Kaiser Question for Federal Employees

[Anonymous]

The Kaiser rep that I spoke to at the Health Fair told me that I can go to an affiliated provider (i.e., not an in-network doctor but part of a network that takes Kaiser); it may cost more but is otherwise allowed (with a referral). The Kaiser rep at the federal health fair gave me a book with their network providers and a book with their affiliated providers.

I talked to a customer service representative from Kaiser today who seemed knowledgeable and she told me that it is not the case unless they don't cover the services at all (ie for reproductive services).
She also told me that an OB/GYN- not your primary care physician - is responsible for any fertility specialist referrals.

this leads me to two questions:

1. is it true that your OB/GYN at Kaiser would be responsible the referrals for Shady Grove. If so, any Kaiser OB/GYN recommendations in DC (West End/ Capital Hill) would be appreciated

2. Is it also true that you can only go to Kaiser in-network providers under the federal plan?

Thanks in advance! The Kaiser system is a bit labyrinthine and before I switch, I want to know what I am actually giving up to get IVF coverage. I am hearing different things from different people.

[Anonymous]

Bump - in the same boat looking for similar answers

[Anonymous]

I am a little confused but your question but this is what happened to me. I went to my ob and asked for a referral to SG she ordered pre referral blood work for which I was responsible at 50% rate. After That I received a letter saying your referral has been approved. I went to SG paid my 50% for IVF which was $2750 Filled prescriptions at KAISER another $1500 had IVF. They require a new referral for each IVF attempt and will not pay for FET

[Anonymous]

Anonymous wrote:I am a little confused but your question but this is what happened to me. I went to my ob and asked for a referral to SG she ordered pre referral blood work for which I was responsible at 50% rate. After That I received a letter saying your referral has been approved. I went to SG paid my 50% for IVF which was $2750 Filled prescriptions at KAISER another $1500 had IVF. They require a new referral for each IVF attempt and will not pay for FET

+1 exact same experience. Kaiser OB did the referral. And you should just choose one at the Kaiser center closest to you.

[Anonymous]

Did you go to a kaiser hospital for the HSG? Does anyone have an obgyn recommendation at their Capitol Hill location?

[Anonymous]

Anonymous wrote:Did you go to a kaiser hospital for the HSG? Does anyone have an obgyn recommendation at their Capitol Hill location?

Yes. It's Kaiser radiology. They have one in every Kaiser center.