Of rationing health care, death camps, Kaiser Permenente, and my 80+ year old mother . . .

[Triana]

I talked to my Mom today and she said she went for her checkup recently and the doc ordered a colonoscopy- since she's had polyps there before they like to keep an eye on that. BUT - the insurance wouldn't cover it. Why? She's over 80.

She went for a mammogram today but said she had to BEG the insurance company to cover it. Why? She's over 80

SO:

I GUESS that Kaiser Permenente figures that if you're over 80 and you get cancer - you can just DROP DEAD.

TALK ABOUT YOUR RATIONING AND DEATH PANELS. THERE YA GO - and it's NOT the big, bad "government" doing this in some skeery future scenario - it's the private for-profit insurance companies DOING IT NOW.

KAISER PERMENENTE apparently decided that Mom can just DIE if she gets cancer because it's not worth a few hundred of their precious MILLIONS to test her regularly.

If the insurance won't cover it because THEY'RE RATIONING HEALTH CARE AND DECIDING FOR HER THAT SHE SHOULD DIE IF SHE GETS CANCER ...

:wtf: is someone like Mom supposed to DO?

Answer:

DROP DEAD!

Pfft!

:mad:

:grr:

THERE'S YA "DEATH PANELS" folks - we haz dem NOW.

[valerief]

1. What about Medicare? nt

[orpupilofnature57]

2. Kaiser and Trickie put us in this boat over 30 yrs ago!

[orpupilofnature57]

11. This is what cut them loose, thanksTrick Dick

http://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973

[SammyWinstonJack]

18. Yep they did! Rotten bastards!

x(

[Duke Newcombe]

3. Our benevolent private insurance overlords would NEVER do something like that...n/t

[Suich]

4. I'm not 80 yet, but

Medicare covers a mammogram every two years. They should pay for your Mom's also.

[Triana]

9. She said she had to fight to get it covered because of her age...

...that's all I have to go on.

[mitchtv]

23. In the case of an HMO`

you sign your medicare rights over to them, they administer. At least that is my understanding.

[Triana]

25. !

If that's the case she is totally screwed because they deny damn near everything whether it's SUPPOSED to be covered by Medicare or not.

[Suich]

27. I'm on Medicare and I don't know what that means,

that I sign my medicare rights over to them (HMO). Isn't Medicare her primary coverage and Kaiser picks up what Medicare doesn't?

I'm confused!

[mitchtv]

29. Kaiser makes the decisions, no appeal to MC

[Triana]

31. Kaiser needs to GO.

They're darn near refusing to do anything and she doesn't understand why they're telling her what they're telling her. Of COURSE no one bothers to explain and she can't read very well - bad cataracts.

[Cleita]

5. Wow, KP has changed since I was a member. My biggest problem was

being able to get an appointment any time before three to six months, but if I got in line, I pretty much got whatever tests I needed and so did many of the elderly I saw there. I have a question though. Why isn't she on Medicare? If she signed over her benefits to Kaiser Permanente, the enrollment period is coming up. Maybe it would be best to move her into traditional Medicare with a supplemental insurance. If she's low income, Medicaid will supplement the co-pays. I have never been denied the tests I need including colonoscopies, mammograms and MRIs The drawback is the prescription drug benefit that doesn't benefit much of anybody.

[Triana]

10. She needs to get away from Kaiser...

...they've given her nothing but a rash of sh*t since she got on it.

Worse, she's in the Medicare "donut hole" with her prescriptions - and insurance doesn't pick up any of that.

[mitchtv]

28. I am on Medicare have HEALTHNET hmo

I have been given sigmoidoscopies instead of colonoscopies. They have a real good presciption plan that keeps me with them. Plus they gave me a liver transplant when Pacificare had denied me, 16 yeara ago

[virgogal]

6. I know nothing about Kaiser but isn't she on Medicare?

I'm on Medicare and show both are covered,mammograms once a year and colonoscopies every 10 years unless high risk,and then it's every 2 years. Just looked it up in my Medicare Handbook.

That said,I wish your mother well.

[Triana]

8. She has said they won't cover it...

...the colonoscopy for sure. It could be that Medicare paid for the mammogram - but she had to fight about it. Who of you is 80 or over? I wonder if that's the issue?

[virgogal]

12. There is certainly nothing about age in the book I have.

What I have is the handbook 'Medicare & You 2009" and it is on p.28 under Colorectal
Cancer screenings. (Part B covered services)

I would assume your Mom has the book and that she has Medicare Part B.

