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Reply to "Any luck with Kaiser for ADHD evaluation ?"

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]Our pediatrician referred us to a Kaiser developmental pediatrician, not a psychiatrist, for an ADHD and autism evaluation. There was a wait, but it was a notably shorter wait than friends waited for assessments outside of Kaiser. I would maybe ask Kaiser/your pediatrician if anyone other than a psychiatrist can do the assessment.

We had concerns about the developmental pediatrician's assessment and a few months later decided to do a private neuropsych assessment. When our kid's doctors found out we were going to pay out of pocket for a second opinion, they initiated the referral for Kaiser to pay for an external evaluation at Kennedy Krieger or Children's National. Unfortunately, the wait times for an evaluation at KKI or Childrens were 18-24 months while we were able to schedule  a private assessment for the next month. That wait time isn't Kaiser specific. We needed the assessment ASAP for school placement so we kept our private neuropsych appointment and paid out of pocket. The private neuropsych also confirmed that our kid is very complex and teasing out the different diagnoses was difficult. The fact that we needed a second opinion was a reflection of our kid's complexity - our clinician knew the Kaiser dev ped and thought highly of him. I don't doubt that the dev ped would be fine for your average kid where the only concern is garden variety ADHD. After getting the diagnosis, our kid's pediatrician added it to our kid's medical record and Kaiser has fully covered services ever since.

Frankly, the wait times for any insurance paid evaluation is long. I don't think moving to another insurer will get you seen faster. If you don't like Bloom Health, you can call Kaiser and ask for the full list of every external provider Kaiser has contracted with - there is likely more than one option for you to choose between. If you prefer a different provider, you can request an updated referral for the provider you selected. You can request a case manager to help you navigate this process. If you have a good pediatrician, they can also help you navigate this too. If you find that your pediatrician isn't helpful I strongly recommend selecting a new pediatrician. I have found in navigating our kid's complex medical needs that a good Kaiser doctor knows how to navigate the Kaiser system. If they don't know, they're not a good Kaiser doctor.  It's not enough for them to be a good diagnostician and have a pleasant bedside manner. With the right doctors, Kaiser is as amazing as your specific health plan can be. (Because everyone doesn't have the same Kaiser plan - the Kaiser plan available through my husband's employer is better than the Kaiser plan available through my employer. It may be that your specific Kaiser plan is subpar, in which case, yes, switching insurance may be the best answer). [/quote]

If you have access to an insurance plan that covers out of network care, then you can get seen faster and get it paid for. There is an issue where it is hard to know how much they will pay for out of network ahead of time. I was really worried about this when we switched but they did end up pretty much paying 80% of the full cost. PPOs can be a PITA (I now refuse to call them because they lied to me so many times to try to get me to give up on getting claims paid out, everything is now done in writing), but at the end of the day we are getting hundreds back every month when we were previously paying completely out of pocket for services Kaiser refused to provide or refer us for. For us, it has also been amazing to be able to choose providers based on recommendations from other providers and find the right fit. Not to mention, I can actually call our providers' offices directly. Personally, I think Kaiser can be great with more obvious issues but if it is less serious/more subtle but still impactful you have to know how to navigate the system and do so over and over again when new needs are identified. And you have to know to when to advocate, which is hard when you aren't an expert. I could not do it anymore and I'm so glad we left.[/quote]

It sounds like every option has trade offs. I’ve never had a problem with getting Kaiser to cover anything and my kid has routinely seen specialists at Childrens Hospital, Johns Hopkins, and HSC; has hundreds of therapy appointments every year; and has regular care from doctors across multiple specialities within Kaiser. Being able to have seamless, well coordinated care has been a godsend. Our annual costs have been limited to our kid’s $1500 deductible, and in the last 5 years I’ve only had to call to deal with insurance payment issues once and that was because the  therapist made a mistake, not Kaiser. I have literally been brought to tears when trying to deal with the administrative nightmare that is Children’s National. The administrative burden it sounds like you take on in dealing with insurance payouts would be a dealbreaker for me because I have 0 bandwidth for dealing with that on top of dealing with my kid’s health. For me, learning how to navigate Kaiser has been much easier. Though I think having good doctors who know how to navigate Kaiser makes a bigger difference than whether your medical issue is complex or simple yet subtle. [/quote]

Yeah, I think we've discussed this before. We had several "good" doctors and frequently experienced a lack of or subpar care. I did research on these doctors, switched when I was unhappy, and never encountered any doctor that would truly help me "navigate" the system. None of them felt our concerns were serious enough. The best I got was one provider who after being on her wait-list for a year admitted she wasn't qualified to serve my child and gave me the phone number for the behavioral health referral unit. I was also numerous times brought to tears by their medical records department including while trying to get mammogram imaging for a biopsy. As soon as we switched to a PPO I was easily able to find providers that were much more helpful. Once I contacted my employer about them denying claims, everything was sorted out.[/quote]

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