Wow! Got it. So they don't take medicare patients. So if a Kaiser member comes down with a rare disease and wants to go to Mayo Clinic or a specialized treatment center they would be stuck.
Kaiser Permanente tops J.D. Power Medicare Advantage plan survey for 5th straight year
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It appears there are folks on this thread that are not familiar with the way HMO's work, and in particular, KP HMO.
KP is a closed panel HMO. Google the term if you don't know what that is.
They also contract with outside vendors which mimics an IPA model. Google that as well but don't get sidetracked by beer with the same name.
KP hospitals and clinics will only treat members covered by KP policies (individual, group, Medicare). Non-members will NOT be treated at KP owned facilities.
If KP members require specialized care that is not available in house they will be referred to an approved contractor.
On occasion KP will honor claims incurred outside their network.
If a member has an emergency and is not near a KP facility they may seek care from the closest provider.
And sometimes a member needs care that cannot be handled in house or by contracted providers. In those rare situations KP will approve a treatment plan and negotiate reimbursement in advance.
There is a very good reason why some agents encourage prospects to consider original Medicare and a supplement plan vs an MA plan, especially when the prospect is looking at an HMO model.
No networks.
No referrals.
No pre-approval
No surprises.
KP is a closed panel HMO. Google the term if you don't know what that is.
They also contract with outside vendors which mimics an IPA model. Google that as well but don't get sidetracked by beer with the same name.
KP hospitals and clinics will only treat members covered by KP policies (individual, group, Medicare). Non-members will NOT be treated at KP owned facilities.
If KP members require specialized care that is not available in house they will be referred to an approved contractor.
On occasion KP will honor claims incurred outside their network.
If a member has an emergency and is not near a KP facility they may seek care from the closest provider.
And sometimes a member needs care that cannot be handled in house or by contracted providers. In those rare situations KP will approve a treatment plan and negotiate reimbursement in advance.
There is a very good reason why some agents encourage prospects to consider original Medicare and a supplement plan vs an MA plan, especially when the prospect is looking at an HMO model.
No networks.
No referrals.
No pre-approval
No surprises.
Last edited:
SueNomie
New Member
- 4
The star rating is a scam and a bunch of crap. I look at enforcement actions and penalties in my state against insurance carriers and it has NO relevance to the star ratings. Kaiser is five star in my opinion, because they have a nonprofit division called the Kaiser foundation which does a lot of free work for CMS, They basically work for them for free. CMS loves Kaiser and it’s a star rating political bunch of nonsense. No one on this planet can tell me Kaiser is better than Stanford, UCLA, UCSF, etc.
SueNomie
New Member
- 4
There is no such thing as Kaiser Medigap plans
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