Agreed. Kaiser does well for the vast majority of problems and for the averafe person, but anything specific, out of the norm, or challenging Kaiser fails. You sometimes need to see someone not in network and that's the main reason for insurance. Anyone really can help treat you for common ailments, but when something unique comes it's better to have the options to see the best in the field.

This happened to my family as well. My wife broke her ankle and is an avid amateur sports nut. She wanted to go see a top sports doctor (KP has none) and couldn't get KP to cover any of it. To pay out of pocket was anywhere between $20k-$30k. We ended up flying to the UK because it was cheaper and she had a trusted top tier sports injury surgeon she knew there.

Well that's how it works. If you want healthcare to work for everyone, you cannot expect that insurance will reimburse treatment from top doctors outside of rare conditions (where top doctors are the only doctors). Sport related injuries are extremely common. Why should an insurance reimburse an incredibly costly treatment when a normal treatment is good enough for most people? By definition, you cannot have an insurance that covers everyone but sends you to a top 1% doctor. What would the other 99% used for?

I'm not discrediting that notion. My point was to echo the sentiment that a closed-loop healthcare system has it's downsides when it hits edge cases.

For the record, I pay the same for healthcare from UHC now and it would cover the $25k cost for the specialist because they're in the UHC network.

Do you pay the same as an individual or through an employer?

When my wife left her job several years ago (but post Obamacare) and needed to get insurance on the open market, her Northern California Kaiser plan was roughly the same price as her employee group plan (inclusive of employer contribution). Not too long ago my sister purchased a Kaiser Mid-Atlantic plan on the open market, which was also reasonable with nearly identical coverage to the group plans I've had.

As far I understand, Kaiser is largely an outlier regarding rough cost parity between group plans and individual plans. I'd be surprised if UHC cost the same as Kaiser for the same coverage on the open market, but if you confirm then I'll have to update my assumptions.

Not sure about open market to be honest. I'm currently on COBRA (left a FTE position that had access to both). Will let you know in 9 months :)

Most of the "top 1% doctor" is marketing hype and BS. Reminds me of the "America's Top Doctors" ads you see on airplanes.

I don't know the kind of therapist you're going to but I was able to still see my therapist after I changed over to Kaiser. You might want to contact yours and ask if they're under the Beacon Health options plan. There are sometimes roundabout ways to get it done and I managed to do such.

You might be on the West coast. Kaiser does individual therapy on the East. Maybe your company isn't willing to pay for individual...

They do it on the west coast as well. You might be right that it's coverage related, but Kaiser in my experience let's you pay out of pocket for anything not covered. Could be that they don't do individual therapy for certain issues or simply can't due to staffing issues.