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The Kaiser Senior Advantage Plan

"The regulations governing managed care and the Medicare + Choice program are found in 43 CFR 417 and   422

The general Rule concerning health care services is that Medicare enrollees must obtain all covered health care services through their Medicare + Choice Organizations ( M+COs).  There are four exceptions to this rule:    
1) for an emergency either inside or outside of the M+CO's service area; 
2) for urgently needed care;
3) for services that the M+CO approved in advance or
4) for medically necessary services which are covered by Medicare that the M+CO refused to provide."

What this means is that Kaiser can and probably will tell you that you can have any medical treatment you want in the world that you have proof that you need and that you can see any doctor in the world that you want, BUT don't count on them paying anyone for it.



There is no sound reason for any human to be a part of the Kaiser Medicare Plus Choice Program. 

Rather than signing up for any Plus Choice Program, if you can, it would probably be much safer for you as a patient to sign up for Part A and Part B of Medicare and pick up a Medigap Policy.  That way you have the freedom of just leaving any doctor at any time if you feel that they are not providing the promised medical care in your contract with them.  Your life is more important than fighting with some HMO over contractual obligation.

Kaiser over bills for services rendered.  See the government action against them at::
http://oig.hhs.gov/oas/reports/region5/50100094.pdf

Now if they are doing that and blaming their secretaries what else do you think they are doing?



If you are considering the Senior Advantage Plan because it sounds great that they say they will give you new teeth and glasses, seriously think it over.  Is it really worth the gamble with your life for teeth and glasses?  Besides the Kaiser Dental service still is going to cost you money. You worked hard for years just to get Medicare, don't blow this earned privilege on a HMO.
 

 

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