Kaiser Permanente of Colorado

October 12, 2016
 
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
[redacted]
 
 
Complaint Case #                [redacted]
Consumer:                             [redacted] 
Case Rebuttal Opened:       October
5, 2016
 
 
Dear [redacted],
 
This is in response to your email received on October 5,
2016, forwarding the rebuttal to our original response provided on October 4,
2016, on behalf of our member, [redacted]. The member is advising that Connect for Health Colorado (C4) will not
change his plan term date to July 31, 2016. He is requesting that Kaiser
Permanente (KP) initiate the term date change and immediately refund any monies
due back.
 
We value the
opportunity to review and respond to the grievance. We also apologize for the
member’s dissatisfaction.
 
The Member Issues Resolution Team (MIRT) Business Analyst
working this case has requested an escalated refund in the amount of $665.72,
which is expected to take 3-4 business days. The 7/31/2016 term date request
has been received by C4, and they are submitting the request on their end; the
account will still need to be worked on after the refund for billing and cash
adjustment are complete.
 
Please thank [redacted] for his continued patience. I
also encourage the member to call me directly with any additionally related
questions or for an update on this case.
 
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]
 
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 Specialist
Member
Experience

[redacted]
*
[redacted]       Complaint Case #               [redacted]...

Consumer:                            [redacted]   Case Opened:                      November 9, 2017     Dear Mr. [redacted],   This is in response to your email received on November 10, 2017, forwarding concerns on behalf of our member, [redacted], regarding the lack of communication he has received which has put his credit at risk.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.   Mr. [redacted] explained phone calls would not be returned over the last five months.  Direct calls have not been answered, and when calling the Kaiser Permanente Member Services Contact Center representatives were unfamiliar with the case and unable to assist.   We have formally documented and shared Mr. [redacted]’s concerns with the leadership of Kaiser Permanente’s Case Resolution Department. In speaking with Mr. [redacted] directly, I have had the opportunity to apologize to him for the frustration caused by this overall matter. Mr. [redacted] informed me of billing issues experienced after having a referral for care.  Despite the referral, he has received several bills that were not clear.  Upon contacting the provider of the services, I have requested the account be placed on hold to prevent any collection activity while the bills are being reviewed.  I will continue to work with Mr. [redacted] to resolve the billing concerns he has.       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 [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 ###-###-####.   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 [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 Specialist Customer Experience

January 31,
2017
[redacted]
Member ID
Number: [redacted]
Dear Mr.
[redacted],
Kaiser
Permanente’s Customer Experience Department received your submission to the
Revdex.com on...

January 10, 2017. 
Based on the concerns expressed in your submission, a second review of
your previously filed complaint has been completed. 
I am very
sorry that you have had a frustrating experience with us.  We take your dissatisfaction very seriously
and appreciate being able to review and respond to your concerns. I have reviewed the initial grievance filed
with the Member Services Contact Center on July 28, 2016.  I have confirmed your grievance was
appropriately documented and shared with the appropriate managers and physician
leaders of our program.
On January 20,
2017, Kaiser Permanente’s Membership Administration Department confirmed that Kaiser
Permanente’s membership system has been corrected; [redacted]’s coverage now
reflects active from December 4, 2015. 
An audit of
claims for services [redacted] received in 2015 has also been completed.  Kaiser Permanente’s Claims Department
determined a Health Insurance Claim Form (HICF) was not received from the
provider for services provided to [redacted] by [redacted].  I contacted the provider
requesting this form, and Kaiser Permanente received a HICF on January 27, 2017,
reflecting the appropriate claim information for services provided to Bailed on
December 4, 5, and 6, 2015.  This form
was submitted to the Claims Department for processing.  I will continue to monitor processing and
notify you once completed. 
If you have
any questions or concerns regarding the final decision of this complaint, you
may contact me directly at [redacted].  In the event you have a new concern, please
contact the Member Services Department at [redacted]
or toll free at [redacted].  Deaf, hard of hearing, or speech impaired
people who use a TTY may call [redacted].
Sincerely,
[redacted]
Kaiser
Foundation Health Plan of Colorado

Revdex.com:
At this time, 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]

Initial Business Response /[redacted]/

June 18, 2015
Ms. [redacted] Adams
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: [redacted], [redacted]
Case Opened: 06/05/2015
Dear Ms....

