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Does/did anyone have issues with Kaiser as a provider...

bdhilton
Posts: 759
Joined: Jan 2010

From not being proactive in their treatments or not monitoring them in the years leading up to their diagnosis of PCa … I had Kaiser leading into my “diagnosis” but for reasons went with my other insurance carrier BCBS for my treatment…Just curious

mrspjd
Posts: 693
Joined: Apr 2010

No real issues but here is our story/experience. My husband, pjd, had never had Kaiser until Jan 1, 2010, although we were familiar with Kaiser since both my sister & mother have Kaiser and I am very involved in their care. In years previous to Kaiser, pjd had consulted with a few urologists for some issues, had his psa & dre yearly from either his private GP or a urologist. Even an annual yearly exam in January by pjd's new Kaiser GP, including dre, was "uneventful." Everything normal.

After consulting with the chief of urology @ Kaiser the last week in January, the doc suggested a thorough exam, even though pjd's current and previous psa's (2.26) had been normal for his age (67yrs), and previous yearly dre's found nothing. Upon exam by the Kaiser urology dept chief, this experienced urologist found a nodule, suggested a 12 core biopsy and the rest is history (see post dated 4/16/10 "RP vs RT..."). If it wasn't for this Kaiser doc, we would not know that pjd has PCa, or the extent of it. If one can be grateful for this dx, so to speak, pjd is grateful to this doc for finding the PCa.

After dx, we did our research & proactively sought out & interviewed 5 of Kaiser's best docs in our area (So Cal) including a robotic RP doc, two open RP urology docs, one urologic oncologist surgeon, and one oncological radiologist. We spent at least 1-2 hours consulting with each of these Kaiser docs who patiently answered our long list of questions, gave us info, etc. These were all fine docs and if we did not have alternatives, we would have been OK with several of them for pjd's PCa treatment.

That said, we also consulted with many experienced docs outside of Kaiser regarding PCa treatment. Because we are very fortunate to have other insurance alternatives, pjd felt that he needed docs that had more extensive experience & stats for treatment, particularly relating to surgery and/or radiation. So as of May 1, 2010 we are out of Kaiser, able to choose our own doctors (not any of the ones pjd had previous to Kaiser). I have always said that HMO's, like Kaiser, are great so long as you're healthy.

Yes, you read this right--even though a Kaiser doc made the dx, we are leaving Kaiser for tx elsewhere. After much research, that is what is right for us. There are so many Kaiser facilities and each is different and many offer excellent doctor & treatment choices. From our experience we know this: If you are in an HMO like Kaiser, you must be proactive, do your own homework & research, seek out the best docs that the HMO offers, and ASK for what you want. Many times it may not be offered to you, but if you make a good case for what you want & why you need it (bring in the studies, literature, etc from your research), then many times, you can get it. Yes, it will take time, maybe appeals, but if this is your only insurance, that is what you must do. If you were buying a car, hopefully you would go about researching it before you made the purchase...this is your body, so it pays to know as much as you can and to be an educated consumer before you make important health choices & decisions, whether in an HMO, PPO, medicare, or other health insurance coverage.

steckley
Posts: 100
Joined: Aug 2009

My cancer was treated (DaVinci)by Kaiser in Denver about a year ago.

I felt they did a good job with detecting the PCa (give 'em an A).

Explaining the biopsies (2 were done because the first came back "atypia" -- they had it confimred at John Hopkins) and offering treatment alternatives - "A".

Hospital (St. Joe's) and hospital stay - "A" (but I don't have much to compare it to).

Surgeon - He'd completed a DaVinci fellowship and worked a bit at a PCa clinic in Texas before coming to Kaiser in Denver; he'd only completed 35 procedures at Kaiser Denver before he had done mine --- I'm sure he's a lot closer to the magic 250 procedures by now (he was the only Denver Kaiser surgeon doing the DaVince). I was glad he had the fellowship. I figured he'd been trained in the right way to do the procedure and wasn't a retreaded "open" surgeon who had done 250+ Davinces -- making the same mistake 250+ times. - "B".

Results of Surgery:
Cancer removal (based on zero PSA's to date) - "A"
Continence (continent on the day the cath was removed) - "A"
ED - this is a work in progress: they've been great on anything I ask (perscriptions for trimix, pills etc.) but they don't seem to offer much in the way of an ED program ... and I am not covered for the cost of perscriptions; - "C".

Swingshiftworker
Posts: 649
Joined: Mar 2010

I have been with Kaiser all of my life to date -- that's over 59 years of association with Kaiser. It has generally served me well, but I will be leaving Kaiser shortly because it will not pay for the type of treatment that I am most interested in receiving -- CyberKnife (CK) Radiosurgery.

I also sought treatment for foot surgery outside of Kaiser for a work related injury that eventually resulted in my disability retirement. So, it's not like I haven't looked outside of Kaiser before because I was unhappy with the services they offered. I considered Proton Beam Therapy (PBT), as well, which Kaiser also does not offer, but have decided that CK is the way for me to go because it is available to me locally, only 4 treatments over a week vs. 40-45 treatments over 8-9 weeks are required, there's no need for a catheter or a balloon up your butt w/CK and the probability of success (and the limited risk of quality of life issues) for both CK and PBT is about the same for early stage, low risk PCa patients like me.

