switching from Kaiser to a PPO

[kariclose]

My husband is switching jobs and we have to switch to a PPO from Kaiser! I'm so scared to switch. Does anyone have any experience with switching, or with PPO's in general?
The thought of finding all new doctor's is keeping me up at night!:frown

[jellybeanmichelle]

PPO's are much easier to deal with when it comes to choosing doctor's.
With HMO's your told which doctor's you can see. PPO's you can basicly see who ever. Plus, Most doctor's don't except HMO's anymore.
For me, it was also easier to bill PPO's cause they always seemed to pay correctly. Where as HMO's I was always calling to get them to pay correctly.

[KaisaG]

I've had a HMO and PPO and I would MUCH rather havea PPO. Although you have to find yourself new docs, the good news is that you also don't need referrals from your family doc for EVERYTHING... That's what I hated about being on a HMO. If I needed to go to an orhtopedic surgeon I needed a referral from my family doc first. On a PPO, you just make yourself an appt. with the orthopedic surgeon. I feel your pain about finding new docs though... Our family doctor left his private practice and went to Kaiser right before I got pregnant. I was so sad cuz he delivered my husband, so I had really wanted him to deliver our son as well.

[daisydoc]

Sorry to hear your have to switch Kari! that is never very fun. But, bright side... PPOs are easier to deal with and if you know which Ins. Co. it'll be you can go online and print out every doctor within a given area (usually like a 10 or 15 mile radius) of your zip code or address. Once you have that you can narrow it down by asking around to see what others think about the practice. I use to work in Medical Records and worked as an office manager and did Ins billing back in the day so I know a lot of the group practices. Once you get a list feel free to get in touch with me and I can tell you what I know!

[jellybeanmichelle]

Have you been to Palm Drive Hospital?
I'm sure they can give you some recomendations too! That's if your looking for Dr's in Sebastopol.

Anna - Where do you take your kids? All of our doctors are in the Doyle Park complex by memorial.

[kariclose]

:thankyou I appreciate all of the info and support!
I will write to you again, Anna, when I have more information.

[Mom of 2]

My kids DR.(who is wonderful, really calm, and answers all of my questions and goes the extra mile) is in the Doyle Park Complex.

Kate
Mom to Patty and Tyler

[Mom of 2]

Anna is right about a PPO and being able to print out the DR's in your area. It is so much easier and you are not limited to certain DR's. It is nice to not have to be refered to everything. Good Luck.

Kate
Mom to Patty and Tyler

[Lynette]

And with a PPO you don't have to be on the verge of death before they will do anything for you!

Little bitter about Kaiser.

[alowe]

Yeah, Kaiser sucks. I also have a little bitterness towards them. It seems like you pretty much have to be your own doctor, do your own research etc. I am not quite over my anger towards my OB/GYN at Kaiser Petaluma, but I am working through it. I am wishing I hadn't done the quick post and could use some smilies or not so smily right now. Kaiser is better than nothing you just have to get the right doctor and push and push until you feel what needs to happen is happening. Sorry I had to rant I have had problems since I had Lucca in 4/04 and am still dealing with Kaiser.

[LMS]

my mom has told jr that if i'm ever unconsious, that he is NOT to take me to kaiser.... they misdaignosed a tumor in my uncle and he ended up almost dying from it.

[Lynette]

My dad went in saying he was having headaches and just felt weird and they told him it was all in his head. He persisted because his vision started bothering him and he suddenly developed diabetes with no family history of it but they told him he just wasn't getting any younger. He went back again and found an inoperable brain tumor on his brain stem the size of a walnut so I guess it was all in his head. Since they had put him off for over a year it had gotten past the point where radiation therapy would probably be successful so they didn't want to do it at all, too expensive. He died a year ago June.

My best friend's dad also died from Kaiser neglect and while I think my MIL played a big role in her demise, Kaiser was in there too by giving her too many drugs that interacted badly with each other so rather than solve the problem they compounded it.

