recommend always doing the 30min physical because you will get acquainted and there will be more time for productive discussions.

Hi bobbys,

The requirement that you see a pcp for a referral to a specialist is common to many health care providers. The rational is that a doctor is more likely to know when this is appropriate than a non doctor (i.e. you). Of course even though your not the expert it is your life so you should choose a different pcp if you aren't confident in this one. Bit be aware that no pcp will (or should) send you to a specialist just because you want him to. Doctors aren't baristas and its part if their job to restrict access to scarce and expensive resources to those situations that really require them. Maybe this particular doctor is wrong, but he is doing his job by exercising his professional judgement in this matter. Re. Kaiser in general, my family has been happy with them; in particular they have one of the best medical record systems around, but there are good doctors and bad doctors everywhere.

I left Kaiser after many years of not feeling better and I am so glad I did. They never did the extensive blood tests I wanted. Luckily, I am now with blue shield and a great doctor who is very thorough. I am now being properly treated and am doing much better. I prefer going to a small private office where I get a lot of attention and help. My sis is with Kaiser and she loves it, so I think it depends on the particular doctor and facility. Good luck!

I just reread your post again, the part about the high bp. I was seeing my doc. a few weeks ago and I was crying because my mom just recently passed away. My bp was high due to me being upset. She said we would keep an eye on it, but she sure didn't record it in my chart. Kaiser is very institutional in the way the handle everything, just be prepared.

Sounds like you signed up for an HMO; the way that they operate is the company pays a PCP a low monthly amount per head to the doc – so he receives somewhere around $10/mo or so a month to provide your care (just a guess, these numbers are confidential) – and they’re often rewarded with bonuses at year end if they don’t refer out to specialists. Their referrals are scrutinized, so that also cuts back on the amount of referrals.

That being said, oftentimes a patient can be treated with medication and it alleviates the symptoms. If the meds don’t work, then an increase in the dosage might work. All of this can be done without testing and multiple office visits. It’s possible to treat the symptoms without the expense and inconvenience of being tested, with the same end results. Even though physicians are restricted by the rules of the insurance company/hmo, most docs are ethical human beings who will do their best to treat the patient. With the advent of the internet, people are becoming increasingly difficult to treat.

Your MD recorded elevated BP because that’s what he saw. Perhaps you could record the BP on a daily basis and upon your next visit present him with your records. He might amend the current record to show your information.

Kaiser is an HMO that has the mission of holding down costs by denying benefits. However, any physician might play it safe and see if the symptoms clear over time. Unless you are in acute distress, you might want to listen to your doc. If you don’t like/trust him, find one who you do like – but it’s possible that the new doc will operate in the same manner.

I've heard tons of Kaiser horror stories. So when I dumped PacifiCare PPO after it was taken over by United Healthcare and I saw my costs sky rocket, I approached enrollment in Kaiser with trepidation and fear.

I have to say that my fears were groundless. What being a patient at Kaiser requires is persistance and chutzpah. In some cases you have to demand the care that you need several times to force their hand. This was no different with the PPO, actually, which required pre-approval for almost any procedure.

I chose a PCP and she's been really good, actually. She helped me to get my cholesterol under control with diet, exercise, and niacin supplements instead of the statins. I requested to not be placed on the statins because I'm on enough medications from my other conditions that stress my liver and statins really do a number on your liver.

And she was the first doctor who took my insomnia seriously. She sent me to Kaiser's Sleep Clinic and they did a sleep study on me. They found out that I have a couple of sleeping disorders. I have mild sleep apnea and major sleep onset insomnia. She prescribed a non-addicting drug for the sleep onset insomnia that has never stopped working. And the Sleep Clinic set me up with a CPAP machine at a reasonable cost. I use it every night and I've never slept so well in my life. I've been an insomniac since I was a small child. It runs in the family, I guess. But this Kaiser doctor was the very first doctor (and I've had some top notch expensive doctors in PPOs) who actually took the time to find out why I wasn't sleeping well and to improve my sleep to improve my health. I have been very happy with her.

