In
Copyright Since September 11,
2000
"The regulations governing managed care and the Medicare + Choice program are found in 43 CFR 417 and 422
The general Rule
concerning health care services
is that Medicare enrollees must obtain all covered health care services
through their Medicare + Choice Organizations ( M+COs). There
are
four exceptions to this rule:
1)
for an emergency
either inside or outside of the M+CO's service area;
2) for
urgently
needed care;
3) for services that the M+CO approved in advance or
4)
for
medically necessary services which are covered by Medicare that the
M+CO
refused to provide."
What this means is
that Kaiser can and probably
will tell you that you can have any medical treatment you want in the
world
that you have proof that you need and that you can see any doctor in
the
world that you want, BUT don't count on them paying anyone for it.
There is no sound reason for any human to be a part of the Kaiser Medicare Plus Choice Program.
Rather than signing up for any Plus Choice Program, if you can, it would probably be much safer for you as a patient to sign up for Part A and Part B of Medicare and pick up a Medigap Policy. That way you have the freedom of just leaving any doctor at any time if you feel that they are not providing the promised medical care in your contract with them. Your life is more important than fighting with some HMO over contractual obligation.
Kaiser
over bills for services rendered.
See the government action against them at::
http://oig.hhs.gov/oas/reports/region5/50100094.pdf
Now
if they are doing that and blaming
their secretaries what else do you think they are doing?
If you are considering the Senior Advantage Plan because it sounds great that they say they will give you new teeth and glasses, seriously think it over. Is it really worth the gamble with your life for teeth and glasses? Besides the Kaiser Dental service still is going to cost you money. You worked hard for years just to get Medicare, don't blow this earned privilege on a HMO.