[LMS]

ugh, isn't that so frustrating how things like this can continue to happen and nothing changes?

Lynette: They told my uncle that it was PTSD from being in the war

[daisydoc]

Michelle: my kiddos see the doctors at Pediatric Associates. They are on Sonoma Ave and they were my pediatricians and my dad's too! I also worked there in high school and a bit in college. We didn't start Sevannah there b/c they didn't accept the Ins we had at the time but as soon as I could I switched her... which heppend to coincide with me getting prego with Jazper! So now both kids are there and I am so much happier. Sevannah started at Primary Care Assoc (our family GP... at 500 Doyle Park) and it just bugged me b/c our doc would always roll his eyes when we said we wanted to treat things holistically; waited to do some of the immunizations (not refused to get them just wanted to wait until she was older); etc... I think our relationship with him went south the day he acted like a complete ass when I told him I wanted to do a home birth with Sevannah (I was 20wks prego at the time). He almost didn't finish that appt! He was so rude it wasn't funny and it was the ONE TIME I was there by myself b/c James had to work and my mom was unvailable too! :mad

[becky]

I second that Anna. My girls are also at Pediatric Associates. I was a patient there when i was little to and i cant say enough good stuff about them. They always are so attentive. Most recently i made an appointment to have a consult with the doctor regaurding myah and the doctor went above and beyond what i expected.

[daisydoc]

Becky: who did you use to see? and who's the girls' Primary? I use to see Dr. Menacoff until he retired to do the residency program at Sutter (well then it was still Community Hosp). Then I saw Dr. Miraglia. Sevannah has mainly seen Dr. Davis and Jazper had been seeing either Dr. Anaka or Dr. Brewer. I love that office! There's a few of the ladies that have been there FOREVER that have basically known me since birth!

[becky]

Becky: who did you use to see? and who's the girls' Primary? I use to see Dr. Menacoff until he retired to do the residency program at Sutter (well then it was still Community Hosp). Then I saw Dr. Miraglia. Sevannah has mainly seen Dr. Davis and Jazper had been seeing either Dr. Anaka or Dr. Brewer. I love that office! There's a few of the ladies that have been there FOREVER that have basically known me since birth!
ANNA: OMG you saw Dr Menacoff too! what small world. Our primary right now is Dr. Sever but she is out on maturity leave and will not be coming back because she is moving. I can't think of who i saw recently but its a female who is covering for her in the mean time. I have seen Dr anaka and dont like him at all. Who do you like better, Dr davis or brewer? From what the staff has told me, Dr Brewer is alot like Dr Sever and i think she was awesome. SHe was very much like the doctors i'm used to at CHLA (Children's Hospital in Los Angeles)

[KaisaG]

This might sound like a dumb question... But do you ladies think that it is important to have a pediactrician instead of just a family doctor? Our family doc is Dr. Armstrong at Doyle Park, and as much as I like her, I've been thinking about getting a pediatrician for Baby Eman instead....

[LMS]

Brendan's always had an actual pediatrician until we moved here. Right now he just has a PCP, and most times we see the NP b/c we just like him better... but i'm considering finding an actually pediatrician b/c his doctors office loses his records after EVERY appointment :hopmad

[alowe]

my mom has told jr that if i'm ever unconsious, that he is NOT to take me to kaiser.... they misdaignosed a tumor in my uncle and he ended up almost dying from it.

