Roger's Journal

Yumiko Ishida  It is my understanding that Medicare can’t deny coverage of pre existing conditions, but you should double check the specific plan you are considering. This will be the time to make the switch, during open enrollment. 

Deena Z  If you don't have confidence in the surgeons that are covered under the Kaiser plan, I would call Cedars’ cardiac surgery dept and:

 1) confirm if they have any experience with Kaiser medicare HMO paying for the surgery there (sometimes there are exceptions), and if no then, 

2) ask what Medicare advantage plans they accept  (if that is what you want) .  There is always regular Medicare fee for service as well. 

 

susan harris  you might see folks here talk about insurance issues -they exist, not just w Kaiser!  definitely good to call Kaiser and ask lots if questions. the videos, interviews and webinars on this site can help you make a list of questions and know what options exist. 

Kimberly Eisenhut  Yes, insurance is an issue for sure. My insurance company just dropped out of the contract with ALL of my Drs and hospitals out here in Illinois and I have been on phone for day/hours this past week changing to one they will take now. I am happy to say at least I will still have insurance with my Drs I have now, but was told by many Dr offices that the plan I now have will require a lot more pre approvals for anything I have done as well as even specialist visits. There has got to be a better way, as the system just does not work as it should. Just keep fighting for what you need and never give up is my motto! Most insurance companies also have  plan care coordinators you can ask for, they just do not tell you about them. Call insurance and ask they assign you to a care coordinator. Let us know if we can helo in any way Roger. 

Susan Eckermann  Hi Roger. I had Kaiser and changed plans just before my surgery. You can contact them and schedule a consult with the surgeon. My condition was mainly severe mitral valve regurgitation. Kaiser did not consider me to be in need of immediate surgery and suggested “watchful waiting.” I sought out a second opinion with a heart surgeon who advised me that if I were his patient, he would recommend surgery within 30 days.  The severity of the regurgitation had damaged the valve to the extent that no surgeon was completely confident in a repair. Waiting would only make it worse and insure I would need a replacement, rather than a repair.  I was able to change insurance and had surgery quickly. Thankfully, 7 hours of OHS resulted in a successful repair. Kaiser does have some excellent surgeons.  When I advised Kaiser of the second opinion, they expedited my case, and the heart surgeon contacted me by phone, on a Sunday, to discuss my condition and surgery. By then, I had already decided to change insurance and go with the surgeon of my choice, but I was  impressed with the response from Kaiser, once I presented them with the second opinion. This site is a wonderful wealth of information. 

Kimberly Eisenhut  Yes, if your insurance says no or denies anything, you can always have your Dr or Surgeon contact them directly , the surgeons offices all have people that do these things, or work with a plan "care coordinator". Almost every insurance company has these, and you should contact your insurance to make sure you have one that you have direct phone number and can contact when you have any issues or need help getting the care your Dr says you need. They will at times coordinate calls with insurance and Drs also. At least that has been my experience. Maybe someone here that is a nurse or works in a hospital or Dr office can better elaborate.