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Amy Umble is health reporter for The Free Lance-Star

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For Kaiser customers, out-of-network now means out-of-area

Kaiser Permanente sells one of the nation’s most popular HMO insurance plans. But Robert and Diane Clauson, who have been members of that plan for more than three years, say that it’s not what it used to be. A story about the Clausons’ attempt to get a CT scan done locally will be published in the paper soon. An excerpt from that story appears here:

Robert and Diane Clauson noticed the change in September when Robert Clauson needed a CT scan.

Before then, when the Locust Grove couple had to have an advanced image or visit a specialist, their insurance company, Kaiser Permanente, allowed them to see providers in Fredericksburg and Culpeper.

In September, however, Kaiser rejected what the Clausons considered a routine request to go to Medical Imaging of Fredericksburg. Instead, they were told they had to get the CT done at Kaiser’s new Tysons Corner Medical Center in Northern Virginia.

“They clearly state they have convenient locations,” Diane Clauson said. “Seventy miles is not convenient.”

A Kaiser spokesman today declined to talk about the Clausons’ complaint because of privacy reasons. He confirmed that Kaiser is sending “certain cases and certain patients to Tysons.”

“What we’re looking at is encouraging members to receive their care in-network,” said Che Parker, director of public relations. “There’s a lot of very solid third-party validation that says that when you use Kaiser physicians and Kaiser facilities, you’re going to get some of the best care available.”

Kaiser is rare among its competitors because it’s also a provider. Its customers get day-to-day care from company doctors at company clinics. The company opened a medical center in Fredericksburg in 2009. The center offers primary care and has a pharmacy, lab and some imaging capability. It does not have CT or MRI.

Robert Clauson, 65, is a veteran and retired Department of Defense employee. Both he and his wife have Medicare as their primary insurance and pay Kaiser $198 a month to have its HMO plan as their secondary insurance.

The company always had speciality doctors and advanced imaging services in Northern Virginia but did not require its Fredericksburg-area customers to go there, Diane Clauson said. Instead, customers could see local providers at no additional out-of-pocket costs.

The Clausons used out-of-network providers in the Fredericksburg area more than 30 times, they said. The ability to stay close to home was one of the attractive features of Kaiser’s plan, they said.

“I like Kaiser. I don’t have any problems with Kaiser doctors,” Diane Clauson said. “But now they’re wanting to change everything, and it’s difficult.”

(The complete story ran Sunday, Dec. 9,  and can be seen here.)