I have Kaiser SoCal but prior to the last two years I had a private dr in Texas and took pain medication, 6 mg of Xanax & ambien for 7 years. No overdose no narcan required. I moved back to Ca after surviving a brutal attack now having anxiety so bad I am having psychogenic blackouts and the ambulance is coming to my job. Kaiser refuses to give me more than 2mg of Xanax even though it’s become physically dangerous s they also refuse to properly diagnose the blackouts as well as the very obvious adhd I’ve always had. If it involves controlled medication you won’t get diagnosed , they also lie on your chart and black ball you from all care of you switch DRs. I have fought them like crazy for proper care and they refuse to do anything stating I refused their treatment plan which is a lie. I already take gabapentin and have tried hydroxozine which is a joke for anxiety at my level, increased gabapentin is not going to stop the severe stress skyrocketing my cortisol and me passing out. I can’t believe there aren’t major groups fighting Kaiser for their horrific treatment.
I realize that not all readers of my blog read all the comments… but this is not the first time that I have received a similar comment – or email – from a pt that has health insurance from Kaiser Permanente telling about similar denial of care from them.
Kaiser Permanente is considered a HMO
Health Maintenance Organization (HMO)
and the definition of a HMO:
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
HMOs often provide integrated care and focus on prevention and wellness.
Does the care that this pt is claiming to be receiving has a focus on PREVENTION & WELLNESS ?
Filed under: General Problems
this is not new Kaiser is actually breaking the law by refusing to treat their patients, by law if they refuse to treat you with the proper meds it is their responsibility to refer u to a doctor who will treat you right, i have been fighting with them for approx. 3yrs i have gone from being a active productive person to being bed ridden today, this person is right Kaiser will lie and do anything to make u the patient look bad including making accusations in your file that will prevent any doctor from taking ur case, no medical group should have the power they have i have filed civil rights charges charges with medicare and medical anyone i can think of to no avail i will not stop fighting them till the day I die, they r torturing and killing their patients
might try looking to placing a complaint here https://qioprogram.org/file-complaint
Another pointer about Medicare Part D plans with conventional Medicare Part A and B: investigate Medicare Health Savings account for your posdible 2021 deductible. Or if you are still working a Health Savings account or Flexible Savings Account through employer. It may help.
My 2020 plan had a $435 deductible. If my late husband still lived and worked, I would be protected by his professional technologist income joint with my SSDI Benefit for paying any out of pocket copayments from my Part D.
More than anything I want a long term return to work as a technologist in computer cybersecurity. Disability workplace accomodations can be put in place with my ALJ SSDI Order saying permanent and total disability.
Denying intractable pain paitents sufficient analgesia relief with opioid therapy is torture. 90 MME one size fits all does not work.
Gary, nana and everyone who is a Medicare beneficiary:
All plans are unalike. Best point of reference to check a plan for your state plus the Part D plan formulary? Check http://www.q1medicare.com for your state, all licensed Medicare Part D plans with formulary for Prior Authorizations, Quantity Limits and forced Step Therapy. I am in the NY-CT region and kept Traditional Part A and B Medicare, having heard firsthand of pain patients being forced into torturesome formularies.
Q1Medicare has a browser based query mechanism allowing the Medicare patient to check by medication name, NDC number and whether Prior Authorization or Quantity Limits apply for the Part D licensed plan by each state.
I steer clear of Medicare Advantage plans for myself. Especially after observing close friends and colleagues impacted by their capricious anti-opioid Rx formulary schemes.
Do your research now, before Dec 7th end of Medicare open enrollment deadline for 2021. If you find a change in your plan decision, check with your prescribing physician(s).
Good afternoon. First I want to thank you for your informative, thoughtful and unique writings. I had a knee replacement and woke up with severe peripheral Neuropathy. The pain is so extreme in my legs that at times I am unable to walk. After one year and three opinions, I was told by two prominent orthopedic surgeons that I was suffering from spinal stenosis. Shortly before a scheduled spinal surgery, I was able to see one surgeon who is considered one of the best in the world. He required a brand new MRI before our first meeting. When I arrived, MRI in hand, he studied it for about five minutes before telling me that he would not operate on my back because “I feel sure you will wake up with the same pain!” He added, “ off the top of my head, I think you have Peripheral Neuropathy and sent me to a Neurologist. After a series of tests, much discussion, I indeed received the diagnosis of severe Peripheral Neuropathy. After another year in which my insurance company insisted I try numerous anti-depressant and anti-seizure medications, ( meanwhile living, or in my opinion existing in horrendous pain), I had to find a pain management doctor. He has been a God send but the only medications which subdue my pain so I live a version of a normal life, are pain medications. I had never taken any except one time for a dental issue. If all that was not enough, i was totally ignorant that the country was in the midst of the “opioid epidemic” I have learned fast as I am constantly belittled by other doctors, and by far the worst, my pharmacist. Since most of the big chain pharmacies do not dispense any pain medication whatsoever, Los Angeles has a hand full of private ones that do. Because there are so few, they treat everyone terribly. I have never in all of my 66 years been called a drug addict, but now it is quite often. I tell that long story because for three months last year I had the nightmare of going to Kaiser. Their pain management people refused to honor my regiment that my pain doctor and I had worked on so hard and long so that I could have some joy in my golden years. He called me a drug addict and refused to talk to me anymore. When I reported this to the almighty primary care guy, he said, and even put it in writing, that he was not about to chance losing his license due to my drug addict needs. I said I was beginning to go into withdrawal, so he suggested that I “suffer”. The pharmacist refused to fill it. Not any of them cared at all about my pain and suffering, or even my withdrawal. Fortunately, I was able to return to my original doctors and pharmacy, so I get my monthly medication sometimes within within 30 days, quite often not. I had a girlfriend dying of breast cancer ( she has now died), and she suffered the same abuse. I know you have written about the “opioid problem, and I am pleased to see you tell today’s sorry regarding Kaiser, and I thank you for the opportunity to share mine. And, since we old folks are in our Medicare open enrollment period, please make sure you understand Kaiser’s Advantage plans. My first month cost me hundreds of dollars in co-pays. My fixed income is still broken. God Bless! Gary Lacy
Gary Lacy, I used to have Kaiser too. I used to say, about them: “They give great pill.” That’s all they did so one visit equalled several 90 days supply of their best guess. I am guessing that now you will get neither a thorough exam nor great pill.
This crisis evidently forced doctors to figure out why you hurt instead of just making the hurt go away. At least that part, the real exam has helped diagnose instead of hiding diseases but the lack of support, physically is appalling. No one should be required to hurt that bad.
You are so right. Ask what Advantage plans cover but also ask what they don’t cover. If you are out of town (maybe a funeral) and get sick.. Are you covered?