Kaiser Permanente of Colorado

March 10, 2016
*
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11155486
Consumer:                             [redacted]  
Case Opened:                       February
25, 2016
Dear Ms. [redacted],
This is in response to your email received on February 18,
2016, forwarding concerns on behalf of our member, [redacted], regarding
the incorrect premium amount being automatically deducted from his
account.  We value the opportunity to review and respond to their grievance and
apologize for the member’s dissatisfaction.
We have formally documented and shared Mr. [redacted]
concerns with the appropriate Consolidated Service Center/KPIF On-Exchange
Department leadership, to include the overseeing Manager. I am very sorry for
any frustration or inconvenience that may have been caused to Mr. [redacted] by
this overall matter. A case has been posted with Kaiser Permanente’s (KP)
Member Issues Resolution Team (MIRT), as they assist specifically with issues
pertaining to plans purchased through Connect for Health Colorado (C4). Your
plan is currently reflecting as termed on February 29, 2016. MIRT was able to
confirm that our third party billing company (HPS) corrected the member’s
premium amount to the $9.03 that it should be. On March 9, 2016, HPS advised
that they are re-running the bill, which will result in a refund to process for
the member.
I will continue to follow through with MIRT, until the case
has been satisfactorily resolved. Please inform Mr. [redacted] that I am available
to contact personally, should he be seeking an update as to where the refund is
the process. Again, I am very sorry for the continued problems experienced, and
I am also happy to answer any additionally related questions.
The member’s
feedback is essential to our commitment of continuous improvement in delivering
the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to
our members.  Grievances
expressed by our members do not affect their coverage in any way.  If the above noted member is dissatisfied
with the resolution, they have the right to request a second review.  Please have them put the request in writing
to:
Kaiser Permanente
Member Services
2500 South Havana
Street
Aurora,
Colorado  80014
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the
member. 
If the Revdex.com or the member has any questions, please contact me
at [redacted]
Also, you may contact Member Services:
Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call 303-338-3820. 
Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874.  You may also contact our department through
our Web site at kaiserpermanente.org.
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

Complaint: [redacted]
I am rejecting this response because:Yesterday, I was pleased to finally receive my refund check in the mail. Thank you for helping me with that. However, the same day I also received a bill from Kaiser. It seems that after writing my check, they immediately added that amount to my balance rather than subtracting it. I want Kaiser to zero out my balance and send me confirmation immediately that I owe them exactly $0. I would do this through your system except I can't figure out how to reopen my complaint. Attached is a copy of the bill I received. Thank you, [redacted]
Sincerely,
[redacted]

Complaint: 11238060
I am rejecting this response because: My wife and I have been patient from literally 12/16/15; following every step and advice given to us regarding my family and their coverage.  I did not want to accept the response by Kaiser and have this case closed as it is not resolved.  The response is what we have been receiving on all occasions 1/9/16, 1/27/16, 1/29/16, 2/1/16, 2/3/16 again on 2/15/16 and on this date we were given 30 days for resolution.  In notes by [redacted] on 2/15/16 was quoted "we need to get this turned around as this was no fault of your's Mrs. [redacted]".  [redacted] from California Rep for Kaiser took enrollment on 1/27/16 English was very broken heavy Spanish accent, clearly marked the wrong box when the same information had been given to her.  We were directed to enroll directly through Kaiser since the Exchange gave us no tax credit.  We followed advice and are in a worse situation.  My children are without Medical Coverage as I am too.  We don't feel that we need to wait even longer to get coverage.  Kaiser has taken so long that even our Certificates of Coverage are now VOID giving us a break in coverage WAY OVER 60 days from 12/31/15.  This has truly left our family in a detrimental position, causing a hardship emotionally and Financially especially if Kaiser rejects reinstatement.  My wife and I are losing sleep over this, we have never been without coverage in over 28 years.Kaiser on many occasions even reference conversation #S197665933 reassured by filing Grievance we would taken care within 30 days (3/24/16) if not sooner, now we have an even longer extension going into April.  My wife is prepared to pay full premiums dated back to 1/1/2016 to bring us current to meet premium requirements.  My kids need medications and visits, and the Believe Policy makes my family feel like we are in the wrong by the way of treatment rec'd in clinic.  I have a hernia I can't take care of and we have had kaiser for over 26 years.  Please help my family get coverage this is all we are asking, we applied within deadlines and gave payment via Credit Card, and the error was not ours.  We are not asking for extra money or anything just the coverage we applied for and by the advice of Kaiser Reps we got off the Exchange.  Now in worse position.The resolution is simple please reinstate prefer back to 1/1/16 if not as recommended by [redacted] in California 2/1/16.  We feel for some reason we are being discriminated against and our Health Coverage is being held hostage.  This wait is long enough and not good for our health at all costs.
Sincerely,
[redacted]

