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BY JIM HALL
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 last week 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 has one of the nation's most popular HMO insurance plans with 9 million customers. The company is rare among its competitors because it's also a provider. Its customers get day-to-day care from company doctors at company clinics.
Kaiser opened a medical center in Fredericksburg in 2009. The center offers primary care and has a pharmacy, lab and some imaging capability.
The company is installing a CT scanner in its Woodbridge office, and it has asked the state for permission to place an MRI there, Parker said. It does not have this technology in Fredericksburg.
The Clausons said they became Kaiser customers soon after the company opened its Fredericksburg center.
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 have had the same Kaiser plan for more than three years. They received no notice from the company that out-of-network benefits had changed.
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 change coincided with the opening of Kaiser's new six-story, state-of-the-art medical center in McLean, which opened in August, Diane Clauson said.
Robert Clauson appealed Kaiser's decision to deny his local CT scan. The appeal was denied, so last month he got a ride to Richmond and had a CT at the McGuire VA Medical Center.
With the deadline at hand for Medicare users and federal employees to choose their 2013 coverage, the Clausons have decided to drop Kaiser.
"We can't travel," Diane Clauson said.
Jim Hall: 540/374-5433
Kaiser's Mid-Atlantic States Region is based in Rockville, Md., and serves about 500,000 people in Maryland, Virginia and Washington.
More than 8,000 of Kaiser's customers get their medical care at the Fredericksburg office, which opened in 2009. The office is near Mary Washington Hospital.