Adams,
This is in response to your email received on June 05, 2015, forwarding concerns on behalf of our member; [redacted], regarding his wife's medical needs. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
I contacted Mr. [redacted]'s wife directly, as we are unable to file complaints or work complaints through a spouse, without written consent of the member. I spoke to Emily [redacted] regarding her experience and the complaint filed by her husband.
Mrs. [redacted] confirmed that she was able to obtain an earlier appointment and that she has received the injection for her back pain. She states she is feeling better and that she is unsure of what steps to take next.
We spoke a while about being her own best advocate for her care and that if she is ever uncomfortable with a suggestion made by a physician, she always has the right to a second opinion. I encouraged Mrs. [redacted] to touch base with her Primary Care Physician about some of her concerns and see if they have any suggestions. I also told her that the kp.org website is useful to email her doctors with any questions or concerns. I told her that I was troubled that she felt she had to become a different person, become rude, to obtain assistance. We talked about what it means to advocate for her best interests and how important it was to communicate with her doctors. I also informed her that if she ever has a poor experience with a department at Kaiser Permanente or a physician, that she can file a complaint directly with the Member Services Department by phone (XXX-XXX-XXXX) or through the kp.org website.
I asked if Mrs. [redacted] would like to proceed with a formal complaint against the Neurosurgery Department regarding the difficulty obtaining appointments, and she said she did not want to file a complaint. I apologized for the frustrations and I informed her that when she files a complaint directly with Member Services, that the Case Resolution Department has a staff of physicians and nurses who assist with trying to get earlier appointments and address medical concerns.
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate [redacted] 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,
Tina K.C. Kimpo
Complex Case Resolution Specialist
Member Experience

October 27, 2016[redacted]Trade Practice SpecialistDenver/Boulder Revdex.com[redacted]
[redacted]Complaint Case # [redacted]Consumer: [redacted] Case Rebuttal Opened: October 5, 2016Dear [redacted],This is in response to your email received on October 5, 2016, forwarding the 2nd rebuttal to our response provided on October 4, 2016, on behalf of our member, [redacted]. The member advised that he finally received his awaited premium refund. However, [redacted] received an invoice showing the amount refunded as again due, and he is requesting immediate confirmation that the remaining balance is $0.We value the opportunity to review and respond to the grievance. We also apologize for the member’s dissatisfaction.As of October 21, 2016, the Member Issues Resolution Team (MIRT) Business Analyst working this case confirmed that the November invoice should be disregarded, as the billing/cash adjustment applied after the invoice was mailed to [redacted]. The net balance due was a $1.80 service fee which was reversed.Please ask the member to keep this letter as documentation that the July 31, 2016 termed plan remains at a $0 balance due. MIRT advised that our third party billing, HPS, will mail a final invoice within 2 weeks after completing the $1.80 adjustment within their system; an invoice cannot be processed any sooner.Please apologize to [redacted] for the frustration experienced throughout this matter, as well as thank him for his continued patience. Should there be any additionally related questions, I may be contacted directly at (303) 338-3073. 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]

Revdex.com:The address change was  submitted months prior on occasions.  At the time of notice from Collections, the employer was no longer allowed access to the site to change the address.A breakdown of the billing would have solved all before sending to collections.  The balance will be paid to Kaiser. 
I have reviewed the response made by the business in reference to complaint ID 11401135, and find that this resolution is satisfactory to me.
Sincerely,
[redacted]
*

May 1, 2017
 
[redacted]
[redacted]
[redacted]
[redacted]
 
 
 
Complaint Case...

