City of Pittsburg

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because: While it is true that at the time of cashing my check for $50.00, there was still an issue pending. In a letter dated April 22, 2016, Enia W*** of the Appeals Department stated that my "request for waiver of co-payments for services provided on April 1, [$20.00], and ambulatory surgery services provided on April 20, [$200.00] by Plan ophthalmologist DrJonathan C***. After carefully reviewing all relevant information, a decision has been made to approve your request." At this point, I should have been reimbursed the $for the check that was never acknowledged
Regards,
*** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***
Regards,
*** ***

Kaiser Foundation Health Plan of the Mid-Atlantic States - East Jefferson Street - Rockville, Maryland 20852January 22, 2016*** ***Revdex.com of Metro W*** DC and Eastern Pennsylvania K StNW, 10th Floor Washington, DC 20005-3404RE: Complainant: *** ***ID #: *** Patient: *** *** Member Number: ***Dear *** ***:This letter is in response to your inquiry dated January 11, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***, authorized representative for her daughter, *** ***The inquiry was received on January 14, 2016.*** *** stated in her complaint that she received a bill in the amount of $57,for a nipple shield that she received on October 30, *** *** believes that that nipple shield should cost $She indicated that she paid the bill to avoid collections.The claim in question was forwarded to the Patient Financial Services Department to be reviewed by the Billing and Collections AuditorOnce the review has been completed, *** *** will receive a corrected billIf the charges for date of service October 30, are incorrect, the claim will be reprocessedIf there is an overpayment on *** ***'s account, she may be due a refund.If you and/or *** *** have any additional questions, please contact Keyla W*** at ###-###-####.Sincerely,Cheryl T*** Director, Appeals and Correspondence

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me as long as I am receiving a refund.
Regards,
*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:From: *** ***Date: Wed, Jun 1, at 1:PMAs per our conversation earlier today the deductible for last year (December 1, through November 30, 2015) was $not the $indicated in the response from Kaiser Permanente and in phone conversations we had with them they admitted that and said they do not give refunds if over paidThe same thing is happen this year they said we had to pay a bill that would put us over our $deductible for this year. Sincerely, *** ***
Regards,
*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:I still have not received adequate treatment for my hip my, my hip still hurts, and I believe that the doctor's actions were inappropriateI have gone over a year and a quarter with this painAccording to current patient protection laws I am not supposed to pay for visits but rather for treatmentAs of yet, I still have not received treatment although a treatment plan has been put in placeHowever, treatment plan is not of my selectionThe doctors have had plenty of opportunities to fix this hip and have continually dismissed me and therefore should not be paid for my visitsOnly after receiving the complaint from the Revdex.com, did Kaiser Permanente professional start to take a more serious look at my itI should therefore not have to pay for appointments proceeding the Revdex.com complaintsFurthermore I have requested that the bone chip be removed from my hipThis request has gone completely ignored and lieu of more unnecessary testsFor these reasons, I reject Kaiser permanente's response to the Revdex.comI also, believe that I am still entitled to a refund for appointments where the visit did not end with a resolution of my issuesKaiser Permanente professionals have breached my privacy by a necessarily calling the police on me on two separate occasionsI was placed on medication by DrHumid S*** for which I had never seen her and that sent me to the Urgent Care with a migraine headache due to her refills running out and me not being able to contact herWhen I am tempted to contact her in person, she had the police called on meClearly, there are damages associated with my case that are not being addressed at all or in any way whatsoever
Regards,
*** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***I received the refund from Kaiser, and consider my complaint to be resolved
Thank you,
*** ***

This letter is in response to your inquiry dated April 11, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***.*** *** stated in his complaint that he overpaid his deductible in the amount of $178,He is requesting a refund for
the overage,*** *** is covered under a High Deductible HMO Plan through an employer group*** ***'s wife is covered as a dependent under his plan coverage.According to the Maryland Small Group Evidence of Coverage (EOC), Summary of Services and Cost Shares Section, if the member has individual only coverage, then he/she is responsible for a $2,individual contract year deductibleIf the member has one or more dependents under his/her plan coverage, then they are responsible for a $5,family contract year deductible,Since *** *** and his wife are covered under his plan coverage, they are responsible for a $5,family deductible per contract yearThe contract year for *** ***'s plan coverage is December 1st through November 30"The previous contract year was December 1, through November 30, The current contract year is December 1, through November 30, There is no record that **and *** *** met their $family deductible for the prior or current contract yearBased on the consideration of this information, **and *** *** did not over pay their deductible, and they are not due a refund of $178.Enclosed are copies of the relevant pages of the EOC.If you and/or *** *** have additional questions regarding this concern, please Contact Ella L*** at ###-###-####.Sincerely,Cynthia W*** Manager, Appeals and Correspondence

