Experience with Kaiser Permanente and diabetes

We’re considering switching over to Kaiser Permanente for our insurance policy but I would like to ask anyone who is currently on a Kaiser policy (if it’s a small organization, better) what your experience is like, specially in regards to covering for pump supplies, test strips and Dexcom supplies.

I have type 1 & have had Kaiser coverage since I came to the USA in 1982. 1st in Southern California now in the Portland area. I have a great GP, who always listens & refers me if necessary to the Kaiser or outside specialist. I was referred to the Endocrinology department when my control got very erratic, it was they who suggested I try a pump & the Endo got it approved. I’ve never had any problems with the amount of pump or insulin supplies that I order. Since the endo wrote my prescription for up to 10 tests per day I get 300 per month & they never query it if I reorder before the month is up. I am now on Kaisers Medicare Advantage policy, before that I had an individual policy, as I converted after being covered by an employer with no gap there was no physical or pre-existing conditions problems. I think with Kaiser the trick is finding the right doctor, PCP or Endo, for you.

Apparently the reason they did that was that someone was selling strips on EBay, the online photo even showed the Kaiser prescription label on the box! I think they found out who it was, but it resulted in all this tightening of rules. If the Doc says more you will get them , change your GP. I see a GP at the the west side Sunset Clinic, & the Endo at West Interstate.

I’m thinking of switching to Kaiser this coming year for financial reasons, though I am so reluctant to give up my PPO freedom. So I am following this thread with interest. It seems to me that people who educate and advocate for themselves do fine with Kaiser - by choosing their docs and finding ones who will work with them. People who don’t do this seem to be the victims of Kaiser mass think and money saving. Like my friend’s husband who is a type 2 who is not proactive about his diabetes and is currently on two shots of NPH and told to check his blood sugar only once first thing in the morning. Yikes.

Thanks, Judith. I am very pro-active as well and tend to think a good doctor is one who writes my scripts as requested and then leaves me alone!

I’m sorry you had that experience, Judith, exactly what you did not need at a time like that.

I have had Kaiser since 2000. I have been very satisfied with it. I have a great endo in Walnut Creek, I get the test strips I want (for testing 8-10 times per day), my pump is covered, and Kaiser offered me the option of the Medtronic Guardian or the Dexcom. Of course the service has not been perfect, but overall I have been very satisfied. You just have to be very selective about your endo, to be sure you get one who will be an advocate for you.

Judith, thank you so much, I was wondering about all those little things :wink:

Great to know about the Dexcom. We really will like to keep it.

How does Kaiser work with pump supplies? Currently my insurance covers 80%, how much is covered with Kaiser? Do you still get your supplies through Animas or whichever pump company you use? How much are regular meds? Can you get them mailed or do you have to go to Kaiser to get them?

I don’t mean to hijack your thread, Manny and Andreina, but hopefully the answers will be useful to you too and other people thinking about Kaiser.

Kaiser pays 80%, you have to reorder through the Kaiser DME department, & they only pay for certain pumps, currently MM & Animas. But they have negociated prices with the vendors, so the 20% you pay is less than 20% of the regular price. When I got my Animas pump in 2007 I think the price was just over $4,000, so I paid $800. Animas bills Kaiser & after Kaiser pays they bill me for the rest. As I have the Medicare Advantage plan I am not paying any copay for test strips.

Kaiser has a good internet site & you can get all your meds online & mailed to you, no charge for postage & the copay for 3 months supply is less if you order online.You can also contact any doctors you have seen for non urgent questions. Go & look at the Kaiser web site www.kp.org & you can see doctors resumes & lots of other info.

Hope this helps.

Yes, that is all good information, thanks, Annabella. I got my Ping for free because my insurance pays 80% but then I got the remaining 20% waived due to low income. But it sounds like the ongoing supplies might be a tad less, I know doctors and tests are free, and I’m guessing meds are less too. (I now pay either $10, 25 or occaisonally $75 for my 3 months supplies of various meds and strips). Thanks I will look at the website and also order a booklet from CalPers that will let me compare insurance.

CGMS coverage varies by region, Kaiser NW says no way never, they do have a price agreement with MM so you can get it yourself cheaper, not sure about Dexcom.

The amount that Kaiser covers (80% versus 100%) depends on what Kaiser plan you have. I get 100% DME (durable medical equipment) covered, so that includes all pump/supplies, all CGM/supplies, and all test strips/meters. And Kaiser does have contracts with both Medtronic and Dexcom for CGMs (the bad news is I chose the the Medtronic, and really wish I had selected the Dexcom). All of my supplies are requested through Kaiser, but come from Animas and Medtronic. For prescriptions, I just have them mailed to me, as I find that more convenient.