I have had bleeding problems since I quit breatfeeding Lucca, which I know is common, but they decided to just put my on bc instead of possibly just doing an in office ultrasound or God forbid giving me a pregnancy test, which would have detected my elevated hcg 1.5 years ago. Not to mention that I had had two miscarriages so I would think that they would have automatically given me a pregnancy test. My bleeding went on and on and I would call and they would say wait one more cycle to see if it works itself out, which the bc finally did make it fairly normal. Long story, but I had a placental site trophoblastic tumor, which is a cancerous tumor of the placenta. When I finally said screw it and went in again the new doctor gave me a preg test and ultrasound and decided there was something in my uterus and I was either having a miscarriage or had retained placenta(two years later). So it took 6 months to diagnose my tumor after they reassured me a million times that there wasn't anything major wrong and it wasn't a big deal.
I was also assured that there was no way it could be the tumor I had, which I was told are so rare there is no possible way that is what it is, but you know they have to happen to someone so why not rule it out first since I have every symptom of it. I actually was the one who did my own research and thought I may have this tumor and found the only lab in the world in New Mexico who can test your blood and urine to find the markers of this tumor. Then it took Kaiser a month and a half to pay for the damn test and send my samples down there. Oh, yeah they also told me throughout the process that I had a fibroid, which actually turned out to be a cancerous tumor(oops!). It was one mistake, miscommunication after the next. Now I am in the hands of my oncologist in the city. He is a Kaiser doc, but I do like him. He has consulted with many specialists during my treatment and done a good job. Now I am without my uterus at 29, which sucks. I can't help but feel that if they had caught it when I initially went in they coud have just removed the tumor instead of it making it 2/3 of they way through my uterus. Many women have just removed the tumor and had their uterus reconstructed, but mine was so far through there was no possible way to make sure we got it all retain my fertility and save my life. Anyways that is my dramatic Kaiser story. Not in love with that bunch at all, but atleast I am alive. Most women who have these tumors for so long end up finding them cause they have spread to their organs and they are having symptoms of that. Sorry for my rant. Lynette you struck a nerve with me and I am a little strung out this week cause I have to go get my baseline post op CT scan and although the tumor was contained in my uterus I am still nervous that it snuck out somehow. I worry about this so much I suddenly develop all these symptoms and am sure it has spread, but in reality I am just a worrier and need to relax.

[daisydoc]

kaisa... my personal opinion... I am so much happier having my kids at a pediatricians rather than with the family GP because they just deal with kids therefore they are almost always on time; the wiating room is made for kids; there are toys in every room; and everyone in the office is kid friendly! It's great. I'll NEVER go back to having the kids at a GP.


Becky: Bewteen Brewer and Davis.... hmmm don't know. They are both great and have both been there forever! Anaka is great too... just different personality. I think I know more about Brewer b/c he use to see me more as a patient there back in the day so we would chat more! I've also seen Alice the NP... sh'e great. She did Sevannah's 2 yr check up and Sevannah had no problems with her... was very good!

[daisydoc]

Sorry for my rant. Lynette you struck a nerve with me and I am a little strung out this week cause I have to go get my baseline post op CT scan and although the tumor was contained in my uterus I am still nervous that it snuck out somehow. I worry about this so much I suddenly develop all these symptoms and am sure it has spread, but in reality I am just a worrier and need to relax.


Sorry you're having a hard time! I hope it all goes well; and don't apologize or think you're having a rant! You're scared and that's completely understandable and you have to have someone/someplace to "talk" about it other than just at home with you DH. We're here for you! :hug

[LMS]

Sorry for my rant. Lynette you struck a nerve with me and I am a little strung out this week cause I have to go get my baseline post op CT scan and although the tumor was contained in my uterus I am still nervous that it snuck out somehow. I worry about this so much I suddenly develop all these symptoms and am sure it has spread, but in reality I am just a worrier and need to relax.

OMG, that's awful. I can't believe so many doctors jsut pass everyone off with a casual "it's nothing"... well you know what? SOMETIMES it's something. And isn't it their JOB as a doctor to be sure it isn't something before they tell you it's nothing!?
UGH.
If you want to hang out this week or get together to take your mind off it, let me know. Wednesday night is the MNO, and Friday is the playdate, i hope to see you at one of them :hug

[lmfike]

Then I'm on the other side. I have had no problems with Kaiser. My mom had then for years(before moving to WA in Aug). She was diagnosed with cervical cancer back in 1998. Her only issues have been due to her behavior. I had my older two kids at Kaisers(two diff ones in S CA). Jules was a state health insurance baby hence the reason she was born at Petaluma Valley. We got Kaiser right before she was born(had to wait for dh health insurance thru work to kick in) and have been with them since.