August 16, 2017
 
                         
[redacted]
[redacted]
[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      09/14/2016
 
Dear [redacted],
 
This is in response to your email received on August 8,2017 forwarding
concerns on behalf of our member; [redacted] regarding his
request for Kaiser Permanente to pay the balance owed on his biopsy completed
on February 24, 2016 at [redacted] We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
Research confirms a check in the amount of $1,055.94 was
issued to the provider ([redacted]) on October 12,2016. The check cleared our bank on
October 18,2016. The check number is [redacted]. The check was mailed to: [redacted] 
 
I have requested a copy of the front and back of the check
and will provide it to [redacted] for the provider to research and apply the payment
to the members account.
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
[redacted]
[redacted]

October 18, 2016[redacted]Dispute Resolution SpecialistDenver/Boulder Revdex.com[redacted]
[redacted]Complaint Case # [redacted]Consumer: [redacted]Case Opened: October 5, 2016Dear [redacted],This is in response to your email received on October 5, 2016, forwarding concerns on...

behalf of our member, [redacted], regarding a request for refund of health plan premiums paid after the Kaiser Permanente health plan coverage terminated. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.[redacted] explained that his last day of Kaiser Permanente health plan coverage was July 31, 2016. Although he was informed that the August premium would not be deducted through auto-payment, $407.83 was deducted. [redacted] states he has called multiple times requesting the refund. Each time an inquiry was made, different explanations were provided as to the time frame of when the refund could be expected.We have formally documented and shared [redacted]’s concerns with the appropriate leadership of our Member Issue Resolution Team (MIRT), to include the Vice President. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration and hardship that may have been caused by this overall matter.I additionally forwarded [redacted]’s refund request to MIRT, as they specifically address issues related to health plans purchased through Connect for Health Colorado. On October 17, 2016, the MIRT Business Analyst was able to confirm the total refund due of $407.83. The refund is in process and is estimated to be issued in the next one to three business days. I will continue to monitor [redacted]’s account to ensure the refund is issued.Please ask [redacted] to review the response and contact me directly if he has any related questions. Again, please express my sincere apologies for the conflicting information when contacting Kaiser Permanente and hardship [redacted] endured.The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care. Our goal is to deliver excellent service to our members. Grievances expressed by our members do not affect their coverage in any way. If the above noted member is dissatisfied with the resolution, they have the right to request a second review. Please have them put the request in writing to:Kaiser PermanenteMember Services[redacted]
[redacted]Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member.If the Revdex.com or the member has any questions, please contact me at [redacted].Also, you may contact Member Services:Denver/Boulder members may call [redacted], toll free at [redacted], between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted].Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted]. You may also contact our department through our Web site at kaiserpermanente.org.Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.Sincerely,[redacted]Complex Case Resolution SpecialistCustomer Experience

June 28, 2017
                         ...


