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Damn, "Thoughts and Prayers!"
(lemmy.world)
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this post was submitted on 05 Dec 2024
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Kaiser's is artificially low because of the vertical integration.
Is that true? My initial thought was that it's because Kaiser Permanente is a nonprofit. Unless I am mistaken.
Yes, it's true. Its nominal "nonprofit" status doesn't stop it from being a major market competitor with a history of regulatory capture, paying its CEO more than other insurance companies do, and having vast cash reserves, for example.
No, of course it doesn't... but I imagine when you don't have a profit motive, your motive to deny claims also decreases.
Just a theory though.
The problem is that they still have an apparent profit motive.
They do, but it's obviously not nearly as disgusting as the rest.
My spouse works for PPO insurer and has worked for Aetna, and she always jump on my Kaiser plan if I work for an employer that offers it. Her coworkers often do the same.
All healthcare in the US is embarrassingly bad, but Kaiser often does cover more and charges less than comparable PPO plans. Problem is, navigating it can be tricky if you’re used to PPO life.
We’re with Aetna right now. We fucking hate it. The love to force out of pocket payments for preventative care. Aetna rather you just hury up and die so they don’t have to pay for you.
My main concern with Kaiser is that it severely limits the pool of covered doctors and specialists. All the Kaiser plans I've seen also have higher out-of-pocket maxima with zero out-of-network coverage.
Covered doctors and specialists... out of network... people on Reddit kept telling me my socialised universal multi-payer healthcare by statutory health insurance, would mean I could not see the doctor I wanted and would wait forever for services. And sure, for everything that's not immediately necessary I do wait some time. But for all things acute I can go to any general practitioner who will either provide immediate help or forward me to a specialist for immediate help. No matter where in my country I am, no matter which hospital, GP or specialist I go to, everything important is covered. And I pay less per month for it than Americans do.
Out of curiosity, what country?
Don't worry, we already know... None of it makes sense in any context besides "making money for corporations and wealthy stock holders"
The limited of out-of-network coverage is kind of the point of Kaiser. There are some times that they’ll do it if they’ve understaffed in a specialist’s area, if it’s emergency / trauma care, etc. But the main point is to try to keep things within the non-profit network, and to limit the cost creep imposed by the for-profit healthcare providers.
As for out-of-pocket, that really depends on the plan you’re buying or your employer is negotiating. When I was picking a Kaiser plan, I was usually choosing between similar PPO offerings with comparable out-of-pocket.
My wife and I, and many of her insurance coworkers, have found that the PPO plans often hide the costs. It looks good on paper at first, but the TOS about what is and isn’t covered can often be much more profit-driven in the PPO space. And you often don’t learn about these details until you need care or a medication.
So it's the vertical integration.
Isn't Kaiser multiple SEPARATE entities? For example their multiple doctor/medical groups are FOR PROFIT and Kaiser (the insurance company portion) is NON-PROFIT? Complicated structure, but I've always seen and heard good things from Kaiser. Sure there are complaints just like for any company that deals with healthcare, but Kaiser always seems like the best option.