City of Pittsburg

September 11, 2015Dear [redacted]:This letter is in response to your inquiry dated August 27, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of Mr. Ian Whibley. This inquiry was received on September 1, 2015.[redacted] stated in his complaint that...

he applied for health insurance Coverage through the Maryland Health Connection (Exchange). He also indicated that his coverage terminated. [redacted] stated that he paid $119.63 for the first month's premium.• According to our records, [redacted] applied for health insurance coverage through the Maryland Health Connection. He requested an April 1, 2015 effective date.• On April 17, 2015 the Health Plan mailed [redacted] a letter advising him of the amount of his monthly premium. The letter also requested the initial premium payment by April 30, 2015 to continue processing his enrollment. Exhibit A contains a copy of the letter.• On May 11, 2015 the Health Plan cancelled [redacted]'s enrollment request because the initial payment had not been received.On May 19, 2015 the Health Plan received a payment in the amount of $119.63. Exhibit B Contains a copy of the cancellation notice. Since the payment was received after the Cancellation date, a refund request was forwarded to the Client Services Department for processing. [redacted] will receive a refund within 4-6 weeks,If you and/or [redacted] have additional questions regarding this concern, please contact [redacted] at ###-###-####.Sincerely,Daisy S.Senior Manager, Member Services

Kaiser Foundation Health Plan of the Mid-Atlantic States - 2101 East Jefferson Street - Rockville, Maryland 20852January 22, 2016[redacted]Revdex.com of Metro W[redacted] DC and Eastern Pennsylvania 1411 K St. NW, 10th Floor Washington, DC 20005-3404RE: Complainant: [redacted]...

[redacted]ID #: [redacted] Patient: [redacted] Member Number: [redacted]Dear [redacted]:This letter is in response to your inquiry dated January 11, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted], authorized representative for her daughter, [redacted]. The inquiry was received on January 14, 2016.[redacted] stated in her complaint that she received a bill in the amount of $57,50 for a nipple shield that she received on October 30, 2015. [redacted] believes that that nipple shield should cost $7. 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 Auditor. Once the review has been completed, [redacted] will receive a corrected bill. If the charges for date of service October 30, 2015 are incorrect, the claim will be reprocessed. If there is an overpayment on [redacted]'s account, she may be due a refund.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####. Sincerely,Cheryl T[redacted] Director, Appeals and Correspondence

Dear [redacted]:This letter is in response to your inquiry dated August 26, 2016 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted] The inquiry was received on August 30, 2016.[redacted] expressed his dissatisfaction with the services that...

he received from Drs. Paul M[redacted], Brian H[redacted], Sweta V[redacted], Humira S[redacted], Anuj T[redacted] and Frank G[redacted].Providing quality medical care is one of our most important values. A copy of [redacted]'s letter was forwarded to the staff in the Quality Management Department for review. This review may involve staff and doctors from Kaiser Permanente and the particular medical specialty involved. The quality review process helps Kaiser Permanente Continue to improve the way we deliver care and service to our members.Our review is performed under special provisions of the federal Health Care Quality Improvement Act (HCOIA) [redacted], and state laws. These laws encourage physicians to participate in identifying issues and improving care for patients. These laws also guarantee confidentiality to physicians or providers that take part in the quality review process. As a result, Our goal is to balance your need for information and the need to follow these laws. To find this balance, Kaiser Permanente has developed a process to look into member concerns. This process is described below. A copy of [redacted]'s letter was also forwarded to the Physician Chief of the Northern Virginia Service Area, Dr. Cheryl K[redacted] for review.A team of Patient Safety experts and physicians have met, thoroughly investigated and discussed this case. Their findings revealed that the medical care provided to [redacted] was appropriate. Health Plan has a clear plan of action and recommendations for his continued care in place and have Communicated that to [redacted].If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

September 2, 2016Dear [redacted]:This letter is in response to your inquiry to Kaiser Foundation Health Plan dated August 12, 2016 of the Mid-Atlantic States, Inc. (Health Plan) from [redacted] regarding his mother, [redacted]. Your correspondence was received in our office on August...

25, 2016.[redacted] submitted a complaint stating that he had requested an investigation and responses to his questions and concerns regarding the care his mother, [redacted] received at the [redacted] Nursing Center in Silver Spring.Given [redacted]' concerns, a copy of his concerns was forwarded to the staff in our Quality Management Department for review. This review may involve staff and doctors from Kaiser Permanente and the particular medical specialty involved. The quality review findings help Kaiser Permanente continue to improve the way we deliver care and service to all members.This review is performed under special provisions of the Federal Health Care Quality Improvement Act (HCQIA) §11137, and state laws, which encourage physicians to participate in identifying issues and improving care for patients.[redacted]' concerns and questions were also referred to the Kaiser Permanente Service Chief Of Continuing Care (Skilled Nursing Facilities and Palliative Care Programs).We were informed that as a part of the investigation the Service Chief met with the executive leaders of [redacted] Nursing Facility. Multiple attempts and messages were left for [redacted] and no callbacks were received.Please refer to the chronology of the calls below;•The Center Nurse Executive, Michelle D[redacted], called the office, home and cell phone numbers on file for [redacted] in the afternoon of June 9th. She left a message informing him that we knew of his concerns and wished to discuss them with him to answer any questions he might have, and asked that he return her call.•Michelle D[redacted] called again at 5:40pm on June 9th, and left her cell phone number at that time.•Finally, she called again on June 10th and left another message.•Elliot R[redacted], Center Executive Director also called [redacted] on his cell phone at 8:30pm on June 9th and left a message as well, explaining that we were following up on his concerns regarding his mother's stay at [redacted] Center. Mr. R[redacted] informed him that Michelle D[redacted] had left messages and that if he was willing to speak with us to give her a call on the number she left. Finally Mr. Roth said that if he could not reach Michelle D[redacted] to contact him.I have spoken with Mr. R[redacted] and he still looks forward to the opportunity to talk with [redacted] Please inform [redacted] that he can contact Elliot Roth or Michelle D[redacted] at ###-###-####.If you and/or [redacted] have additional questions regarding this complaint, please contact Ella L[redacted] at ###-###-####.Sincerely,Daisy S.Manager, Appeals and Correspondence

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Thank you for all your help in resolving this matter.
Regards,
[redacted]

July 2, 2015Dear [redacted]:This letter is in response to your inquiry dated June 25, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on June 25, 2015.[redacted] stated that she applied for health...

insurance coverage through the DC Health Link (Exchange). [redacted] requested an effective date of January 1, 2014. She further indicated that the problems began when her dependent son, [redacted], was born on September 26, 2014,She outlined the following issues in her letter;• Her son was erroneously added to her policy from January 1, 2014 through September 25, 2014, prior to his date of birth• After her son's birth he was removed from the policy• When she renewed through DC Health Link for this year (2015), her son was enrolled twicePlease be advised that the Health Plan has reviewed and verified the correct information regarding the dependent son's enrollment. Our records have been updated and adjusted to reflect the correct enrollment period for [redacted] of September 26, 2014 through December 31, 2014 and a current enrollment of January 1, 2015 to date.Additionally, action requests have been submitted for review of the premium account and billing invoices to determine any necessary adjustments.We called [redacted] today to inform her of the actions taken to address and correct this matter and answer any questions for her. Since we were unable to reach her, we left a message for a callback.We regret the circumstances that caused this issue and the inconvenience to [redacted]. If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S.Senior Manager, Member Services