                         
[redacted]      
[redacted]
                                  
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      06/12/2017
 
Dear [redacted],
 
This is in response to your email received on June 15, 2017 forwarding
concerns on behalf of member; [redacted] regarding his request
for Kaiser Permanente to apply his premium payments to his account correctly. We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
We have formally documented and shared [redacted] grievance
with the appropriate leadership.
 
Based on review, a one-time service gesture
will be honored and the member’s health plan has been reinstated.  The health plan is effective January 1, 2017
to current and there are no gaps in coverage. 
Additionally, Kaiser Permanente will honor a one-time service gesture
and [redacted]’s June premium amount of $586.22 has been adjusted off his account.
 
We confirmed a payment of $586.22 was
received in Kaiser Permanente’s Patient Financial Services Department on May
23, 2017, and another payment of $845.56 was received on June 6, 2017.  [redacted]’s medical services account had a
balance of $845.56 due and the June 6, 2017, payment covered the
cost-share.  The $586.22 payment will be
transferred to [redacted]’s premium account for July’s premium and the account
will be paid through July 30, 2017.
 
Enclosed please find the past-due notice
mailed to [redacted]’s current address on May 6, 2017.
 
Please note, premium payments may be mailed
to:
 
[redacted]
 
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]

Complaint: [redacted]
I am rejecting this response because: THIS WAS THE 2ND TIME I WAS TOLD I WOULD RECEIVE MY REFUND IN 72 HOURS, 1ST TIME I WAITED THREE WEEKS UNTIL I SENT IN ANOTHER COMPLAINT, THIS TIME IT SHOULD HAVE BEEN HERE BY TUES SEPT 13TH AT THEE LASTEST BUT I DID NOT RECEIVE UNTILL THURS SEPT 15TH.KAISER HAS NEVER DONE WHAT THEY SAY THEY WILL DO. I HAVE BEEN DEALING WITH THIS SINCE MARCH!! ME SENDING MY PAYMENT THEM SENDING IT BACK DUETO 2 ACCOUNTS NONE OF WHICH WAS MY FAULT, HAVING TO CALL EVERY MONTH SPENDING HOURS YES HOURS ON THE PHONE ON HOLD WHILE THEY ARE WORKINGON IT AND THEM TELLING ME YA I THINK WE GOT IT AND WE WILL CALL YOU BACK  TOMMOROW WHEN WE KNOW FOR SURE AND NEVER RECEIVING A CALL BACK,NEVER EVER DID THEY CALL BACK MONTH AFTER MONTH. REMEMBER NONE OF THIS WAS CAUSED BY ME! BUT I PAID THE PRICE. ONE TIME YOU PULLED OUT$1294.80 OUT OF MY CHECKING ACCOUNT ON JULY 12 TH WITHOUT TELLING ME WHEN I WAS PAID IN FULL!!! COME ON REALLY! I HAD TO SCRAMBLE TO COME UPWITH MONEY TO COVER THIS MONEY SO I DIDNT BOUNCE CHECKS, REMEMBER I DIDNT GET THIS MONEY BACK UNTIL 9/15/16. AGAIN NONE OF THIS WAS MY FAULT!! I SHOULD AT THE VERY LEAST GET ONE MONTH OF MY PREMIUM  FREE FOR ALL THIS COMPANY HAS PUT ME THROUGH. PLEASE RESPOND WITH AN ANSWER FOR THIS COMPCATION I DONT FEEL I AM ASKING TO MUCH!!  COVER THIS THEN IT TOOK UNTIL 
Sincerely,
[redacted]

