Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
Whether the plan covers any part of your monthly Medicare Part B premium. Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care. Whether you require extra benefits, and if the plan charges for them. You can select by insurance carrier to see only Kaiser Permanente plans or compare across carriers. Average star rating, weighted by enrollment: 4. This performance is unmatched by any other major provider.
The average star rating for plans from all providers was 4. To get an overall star rating, the CMS ranks contracts on 40 plan factors. Kaiser Permanente delivers on the majority of them. Special needs plan, or SNP, care management. Care for older adults — medication review. Care for older adults — pain assessment. Osteoporosis management in women who had a fracture. Diabetes care — kidney disease monitoring. Diabetes care — blood sugar controlled.
Medication reconciliation post-discharge. Health plan: Members choosing to leave the plan. Plan makes timely decisions about appeals. Health plan: Call center — foreign language interpreter and TTY availability. Drug plan: Call center — foreign language interpreter and TTY availability.
Drug plan: Members choosing to leave the plan. Medicare Plan Finder price accuracy. Medication adherence for hypertension. Medication adherence for cholesterol. Kaiser Permanente contracts averaged a sub In its Medicare Advantage Study — the eighth it's done so far — J. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment.
On these measures, Kaiser Foundation Health Plan scored points out of 1, and came in first out of the top nine Medicare Advantage providers  J.
Power Finds. The top-rated plans with scores of 5. Health Plans. Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county. Aetna Medicare Advantage plans. Anthem Medicare Advantage plans. Cigna Medicare Advantage plans. Humana Medicare Advantage plans.
Kaiser Permanente Medicare Advantage plans. UnitedHealthcare Medicare Advantage plans. Wellcare Medicare Advantage plans. Kaiser Permanente, headquartered in Oakland, California, was founded in and serves Here are some questions to consider asking:. Can you afford them? Is your doctor in-network? Are your prescriptions covered? What tier are your prescription drugs on, and are there any coverage rules that apply to them? Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
Kaiser Permanente Medicare Advantage pros and cons. Back to top. Available Medicare Advantage plans. HMO plans. Additional benefits. Customer service. Kaiser Permanente Medicare Advantage service area. Medicare star ratings.
Where did Kaiser Permanente outperform? Breast cancer screening. Colorectal cancer screening. I ended up picking up the meds that were ready and having to come back a few days later to get the other. My employer-sponsored coverage started at the beginning of the year. I hadn't received my Kaiser membership cards yet so I called Kaiser. I spent over an hour talking to 2 people from Kaiser, which ultimately ended with them saying, "you'll need to work with your company's HR because we don't see you in the system.
The next day, I asked my company's HR if there was an issue. They said it looked like everything was correct on their end and even sent me a screenshot of my info in Kaiser's system.
I was now able to login to Kaiser's portal, but could only access Northern California, where I used to live multiple years ago. I had been a member of Kaiser Southern California for a couple years since then so I was very confused by what was going on.
I called Kaiser back, spoke with a total of 4 people over a couple hours. The call ended with them telling me, "we changed something on your account so you should be able to access it now. Later that day, I get a text saying one of my prescriptions is out of stock.
Fine, I'll just go pick up the other prescriptions that are marked as ready. I go in to pick them up. The price is way higher than usual so I ask why. The pharmacist looked and said, "weird, for some reason it didn't go through the insurance.
Do you want me to do that? He then takes a while to try to run it through insurance with his manager, comes back and says my insurance only covers a 30 day supply so I'll have to pay out of pocket.
I said, "I've been getting 90 day supply for years and it's always gone through. I said, "fine, I need the prescription so I'll just pay out of pocket. He replies, "Oh, we need to re-process it without the insurance.
I see his manager talking to someone else about it. He comes back to tell me that they actually can't give me the 90 day supply at all and will need to completely start over to only give me Needless to say, I will not be staying with Kaiser any longer.
I wouldn't recommend them to my worst enemy. Saw my Dr one time for a very serious condition. Was on lots of medicine. Was not listened to. Was not checked up on. It is a medical factory line. If you are slightly diff from the normal patient and need individualized care you will not receive it here.
This is an insurance company out to only make money. Please I beg you do not support them. Thank you for reading. Get buying tips about Health Insurance delivered to your inbox.