[KaisaG]

Is it hard to get appts. with Primary Care Associates... and does anyone know if they take new patients?? That seems to be the biggest problem that I run into a lot..........

[alowe]

OMG, that's awful. I can't believe so many doctors jsut pass everyone off with a casual "it's nothing"... well you know what? SOMETIMES it's something. And isn't it their JOB as a doctor to be sure it isn't something before they tell you it's nothing!?
UGH.
If you want to hang out this week or get together to take your mind off it, let me know. Wednesday night is the MNO, and Friday is the playdate, i hope to see you at one of them :hug

I will definitely be at one if not both.

[LMS]

yay! I can't wait to see you!

[jellybeanmichelle]

Primary Care Associates takes new patients.
I've had no problems with getting appts.
I don't really like Mary Pat the NP.
Dr. Smith, he gets right down to the problem.
I love Dr. Britt! She is wonderful.
Dr. Prosser, he is good to.
Each room is different - whales, Zoo, dinosaurs, etc...
Victoria has her next appt there on Oct 10 for her 1yr check.
Oh, and the medcal records are now all on computer, no more paper!

[LMS]

wow, they sound like a great place! Do you have one dr that you go see almost every time, or do you rotate through their drs? (I know you said one is okay and one you really like)

[jellybeanmichelle]

For her well visits I stick with Dr. Britt.
But, If she needs to be seen the same day I'll take who ever.
I would rather she be seen by a doctor than a NP.
Plus, they have a urgent drop-in clinic from 8-8:30am M-F, no appt needed.

[Mom of 2]

My kids also were at Pediatric Associates too. They were wonderful with the kids. However, their Dr. left the practice and went elsewhere and we went to his new office on Doyle Park Drive. I would have stayed with Pediatric Associates, but I really liked the DR. that they are with and he is so attentive and goes the extra mile, answers all my questions so I felt it was best to continue with him. The kids are now at Primary Care Associates on Doyle Park Drive with Dr. Gaitan.

Kate
Mom to Patty and Tyler

[Mom of 2]

Yes, kaiser is BAD. I had to have them for insurance before I married my husband. It was either Kaiser or no insurace where I was working, so I figured I had better take Kasier(it was better than nothing). Thank god I never had to use them since I have seen the poor care that they give to friends and family members who think nothing of bening sent home with'Its okay, its normal to feel like that" or how they don't order blood work to figure out the problem..... NOt a fan of kaiser

Kate
Mom to Patty and Tyler

[jellybeanmichelle]

V saw Dr. Gaitan once.
He is young. My 17 yr old sister saw him and thought he was cute!
Since the age of 2, I was a patient there until I turned 18.

[Mom of 2]

Yes, Dr. gaitan is one of the younger ones(probably late 30's), but he has kids too around the same age as mine, so he can relate which is helpful. He has always been very complete and my kids are very comfortable with him.

kate
Mom to Patty and Tyler

[becky]

This might sound like a dumb question... But do you ladies think that it is important to have a pediactrician instead of just a family doctor? Our family doc is Dr. Armstrong at Doyle Park, and as much as I like her, I've been thinking about getting a pediatrician for Baby Eman instead....
SInce the very beginning both my girls have only seen pediatricians at CHLA (children's hosp. LA) and i wouldnt have it any other way. When kayla was born she had to stay at CHLA until she was about 3 weeks old and at one point had 11 docs. When Myah came alot she was perfect but we had her at CHLA too becuase i jsut loved our doc. I think that is the worst thing about moveing to No Cal. Personally i would never use a GP just becuase ped docs deal with children all day long and that is there specialty.

