Kaiser Permanente

[Mark]

I have Kaiser Permanente (Georgia) on myself.

I pay them over $700.00 a month for my family and myself. I have very few claims, other then normal doctor visits, which I pay them like $50.00 bucks for anyways.

But the very few times, I have to go the local E.R. in Griffin GA, they always find a way, not to pay the bill in full and try and stick me with more then what I should have to pay. I have a $100.00 Dect. for the E.R.

They always tell me which ever E.R. I go to is out of the network and won't give them a discount, and they want me to pay whatever they think the discount should have been out of my pocket.

The last time this happend, I had to file a complaint with the GA INS DEPT to get them to pay the claim.

I have to spend hours trying to get them to do what they should do to start with.

Do any of you sell of these jokers?? Do you know of people having the same problems??

Is there some kind of a secret memo that says, don't pay a claim until they either call a lawyer or the Ins Dept?

 

[CHUMPS FROM OXFORD]

Just curious....why did you start a new thread when you said the same thing on another thread:

Kaiser Permanente appointment worth it?


Not just you, but there seems to be a lot of "double" postings around here. Or maybe not.

 

[somarco]

KP is good, but why buy a plan that is $700/month? There are better values.

If they are "shorting" you on an ER bill it is probably the way it is coded. If it is a true emergency, there are no non-par ER's. If it is not an emergency, you should go to an ER that is in network or one of their centers.

I don't place as many clients with them as I used to, but I never hear complaints about KP.

BX & Coventry is a different story entirely . . .

 

[Mark]

Just curious....why did you start a new thread when you said the same thing on another thread:

Kaiser Permanente appointment worth it?


Not just you, but there seems to be a lot of "double" postings around here. Or maybe not.

Because I responding to something on the other post that someone wrote. The other post was about should they sell Kaiser.

On this post I wrote something different and wanted to get answers from others. This post is about me being a client, and it not about if an agent should work for Kaiser.

I was answer the question should someone work for Kaiser on that post

On this post, I'm not talking about if you should work for them, but talking about a problem as a consumer that I'm having and wanting advise from agents.

I hope you see the difference.



I hope this answers your question.

 

[CHUMPS FROM OXFORD]

Did not see a difference, but not a big deal.










Miami University...now the ONLY Div. 1 MAJOR school with...

 

[Bob_The_Insurance_Guy]

Mark,

I don't know how much Health sales you do, so I am going on just what was posted.

First off, a well-educated health agent (and I'm not here to assume that whether or not that is you) knows that each company has their niche - a certain segment of the population that they best fit.

For Kaiser Permanente, that segment is young, single adults and children, up to teenagers. Families are NOT their forte'. Their after hours care facilities, the 24 nurse advice line, and the ability to have same-day appointments are there strong benefits.

Having to worry about being in-network or out-of-network will get you every time.

I don't know who got you involved with them for family coverage, but doing so did not do you justice. I would have separated the child(ren) from the adults, and put the adults on a HumanaOne Monogram Plus Rx plan, or an Assurant One Deductible plan.

That is why, with health insurance, finding out what, other than cost, is important.

Like #1, I've had no complaints about KP.

BX is for those that travel across country continuously.

Assurant/Humana are for those that want a HDHP or HSA plan.

These are things you learn by knowing the company's idiocincracies (sp?), and that comes from research and trial and error.

If I were you, unless there are any pre-ex's, I'd dump KP for you and your wife, keep it for the child(ren), and go with Humana's Monogram Plus Rx plan, or Assurant's One Decreasing Deductible Plan.

Just my two cents worth. Again, that is just from what I've read, I know absoutely nothing about you, or your particular situation.

 

[somarco]

If you bought KP for the maternity benefit, which a lot of folks do, then it depends on whether you are planning on siring more insurance agents. Even if you are, you might want to look at other carriers with maternity, as long as you can keep your swimmers in check for a few months.

KP has their strong suits, as do most carriers. For the right situation they are top notch. But if it isn't a fit . . .

 

[HealthGuy]

Bob: I have heard that hoping that your BX coverage will give you good in network possibilites IF you are traveling constantly is a false hope because BX is owned by different entities nationwide and although they proclaim a nationally linked network getting one ownerships network to work with another is like being in the middle of a street fight.

 

[Mark]

Mark,

I don't know how much Health sales you do, so I am going on just what was posted.

First off, a well-educated health agent (and I'm not here to assume that whether or not that is you) knows that each company has their niche - a certain segment of the population that they best fit.

Just my two cents worth. Again, that is just from what I've read, I know absoutely nothing about you, or your particular situation.

For those that don't know this about me. I don't do any health insurance what so ever. I know very little about health insurance. Besides the fact that I own it.

I bought Kaiser at a young age, and it was a great deal. A few after buying Kaiser, I became Ill and my heart started acting up. Now I have a preexisting condition. If I lose this, I won't get any more insurance. I'm self employed so I pay for all of this on my own.

Kaiser is great for normal doctor visits and some stuff. My problem with them is I should not have to contract the Ins Dept, to get them to pay what they are should pay. I'm 100 percent sure that this bill should be coveraged. Every time I call the claim dept I get the run around. I was promised over 1 month ago that they would pay it. Now they are fighting the hospital over some discount and now, they tell me I need to pay for it because they think the hospital is over charging them.

I know after spending about 8 hours working on this and filing a complaint, they will pay the bill. But why can't they just pay the bill to start with. I'm paying over $700 a month and don't have many claims. So if they get a small bill for around $300 bucks, I want them to pay for it.

Also, I'm talking to you agents as a client/ consumer. I do not do health insurance what so ever. In some of my other post you will read where I say I'm dumber then dirt on health insurance.

Another thing is they have paid two bills just like this one, exactly the same, after I filed a complaint. The same hospital which is not out of network and 3 miles from my home. Out of network, I thought means like out of state or far away. It's not my fault the hospital wont give them a discount.

I would love them, if they would only pay what they should pay. If I'm wrong, then why do they end up paying the claim after the Ins Dept looks into it.

My agent told me that Kaiser should have paid this claim and I don't think it's his fault.

 

[GreenSky]

My agent told me that Kaiser should have paid this claim and I don't think it's his fault.

I think your agent should be working on your behalf to get claims paid. Otherwise he should give you back his commission.

Rick