I currently have individual insurance through Anthem BC/BS and the cost is just killing us. I am looking at some HMO options including Kaiser-Permanente. I am very new to this but have heard somewhat good things about Kaiser-Permanente in Northern California. Can anyone comment on Kaiser in Northern, VA. I would greatly appreciate info about durable medical goods coverage and your experience with Endos. Thank you!!!
Ive had experience in southern Cali. I find that KP is really good about covering preventive care things. My coverage is 70% for all glucose testing CGM as well as finger sticks. I think that is standard for individual plans. You should check for sure before you switch over. My endo never batted an eye when I told him I wanted to get a CGM. He approved it the same day I asked for it.
There is an odd way of getting your supplies though. you have to order through Kaiser DME. Then they put the order through to the companies. It works that way for pumps and supplies too. It is ok once you get used to it, but I have had a few orders get lost over the years.
Insulin though comes from the pharmacy as do test strips.
Over all I am happy with them even thought I pay through the nose for it, I am glad to have coverage.
Thanks Tim. Do you have a plan with a deductible or a copay? Or a combination of both?
Does Kaiser limit the number of strips that you use?
My plan has a deductible and a copay but really i've never used the deductible at all. I just pay copays.
All glucose testing is paid 70% that is for strips and CGM. I think that is for everyone. But i'm not sure. That is how they dealt with people who wanted to test more than others. There is no limit to the finger sticks I can get but I am limited to 10 CGM sensors a month . I never use that many because I use each of them twice at least. When I was with a group plan they paid the same way except 80%. The same goes for Pumps and pump supplies. You need to check the DME benefit on your policy first tho, as they differ from plan to plan.
Kaiser also contracts finger sticks and CGM sensors at a discount so the cost is not very much even with a 30% copay.
My pump if I bought it directly was $6,700 US. But Kaiser price was $4,900 . SO I paid 30% of the $4,900 . Same goes for all the other stuff. The base prices are lower than you can buy directly.
I was a member of Kaiser Northern VA years ago, before I was diagnosed. They were fine if you had routine health issues. In the end we dropped Kaiser because of their stingy practices and that they didn't handle things well if something is actually wrong. I'm sorry I can't tell you anything about their durable goods coverage or endos.
I do believe that Kaiser is pretty consistent throughout the nation, so Tim's experience in Southern CA is probably what you will encounter in Northern VA.
Was your coverage more than 10 years ago? Supposedly they have made some big changes over the last 5 to 10 years.
Sorry, this was more than ten years ago. We used to go to the fairfax and springfield Kaiser.
One possibility is to contact a local diabetes center, I know there are ones at Inova in Fairfax, Alexandria, Fair Oaks, Loudon and Mount Vernon. The staff there may actually be well versed in the local insurance practices. There is also a pumper support group out of the Fairfax center, if you contact me I can connect you up.
Have you tried any other sites. I live in the NO VA area, but do not use KP. I do have a friend who is a psychiatric nurse at KP. You might try some local sources of information. All KPs will not be alike, for sure.