April 26, 2016
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11401135
Consumer:                             [redacted]
Case Opened:                       April
19, 2016
Dear Ms. [redacted],
This is in response to your email received on April 21, 2016,
forwarding concerns on behalf of our former member, [redacted]. Mr. [redacted] wife,
[redacted] submitted an email explaining that they her husband is being billed by a
collections agency for date of service September 10, 2015. She disagrees with
the charge, being that the copay was paid at the time of service. Additionally,
a general bill or past due notice was never received prior to the collections
letter.
We value the
opportunity to review and respond to this matter and apologize for their
overall dissatisfaction. I’ve outreached the Kaiser Permanente (KP) Patient
Financial Services Department for further research and clarification of the
collections bill. I’ve been advised that the $40 copay was paid for Mr. [redacted] September 10, 2015 office visit with [redacted], PA., at Westminster
Family Practice. The member had an x-ray following that visit, which billed out
for $56.17. Per the member’s Evidence of Coverage, the x-ray was billed
appropriately towards the plan deductible:
DEDUCTIBLES
The
following Deductibles apply under your plan:
Embedded
Medical Deductible:
$500/Individual
per year
$1,500/Family
per year
Does not
apply to Out-of-Pocket Maximum
X-ray,
Laboratory and Special Procedures You Pay
Diagnostic
and therapeutic X-rays
(Subject to
medical Deductible; Applies to Out-of-Pocket Maximum)
30%
Coinsurance
The bill is documented as having been mailed to the address
we have on file for the member from his group plan employer:
613 WCR 53
Kennesburg, CO 80643
Our Health Connect system shows the member’s address as
being in Fort Lupton, which is a system that can be changed by KP staff.
However, our Membership Administration system shows the Keenesburg address, and
this information can only be changed by the submitted request from the group
plan employer.
I am very sorry for any frustration that may have been
caused to the member and his wife by this overall matter. Please encourage them
to contact me directly, should they have any additionally related questions.
Sincerely,
[redacted]
[redacted]
Complex Case
Resolution Specialist
Member
Experience

August 22, 2017
 
                         
[redacted]...

[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                         [redacted]
Case Opened:                     08/13/2017
 
Dear [redacted],
 
This is in response to your email received on August 14, 2017
forwarding concerns on behalf of our member; [redacted] regarding her request
for an adjustment on her account in the amount of $334.62. We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction.
 
We have formally documented and shared [redacted]’s grievance
with the appropriate leadership.
 
Research indicates that [redacted] was billed $334.62 for non-preventive
services including diagnostic labs and X-ray’s ordered for a specific symptom
and or diagnosis, on July 12, 2017 at the [redacted] Medical Offices.  The preventive labs she also had were all processed
appropriately with no cost-share. The amount of $334.62, [redacted]’s
responsibility, was appropriately applied as her member cost-share, per her Deductible Health Maintenance Organization
(DHMO) health plan.
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at [redacted].
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]

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. I will submit the requested written account to the address KP provided.
Sincerely,
[redacted]

Initial Business Response /* (1000, 5, 2015/08/28) */

August 28, 2015
[redacted]
Trade Practices & Helpline Specialist
[redacted]@denver.Revdex.com.org
XXX XXX-XXXX
XXX XXX-XXXXFax
Complaint Case # XXXXXXXX
Consumer: [redacted]
Case Opened: August 20,...

