The limited of out-of-network coverage is kind of the point of Kaiser. There are some times that they’ll do it if they’ve understaffed in a specialist’s area, if it’s emergency / trauma care, etc. But the main point is to try to keep things within the non-profit network, and to limit the cost creep imposed by the for-profit healthcare providers.
As for out-of-pocket, that really depends on the plan you’re buying or your employer is negotiating. When I was picking a Kaiser plan, I was usually choosing between similar PPO offerings with comparable out-of-pocket.
My wife and I, and many of her insurance coworkers, have found that the PPO plans often hide the costs. It looks good on paper at first, but the TOS about what is and isn’t covered can often be much more profit-driven in the PPO space. And you often don’t learn about these details until you need care or a medication.
The limited of out-of-network coverage is kind of the point of Kaiser. There are some times that they’ll do it if they’ve understaffed in a specialist’s area, if it’s emergency / trauma care, etc. But the main point is to try to keep things within the non-profit network, and to limit the cost creep imposed by the for-profit healthcare providers.
As for out-of-pocket, that really depends on the plan you’re buying or your employer is negotiating. When I was picking a Kaiser plan, I was usually choosing between similar PPO offerings with comparable out-of-pocket.
My wife and I, and many of her insurance coworkers, have found that the PPO plans often hide the costs. It looks good on paper at first, but the TOS about what is and isn’t covered can often be much more profit-driven in the PPO space. And you often don’t learn about these details until you need care or a medication.
So it’s the vertical integration.