My experience with them in regards to my father's group plan in CA showed them to be a managed care company that was very very very managed. Out of network being more frowned upon than than other carriers plus many plans where out-of-network was just not offered at all.
However, in fairness to them, they're not in my state or the east coast in general. They can't manage care as strictly in New England is my guess.
Kaiser is the only insurance company/medical group that I know of. Unlike other HMO plans, if you don't like your doctor (let's call him Dr. Kaiser), you can see another doctor (also named Dr. Kaiser).
In my experience, when someone is currently with Kaiser, they stay there until they die. Rarely have I moved someone into another plan.
Appointments may take quite awhile - in fact it can take hours to get them on the phone. However, everything is under one room and that makes it attractive, especially to seniors.
Kaiser stared here in Northern CA and they are very strong. Out here they "own the stack." By that I mean they sell the insurance, they hire the docs and nurses, and they own the hospitals and clinics. There is very little "out of network" in the Kaiser system... although they are experimenting with some PPO and POS plans.
On group they pay about $14 per member per month commission which, if compared to the 7% you get from Blue Cross for group would equate to about a $200 a month policy. You decide if this is fair compenstation. Some think it is, others think them cheap.
On the individual side they pay a flat, one-time $100 and the same at renewal. No agent that I know of will bother to write indiviudal Kaiser.
I don't recommend Kaiser for the simple reason that I don't believe ON THE WHOLE they provide good care. Yes, there are exceptions. A good friend of mine is a nuro and he is terrific. I'd go to him in a heartbeat if I needed brain surgery.
My wife is a retired surgical nurse and she saw a hell of a lot of botched surgery from Kaiser that came into her hospital (Mercy). From the mid 80s to the late 90s Kaiser hired a lot of foreign trained docs and the work showed and the word got around. No one wanted to have surgery at Kaiser. It was fine for diagnosis and drugs, but no one wanted anyone with a knife to come near them! To their credit Kaiser has corrected most of this and have raised their standards considerably... but not high enough to my satisfaction.
To be truthful (and to expose some of my bias against Kaiser) I don't like HMOs at all. All manged care plans have an incentive to NOT treat the patient. But HMOs tend to have this disincentive magnified. At least 20% of the cases I write are people who have had a bad experience with Kaiser (group) and who want an indiviudal PPO plan from one of the Blues.
Another issue is that Kaiser is on a HUGE expansion program... building a hospital or clinic next to every Starbucks! Guess who is paying the bill? The rate-payers, which explains why Kaiser rates have become so high that the HMO is now offering deductible plans... something they never did before... to keep their rates lower.
People say that Kaiser is great for children and for maternity, and for pills. But finding a gatekeeper doc you like and then getting a referral to a specialist that you want can be a trying experience. And you want a surgeon and a gass-passer? Well, good luck finding docs you feel have the skills and experience you want. Some patients do, some don't. I hear all sides.
My belief is that Kaiser is expanding so much and so fast because they hope to become the model of some kind of national or universal healthcare.
Given the choice of having nothing and having Kaiser, I'd take Kaiser in a minute. It is NOT terrible. But it is 'assembly line' medicine and I'm afraid that this is what we are going to get when Hillary-Care or Obama-Med is enacted.
Managed care plans (including HMO, PPO, POS, etc.) have a fiduciary obligation to their patient to provide a high level of care while keeping the costs under control. At the extreme end of the spectrum, the least care ends up being the most expensive (unless the patient dies before running up a bill). HMO's in particular, because of their closed panel approach have a higher level of accountability than any other MCO when it comes to treating the patient.
For every "botched" job under an HMO you can find an equal number of complaints with any other managed care plan.
KP of GA is the highest ranked HMO in the state (by the DOI) and has enjoyed that rank for several years. They have been very progressive in this state, offering POS plans to group clients for years. They experimented with an individual POS a few years ago and it ended up being a poor experiment. They discontinued that plan a bit over a year ago.
Now Coventry has entered the fray with their individual POS and it remains to be seen how well it will work.
It really is a state by state issue, just as it is with other carriers (such as BX).
Interesting that no HMO in CA got 4 stars. I don't know much about the Office of Patient Advocate here, but I spent almost a year working at the Dept. of Managed Health Care and saw and heard a ton of things, most of which I'm contractually bound not to disclose. The fact that there is a whole bureauracy JUST to regulate HMOs says something about that segment of the healthcare delivery system here in CA. Why was it formed? Because of huge 'abuses' that the HMOs "took" in he laste 80s and 90s with respect to rates, treatment, and customer service.
To it's credit Kaiser was the HMO that all others aspired to and Kaiser escaped most of the criticism that the others received. They were the 'good apple' in a large barrell of bad ones, as I remember.
People either love or hate Kaiser. There is just no two ways about it here in CA... and it's also a regional thing.... almost a district thing. People in a 250 square mile area all of whom go to different Kaiser clinics and ACFs have widely differing opinons about the HMO.
I've never used them. I only know what I see and hear. I like to choose my own doc, my own hospital, my own specialists, etc.
(And by the way, for those of you who ever have to have surgery, pay MORE attention to who the gas-passer is. He or she is who will keep you alive... not the cutter. And if you don't know whom to choose (either a surgeon or gasser) call (better to visit) the hospital and talk to the surgical RNs and just ask whom THEY would choose. Believe me. THEY KNOW and will be more than happy to share info with you over a pastry and coffee. If you hear "Dr. Smith is very fast" thats the guy/gal you want. The longer you are on the table the more bad crap that can go down. There are exceptions (depending on the procedure) but in general fast is good, slow is not so good. The RNs and Techs know. Oh yeah! They REALLY know. [Note: my wife spent 30 years in the OR as an RN.])