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Kaiser and referrals out of network
MAC & Bronchiectasis | Last Active: 3 days ago | Replies (20)Comment receiving replies
@chris1321 very interesting … a few questions if you would be open to answering:
1) with your care at UCSF, are they also doing your imaging, sputum samples, etc., or is that workup still done at Kaiser and the UCSF visits are doctor-only office visits and UCSF relies on your Kaiser workup testing/imaging (I think you previously mentioned you see and like Dr Zha at UCSF.
2) Are you being treated for BE only or do you also have NTM?
3) If the UCSF doctor says I want to do XYZ test or prescribes a certain medication or wants you to see another specialty, does that all get done at UCSF or does it go back to Kaiser and does Kaiser automatically approve whatever UCSF orders as part of Kaiser’s referral?
4) Do you see a respiratory therapist at UCSF?
5) Regarding paxmundi’s question about who you have spoken to 5-6 times, I am assuming from your post that you mean the UCSF doctor and whenever you need to speak with her you reach out to your Kaiser pulmonologist for the referral. Is that right?
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Happy to elaborate.
1) Kaiser does all the tests: CTs, sputums, genetic etc. I communicate with Dr. Zha, a NP on the team, the pharmacist, possibly RT (haven’t gotten to him yet). Basically I just set up appts and tell my pulmonologist at Kaiser if I need a new referral or not. I am concerned about sputums as Kaiser SR does not automatically do susceptibility testing. And, I seem to have to prompt my pulmonologist to call it in. If any treatment is planned, we must know what’s going to work.
2) I’ve got BE, MAC/NTM, & colonized pseudomonas aerunginosa. I had a bilobectomy 5/3/23, RML & RLL.
3) Any prescription or specialty referral is at Kaiser. I’ve had Dr. Zha prescribe 2 different inhalers & an antibiotic. Kaiser filled them. My pulmonologist just followed her order.
4) RT is in the works. Kaiser has a pulmonary rehab program in Novato I’ve never used. RT at Kaiser SR is responsive but not a subspecialist in BE/NTM.
5) Sorry for the misunderstanding. If I have a question, I often message both pulmonologists, UCSF & Kaiser. Sometimes just UCSF if Dr. Zha is leading the treatment plan. For instance, I was treated with Azith/Etham/Rifampin for MAC 9/23-12/24. I cleared 1/24 and remained clear until 11/24 & again 1/25. I stopped all 3 and will be starting Azith/Etham/Amikacin per Dr Zha dosaging and plan.
I’ve only been talking telemedicine with Dr Zha about this. See kaiser pulmonologist in a week or so to bring him on board.
6) It’s tricky. Trying to keep both pulmonologists aware of plan & clear they are both treating me. Not an ideal setup for sure.