2015
Dear Ms. [redacted]
This is in response to your email received on August 20, 2015, forwarding concerns on behalf of our member; [redacted], regarding his July 8, 2015 [redacted] Saint [redacted]'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction.
We have formally documented and shared Mr. [redacted]'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. I have also reached out to St. [redacted]'s Patient Representative requesting additional research and feedback.
The KP MFC department does not have any documentation of Mr. [redacted] requesting/receiving a cost estimate for his July 8, 2015 procedure, nor do they have an employee by the name of [redacted]. I was also informed that, per MFC protocol, the member would've been advised to contact the hospital in which the procedure would be performed for any requested cost estimates.
The St. [redacted]'s Patient Representative put me in contact with their Medical Financial Counseling Supervisor, though she was also not able to locate any documentation of a cost estimate being provided. She did confirm, however, that St. [redacted]'s does typically contact patients prior to a scheduled hospital visit. The Supervisor also stated that Mr. [redacted] was initially checked in for his procedure as "inpatient" surgery; inpatient surgery falls under the $500/day member benefit. The procedure type changed to "outpatient", which she explained is usually due to coding changes prompted by physician driven orders. Outpatient falls under the 30% member responsibility benefit.
The member disputed July 8, 2015, Exempla Saint [redacted] procedure costs incurred were appropriately billed in accordance to the member's Evidence of Coverage (EOC), and I am unable to honor the member's monetary request. Please sincerely apologize to Mr. [redacted] on behalf of KP, as it is disappointing to have a valued member express frustration. The St. [redacted]'s MFC Supervisor provided me with the following contact, should Mr. [redacted] choose to further discuss this perceived cost misinformation issue or any additional concerns relative to this case:
Rose Bonet (Director of Patient Access-Exempla St. [redacted]'s)
(XXX) XXX-XXXX
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care. Our goal is to deliver excellent service to our members. Grievances expressed by our members do not affect their coverage in any way. If the above noted member is dissatisfied with the resolution, they have the right to request a second review. Please have them put the request in writing to:
Kaiser Permanente
Member Services
[redacted]
Aurora, Colorado XXXXX
Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member.
If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX.
Also, you may contact Member Services:
Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX.
Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXX. You may also contact our department through our Web site at kaiserpermanente.org.
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (3000, 7, 2015/09/12) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Changing coding and verbiage of said stay overnight in the hospital after I was quoted a specific price in order to up charge the patient us very close to being illegal. This is what is referred to as a shell. Stating one thing to make a qualified decision and to budget for a procedure only to be lied to, cheated and over charged is unacceptable in any business, but in the new universal healthcare world is a crime.
Final Business Response /* (4000, 9, 2015/09/17) */
September 17, 2015
[redacted]
Trade Practices & Helpline Specialist
[redacted]@denver.Revdex.com.org
XXX XXX-XXXX
XXX XXX-XXXXFax
Complaint Case # XXXXXXXX
Consumer: [redacted]
Case Opened: August 20, 2015
Dear Ms. [redacted]
This is in response to your email received on September 15,2015 forwarding the rebuttal to our original response provided on August 28,2015 on behalf of our member; [redacted], regarding his July 8, 2015 Exempla Saint [redacted]'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction.
We regret his continued dissatisfaction. However, Mr.Bishcoff request for review of these concerns was completed on July 27, 2015 and again on August 28, 2015 when a final resolution was rendered. Therefore, he has exhausted all internal grievance options offered by Kaiser Permanente.
However, we have formally documented and shared Mr. [redacted]'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. In addition we had all calls that were made to our Member Services Department pulled and reviewed. The call completed by Mr.Bishcoff on July 6, 2015 at 8:46am was to cancel an appointment. The member did not discuss or request any cost estimates in regards to any upcoming procedures.
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case Resolution Specialist
Member Experience Department
Kaiser Foundation Health Plan of Colorado
Final Consumer Response /* (4200, 11, 2015/09/18) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The call on July 6 was NOT TO CANCEL AN APPOINTMENT. Kaiser is not telling the truth and will now cause me financial distress withhold get to declare bankruptcy due to you not honoring your price quote on July 6, 2016 in the afternoon. Not in the morning. I have repeatedly ask you to honor your quote and you repeatedly lie about the quote. How would I know all these details if I did not call? This is just a shame in the way you treat your members. I have not exhausted all my requests to remedy this matter because I was given the opportunity to appeal the August 28. 2015 decision which I sent a certified letter to the department, so that would be yet another questionable statement by Kaiser. Thank you Kaiser for taking care of your patients with such care.

October
2, 2017
 
                         
[redacted]
[redacted]
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                         [redacted]
Case Opened:                     09/18/2017
 
Dear Mr. [redacted],
 
This is in response to your email received on September 18,
2017 forwarding concerns on behalf of [redacted] regarding charges $2040.92
billed to [redacted] for emergency he treatment received on June 18, 2017. We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
We have formally documented and shared [redacted]’s grievance
with the appropriate leadership.
 