My cardiologist is nothing special but he consults with my old electrophysiologist whom he knows professionally who treated me for my tachycardia through my PPO. He just helps me to maintain a normal heart rate with monitoring and continuing the meds I was on before.

I do have to say that their mental health care could improve. They only provide psychotherapy for acute episodes without allowing people to continue psychotherapy as prophylaxis and as a way to improve your over-all mental health thus preventing acute episodes. Oh sure they have tons of classes for various mental illnesses for outpatient care. The classes are very basic and free. They are useful if you aren't very mental health savvy. They do believe in psychiatry (prescribing pills) for mental disorders and they seem to favor pills over psychotherapy. I would guess that they believe that this is the cheaper route to go. In reality, pills without psychotherapy just ends up pushing a problem into the future without adressing the underlying causes in many cases. There are very good studies that prove that psychotherapy plus medication is the most effective means when treating a mental illness. The psychotherapy helps those who suffer to re-order their minds, life, etc. so that they can prevent relapse. Sometimes people are able to come off of medications through the use of psychotherapy. And sometimes people need less medications while using psychotherapy. Also they have proven that people who suffer from chronic severe mental illness will experience less psychiatric hospitalizations (very expensive hospitalizations) if they are getting good psychotherapy with their psychiatric treatments.

This is endemic in our health non-system where even professionals who know better still believe that mental illnesses aren't "medical illnesses." There isn't any parity for mental health in any part of our non-system. Even the PPO's that I had only covered psychotherapy for 26 visits max per year and had a separate copay that was much higher than "doctor visits." Some plans only give you 10-12 visits per year. That's no where near enough for someone suffering from a chronic mental illness. But they wouldn't think twice about paying for daily insulin and doctor visits for a diabetic. I assure you that chronic mental illnesses are chronic medical illnesses. The mind and body are intimately connected. Until we have mental health parity our non-system will continue to be an incredibly ineffective hodge podge of crappy care that serves no one.

Well, that was my soap box speech for today.

Anyway, I'm still satisfied with my Kaiser coverage. I have a couple of chronic conditions and Kaiser is more than adequate at treating them. Your results may vary because I do know people who have been royally screwed by Kaiser. I'm just not one of them, yet.

In the book "Who Rules America?" the author shows that both Social Security and Medicare exist only because it looks bad for the elderly to starve or die from lack of medical care after a lifetime of laboring for the uber-capitalists. Such disregard for the working peons could lead to revolution and loss of privilege for idle rich. So they give in a little now rather than risk giving in a lot later.

http://sociology.ucsc.edu/whorulesamerica/

We have again arrived at the point where a large and growing part of the population is without a means of support or medical care because wealth is increasingly concentrated in the top 1% as they keep shifting more of their income to low-taxed capital gains to avoid the higher income tax rates that the rest of us are forced to pay.

They have sophisticated and very well funded propoganda machines which attack any suggestion of fair taxes on the very rich or of universal health care as "liberal" and somehow unamerican. Fox News and Glenn Beck are good examples.

We need our own media machine which loudly and publicly points out that every single utterance of Fox and Beck is aimed squarely at preventing fair taxes on the very rich, and that this prevents universal health care.

Wow, and I thought I was alone in spouting off violent rhetoric against the Conservative Elite who are the Super Rich Corporate Plutocrats. I wonder if this rhetoric is spreading and what the result will be.

I've always kind of thought that we Americans had become too complacent and too willing to give up freedom for security and too willing to believe conservative propaganda that convinces us to give up prosperity to the Super Rich Corporate Plutocrats in the hope that they will "trickle down" bits of gold. Perhaps there is a rustling in the air of masses yearning to be free at last in the USA. One can only hope. The Super Rich Corporate Plutocrats have been raping us anally without lube and without condoms far too long. It's time America squeezes its collective cheeks and refuses them entry!

Religion is the lube of the masses.

Religion is the lube of the masses.

Karl Marx would be so proud. :-)