[Triana]

13. I will pass this on to her...thanks. n/t

[excess_3]

7. there will always be a claims adjuster

everywhere

get used to it

[REP]

14. That doesn't sound right; I'm KP with Medicare and there's no age exclusion in my coverage

Trust me, I go over that thing because I'm a kidney patient with the worst blood group for tx. There's no age exclusion for preventive screenings. Either her doctor is an ass - plenty of those in the KP system - or there was a miscommunication somewhere. Get the HIPAA releases and see if you can navigate for her.

[Triana]

15. I think her doctor and KP are acting like asses

She's going to check to see wtf is going on.

Thanks everyone for the info. I'm not on medicare so don't know anything of it - but at least I know what to tell her to check on.

Sheesh - what an effed up system.

[Suich]

16. Good luck, Triana!

Please get back to us and let us know what happens. I'd be shocked if Medicare doesn't cover both the colonoscopy and mammogram because of her age. If that's the case, the doo-doo is going to hit the fan!

[Triana]

17. I hope it does - however Kaiser has treated her like sh*t since she got on it

....they won't tell her anything (obviously) and her doctor is about useless. (The office, anyway). SOMEBODY told her they would not schedule a colonoscopy due to her age. (?) She is "high risk" and hasn't had one in at LEAST 4 years.

A$$holes.

She'll be calling the doc's office Tuesday with some very blunt questions. Mom has bad cataracts too and can't see well so she has a hard time reading - my older sister will have to read the Medicare booklet to/for her if she can find it. She moved recently so hadn't sorted out her papers yet.

Ugh.

[Stinky The Clown]

19. Why is your Mom, at 80, not using Medicare first and insurance to plug gaps?

[Triana]

20. That's supposed to be what she has (I think) but

the insurance company and her doctor's office seems to keep it pretty screwed up and they are ALWAYS refusing to schedule tests, etc, insisting it's "not covered"

Somehow she/we have to sort it out - and I think she needs to dump Kaiser and get a different doctor.

Edit: She is confused by what they're telling her, and frankly, so am I. It sounds like bullshit to me. SOMETHING ain't right. . .

[Stinky The Clown]

21. Having been there (caring for an aged parenet) more than once ......

..... make no assumptions that she understands what's going on. Not even thinking of dementia. Just the natural loss of the sharpness of mind we all possess when younger.

[dflprincess]

22. If your mom wants these tests she should get them

Personally, if I make it to 80 I'm giving up paps smears, mammograms and colonoscopies just because I really hate them all. (Of course, it's easy to say that when I still 25 years away from 80).

[Triana]

24. Well they aren't fun tests..

...I wouldn't blame you!

[SmileyRose]

26. I think your mom is confused -- we have Kaiser Senior Advantage too - please read

Your Mom has enrolled in Kaiser Senior Advantage. She does NOT have regular medicare plus a Kaiser supplement. Instead Medicare has paid Kaiser to take your Mom off their hands.

With Kaiser Senior Advantage and Senior Advantage Plus if a primary care doctors orders it - IT'S COVERED !!! - there's no question at all about that. None whatsoever. Now the red tape on where she should go and who she could talk to within the Kaiser system is another matter. My local Kaiser has their own Gastroenterology center right next door to the medical building. It's just a matter of going up to the specialty referral coordinators office with the orders the primary care doctor sent you out with and get the colonoscopy scheduled.

Your Mom may need a patient advocate to help her navigate the Kaiser system. My suggestion is to start by looking at the orders the doctor's nurse gave her when leaving. If she did not get a copy of the visit record then she will need to contact the primary care's nurse and get that. You can help her sign in for Kaiser online communication by going to KP.org - once you get her signed in, you can help her email the doctor her question -- or you may have to just show up at the clinic and explain to the desk clerk what you need.

Remember, with Kaiser, if primary care orders it, IT'S COVERED. The directions on how to obtain the specialty care service should be on the sheets they gave Mom at the end of her visit.

Edit to add yes I agree getting the primary care to order specialty care can be very challenging.

[Triana]

30. So what's happening is the primary care Dr. is simply NOT ordering tests

that are needed?

She said they are listed on a sheet - telling her which diag tests she is due for. The doc WON'T schedule or order them even though they're due. SOMEONE told her the colonoscopy isn't covered because of her age.

I HATE Kaiser and she needs to just get on Medicare. This sucks.

[SmileyRose]

32. If the tests are listed on a sheet

then the doctor has probably ordered them. The doctor does not do the scheduling and unfortunately with Kaiser it's kindof a hodgepodge on how you schedule tests and appointments with specialists. It depends on if it's something Kaiser has in house or has to contract out. Knowing which is which sometimes takes a Houdini.