[Mom of 2]

I think a ped. Dr. is someone I would be most comfortable with since they work with children all day and that is thier specialty and what they went to school for.
It is reassuring to have someone who is familar with how the kids act and respond to the latest things and medicine and all of that. I think it is also important that you feel comfortable with whatever DR. you end up taking your Baby to. You want to feel comfortable about asking questions and having that trust in whoever is looking at your child.
Good Luck with your search.
Kate
Mom to Patty and Tyler

[becky]

I agree. I have always tried to find doctors i'm confortable with although I'm not happy with the GP we have right now for my husband and I. Since we have HMO there aren't many choices. I have been very fortunate to have found a wonderful OB/GYN who really listens to me and already has taken the extra measures to double check everything he ccan to be sure we don't miss anything with this baby. With the trouble I had with my first and my history he is treating my pregnancy high risk which i love. We already have an eco scheduled for the new baby once i"m about 22-24 wks.

[daisydoc]

Is it hard to get appts. with Primary Care Associates... and does anyone know if they take new patients?? That seems to be the biggest problem that I run into a lot..........

My kids aren't with Primary Care Assoc anymore. They are a GP office and I didn't like it very much. Plus funny story about Dr. Gaitan... I talked to him while he was still with Pediatric Assoc b/c we were in the middle of switching from Primary Care Assoc to Pediatric Assoc and when he asked me who she had been seeing (which was Dr Begert... one of the founding doc of the PCA) he had no idea who he was! :biglaugh Then on Sevannah'a appt with Pediatric Assoc I saw the signs they posted about him leaving and going to PCA... I almost pissed my pants! I though "he had better figure out who Dr. Bergert was and do it in a hurry! :smile

My kiddos are with Pediatric Assoc now. Here's some info about Pediatric Assoc if you're thinking about swtiching Baby Eman to a pediatrcian:
~ Appts are not really that hard to get. Depends on the appt type but they're pretty good about it
~ YES they do accept new patients. Their ph # 545-2545. Their address is 1200 Sonoma Ave #6.
~ Best thing.... once you're an established patient, if something comes up in the middle of the night that you want looked at first thing in the morning they have drop in time from 8-845 M-F. All you have to do is show up and they'll see you... no appt needed! You just get to see whatever doc has that shift that day so you may not see "your" primary doc but they are all great!

[Lynette]

Lynette you struck a nerve with me and I am a little strung out this week cause I have to go get my baseline post op CT scan and although the tumor was contained in my uterus I am still nervous that it snuck out somehow. I worry about this so much I suddenly develop all these symptoms and am sure it has spread, but in reality I am just a worrier and need to relax.

Soooo understandable though since you had poor care and they are still the ones responsible for keeping you healthy. I do believe there are some good doctors at Kaiser, it is just the pressure of corporate run health care that gets in their way sometimes.

Although I get mad about not having my dad around to watch my kids grow up (he was only 56), I don't know for sure that even if Kaiser did everything they could that things would have turned out differently. It is the "What if?" that gets to you.

Remember to dwell on all the things you are thankful for and can look forward to as you watch your little one grow up :) I will think good thoughts for your CT and that they give you a clean bill of health!!

[Lynette]

Since Alaina is not vaccinated and I have found no peds who will take an unvaccinated child (which *really* makes no sense to me), she has a GP who is the doctor in the practice that specializes in children. I actually like this GP in that she is the first doctor I have found who really seems to believe in the body's ability to heal itself and doesn't throw pills at you every time you come in. After I had Alaina I somehow got pink eye for the first time in my life and she told me I didn't need meds, it would go away within a week on its own and it did. She totally supports bfing as long as you and the child want and although she does believe in vaccinating, she respects patient's abilities to think for themselves and doesn't treat you like a moron.

[becky]

I think its wonderful that you have found a doctor lynette that you are in sync with. that is awesome.

[KaisaG]

Lynette- My chiropractor believes in the same idea- about the body healing itself I mean... Next time I am in there I will ask who he sends his kids to (he has 3 and none of them are vaccinated). I probably would have waited to vaccinate Baby Eman too- but daycare wouldn't have taken him if I didn't do it. It's not l ike public school where you can just sign the back of the form and waive stuff... Daycare can just say "Nope, sorry... I don't want your kid here."