Health Insurance Ideas Anyone?

[sunru]

Does anyone know of an Insurance Company that they are happy with? I need to change from Kaiser to a PPO plan so I can be seen at a Univ. Medical Center although this may be one expensive change with my pre-existing condition. It may be impossible to leave Kaiser for a while for that reason.  Anyone have any ideas?  

[hepcandme]

I would Love to join that group Hector!

[sunru]

I like the idea of the support group over there. What an excellent idea! Hope it happens.  Thanks so much.

[can-do-man]

Great ideal to check it out as you never know until you search, I had a friend who thought, "wow" this will be great. Well the good news was his premium did go down, the bad news was his deductible was way higher then before which = a lot higher cost on his part. and to top it off the doctors he saw were not in net work which = even higher cost.

Crunch them numbers.... Wishing you the best.

[sunru]

I asked the business office at kaiser yesterday about getting a patient advocate to help me out on some of these issues. They said I could Not get an advocate unless I was hospitalized. She then referred me to my primary care dr. to authorize an occasional referal to ucsf for a second opinion or specialized treatment.  

Hey, do your best, then don't worry be happy.  Right?

[sunru]

Yes, deductibles, co-pay, and getting approval for procedures in advance is very important. Certain plans are more accomodating to this process. There's a lot to add up - so I might not be able to change plans right now.  It's going to be worth it to look into it and check out the marketplace exchange and do the math. Hope I can come up with a PPO that is comparable to what I'm paying with kaiser.  Hey,  thanks for your help.

[sunru]

As you can imagine I get very nervous with kaiser's care as all but one of the doctors there seem to know nothing about what to do -patients with cirrhosis. That's why I decided to follow their advice on getting referred to ucsf whenever there's any question about how they are handling my care. I saw Dr Terrault on one occasion and one of her NP's, Lisa. I heard it is best to schedule appts. in the a.m. if possible to avoid the wait. It was not a long wait to see Dr. T., she is awesome. I now know how important knowing our IL28B is along with Geno type is in determining which tx approach to take thanks to her wisdom. Thanks so much HOwie!

[dontworry_behappy1]

Be careful changing insurance.  Your right about charging for additional coverage.....and yes you can get a referral from Kaiser.  

[HectorSF]

On the California Exchange or Marketplace cost is very dependent on your income. Federal subsidies can make a HUGE difference in your actual cost.

UCSF imaging is 1st class and they know how to differentiate lesions and diagnose HCC accurately. Frankly I would be hesitate to go anywhere else as I have heard too many stories of inconclusive findings or improper follow up. The most accurate test for HCC is a multiphase MRI with/without contrast. UCSF has some very high resolution MRIs but more importantly the folks reading the scans have the regular experience of viewing HCC on a regular is not daily basis because of patient's like me. ;-)
I have had more MRIs than I can ever count.

"a 4mm segment 8 cyst and heterogeneous early arterial phase enhancement of left lobe and left lateral portal vein tributaries likely related to portal venous shunt "
Nothing to be concerned about here.
Also men are more than twice as likely to develop HCC than woman. Although it does unfortunately happen.

Only two hours? haha
Seriously, I really can't be objective about Dr. Terrault (who has been my hepatologist and supporter for 6 years now). Quite frankly without her I would not be alive now. Dr. Terrualt's team is in very high demand, and rightly so. So yes be prepared to wait a long time. Also please realize that Dr. Terrault and her teams work with the sickest of the sick so there will be times that issues arise with hospitalized patients that need immediate attention. In my opinion it is worth seeing her as you can be assured you are getting the best of the best for hepatitis and liver disease. If you don't mind me asking which NP do you see? Or do you see Dr. Lai?

As far as the Hep C support group we will have one of Norah's NP come by during the last 15 minutes of the meeting to speak from the medical side of things.

Best
Howie

[sunru]

Hector, thanks for the insurance info - I will get on the insurance exchange and see what they have to offer. I think they can charge more for Age and for Additional Coverage without saying they are denying coverage for a pre-existing health condition. I will do the comparisons and see if there is anything comparable in price. As it is I have to pay kaiser a lot for a high level plan.  

That's right -Kaiser does not refer pre-transplant patients at all. They just try to handle cirrhosis patients as best they can and scramble to keep them from decomp by watching patients closely and give them whatever they need to hang in. I've been on a 3-6 month watch since 2008 with afp, ultra sound, ct and mri's. So far, what there seeing is a 4mm segment 8 cyst and heterogeneous early arterial phase enhancement of left lobe and left lateral portal vein tributaries likely related to portal venous shunt with no obvious mass lesion. I've finally got something to compare their findings with over the years with the report you posted recently on AASLD recommendations for monitoring potential hcc. I went to the Kaiser business office today to request
a referral for a second opinion and specialized hcc testing at UCSF, they said
I could get a second opinion referral over there possibly thru my primary dr.

Hector, it's a good idea to start an hcv support group at UCSF. It's real busy over there and what a huge support that would be.  You certainly have the knowledge and experience you've shared over the years.  I think most tx facilities don't allow the coordinators enough time for support during tx. Hcv  treatment is a time when patients really need information and often they aren't able talk to someone when something has come up. Or at least that has been my experience. I had to wait 2 hours just to see Dr.Terrault's assistant on one occasion at the transplant clinic. So I hope you are able to do it.

[HectorSF]

Starting January 1, 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition due to the passage of the The Affordable Care Act in 2010, otherwise known as Obama care. This is something we patient advocates have all fought for.

Kaiser has a contract with UC and here at UCSF we perform Kaiser patients liver transplants on a routine basis. But Kaiser doesn't refer pretransplant patients until there are End-Stage from my experience.
As far as hepatitis C management/treatment and management... It is expected to get very busy at UCSF early next year as we see the introduction of the new DAAs. This is why myself and a friend have started a Hepatitis C Support Group at UCSF to help patients through their treatments.

Here is a listing of all of the health insurance plans that UCSF excepts.
http://www.ucsfhealth.org/billing_and_records/health_insurance/

I used to have Anthem Blue Cross (before my current Medicare + Anthem supplemental) and have had no issues with payments at UCSF. "Your mileage my vary."

Ciao
Hector

[sunru]

Thanks, you are the second friend who has suggested doing this. I'm going this route, it's my only option. I do know that I have to go to the business office and request a patient advocate to be assigned, then start the appeal.

[dontworry_behappy1]

Kaiser refers to the University Medical Center.  You need to check into your Kaiser benefits.   Contact Kaiser.  There is a line you can call to get answers
at Kaiser where you get an answer in 24 hours.  I would be giving them a call
and getting answers to you questions.   Ask!!!! and demand an answer.