Yes it is true. Kaiser is the template for all HMOs which today are really glorified Urgent Care Centers. They can be great for quick fixes, and a lot of other fairly minor things in comparison to expensive to treat, long term, chronic disease and illness. You probably need a more expensive policy for that. They can also be horrible due to program restrictions with expensive to treat, chronic or life-threatening problems. They often find a way to accidentally just not provide services when they don’t want to provide care for any reason. At the very least, people that are paying money for these programs need to know what services are likely and not likely to be provided. When you are stuck with Kaiser or any other HMO and are banned from picking up another plan for a set period of time and then you find your loved one will be denied care there isn’t a whole lot that can be done. Kaiser started this whole mess and the least you should do is learn what it is all about. It is a business first and health care second.
The Kaiser Papers was created out of necessity so that people can learn to become proactive with their and their loved ones health care. Health Care is not what it used to be. A patient is often only an item, a commodity of sorts, and often a professional is only concerned about how much money they can make, whether by salary, bonus, data manipulation, government contract , experimentation and/ or many other things. People must become aware of this and do need to not be timid and learn to ask questions and then verify the answers.
People must understand that Kaiser does employ many fine, well trained professional personnel and that they also employ those that sometimes do things that are not professional and which do end up harming people or taking lives prematurely. Additionally, many of these specialists are limited by the Kaiser system and can only provide top services as volunteers at other not Kaiser facilities, thus helping to satisfy the Kaiser, not for profit status. Many other health care organizations and/or corporations do the same thing. It is not only about Kaiser but Kaiser has been a template for them all. With that knowledge alone the American patient if they choose to learn will have information that may very well help to get proper care for themselves or their loved ones from this web site.
To reduce the cost of the medical services it insures, Kaiser covers the medical care of its HMO insureds only if they seek treatment from and/or through its medical service providers. The only exceptions to this requirement are for emergencies or in the rare case that Kaiser authorizes treatment by a physician not within its network—something Kaiser does only on an individual basis. These facts are disclosed by Kaiser to actual and prospective HMO participants.
Kaiser promotes its insurance products by, interalia, (among other things,) advertising the quality of care prescribed, recommended, and provided by its physicians as well as touting the independence of its physicians in making medical necessity determinations.
In fact, however, the nature and extent of care recommended and/or prescribed by Kaiser physicians is often significantly limited or affected by the incentives and restrictions imposed by certain provisions of the contracts between, and policies set by, Kaiser and its physician groups or between Kaiser and other medical care providers. Thus, these incentives and internal policies create a material risk that the medical treatment prescribed or recommended for a Kaiser member, and/or the treatment such member actually receives, will differ significantly and materially from the treatment that would be dictated by the independent medical judgment of the treating physician(s). For example, Kaiser provides financial incentives to its physicians for meeting certain performance targets that have been set for a particular year, goals such as maintaining low hospital admissions and hospital days or goals such as maintaining a low number of a specified medical procedure. Periodic reports are then distributed throughout the year reinforcing the targets set and informing physicians of their status in meeting those targets. Such incentives may affect, and possibly do affect, the medical necessity determinations made by the treating physicians.
As a result of the restrictions and incentives in Kaiser’s policies and its contract with its physicians and other medical care providers, the treatment recommended or prescribed for a Kaiser member, and/or the treatment such member actually receives, may differ from the treatment that she or he would receive according to the dictates of the independent medical judgment of the Kaiser member’s treating physician. A reasonable person would thus deem such restrictions and incentives as material facts when assessing whether to become or remain a Kaiser participant. The fact and nature of these incentives and restrictions are also material facts bearing on the extent to which the treatment recommended or prescribed for a Kaiser member, or the treatment such member actually receives, can be expected to differ from the treatment that a member would receive according to the independent medical judgment of the member’s treating physician. As such, the nature of such incentives and restrictions are also facts that a reasonable person would deem significant in his or her assessment of whether to become or remain a Kaiser participant.
None of the material facts identified above is accurately set forth, if set forth at all, in the literature Kaiser makes available to actual or prospective Kaiser members.
The public should have some capability in knowing what to look for when they seek help. They need to be able to determine when they are being lied to and they need to know what other people have gone through so perhaps they will be able to avoid similar problems.
They also must realize that medical personnel are the same as everyone else. They have the same personal problems, the same frustrations, are prone to the same financial distresses and also react, sometimes stupidly to these stresses just as everyone else does.