i'm moving out to san mateo at the end of december and my business partner and i are looking into small business group insurance since i've been told if i'm on insulin i can't get individual or family plan coverage. one of the plans i'm looking at is the kaiser $20 copay plan here.
everything looks pretty good except the hospitalization fees, but i have to sacrifice somewhere if i want to keep the premiums low. dme is also capped at $2k a year, but i expect very few affordable plans fully cover insulin pumps. the out of pocket is also low - $2500, and there's no deductible or coinsurance - everything is done on a pretty clear and inexpensive copay system.
however, the one thing i'm worried about, because it's an hmo, is the doctor choice. when i get there i'll have to pick a pcp and then get a referral to an endo. i was wondering if anyone in this group had kaiser and could give me some recommendations on this - both pcp and endo. my uncle, who's a doctor in atlanta, warned me that at least in his area a lot of the better doctors stayed away from hmo plans. i'm hoping this isn't the case for the bay area as well.
Hi Dan,
I’m a Kaiser Permanente physician working in San Francisco and also a
type 1.5 diabetic. I work with many caring and highly skilled physicians, so I think you couldn’t ask for a better health care system. I know the endocrinologist at Kaiser South San Francisco (the closest facility to San Mateo) well: his name is Marc Jaffe and he’s a great guy.
If you have any further questions, please don’t hesitate to contact me.
Rob
I’m at Kaiser in Nor Cal. I think the plans are pretty variable so it’s hard for me to say if it is a good financial value for the one you mention. I work at UCSF which is a huge employer so have really good coverage. There are a few endo’s to choose from; a lot of people like the endo in Walnut Creek, who also has a degree in exercise physiology. I also have a good relationship with my current endo, although he has less experience managing type 1 and athletics. (I’m not sure if this would be a concern for you.) I have had Kaiser for 8 years and even though I work in the same building as the UCSF Diabetes Center, have decided to stick with it. It is a really well-run organization. I used to have Kaiser in Maryland and it pales in comparison to Kaiser Nor Cal. Send me an email and I’ll get you my phone # if you want to chat more about it.
It was quite a struggle to get approved for a CGM but I finally got that taken care of. They cover my pump supplies and test strips really well.
Welcome to the Bay Area!
thanks rob! good to know. they have a redwood city facility too, which i think may be closer, do you know anything about that group?
by the way my endo is Marc Jaffe and he came out to see the Triabetes documentary when we showed it at UCSF. Like Rob said, he is a great guy.
is there any limit on strips? i remember seeing someone post on tu that kaiser reduced their strip coverage after the person exhibited really good control, which was quite upsetting to hear. when i called them up they said they should cover you for as many strips as the doctor writes down for you. right now i’m testing around 8x a day.
also, is there any period on how frequently you can buy a new pump/cgms? the plan i’m looking at has a 0 deductible and $2.5k/year out of pocket max, but 2k DME coverage with 20% coinsurance - so i’m thinking if a pump is 6k i’ll pay 2.5k myself - my whole out of pocket for the year, and then every other service i need will be free for the year, which is an ok option i think, but i doubt they’d let me eat up my entire out of pocket on one big purchase like that very frequently. i saw some other plans that had 3 year renewal cycles on dme.
Congrats on the CGM coverage, Anne!
I pay out of pocket for all of my supplies except for test strips (Use the Omnipod system (not covered) and Dexcom CGMS).
What’s your secret 
?
Hey Dan,
I don’t know the physicians at Redwood City as well, but can scout out who the endocrinologist is there for you.
Hi Dan,
The pumps are usually replaceable once the warranty period is over (used to be 4 years…not sure what it is now).
I usually get 200 strips at a time which ends up lasting about 6 weeks or so. Never have a problem getting more as long as your physician has ordered refills for you.
thanks rob - actually it turns out that south san francisco and redwood city are about the same distance from san mateo - one is 10 miles north, the other is 8 miles south. i’m willing to drive an extra 2 miles for the right doc
rob, does kaiser specifically not cover the omnipod, or is it difficult to get other ones as well?
Yes, with traffic patterns being what they are (usually heavier towards Redwood City), South San Francisco may be a better bet.
they bought a new pump when my warranty expired on my current one and it finally died. Plans really do vary even within Kaiser. My secret is working for a university with 1000’s (10s of thousands? I have no idea) of employees and getting paid less than I could working in industry to have better benefits… They have not restricted the # of test strips I use; although you need to get the proper prescription and may have to bug them about it a couple times.
Thanks Rob–I’m really surprised you have to pay out of pocket for your DME like that, being a KP employee and all! Then again, I work for UCSF and get none of my medical care here! The Kaiser plan is actually cheaper for me.
Kaiser does not cover the Omnipod…your choices for pumps are the Animas PIng or the Paradigm (Medtronic)
I have had Kaiser NorCal for about 10 years now, and I have found them to be quite good as Anne and Rob say. I get test strips for testing 8X a day, no problem there. Pump replacement frequency just depends on the warranty period, which usually is every 4 years.
Hey all - i just moved in and I have an appointment with Dr. Lee in South SF. Has anyone had experience with her? Dr. Jaffe wasn’t showing up as having appointments, so I went with Dr. Lee for the time being.
is Dr. Lee an endocrinologist? If so I think she must be relatively new to Kaiser So SF.
it says she joined in 2008 on the kp website - https://members.kaiserpermanente.org/kpweb/medicalstaffdir/results.do?process=detail&rcn=1787415&npgID=&ntwrkID=
Met with Dr. Lee - she was really nice. Unlike my doctor in NJ she didn’t tell me i was crazy when I said I tested 6-10 times day on average, and she seemed up to date on other things that I’ve been trying, like reduced carb dieting. i’d recommend her.
I do and am very disappointed with them. My insurance had lapsed when I became sick and on the wait list to get back on, and the doctor would not even speak to me. I went to St. Joseph’s and to Memorial in Santa Rosa, they saved me ! I can only hope the after care is better ! I will keep you posted!
Namaste, Cathy