My PCa was discovered in late January 2010 at Kaiser San Francisco following a routine PSA test and a biopsy initiated by my PCP (primary care physician) and the urologist that I was referred to, so I have no complaints about their vigilance in obtaining the diagnosis. I paid Johns Hopkins for a 2nd Opinion on the biopsy, which confirmed the result of Kaiser's pathology report. So, I have no complaint about that either. However, Kaiser only offers Brachytherapy (BT) or DaVinci Surgery for treatment of early stage, low risk PCa (like I have) and I don't like either option.

Kaiser has a centralized BT treatment center in Roseville (near Sacramento) that treats all Kaiser PCa patients north of Fresno. They've treated over 2800 patients w/BT over the past 10 years and the program is so highly regarded that people outside of Kaiser try to get treated there. I visited the BT center, attended an "informed consent" seminar on BT and had a volume study ultrasound done in anticipation of receiving BT treatment, but after doing more research I decided it was not for me -- just don't like the idea of all of those "seeds" remaining in my body for life (even after the radioactivity has passed), the possibility of some of them "floating" around my body and the need for a special ID to board an airplane because of them. So, that's out.

I also spoke with 2 Kaiser urologists regarding DaVinci Surgery. One only had 50 surgeries under his belt and the other (supposedly the most experienced in the SF Bay Area) only had about 180. Experience is the key factor in the success of DaVinci PCa surgery and read I an article that said that doctors are still "practicing" on patients if they have less than 200 DaVinci surgeries. So, if that's the best Kaiser can offer me, there's no way that I'd let them "practice" on me -- notwithstanding my general aversion and objection to the life-threatening risks of surgery (infection and surgical malpractice) and the substantial risk of the negative "side effects" of ED & incontinence (as well as other things), even if the surgery is performed "properly." So, that's out too.

I met last week with the Director of CK Radiosurgery at UCSF (paid for it out-of-pocket) to discuss the treatment. Although it is not "automatic," the Director of Operations at UCSF for Radiation Oncology says that Blue Shield has paid for CK in the past and should pay for it for me too. Open Enrollment to change my medical coverage ends this Friday, April 30th and I will be signing up that day to change to Blue Shield. The change becomes effective on July 1st and I should receive CK treatment w/in a month or so after that. So, since follow-up for any radiation treatment lasts at least 5 years, I don't think that I will be returning to Kaiser anytime soon.

mrspjd
Posts: 693
Joined: Apr 2010

Since you are interested in cyberknife, thought you might like to know that in our research we found out that UCLA has a cyberknife study for low level PCa and if you qualify for the study (don't know if it's still open) then, of course, it is free (except for your travel and stay down here). The Dr. doing it is Dr. King and he was recruited from Stanford. Hope this info is useful to you. pjd, has a high volume PCa so cyberknife is not an option. interestly, we recently traveled to UCSF (we live in so cal) because he got into the UCSF study for the endorectal mri w/spec for PCa. Hope this info is helpful.
Good luck to you.

mrs pjd

Swingshiftworker
Posts: 649
Joined: Mar 2010

Thanks for the info. I knew that UCLA offered it, as do other university medical hospitals such as Harvard and Stanford, but it makes no sense for me to get CK treatment there (even if it's free), since it's available at UCSF and my treatment should be covered entirely by Blue Shield.

johndz
Posts: 33
Joined: Jan 2010

I have Davinci with Kaiser in Santa Clara Homestead medical center in California - Nice facility - nice staff - new equipment - valet parking - everything are new -I had Davincy date 12/18/09 - no ED problem - 1 pad a day, just for precaution - so far pad very dry - 2nd PSA checked =Zero -
Very please with Kaiser at Homestead medical center - I don't know about other facilities.
gleason score 3+3=6 - localize - good for earlier detection. 59 year old.

John

CHC
Posts: 3
Joined: Mar 2011

Do you more info on Kaiser: who was your Dr.?, etc?

rosegooch
Posts: 1
Joined: Nov 2010

Can you recommend a urologist at Kaiser for me?
Many thanks!
Rose

BELESSA
Posts: 6
Joined: Feb 2009

Dr. Thomas Shu. He is the best.

CHC
Posts: 3
Joined: Mar 2011

can you provide any more info on Dr. Hsu (SHU)

kddh
Posts: 14
Joined: Nov 2010

CHC: here is Dr Hsu's Kaiser homepage. Not sure if you know you can look up these for any of their providers.

http://mydoctor.kaiserpermanente.org/ncal/provider/thomashsu

I did some surgeon-shopping although I am now heading in another direction. I interviewed Dr Hsu in Santa Clara. The facility looks great, and I am sure he's very competent. He did not seem the "warm and fuzzy" type, but he did me a service, in emphasizing the likelihood of surgery's after-effects.

The other DaVinci surgeon I spke to is Joseph Lee, in San Rafael. Again, very thorough and informative. Unlike Dr Hsu, Dr Lee did a whole exam as part of the consultation. I did ask him and he said he had done 215 DaVinci surgeries as I recall.

What I most appreciated about both Dr Hsu and Dr Lee was that they were both NOT eager to do the surgery!

My urology is Walnut Creek-based, though I travelled to Santa Clara and San Rafael for the consultations I mentioned. There's a woman named Theresa in WC -- a surgery scheduler or some such title--who was great.

Good luck!

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