Research indicates the claims received from [redacted]
Medical Center, and Carepoint Emergency Medicine was appropriately denied for
service date June 18, 2017.
 
Mr.
Jensen, was seen and treated on June 18, 2017, at [redacted] Medical Center,
Emergency Department.  The claims received
for the services were appropriately denied because [redacted]’s coverage with Kaiser
Permanente, terminated May 31, 2017. Feedback received from the Policy
& Contract Administration Department, confirms that there is no coverage
available to the member past their disenrollment date.  [redacted]’s new coverage would be
responsible for the ER visit and they would need to give authorization for any
follow up visits he would want/need with a Kaiser Permanent’s Colorado Physician
Medical Group physician.
 
In addition, emergency room services would not fall under
the scope of a post-operative visit.  Kaiser
Permanente cannot honor [redacted]’s request to cover service date June 18,
2017. [redacted] will need to supply the treating providers with his new
carrier information.
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at [redacted].
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
[redacted]
[redacted]

Complaint: [redacted]
I am rejecting this response because: I appreciate the timely response from Kaiser Permanente and am not surprised with the lack of resolution.  I would like to make clear that we have been with Kaiser Permanente for several years and am only a new member because your organization mandated it.  We had our coverage dropped when Obama Care became active and were told we had to get coverage through Connect for Colorado.  Kaiser Permanente would not honor our current coverage and would not let us go through them to get a plan.  Going through Connect for Colorado started our account which made us a new member.  We changed our plan last year through Connect for Colorado which again started a new plan.  The first year of billing with Obama Care was a complete mess but we were patient.  However with the beginning of the new year, Kaiser Permanente changed their billing practices in which you had to pay a month ahead as opposed to having the payment by the last of the month.  Again I am aware I was a little late on the payment but a letter 30 days prior with no subsequent reminder, the payment got overlooked.  I was trying to make the account current with a payment but was told my family could not be reinstated, all this for a one late payment.  My family is now unable to get health care coverage until open enrollment for Obama Care in November.  I am extremely disappointed by how this situation is being handled and wanted to make clear that we are not new members, we have been members for many years.
Sincerely,
[redacted]

April 2, 2016
[redacted]
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               11238060
Consumer:                            [redacted] 
Case Opened:                      March
16, 2016
Dear Ms. [redacted],
This is in response to your email received on April 1, 2016,
forwarding the rebuttal to our original response provided on April 1, 2016, on behalf of our member, [redacted]. The member is seeking an immediate
decision from Kaiser Permanente (KP), as to whether his 2016 healthcare plan
reinstatement request will be honored.
We value the opportunity
to review and respond to their grievance and apologize for the member’s
dissatisfaction.
The KP Membership Administration has now been able to review
the retrieved call recording, between the member and KP representative
assisting with the initial 2016 enrollment. The emailed response received from
the Membership Administration Team Lead is as follows:
RE: [redacted]
This request was further reviewed by upper management, and I am
pleased to inform you it was approved. Prospect will have the option to choose:
Open Enrollment, which will
give an effective date of 3/1/16. Requirements: a new completed/ signed
application and binder payment through current month (April)Special Enrollment Period,
with an effective date of 2/1/16: Requirements: a new completed/ signed
application and binder payment through current month (April)Please review with prospect
which options he prefers.   Once a
response is received, we will email you an application and provide you a secure
fax # where the application can be faxed. I have contacted the
member’s wife, [redacted], and communicated this information, and I will be further
assisting the family with the enrollment process. Please thank Mr. and Mrs.
[redacted] for their patience with KP, while we were reviewing/considering the
reinstatement of Louie and his dependents. I am also sincerely sorry for any errors
or misunderstandings that may have been caused this inconvenience to Mr.
[redacted].The member’s
feedback is essential to our commitment of continuous improvement in delivering
the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to
our members.  Grievances
expressed by our members do not affect their coverage in any way.  If the above noted member is dissatisfied
with the resolution, they have the right to request a second review.  Please have them put the request in writing
to:Kaiser PermanenteMember Services 2500 South Havana
StreetAurora,
Colorado  80014Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the
member. 
If the Revdex.com or the member has any questions, please contact me
at ([redacted].
Also, you may contact Member Services:
Denver/Boulder members may call [redacted], toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874.  You may also contact our department through
our Web site at kaiserpermanente.org.
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

