Has anyone had Kaiser give them an outside referral?

[cpap626]

Hi,

I am looking at getting a second sleep test after I was diagnosed by kaiser for having mild sleep apnea. I found a company that does sleep tests with eeg so they know when I would be asleep. In order to get the test done I need a referral from my doctor. I will be paying for the test out of my own pocket. Has anyone ever been able to get an outside referral outside of kaiser for a second opinion. I know kaiser trys to keep everything in house.

Thanks

[kteague]

Mostly replying to bump this up so more can see it, possibly someone with Kaiser experience. In general, payment source is the factor in outside referrals in systems such as Kaiser. A self-pay procedure doesn't require the doctor to jump through hoops to justify and get payment approval. Is the doctor recommending treatment for your "mild" results? If you are unsure about your results, have you talked with the doctor about it, and if you could qualify for an actual in-lab study? It sounds like you are questioning if some of the events reported could have been while awake. Is that the issue - the validity of your diagnosis? If you have a copy of your report, you could post it here and maybe get some input on legitimate concerns you could present to your doctor.

[SewTired]

I'd give the place you are going to a call. If you are self-pay, you usually don't need a referral. Letting your doc's office know that you are getting a second opinion helps if there is medical data that needs to be sent to the new doc.

[Janknitz]

Kaiser will NEVER EVER refer you outside their system. If you absolutely must have a referral, ask if your dentist can make the referral. That’s your best bet.

[DxRxTx]

Kaiser will only give outside referrals for services that are unable to be handled in house. As for the your Dx, Kaiser will not not provide PAP therapy (or pay for supplies) unless there is a Dx of at least moderate OSA. But neither does Medicaid or Medicare.

[Lucyhere]

Kaiser will NEVER EVER refer you outside their system.

Jan... my daughter got a referral (not sleep apnea related) outside of their system last year. I don't have Kaiser so not sure how that came about.

[Janknitz]

Kaiser will NEVER EVER refer you outside their system.

Jan... my daughter got a referral (not sleep apnea related) outside of their system last year. I don't have Kaiser so not sure how that came about.

I think if there is a specialty they do not have available and in certain very limited circumstances for a second opinion they will, but when they have a full department available its not going to happen.

[chunkyfrog]

Avoid.
Kaiser.
If at all possible.

[Lucyhere]

Avoid.
Kaiser.
If at all possible.

Years ago I may have agreed with you. Today Kaiser Hospitals are among the best in the country. Just pick up a copy of Consumer Reports. My daughter has had relatively minor surgeries but all have been successful and with excellent doctors. Kaiser no longer has the reputation it had even fifteen years ago. Sure there have been incidences, but that goes for any hospital or doctor anywhere in the country.

[cpap626]

I just wanted to give an update, I went to my pcp at Kaiser and I told him that I wanted a second opinion on a sleep study mainly because I think the 02 sensor was way off! During my Kaiser test it said my heartbeat got up to 196bpm and my 02 level went down to 81%. I have my own 02 monitor and it does not get nearly that low when I am sleeping. It sometimes goes to 88-90% but very rarely and for less than 10 seconds. I was awake during the majority of the test so I think some false events were recorded as Kaiser dosent have a human grade the test. My Doctor signed off on the referral as long as I was paying for it. The sleep study I want to do is a t2 take home test that actually reads my brain waves to see if I am asleep or not. My test said my ahi was 8, I am hoping with this new test I can get a more accurate number. It may be higher or lower. Even on auto bipap right no my AHI is usually around 5-6. I just want to know for sure if I have it because I did not trust the test I took.

About staying away from Kaiser...I know everyone has an opinion about them, but personally I will be changing insurance company's. Recently I had an endoscopy and they thought they botched it up and sent me to the hospital for a perforated esophagus. Then they made a mistake and gave me 3 meds at the same time that could have stopped my heart. After 3 days of feeling horrible, I googled the meds and found out they should not be taken together at all because all three of them prolong the heart QTC signal and can lead me to have a heart attack. Well 3 EKGS later and a treadmill test, all I got was a "Im sorry our pharmacist did not catch it we will rely less on the computer systems in the future". The doctor who proscribed it to me strait up lied and said there was no problem with the meds they gave me. The worst part is they totally lied about the records, when I went to the hospital that my doctor sent me to after the procedure, the ER doctor said, don't freak out if the medical paperwork says your here for trouble swallowing because we dont have a drop down complaint for complications from an endoscopy. All they do is cover their rear ends.

Additionally last year my uncle went in for an outpatient shoulder surgery, he dies on the table. They came out and told my aunt sorry....and made her drive home after losing her husband. She paid $5000 for an independent autopsy and they discovered that his heart was twice the size, he had a heart attack earlier and didn't know it, he had really bad emphysema, had diabetes, and early Alzheimer's. He was a Kaiser lifer and went in regularly but they always said he was in good shape because he was active regularly. From my experience Kaiser only tells you that you are OK to make you go away. Sorry for the rant....Does anyone know if I switch to a different HMO can I refuse to bring my Kaiser records over because they have so many errors in them? Or will my new insurance not cover me without bringing my old records over?

[chunkyfrog]

Good question.
AFAIK, you can attach comments to your permanent record--but court documents would be more compelling than anything appended by a patient.

[SewTired]

Never lived in CA, but when I switched health systems, also due to many errors, I just got copies of all my records and took out those that were questionable. I just told my new doctor that the records at my old system appear to have been combined with that of another patient and they won't fix them. I want him to have accurate records about ME. Unless you are an active patient, most systems dump your records into archive after 5-7 years. Hospitals seem to keep them in the system longer though.

As to the enlarged heart, I don't know what to tell you. My doc says that he would love to have every one of his patients over the age of 55 to get a chest xray every 5 years to check for weird stuff that shows up. However, insurance doesn't pay for a chest xray unless there is a medical reason for justifying it and preventive care isn't one of them. It would show that you had an enlarged heart. Otherwise, you can go years with an enlarged heart without any symptoms at all.

As shocking as the event was to your Aunt, hopefully she will take comfort in that he went before he was heavily affected by Alzheimer's. FWIW, my Dad also had a heart attack and didn't know it because he poo poo'd his symptoms. It was when he got the flu and was hospitalized that it was discovered. The heart attack was probably 6 months prior.