For in house tests and specialties the patient simply calls to schedule on their own by calling the specialty scheduling phone number. It's always on our sheet when we are giving "in house" referrals. For outside referrals, their is a referral coordinator in another part of the Kaiser building that sets up the initial appointment - and/or works out where to send you and tells you who to call to make the appointment.

We LOVE Kaiser here in Atlanta. No we don't get everything, but we do get what we actually need. My husband and I have Kaiser and husband's 90 yr old Uncle is on Kaiser Senior Advantage. He had some trouble too in the beginning. For instance he came home and said Kaiser refuses to cover diabetic testing supplies. Well I knew that can't be right. So we went with him to the next primary care appointment and as it turns out of course they cover it - they just cover a different brand than what Uncle had previously. The doctor told him they don't cover AccuChek and wrote a prescription for OneTouch - my uncle did not understand and the doctor did not make it clear enough.

I don't know your mom and please understand, I'm not badmouthing her. Honestly. But I'm telling you I'm pretty sure your Mom needs a patient advocate. When one's mind is just not as sharp as it used to be, plus throw in pain or sickness, plus throw in an HMO system that must be learned to be negotiated effectively..... I really encourage you to go to Kaiser with Mom and get all the HIPAA release forms filled out so it's legal for them to allow you work the system for your Mom and then be her advocate. The key to getting good care from any HMO is knowing their system and how to negotiate it. You'll also want to make yourself known to your doctor's nurse. And if that doctor and that nurse is a pain in the butt, or if you don't communicate well, then change your primary care. YES YOU CAN.

[Triana]

33. I live on the other side of the country from her so..

...some of this isn't possible - but my brother and sister are there. My sister is the one who got her on this thing, so she will have to navigate this for her.

Really though - ANY health care system / insurance company should NOT be this bureaucratic, red-taped and complicated. There are many people who don't HAVE anyone to be an advocate and the system ought to be simple enough for them to navigate themselves - elderly or not - at least most of the time.

This bureaucratic mess is why everyone should just be on Medicare - PERIOD.

It's exasperating and rediculous. And I STILL have to wonder what idiot told her a colonoscopy isn't covered due to her age.

[SmileyRose]

34. Medicare has it's quirks too.

I am all for single payer universal medical care - but there will be a "system" that we will have to learn to negotiate. There will be primary care and referrals.

I don't find the Kaiser system difficult once I learned where things are located and which person can help with what we need. It took a few visits to get a handle on things but after that Kaiser has been effective and fairly easy. I was in the Cigna HMO before this and it was pretty complicated, since they were constantly in a fight with one group of providers or another. Kaiser is a closed system - they don't send you in the first place unless it's covered.

[WeCanWorkItOut]

35. Kaiser does ration care. It would be good to see comparisons

Quite a bit less surgery is done by Kaiser than by for-profit doctors,
that's one old fact. Then the HMOs caught on to that trick too,
I believe, and Kaiser had to look for other ways to stay the cheapest.

Now I understand that Kaiser rations in many ways.
They tend to ration by waiting times, there's a little
price-rationing, some age-rationing, and they may not perform as many tests.
Although I've heard that they really like those mammograms.

It's too bad consumer groups don't offered basic rationing-comparisons.
Then if one HMO, or Kaiser, refused some form of care,
you could find if that was general practice, or if others did offer it.
Not only would consumers benefit from the transparency,
but it would aid in our policy debates.

[WeCanWorkItOut]

36. I forgot (it was so obvious): Kaiser also rations access to specialists

Or it severely limits access. As do many other health plans.

[Justitia]

37. Sounds like your mom is on a "Medicare Advantage" program (Medicare Part C), not traditional MedC.

Therefore, her care has been turned over to an HMO (Kaiser), instead of being provided by original Medicare.

She could switch doctors within the Kaiser Medicare Advantage plan, that might be the quickest, easiest fix.

She can also disenroll from the Medicare Advantage plan and enroll in traditional Medicare.

She can also get an additional Medigap policy to cover what is not covered by traditional Medicare.

Best of luck to you, I know it must be so frustrating.

[Epiphany4z]

38. she can also write Kiaser and complain

I had to do that when I was in a high risk pregnancy and one the docs was so mean, rude and so upsetting me that she was making things worse. It worked the doc had to say sorry. I got a new doc and They never let me wait in the waiting room anymore.... my butt was generally kissed. I also wrote to get extra days in the hospital and I got them. Good thing too because my BP spiked on the 2nd day.

The thing is these companies say no and save money just by the fact that folks that don't fight it. sometimes just fighting for it a bit or turns things around. go over the docs head.