February 14, 2018Dear *** ***:This letter is in response to your inquiry dated February 2, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***.On January 19, 2018, we received an email from *** *** that expressed
dissatisfaction and he felt that his mother was being discriminated againstAttached you will see a copy of the response provided to *** ***A copy of this communication was shared with our Membership Administration Department for reviewUpon the completion of their investigation it was determined that the original application was filled out incorrectly*** *** incidentally indicated that she did not have End Stage Renal DiseaseThis notation was not consistent with the information being provided by the Center for Medicare/Medicaid Services (CMS) which resulted an initial denial due to the mismatchA request for additional information (R.F.I.) was placed on the account during this investigation periodDuring the R.F.I period *** ***'s policy was placed on hold.*** ***'s post-transplant information was received from CMS on January 19, Based on the findings the Health Plan reinstated the policy retroactively to the original effective date of January 1, *** *** was notified of the reinstatement on that dayAdditionally, we confirmed that *** ***'s policy is now active.If you and/or *** *** have any additional questions, please contact Rodolfo M*** at ###-###-####.Sincerely,Daisy S. Manager, Appeals and Correspondence Department

This letter is in response to your inquiry dated September 13, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***.*** *** received a copy of the Health Plan's response letter dated September 8, 2016; however he rejected the response*** *** rejected the response because he believes that he has not received adequate treatment; therefore, he should not be responsible for his Copayments.As previously stated, a copy of *** ***'s letter was also forwarded to the Physician Chief of the Northern Virginia Service Area, DrCheryl K*** for review.A team of Patient Safety experts and physicians have met, thoroughly investigated and discussed this caseTheir findings revealed that the medical care provided to *** *** was appropriateHealth Plan has a clear plan of action and recommendations for his continued care in place and have communicated that to *** ***.Section 3-Benefits of *** ***'s Evidence of Coverage states the following; In addition to Premium Payments, you may be required to pay a Cost Share for some ServicesThe Cost Share is the Copayment, and Coinsurance, if any in the Summary of Cost SharesYou are responsible for payment of all Cost SharesCopayments are due at the time you receive a ServiceYou will be billed for any Coinsurance you owe." If *** *** continues to dispute the cost share for the medical services provided to him, he may submit a written appeal to:Appeals and Correspondence *** *** *** *** Rockville, MD *** FAX: ***Please note that *** ***'s appeal request must be filed in writing within days from the date of receipt of the original denial notice (Explanation of Benefit statement).If you and/or *** *** have any additional questions, please contact Keyla W*** at ###-###-####.Sincerely,Daisy S*Manager, Appeals and Correspondence

This letter is in response to your inquiry dated April 11, 2016, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan), submitted by the complainant, Mr. [redacted].Mr. [redacted] indicated in his complaint that effective February 1, 2015 he enrolled with the Health...

Plan through the Marketplace and setup automatic deduction of payment of his monthly premiums. In August 2015, Mr. [redacted] learned that his policy was terminated for non-payment of his monthly premiums as of May 31, 2015. Mr. [redacted] also indicated that he quickly sent a payment of $1,045.36 by check to the Health Plan to prevent his account from being cancelled. Mr. [redacted]' policy was not reinstated and he did not receive a refund of payments applied to his monthly premium. Therefore, Mr. [redacted] is requesting from the Health Plan to refund payment of $1,045.36.As a result of our research, it was determined that Mr. [redacted]' refund premium payments totaling $1,045.36 was processed. A check for payment was mailed on May 3, 2016, to Mr. [redacted]' home address on file as of May 3, 2016. He should expect to receive payment on or before May 17, 2016. If you and/or Mr. [redacted] have any additional questions or concerns regarding this matter, please contact Enia Walker at ###-###-####.Sincerely,Cynthia W[redacted] Manager, Appeals and Correspondence

This letter is in response to your inquiry dated September 21, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted] and [redacted]. The inquiry was received on September 27, 2016.The Complainants stated a Health Plan...

representative informed them that they did not have Coverage for a breast pump. **. and [redacted] purchased a breast pump at their own expense.After the purchase, another Health Plan representative advised **. and [redacted] that they have coverage for breast pumps. The complainants submitted a claim for reimbursement but it was denied. The Complainants are requesting reimbursement in the amount of $311.64.On behalf of the Health Plan, I apologize for the inconvenience this situation has caused **. and [redacted]. Health Plan has initiated an appeal on behalf of the complainants to review the denial of reimbursement for a breast pump. **. and [redacted] will receive an acknowledge letter under separate cover which explains the appeals process.If you and/or **. [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S[redacted] Manager, Appeals and Correspondence

September 4, 2015Dear [redacted]:This letter is in response to your inquiry dated August 25, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. This inquiry was received on August 27, 2015.[redacted] stated in her complaint that she...