Thank you, you have successfully subscribed to our newsletter! Enjoy reading our tips and recommendations. Two years ago I had major joint pain. Then, a year and a half later….
No reply. Every week, for four weeks, I emailed with no reply. Again, I changed doctors. I waited. My KP app showed my appointment, until a week before, when it disappeared. I email a note, asking if it was still on. Two notes later, and two days before my assignment, I got a phone call.
His next first available is February. At this point I settled for any doctor that could see me, and got in to meet a very nice resident that spent time with me and even looked at my joints. The referral I was given for my joints got me to a person that could identify swelling and painful areas just by comparing sides.
Same with my elbows. So, I could have gone six months waiting for an appointment with my PCP, in hopes it would not be canceled again. Things that could have been treated as soon as discussed were discounted and treatment was seriously delayed. The doctor is the expert on the human body.
But, with Kaiser, it seems that people get only urgent treatment anymore. We are told to wait six months for an appointment, but pay our monthly premiums on time. From what I have been made aware of and it was backed up by the pulmonary doctor my problem started on June 15 I was not aware that I had fluid in my lung then but it states that in the info on their website.
I was never treated for that or informed of it either. They put me on blood thinners and hospitalized me for 3 days. I talked to the pulmonary doctor and she agreed with me.
She said she did not think it was a blood clot I had back then and took me off the blood thinner because of the kind of work I do.
Because an injury could cause me to bleed out faster. She figure it was the lesser of two evils because the downside of that is that in putting me on a blood thinner and taking me off them I am now more likely to a blood clot than if I had not been put on them. Anyways now onto the rest. I had multiple visits after the being hospitalized as follow up appointments.
I went in on Sept 21, to the urgent care with swelling in my legs. They treated me but it never really went completely away. Then on Dec 8 I went to the urgent care who sent me to the er because I was suffering from shortness of breath. They never did a chest x-ray.
It kept getting worse to the point that on April 12, I again went to the urgent care complaining of shortness of breath. They prescribed me more meds and sent me home. Again they never did a chest x-ray. And again it got worse not better and I went back to the urgent care on April 26th with the same complaints.
We waited thinking that maybe it was kidney related and since I had an appointment with my kidney doctor on May 16th. Nothing came of that and it kept getting worse. It got so bad that I could not walk half a block without gasping for air.
I had to be pushed in a wheelchair by my girlfriend from the parking lot when I had to go in for my MRI because I could not walk that far without having an attack.
I missed the phone appointment because I could not answer the phone in time. I waited 30 minutes for him to call again and he did not call again so I called to try to let his office know what happened and the person I talked to could not get hold of anyone in his office so I left a message telling what happened.
Meanwhile my girlfriend and me as well as her son had called his office trying to get help at least twice so he aware there was a problem. On June 11, I went back to the urgent care with the same complaints as well as complaining my shoulder hurt when I fell down from having a problem breathing. I basically passed out when that happened. They finally did a chest xray but did not contact me with the results.
On June 15th I came home from work and felt really bad, so bad it scared my girlfriend who told me, "You are going to the urgent care again" so I went back to the urgent care and the doctor there took one look at the xray from my last visit and sent me to the er where they hospitalized me. One lung was almost completely full of fluid. I am so frustrated with Kaiser in Northern California and the service that I am receiving. They are horrible, it takes months to get in to see someone, to get a specialist is almost impossible and the doctors just don't seem to care if you are hurt or in pain.
Kaiser Folsom is the worst insurance to have. Doctors prescribe meds without even examining you. I have been sick for 3 weeks now and they keep prescribing meds and have not seen me once. They need to be investigated. Kaiser doctors do not give adequate consideration to the symptoms you report. Instead, the symptoms are brushed off based on statistics and age believing that everything is ruled out and advising to take better care of yourself.
When you already take care of your health and body and practice a healthy lifestyle but still have certain symptoms that are dismissed, something is wrong with the system. Kaiser is not for people with real concerns, nor is it a good health insurance provider. The doctors having the power to decide whether referral is warranted for a specialist or specific test is detrimental to one's health. Kaiser is good when it is good but overall bad in an emergency unless I suppose you get to Emergency in an ambulance.
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