August 16, 2017
 
                         
[redacted]
[redacted]
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                         [redacted]
Case Opened:                     08/2/2017
 
Dear [redacted],
 
This is in response to your email received on August, 2017 forwarding
concerns on behalf of our member; [redacted] regarding his
request for reinstatement. We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction.
 
We have formally documented and shared [redacted]’s grievance
with the appropriate leadership.
 
Research indicates that [redacted]’s coverage with Kaiser
Permanente was terminated May 31, 2017 for non-payment. [redacted]’s May premium of $438.50 was
not received until July 05, 2017.
 
Kaiser Permanente has approved [redacted]’s request for
reinstatement.  A reinstatement bill was
mailed to the member on August 11, 2017. 
The total premium payment due is $2192.50 for April through September.  This payment is due by September 11, 2017.
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at [redacted].
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
[redacted]
[redacted]

December 14, 2017                                            [redacted]      
[redacted]
[redacted]
[redacted]                               Complaint Case #               [redacted]                                   ...⇄ Consumer:                         [redacted] M [redacted]Case Opened:                   11/28/2017 Dear Mr. [redacted], This is in response to your email received on December 8, 2017 forwarding concerns on behalf of member; [redacted] M [redacted] regarding his rebuttal regarding Kaiser Permanente (KP) not renewing outside providers for chiropractic care. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction. Based on the review, Mr. [redacted] received a call from the Regional Director of Complementary Medicine Services on Wednesday, December 13, 2017. During the call, Mr. [redacted] scheduled an appointment in the Complementary Medicine (CCM) department. He was provided the CCM direct phone number, the Business Office Assistant's name and the Highlands Ranch medical office address. Mr. Flora expressed he was happy that the CCM chiropractor will be able to view his records and was satisfied with the plan.  If the Revdex.com or the member has any questions, please contact me at ###-###-####. Also, you may contact Member Services:  Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-####.   Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.    Sincerely, [redacted]Complex Case Resolution SpecialistMember Experience

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.
Sincerely,
[redacted]

January 26, 2016
Revdex.com
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11083952
Consumer:                             [redacted]
Case Opened:                       January
12, 2016
Good morning,
This is in response to your email received on January 13,
2016, forwarding concerns on behalf of our member [redacted], regarding
the termination failure of his KPIF/Off-Exchange healthcare plan.  We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
We have formally documented and Mr. [redacted]’s complaint
details with the appropriate Consolidated Service Center/KPIF Membership
Administration Department, to include the overseeing Manager. My sincere
apologies for the frustration Mr. [redacted] has expressed pertaining to the
matter.
The Membership Administration Department has agreed to retro
the health plan cancelation to reflect December 31, 2015. I realize that the
member is seeking a cancelation date of October 31, 2015, as he has been
attempting to cancel for some time now. Though we are unable to locate any
previously submitted cancelation forms, the member has explained to me that he
did in fact fax them to the number that a Kaiser Permanente employee had
provided him with. I am currently in the process of reviewing calls between the
member and the Member Service Contact Center, as well as with the Membership
Administration Department. Should I find any misinformation provided, I will
submit the retro date change request according to the information he was given
and contact him immediately. Again, I am very sorry for this inconvenience, and
Mr. [redacted]’s is encouraged to contact me with any additionally related
questions.
The member’s
feedback is essential to our commitment of continuous improvement in delivering
the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to
our members.  Grievances
expressed by our members do not affect their coverage in any way.  If the above noted member is dissatisfied
with the resolution, they have the right to request a second review.  Please have them put the request in writing
to:
Kaiser Permanente
Member Services
2500 South Havana
Street
Aurora,
Colorado  80014
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the member. 
If the Revdex.com or the member has any questions, please contact me
at ([redacted].
Also, you may contact Member Services:
Denver/Boulder members may call [redacted], toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874.  You may also contact our department through
our Web site at kaiserpermanente.org.
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