is waiting for a refund from the Health Plan in the amount of $1322.00 under check number [redacted]. She also indicated that the she was advised that a refund check was mailed to her home address in June 2015 but she has not received it.On June 25, 2015 the Health Plan mailed [redacted] a refund check in the amount of $1,322.00. The check was mailed to [redacted], Washington, DC [redacted].Upon receipt of the inquiry from the Revdex.com, Health Plan found that the refund check (check number [redacted]) has not been cashed. The Health Plan updated [redacted]'s mailing address to add her apartment number **. Also, Health Plan will stop payment on the outstanding check and re-issue a new check in the amount of $1,322.00.On behalf of the Health Plan, I apologize for the inconvenience this situation has caused [redacted],If you and/or [redacted] have additional questions regarding this concern, please contact Keyla W[redacted] at ###-###-####,Sincerely,Daisy S.Senior Manager, Member Services

July 14, 2015Dear [redacted]:This letter is in response to your inquiry dated June 29,2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on July 6, 2015.[redacted] stated in his complaint that he...

received a delinquent notice for his monthly premium prior to receipt of his welcome letter.On behalf of the Health Plan, I apologize for the inconvenience this situation has caused [redacted].[redacted] is enrolled in the VA Silver 1500/30 Dental Plan which became effective February 1, 2015.On February 7, 2015 the Health Plan sent [redacted] a warning letter informing him that the first month's premium payment was still outstanding. The delinquent notices are used to inform members of arrears. The February 2015 premium payment was subsequently received on March 5,2015.On February 11, 2015 the Health Plan sent [redacted] a "welcome letter" advising him of his plan coverage, effective date, and medical record number.[redacted] also stated that the Health Plan enrolled him in the automatic monthly premium payment debit program without his consent or knowledge.On the initial enrollment application, [redacted] [redacted] completed the automatic monthly payment section authorizing the Health Plan to automatically debit his credit card for his monthly premiums. Exhibit A contains a copy of the application. Please see page 7 of the application for the automatic monthly payment information.If [redacted] would like to discontinue the automatic monthly premium payments, he must submit a letter to the Health Plan requesting cancellation of the automatic monthly payments. The notice may be sent to the following address and/or fax number:Kaiser Permanente Attn: Membership Administration/Direct Pay Unit PO Box 6306 Rockville, MD 20852-6306 Fax: ###-###-####Once the automatic monthly premium payment debit program has been cancelled, [redacted] may use the Health Plan's online premium payment system to pay his monthly premiums.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S. Senior Manager, Member Services

October 3, 2017 OCT 6 207[redacted]Revdex.com of Metro Washington DC and Eastern Pennsylvania 1411 K St. NW, 10th Floor Washington, DC 20005-3404RE: Complainant: [redacted]ID #: [redacted] Member Number [redacted]Dear [redacted]:This letter is in response to your inquiry to Kaiser...

Foundation Health Plan of the MidAtlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on September 28, 2017.[redacted] stated in her complaint that her premium was increased without notice. Therefore, she is requesting that the Health Plan refund her $823.86.[redacted]'s was enrolled into a Kaiser Permanente Silver $6000/30/idental plan on November 22, 2016 with a premium of $274.62. On January 24, 2017, the Health Plan was notified by the exchange to enroll [redacted] into a Silver Plan $2750.00/20%/HSA/Dental Plan with a premium of $248.20. The Health Plan senta plan change letter to the members address on January 24, 2017. The Health Plan also sent monthly statements of account to [redacted]s home address which included her monthly premium. A warning letter was sent to [redacted]s home address on March 7, 2017 and a termination letter was sent on April 5, 2017. Enclosed for your review are the members notifications and monthly statements.We regret that we are unable to refund [redacted] $823.86 because she was covered under her exchange policy from January 1, 2017 to April 1, 2017. If [redacted] would like to appeal her enrollment into the Silver Plan, she may dispute her enrollment though the Maryland Health Connection. [redacted] may appeal by mail, by email or by phone.By Mail: Complete the Request for Case Review form or write a request to:Maryland Health Connection P.O. BOX 857 Lanham, MD 20703-0857O: Office of Administrative Hearings 11101 Gilroy Road Hunt Valley, MD 21031By Email: Complete and SCan the Request for Case Review form and send an email to: MHBE.Appeals (Gmaryland.govBy Phone: Call Maryland Health Connection at [redacted] (TTY ###-###-####)If you and/or [redacted] have any additional questions, please contact Evral M[redacted] at ###-###-####.

November 16, 2015[redacted]Revdex.com of Metro Washington DC and Eastern.Pennsylvania 1411 K St. NW, 10th Floor Washington, DC 20005-3404RE: Complainant: [redacted]ID #: [redacted] Member Number: [redacted]Dear [redacted]:This letter is in response to your inquiry dated November...

2, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted]. The inquiry was received on November 6, 2015.[redacted] stated that in his complaint that he is being billed by [redacted] Hospital for the medical services provided to him from November 27, 2014 through November 28, 2014.The Health Plan contacted [redacted] Hospital's Billing Department to inquire about [redacted]'s account balance. The Health Plan was informed that [redacted] is being billed his cost share of $693.70 for the consultation and outpatient surgery services provided to him on November 28, 2014 by Dr. [redacted] of [redacted] Healthcare Services.The claim was processed for payment on June 24, 2015 and $693.70 was applied towards [redacted]'s applicable co-insurance.According to the Summary and Cost Share Section of the 2015 Group Evidence of Coverage (EOC), Specialty care office visits are subject to a $40 Copayment per visit. Also, [redacted] is responsible for 30% of the allowable charge for outpatient Surgery Services.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Cheryl T[redacted] Director, Appeals and Correspondence

This letter is in response to your inquiry dated September 21, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on September 27, 2016.The [redacted] stated in her complaint that she was enrolled with the Health...

Plan from January 2014 through March 2016. However, she received a billing statement after her termination date. [redacted] is requesting that the Health Plan terminate her coverage effective March 31, 2016 and cease all premium billing statements after that date.Ms. Jackson's concern was escalated to the Client Services Department to process her termination request effective March 31, 2016. Any outstanding premium balance after March 31st will be adjusted.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at [redacted].Sincerely,Däisy S[redacted] Manager, Appeals and Correspondence

This letter is in response to your inquiry dated December 16, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of Mr. [redacted]. The inquiry was received on December 20, 2016.Mr. [redacted] stated that on December 11, 2016 he refilled his medication through...

the Health Plan's website and was promised a 2-5 day delivery timeframe. He stated that he contacted the customer service department, and was advised that the medication would take 10-15 days for delivery. Mr. [redacted] is requesting a $22 refund for the mail order medication.According to the Health Plan's records, Mr. [redacted] ordered his medication on December 14, 2016 at 2:23pm via kp.org. The delivery time for mail order medication is up to 10 days. On December 20, 2016 the Health Plan delivered Mr. [redacted]'s medication to his home address, Mr. [redacted] declined the delivery.Mr. [redacted] obtained his medication from the [redacted] Center's Pharmacy Department. Health Plan will process a refund in the amount of $22.00 for the mail order medication that was declined by Mr. [redacted].If you and/or Mr. [redacted] have any additional questions, please contact Keyla Washington at ###-###-####.Sincerely,Daisy S[redacted]Manager, Appeals and Correspondence

This letter is an interim response to your inquiry dated July 6, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of Ms. [redacted]. This inquiry was received on July 8, 2015.Ms. [redacted] stated in her complaint that she contacted the Health Plan to...

terminate her coverage effective March 31, 2015. Ms. [redacted] stated that she was not advised that she would need to contact Maryland Health Connection to terminate her coverage. She indicated that she has been receiving premium billing statements after March 31, 2015. Ms. [redacted] is requesting that the Health Plan terminate her health insurance coverage effective March 31, 2015, and write off any premium balance after that date.Ms. [redacted]'s letter was forwarded to Mr. Victor N[redacted], Operations Manager of the Member Services Call Center for review and appropriate action.The Health Plan is unable to process Ms. [redacted]'s termination request without approval from the Maryland Health Connection (Marketplace).Ms. [redacted]'s coverage with Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. is currently active. She must request termination of her health insurance coverage through Maryland Health Connection. Ms. [redacted] may file an appeal with the Maryland Health Connection (###-###-####) to request termination of her coverage effective March 31, 2015.Upon receipt of the approval from Maryland Health Connection, the Health Plan will honor the request and terminate Ms. [redacted]'s coverage.I regret the circumstances that prompted Ms. [redacted]'s letter. At the same time I thank you for the opportunity to address her concerns.If you and/or Ms. [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S[redacted] Senior Manager, Member Services

This letter is in response to your inquiry dated September 6, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on September 8, 2016.[redacted] stated in her complaint that her check payment for the...

amount of $50 that Was Submitted to the Health Plan in January 2016, was not cashed. Member Contacted the Health Plan in February 2016 and paid $50 over the phone. Her check payment was cashed in March 2016. Member did not receive a refund.According to our records, [redacted] owed a $200 co-payment for an outpatient Surgical procedure performed on April 20, 2015. Her $50 payment was applied towards the charge.[redacted]'s appointment on April 5, 2015 was a post-operative visit and the Health Plan should not have billed her a $20 co-payment. Therefore, she will be receiving a refund for $20. If you and/or [redacted] have any questions, please Contact me directly at ###-###-####.Sincerely,Cathleen M[redacted] Appeals and Resolution Specialist Member Services