From: Bill Lucy 

In article <39234186{at}w3.nls.net>, greggstrom{at}earthlink.net says...
blucy{at}mediaone.net> wrote in message
> news:MPG.138cf57e6ecd14259898cd{at}news.barkto.com...
3922d511{at}w3.nls.net>, greggstrom{at}earthlink.net says...
> >
> > > > I think that existing health insurance and government
programs have
> > > > gone a long way toward elevating prices payed by the
uninsured who
> > > > don't qualify for government programs.
> > >
> > > A very good point.  When I told Markus about the rates at Kaiser
> (including
> > > the co-pay), he said, "Is THAT all it is? Then why this
big deal about
> > > health care?" (I believe I've mentioned that here before....)
> >
> > Does he have a pre-existing condition which may prevent or impide
> coverage?
>
> No.
>
> > Does his job permit him to enter into that particular program? Does he
> travel?
> > Does the contract disallow him from anything but emergency services
> outside the
> > normal coverage area? Is he limited to certain clinics? Are referrals easy
> or
> > difficult to get under the contract?
>
> My understanding is that this is a standard contract: Kaiser
> clinics/hospitals for normal coverage, ANY facility for out-of-area
> emergencies, urgent care at Kaiser facilities when available, or any
> facility if Kaiser not available.

The "any facility in an emergency" is pretty standard, although
many HMOs hassle people who do so (it happened to my boss after a skiing
accident to one of her kids this year). The urgent care at Kaiser
facilities is expected (although it's not universal). The urgent care at
any facility if Kaiser is unavailable is not expected. That's highly
unusual, in fact.

> I don't know if Kaiser has coverage for out-of-country, because I only had
> minor problems when traveling, so simply paid cash to a local doctor (as
> referred by American Express).

In almost any situation out of country, most HMOs don't cover anything
other than life-threatening situations.

> Referrals are getting expotentially easier. (The Kaiser doctors did a job
> action forcing that: "Work to rule.")

The State of Illinois just passed a law that requires easier referrals. As
an example, now only one referral is necessary to a specialty care
physician for that physician to treat a patient over a period of time.
Before, it might be necessary that a person see their PCP everytime they
needed to see the SCP.

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