March 19, 2016
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11193296
Consumer:                             [redacted]
Case Opened:                       March
9, 2016
Dear Ms. [redacted],
This is in response to your email received on March 10, 2016,
forwarding concerns on behalf of our member, [redacted], pertaining to
her November 12, 2015 inaccurately processed claim.  We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
Ms. [redacted] case was already being worked within the Case
Resolution Team. Therefore, I’ve opened a Second Review of the initial complaint
and have followed through to ensure that the matter was resolved. Ms. [redacted]
concerns were appropriately documented and shared with the Claims Department
leadership and the disputed claim submitted for reprocessing due to the
accumulation discrepancy expressed.
The member has probably already been advised by the Case
Resolution Specialist (CSR) working her initial grievance, that the disputed
2015 claim was in fact reprocessed. Banner Health was consequentially paid for
the November 3, 2015 date of service accordingly.
Please express my sincere apologies to Ms. [redacted] for any
frustration and inconvenience that may have been caused by this overall matter.
Should she have any remaining questions related to the claim situation, please
encourage her to contact the CSR, per the contact information listed on the
response letter provided.
The member’s
feedback is essential to our commitment of continuous improvement in delivering
the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to
our members.  Grievances
expressed by our members do not affect their coverage in any way.  If the above noted member is dissatisfied
with the resolution, they have the right to request a second review.  Please have them put the request in writing
to:
Kaiser Permanente
Member Services
2500 South Havana
Street
Aurora,
Colorado  80014
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the member. 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
Also, you may contact Member Services:
Denver/Boulder members may call [redacted], toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874.  You may also contact our department through
our Web site at kaiserpermanente.org.
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

Initial Business Response /* (1000, 6, 2015/12/02) */
December 2, 2015
[redacted]
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXX
Consumer: [redacted]
Case Opened: November 25,...

2015
Dear Ms. [redacted]
This is in response to your email received on November 26, 2015, forwarding concerns on behalf of our member, [redacted], regarding a disputed December 26, 2015 service charge. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
I confirmed that Ms. [redacted]'s concerns were appropriately documented and shared with Lone Tree Medical Office Obstetrics and Gynecology Department leadership. The member's initial complaint was filed on September 24, 2015, and the notification included the department Chief.
Please apologize to Ms. [redacted] for any miscommunication that may have occurred with the provider at her visit, and ultimately, resulted in a charge for a test that was not related to her clinical care needed. Though the disputed charge was appropriately billed in accordance with the member's Evidence of Coverage, Kaiser Permanente has removed the outstanding balance. As of today, the member's account has a $0 balance. Should there be any additional questions, please do not hesitate to contact me directly.
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care. Our goal is to deliver excellent service to our members. Grievances expressed by our members do not affect their coverage in any way. If the above noted member is dissatisfied with the resolution, they have the right to request a second review. Please have them put the request in writing to:
Kaiser Permanente
Member Services
2500 South Havana Street
Aurora, Colorado XXXXX
Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member.
If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX.
Also, you may contact Member Services:
Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX.
Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXX. You may also contact our department through our Web site at kaiserpermanente.org.
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted] M. [redacted]
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (2000, 8, 2015/12/11) */
(The consumer indicated he/she ACCEPTED the response from the business.)