Open Enrollment Coming...HealthNet vs Kaiser

Apparently, ( I should have guessed) the new changes coming in the Health Insurance Field between now and 2014 have brought about some unwelcomed changes in policy.

I thought I would be able to change to Kaiser from HealthNet (via my Employer) and have better access to the doctor (Rabkin) I wanted for my DS surgery. There are several changes, the main one which states that you can't change over from HealthNet to Kaiser and expect "continuity of care" coverage (read pre-existing condition), so is WLS a pre-existing condition if I've consulted with my PCP about how to get it? 

This is a whole can of worms I don't even want to acknowledge let alone open. LOL.

Including my financial picture over the next year or so, I might just have to keep "lurking/learning" vicariously. CRAP~CRAP~CRAPPITY lol

 Don't quote me on this, but I believe that northern ca patients who have the DMHC overturn Kaiser's refusal to do the DS are sent out to Rabkin anyway. At least, they used to be. 

Kaiser does not offer the DS, but the CA dept of insurance, DMHC, approves nearly every appeal for this surgery. Read my profile for a quote from them that came with my approval. I was sent to Dr. Rabkin two years ago and I think that is still the policy. I, personally, like the Kaiser system because i know how to work it. If you decide to go with Kaiser there are people on this board, including me, who can help you get the DS. Talk to us about it before ever mentioning it to Kaiser.

I understand that...But I've already talked to HealthNet about getting WLS so I'm thinking this falls under their new "Continuity of Care" stipulations, in that if I NO LONGER have access to HealthNet I could change over to Kaiser but since that isn't the case, I'm kinda stuck with HealthNet.

the way it reads is...

For New members, when the member enrolled in Kaiser Permanente Health Plan, the member did not have the option to continue with his/her previous health plan or to choose another plan (including an out-of-network option) that would cover the services (pre-existing condition) of the member's current non-Kaiser provider.

That is such insurance double talk that i cannot comment. I hope Diana Cox sees your post and responds. She was my biggest help.

I work for a health insurance company and this verbiage is really confusing.  Obesity can be considered a pre-existing condition.  The only exception I've seen is pregnancy and that only applies with group policies.

It's up to your employer whether or not they want to cover pre-x.  Of coures it's cheaper for them if they don't.  You should probably speak with someone in your benefits or HR office. 

I'm pretty certain, but I thought that the changes to the healthcare system per Obama made it such that insurance companies can no longer preclude "pre existing" conditions. 

Section 2705 spells the prohibition out in even more detail:

"A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual: health status; medical condition (including both physical and mental illnesses); claims experience; receipt of health care; medical history; genetic information; evidence of insurability (including conditions arising out of acts of domestic violence); disability; any other health status-related factor determined appropriate by the Secretary."

In addition, the bill makes clear that insurance companies cannot charge more for people with pre-existing medical conditions; nor can they charge more for women.

Could you stay with Healthnet, and when they deny you the DS just do an appeal with DMHC? (or does HN have someone who they claims does the DS?) You would probably have to appeal to the DMHC with Kaiser even if you did change over insurance.

As for the pre-existing conditions and what RFW said above, I'm not sure if that is in effect now or doesn't apply until 2014. I haven't really looked into it.

Thanks Everyone for your responses...
Back in September, my understanding (with Diana & Larra's help) was that Kaiser has a "contract" w/Rabkin so it is possible to get him as a DS Surgeon. Yes, I might have to appeal (not the problem). The Problem as I see it right now is that Kaiser is (as of October 2011) saying that I have to have no option to continue my current insurance (for whatever reasons) in order to choose Kaiser and not be denied "continuity of care" on conditions that are currently being treated/paid for by HealthNet.

Thank You RFW for that quote, I wondered as I read, (just what ModestoK mentioned) if that is in effect in 2012 or later. I have a call in to our HR reps at the Corp Office to find out more.

ModestoK, Yes, I could stay with HN but was trying to avoid the huge-ass co-pay/deductible/out-of-pocket costs and was thinking about transferring to Kaiser even before this, (for various reasons). 

Gail, We spoke after the September Support Group Meeting in SF, I remember you mentioning the  way to bring up the WLS request with Kaiser and appreciate the input.
I've been researching/thinking about WLS since my Ex Husband and his wife had it back in 2000 with Dr. K (when he was still in Delano). I am READY to get cut, and want it NOW....However, because of my personal life's current events, I'm open to the idea that it may not be the right time.

I'll keep reading/lurking on OH until I get switched.
S~