#                [redacted]
Consumer:                             [redacted]  
Case Opened:                       April
3, 2017
 
 
Dear Mr. [redacted]
 
This is in response to your email received May 1, 2017
advising that a reply email had not yet been received regarding our member,
[redacted], and his concerns submitted to the Revdex.com on April 3, 2017. Unfortunately, we haven’t any record
of receiving the previous Revdex.com due to changes in our notification preferences
that we were not aware of. We have since confirmed with you that our preference
has been changed back to email format. We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
 
Mr. [redacted] is
requesting reinstatement in his 2017 healthcare plan purchased through [redacted] ([redacted]), due to his auto-payment unknowingly discontinuing.
We have formally documented and shared Mr. [redacted]’s concerns with the
appropriate Consolidated Service Center/On-Exchange Issues Department leadership,
to include the Department Manager. Please apologize to the member for any
experienced frustration, on behalf of Kaiser Permanente (KP), by this issue in
which I’ve additionally assisted him with. Our Membership Administration Case
Excellence (MACE) team assists with issues specific to plans purchased through
[redacted] ([redacted]). They had previously concluded their
research with the decision that Mr. [redacted]s plan reinstatement request would
not be honored. However, almost immediately upon receiving my response letter,
Mr. [redacted] contacted me via telephone confused about the letter details
conflicting with his reinstated status; he had received a premium invoice and
was able to utilize services on his KP.Org account. I confirmed in our
membership system that Mr. [redacted] was in fact reflecting to be reinstated
for 2014 without a break in coverage and immediately outreached the MACE
Analyst whom assisted previously for an explanation. Additionally, I again
requested that we reconsider the decision pertaining to Mr. [redacted]’s
request, especially due to the current eligibility status showing in our
systems. The MACE Analyst researched what occurred and advised that a different
KP department had also submitted a reinstatement request on behalf of Mr.
[redacted], and that request was approved.
 
I contacted Mr. [redacted] via telephone on May 1, 2017,
apologizing again for this overall scenario, advised that the reinstatement has
been completed, and assured that MACE would ensure that no further
communication was needed with [redacted]. I also asked Mr. [redacted] to contact me
directly should any additionally related issues arise.
 
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
[redacted]
[redacted]
[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:
 
[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 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]
[redacted]
[redacted]

July 10, 2017
                         ...


                         
[redacted]      
[redacted]
[redacted]
[redacted]
                                  
 
Complaint Case #              [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      07/06/2017
 
Dear [redacted],
 
This is in response to your email received on July 6, 2017 forwarding
concerns on behalf of member; [redacted] regarding his
request for Kaiser Permanente to reinstate his health plan. 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. Peelgrane grievance
with the appropriate leadership.
 
Based on review Membership Management has
approved reinstatement. Member's health plan was reinstated with no gaps in
coverage. A reinstatement bill and EFT form were sent to the address on file.
Member must pay $1216.24 before August 10, 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 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]

February 21,
2017
 
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
 
Complaint
Case #              ...

[redacted]
Consumer:                            [redacted]  
Case Opened:                      February 20, 201
 
Dear Ms. [redacted],
 
This is in
response to your email received on February 21, 2017, forwarding concerns on
behalf of our previous member, [redacted], regarding a disputed 2013 claim.
We value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
 
Ms. [redacted]
states that she is being billed for her December 13, 2013 through December 21,
2013 hospital stay, which had already been preauthorized and claims paid. Ms.
[redacted] is requesting that Kaiser Permanente (KP) pay the claims per her health
benefits at the time of service.
 
Ms. [redacted]’s
concerns have been appropriately documented and shared with the Claims Department
leadership, to include the Sr. Manager. Please apologize to the member, on
behalf of Kaiser Permanente (KP), for any frustration that may have been caused
by this overall matter.
 
We were able to
confirm that the disputed claim ([redacted]) was submitted to KP on
December 31, 2013 and paid correctly, per the health insurance we had on file.
Ms. [redacted]’s coordination of benefits was changed in our system on August 24,
2016, reflecting that [redacted] was her primary insurance during the
disputed December 13, 2013 date of service; payment from KP as the primary
insurance carrier was rescinded, as KP was the secondary insurance and the
$48.786.18 was the Allowed/Total Not Covered amount. The provider billed the
member’s primary insurance, and they denied the claim due to timely filing. The
member submitted the [redacted] denial to KP, which KP would not agree to
pay.
 
Ms. [redacted] was
responsible for providing the hospital/provider with her complete health
insurance information. She will need to contact the billing provider to prove
that she did in fact provide them with both her [redacted] primary
insurance and KP secondary insurance information needed for accurate billing
purposes – and within the time frame necessary (timely filing) for them to
appropriately bill [redacted].
 
I am sincerely
sorry that KP is unable to further assist Ms. [redacted] with this claims issue. She
will need to communicate with the billing provider to see how they would be
able to additionally assist her or the next step she needs to take with them in
this claim dispute.
 
