Kaiser Permanente is an organization that strives to keep all care in house.  This can lead to lower costs on them but if you need doctors that they do not provide, it can be costly because most private doctors do not take Kaiser Insurance.

Being in network with Kaiser can be very hard on the doctor and staff.   I used to be "in network" with Kaiser but after years of fighting with them for my patients health, I choose to decline being in the network in 2008. 

Being "in network" with kaiser really has little benefit for the doctor or the patient unless you are going in for something routine.

This is how being in network is set up:

1. All doctors are put on a tier system.
This means only 5 visits are approved for each patient.  It does not matter how severe your situation is.   If someone comes to your clinic with insurance that states they get 30 visits per year on their plan, they really only get 5 with a doctor that is in the lowest tier.  

This tier system has nothing to do with skill or results.  It has to do with how long the doctor has been in network with Kaiser and if the doctor averages only 7 visits per year on average for each patient. So, even if you come to see a chiropractor for a severe injury, Kaiser really only wants you to get care 7 times per year. 

2. Their copay system:  

Kaiser copays are low and so are the payments to a doctor.  Kaiser pays around $26.00 per visit which includes the copay. So, if a patient has a $15.00 copay, they pay out $11.00 more. This is well below what is normal and customary.  We as doctors want to give the best care out there but we also want to get paid adequately for what we do. A Chiropractor who adjusts, does soft tissue work, exercises etc each visit deserves well more than $26.00 per visit.  

This is why when you go to clinics which take Kaiser, visits are usually pretty quick opposed to clinics that do not take the insurance. 

3. Paperwork: 

American Specialty Health (ASH) works in the Medical Necessity realm of care where doctors have to prove this patient needs care even though the insurance says they are approved for a specific amount of visits. Paperwork and exams must be done the way Kaiser or ASH wants which may not be the way this specific doctor works.  They want re-evaluations every 5 visits and then may only approve 2 visits afterward.  Then after those 2 visits, they want another re-evaluation it is time consuming and not realistic with healing and how the body works. 

A doctor is bombarded with constant paperwork and most of the time ASH declines some of the visits so the patient really loses out unless they pay out of pocket for the rest of their care (which most patients do). 

So why do patients want to pay out monthly premiums and then get limited coverage?  Because this insurance has a low monthly rate and patients that feel pretty healthy only want to use it for an emergency.  

PPOs are better plans with better health benefits and cover emergencies too.  In my opinion (and I have tried Kaiser as a consumer), PPOs with and HSA plan are the better bet.  Insurance companies are in business to make money, not pay out money.  An HSA assures that if a procedure is not covered, the HSA will pay for that portion of care. Hidden Barriers:  Some Blue Cross and Cigna PPO plans are run by ASH and they monitor your PPO like an HMO even though it is not. 

Please check your plans to make sure that ASH does not run this plan or it will require Medical Necessity and tons of paperwork from your doctor.  Out of network doctors do not have to fill out such paperwork and this may come down to you having to argue your point to the insurance company.  Not so much fun.  Make sure if your plan says 30 visits or 12 visits, that you get what you are supposed to out of your plan. As you know insurance is a complicated matter and it can really bogged both you and your doctor down so make sure your plan does what it says and it is as easy as going to the doctor and paying a copay! It would cost you less in total if you just paid out of pocket for your chiropractic, acupuncture care.  Visit rates and packages are pretty competitive and getting care will decrease illnesses and symptoms that you would have to address later on.  Those procedures may end up costing you more in the end. 

According to the NYTimes people go bankrupt because insurance companies do not cover expenses: https://www.nytimes.com/2016/01/06/upshot/lost-jobs-houses-savings-even-insured-often-face-crushing-medical-debt.html. Chiropractic care is affordable and helps prevent illness.  Keeping your body working at its highest capacity is a necessity not a luxury.  We can help at our Redwood City Chiropractic Facility.