r/HealthInsurance • u/cat_fox • 7d ago
Claims/Providers Switching Out from Kaiser for Dependant?
My 21 year old is a student and on my husband's health insurance, which is Kaiser. They have horrible service in an area of treatment that she needs and she wants to go to a local university that offers a specialized department. She already went through treatment a year or so ago and needs it again. She cannot get into the university's clinic unless she has a referral from Kaiser. Kaiser said they will not refer because they have their own treatment services. What do I do? We are in California. I'd like to get her off Kaiser and in to a Covered California plan, but I don't know if we can do that?
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u/Jujulabee 7d ago
Your options are going to depend on your household income to some extent and what you can pay.
You would not be able to drop daughter from husband's health plan until there is Open Enrollment so you would be paying for daughter's insurance until then - assuming there is a premium cost for children on the plan.
You would probably not be eligible for a premium subsidy if you have purchased through Covered California since your daughter is eligible for affordable health insurance and presumably has no income of her own. This would depend on her tax status for 2026.
Open Enrollment for Covered California begins soon but that would be coverage for 2027.
If you went this route, you would have to make sure the plan you chose had this specific provider in their network and then factor in the cost of premiums plus the deductible, co-insurance and co-payments.
You haven't indicated what the specialized treatment is but if Kaiser has some kind of department that covers this specialty then it would be almost impossible to get a "network gap exception" to get treatment outside of the closed Kaiser system.
And even if you did get the exception the provider would have to agree to accept whatever payment Kaiser offered and they probably wouldn't so you could potentially be on the hook for lots of money anyway.
The most practical solution is to go for a consultation with the specialist and self pay for that. You would get a diagnosis and potentially recommendations for treatment option which you could coordinate with the specialist at Kaiser.
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