Kaiser- How Easy is It to Get Out of Network Coverage?

[marketpantry]

I am a male and I am currently seeing someone for pelvic floor dysfunction physical therapy. There arent many physical therapists out there that do this treatment. The majority of providers that do this type of physical therapy only accept female patients. How easy is it to get in network coverage for out of network provider services with kaiser?

 

[somarco]

How much time do you have?

If you want a non-par provider to treat you under your KP plan you will need to give them a request for appointment form. They must agree to accept KP's fee schedule, then KP must review the application and approve it.

This can take months.

 

[Mark]

I am very unhappy with Kaiser! They decided to stop using my heart doctor at Piedmont Heart Institute and force me to use one of their heart doctors that just became a doctor.

The doctor had never even heard of "Marfans" which I have.

I'm having pvc really bad, and the Kaiser doctor is clueless.

I finally got the okay from Kaiser to go back and see my old doctor 1 more visit to see if he can fix my issue. What is one visit going to do?

 

[Guest]

I am very unhappy with Kaiser! They decided to stop using my heart doctor at Piedmont Heart Institute and force me to use one of their heart doctors that just became a doctor.

The doctor had never even heard of "Marfans" which I have.

I'm having pvc really bad, and the Kaiser doctor is clueless.

I finally got the okay from Kaiser to go back and see my old doctor 1 more visit to see if he can fix my issue. What is one visit going to do?

Man that stinks. If he doesn't know your condition, they are being negligent with your care. If you yell loud enough you can probably switch heart docs, within their network of hired cardiologists of course. It may not be very close to where you live though.

 

[Mark]

Man that stinks. If he doesn't know your condition, they are being negligent with your care. If you yell loud enough you can probably switch heart docs, within their network of hired cardiologists of course. It may not be very close to where you live though.

I did change heart doctors within the network again. The southwood is just now adding heart doctors. SO I will see yet another new heart doctor and I bet one that just became a doctor again.

I had been seeing my old heart doctor for over 12 years. He knew my condition and was able to treat it well. Now, I'm forced to deal with brand new doctors that are clueless.

 

[GreenSky]

I don't have one IFP client in an HMO plan. Every one is in a PPO.

My senior clients get a "lecture" from me if they prefer an HMO instead of a PPO or supplement.

Rick

 

[Guest]

I don't have one IFP client in an HMO plan. Every one is in a PPO.

My senior clients get a "lecture" from me if they prefer an HMO instead of a PPO or supplement.

Rick

Just copy Mark's experience and email them the story. A heart condition isn't allergies or a sniffle. KP should know better, but alas we know that isn't true.

It just occurred to me, we probably aren't making the original poster too happy with our comments here. At least somarco gave him some instruction.

 

[marketpantry]

I am currently going to physical therapy for pelvic pain. my father's employer changed the plans effective 9/1 with blue cross and i am just finding out about it now. they are now shopping for a cheaper plan (kaiser mainly) and it looks like they wont be getting a PPO so i think i will need to get my own plan. If kaiser doesnt cover my pt. the type of physical therapy i am needing is specialized.

 

[somarco]

i think i will need to get my own plan. If kaiser doesnt cover my pt. the type of physical therapy i am needing is specialized.

Won't do any good unless you are in a guaranteed issue state. Good chance you will be denied in underwriting. Best case scenario is they approve you but rider (exclude) coverage for your affliction.

 

[marketpantry]

How much time do you have?

If you want a non-par provider to treat you under your KP plan you will need to give them a request for appointment form. They must agree to accept KP's fee schedule, then KP must review the application and approve it.

This can take months.

As of April 1 i will be switching to coverage under either kaiser or united healthcare. My pelvic pain pt accepted the blue cross rate of ~ 90$ as apposed to what she bills (225) is this what you mean by fee schedule?
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Won't do any good unless you are in a guaranteed issue state. Good chance you will be denied in underwriting. Best case scenario is they approve you but rider (exclude) coverage for your affliction.

if i am going under my mother's insurer (she will be getting it from work) and havent had a lapse in coverage would they deny coverage for my issue?