Question

[TJM]

All,

My current insurance is Kaiser. Lot of nice things about Kaiser....the biggest benefit is no arguments about bills.

Problem is is that I dont get the feeling they are cutting edge.  My son got very sick with aplastic Anemia years ago and was treated at OHSU. His doctors were awesome and I have nothing but positive feelings about them. Plus they saved his life and he is now a very energetic young man.

To get to my question...its open enrollment right now and I am considering changing my insurance. Has anyone done that while in the midst of the struggle?  I want more control of my doctors, but what I really want is an oncologist who relates to me. I know that the fact I'm an Engineer makes me a difficult patient but now that the first line treatment is over I think it might be a good time to switch?

Any and all advice is welcome.

Peace

Tom

[Babs]

Tom,

I am assuming with Kaiser you don’t get to choose your own Doctor?  That’s it an HMO where you’re treated within their family of Physicians?  If that’s the case, If it were me, I would definitely change Insurance.  I cant imagine not being able to choose where and who I get my care from.  I currently am getting care from both my oncologist here, my choice and also from the Mayo Clinic in Rochester, also my choice.  I’m sure you’re getting excellent care and there’s something to be said about not having to fight with Insurance.  It’s a personal preference.  
 

Take care,

Babs

[LexieCat]

I switched insurance during open enrollment after my lobectomy three yeas ago, to a plan that permits me to go out-of-network. Of course, in-network saves a ton of money and all my providers have been in-network, but I figured if anything got complicated down the road (like it is now) and I wanted, for whatever reason, to be treated out of network, I wanted to have the option to do that.

When you're dealing with a serious illness, I think getting the most flexible plan you can afford makes sense.

Oh, one more thing. I DEFINITELY would not want to be tied a single provider. I switched providers after my Stage IV diagnosis--my original provider at MD Anderson-Cooper Hospital was terrific for my lobectomy, but after the Stage IV diagnosis, I consulted with an oncologist from Penn Medicine (U. of Penn.), with whom I felt more comfortable. I would have hated not to have the option to shop around.

[Judy M2]

I haven't needed to switch because I'm happy with my coverage. But as Lexie notes, I'm free to go anywhere else if I'm not satisfied with my current doctors. 

When I became eligible for Medicare and selected my Medicare supplement and RX plans, I based my own decision on my experience managing my 99 year old father's health care. He's had numerous chronic health conditions and numerous hospitalizations over the years. I was okay with his supplement plan but had to change his RX plan due to high co-pays or drug tier designations. 

If you do call and compare plans, be sure to list every prescription drug you take and ask them what tier each drug is in and what your co-pay would be. Be forewarned that RX plans can change tiers mid-year without any notice to you. I've had that happen and was not happy but there wasn't much I could do. 

Good luck. 

[Rower Michelle]

Hi Tom, 

Ditto to all of these above.  I'm about to have the third insurance company since my diagnosis.  This is what I've learned along the way: 

1.  I sit on two Advisory Boards at my  NCI, KU.  There was a study recently published that was pretty compelling, patients treated at a NCI have 25% better outcomes, primarily due to the reasons you cited, access to cutting edge care. 

2. You get what you pay for with employer sponsored health plans, cheaper isn't necessarily better. 

3.  In addition to the premium, pay attention to the total out of pocket expenses.  We are in the process of changing to my husband's employer's health plan.  The total annual pocket max is "only" $2200 with 100% coverage after the max.   One month of my COBRA coverage is $2400.  

4. Insurance hassles come with the territory. The trick is to know what your rights are and who to complain to.   There's a lot of middlemen in the healthcare mix.  It's important to find out if specialty care for cancer or scans (aka nuclear medicine) has been farmed out to a vendor (like Evicore).   

Good luck! 

Michelle 

[BridgetO]

I alao have Kaiser and i see pros and cons. I have some choice of providers, but only within the network. The main pro is the cost. I have a fairly expensive Medicare Supplement plan through the county I used to work for. The coverage is way better than any publicly available Medicare Supplement plan. I've had treatment for 3 primary cancers and my out of pocket costs have been minimal. For my second cancer (gynecologic) especially, the treatment was long and would have had heavy out-of-pockets. Also, my policy covers stuff that many don't, including zero copay durable medical with a broad view of what constitutes durable medical. And, as has been mentioned above, no hassles with insurance coverage.

I agree that the providers and treatment are not generally cutting edge,There are some expcetions. The gynecologic oncologist who did my gyn surgery was probably as good as any. Unfortunately, Kaisers policy on gyn cancers is to send you  back to generic medical oncologists after surgery, and my experience with those has not been great and they seem to have a high turnover at our Kaiser. I did pay on my own for a second opionion on my gyn cancer chemo at Oregon Health Sciences University, a Comprehensive Cancer Center. My Kaiser med onc agreed to follow the recommendation of the OHSU expert. 

One complaint I do have is that I don't have one oncologst that follows all 3 of my cancers, so my care seems a little "bitty". 

If my lung cancer were advanced or unusual, I would seriously consider a change, but for now, I'm sticking with what I have, since it seems adequate and money is a big issue.

Bridget O