Has anyone here gone outside of Kaiser and had luck with them covering the cost?
Our son needs eating disorder treatment that isn't offered by Kaiser. Only two places in the entire country provide treatment for his condition. We are meeting with one of them in a couple weeks.
I have a request in for a referral to his therapist. When I called Member Services, they made it sound piece of cake if a doctor makes the recommendation for treatment outside of Kaiser. I'm wondering if that's really the case? It sounds like they only cover their normal rates, so I do expect we'll have to cover a lot of cost beyond that since Kaiser is good at keeping costs down (and we'd be going to a freestanding clinic with higher expenses).
I welcome any and all tips on navigating this process. Thanks!
ETA: I don't intend for this to be a debate about Kaiser. Just want some BTDT advice on this type of situation.
*****NOTE: I did ask the practice about experience with Kaiser. They said it varies as far as coverage potential (depends on each child's unique situation), but told me to contact the doctor and Member Services, which I did. I would really love a member's perspective, too.
As of 7/31, we've lost our battle with Kaiser. They want their eating disorder specialists to try to help first, even though they have no program designed to help treat his specific eating disorder (food neophobia/selective eating disorder). We're going to pay out of pocket now to see the specialty clinic out of town and get an assessment and then meet with Kaiser's eating disorder person to see what we think. The particularly frustrating thing is that I've said to his doctors for years this is an eating disorder and not once did anyone suggest referring him to one of their eating disorder specialists (who happened to be in the very same hallway as these therapists). Suddenly, now that we're trying to get him targeted help, we need to see one of their people. I'm livid.
We had Kaiser for about 6 years. I never had to have an outside referral, but once while visiting my family in another state where there was no Kaiser I needed to go to the doctor. Anyways they paid the doctors bill in a very timely manner no problem.
Why don't you ask the private practice if reimbursement from Kaiser had ever been an issue.
I've had Kaiser since 2010. I've needed referrals for services they didn't (or preferred not to) provide, including a D&C and physical therapy for my 12 month old. As long as a Kaiser doctor makes the referral, you shouldn't have problems getting outside treatment. It seems Kaiser contracts with quite a few outside providers.
As long as you have a referral from Kaiser, and you've done your due diligence with Member Services, they'll cover it. Member Services will be able to tell you at what level the services will be covered, and what your co-pay (if any) will be. I've had better luck going in to Member Services directly, rather than taking my chances with calling in. (We go to the one in Elk Grove; they've been able to resolve some fairly complicated billing issues in nothing flat every time I've gone in there in person.)
I would call the places you want to go and ask them about Kaiser. I have no idea what it is mind you but I know our billers know exactly how each insurance company treats our patients, well that and we know what our contract states.
Much easier than posting here.