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]
[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 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. 
 
[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 had a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
Sincerely,
 
[redacted]
[redacted]
Member
Experience




















 
 
 


 
Tell us why here...

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, under the condition that I be notified when they have completed processing the claim with their Claims Department. If I do not receive a notification that this claim has been successfully completed, I will reject the response because this is the same step we have been working on for months.
Sincerely,
[redacted]

August 31, 2016
 
                         
[redacted]
Revdex.com Serving Denver/Boulder
[redacted]...

[redacted]
 
 
Complaint Case #               [redacted]
Consumer:                            [redacted]
Case Opened:                      8/17/2016
 
 
Dear Mr[redacted],
 
This is in response to your email received on August 18, 2016 forwarding concerns on behalf of our member; [redacted] regarding her request to have a refund for $1200.00 for premium payment that was deducted from her 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 [redacted] grievance with the appropriate leadership.
 
Research indicates the correct refund amount based on premiums due verses premiums paid is ($777.70). A request was processed and the member should have her the fund returned to her in 72 hours based on her financial institutions posting policies. Please note the members’ 2016 policy currently has a correct balance due of $258.60.
 
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 [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]
Complex Case Resolution Specialist
Member Experience

January 29, 2018 [redacted]Revdex.com Serving Denver/Boulder 3801 E. Florida Ave., Ste.350 Denver, Colorado 80210Complaint Case #     [redacted] Consumer: [redacted]Case Opened: 1/19/2018Dear Mr. [redacted],This is in response to your email received on January 24, 2018, forwarding continued concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted], or [redacted] in Aurora, Colorado. 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] grievance with the appropriate leadership. Our Provider Relations Department has confirmed that there are two contracted physicians in the Southern Colorado region that are both Hepatology Specialist and treat PSC.  In addition, Children's Hospital will not start treatment for patients Mr. [redacted] age and would refer to adult hepatology.Mr. [redacted] rebuttal received on January 24, 2018 was submitted and accepted with Kaiser Permanente’s Member Appeals Department. On January 25, 2018, the Member Appeals Department sent Mr. [redacted] a written request for copies of his medicals records. An Authorization to Release Medical Records form was attached and must be completed and signed in order for us to obtain those records. The authorization form must be signed and dated by Mr. [redacted] or his authorized representative.  With this request Mr. [redacted]’s was also provided with his Member Appeals Analyst contact information for questions as it relates to his appeal.  Mr. [redacted]’s will receive separate correspondence with the decision of his appeal which will include the next steps if the decision is not in his favor. If the Revdex.com or the member has any questions, please contact me at (303) 338-3827.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,Suda P[redacted]Complex Case Resolution SpecialistMember Experience

January 23, 2018                           [redacted]Revdex.com Serving Denver/Boulder 3801 E. Florida Ave., Ste.350 Denver, Colorado...

80210  Complaint Case #[redacted]                                  �...⇄ Consumer:           [redacted]Case Opened:       1/19/2018 Dear Mr. [redacted], This is in response to your email received on January 19, 2018, forwarding concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted], or [redacted] in Aurora, Colorado. 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] grievance with the appropriate leadership.  Mr. [redacted] request for authorization to see a specialist at [redacted] in Aurora, Colorado for a second opinion was denied because services are available with a contracted Southern Colorado Kaiser Permanente provider. In addition, a new denial letter was generated on January 23, 2018 to reflect the correct diagnosis for this request. Mr. [redacted] appeal rights have been provided in the denial letter. Mr. [redacted] may appeal this decision in writing by sending his request to:Appeals ProgramKaiser PermanenteP.O. Box 378066Denver, CO 80237-8066Or you can fax the letter to:  1-866-466-4042  If the Revdex.com or the member has any questions, please contact me at (303) 338-3827. 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, Suda P[redacted]Complex Case Resolution SpecialistMember Experience

Complaint: [redacted]
I am rejecting this response because: I have to include actual information from the PSC Foundation.  Again, you note Kaiser failed to actually name a single provider specifically.  That is because, one of the only appropriate and listed PSC treatment facility, is [redacted] as my Kaiser primary originally referred me.[redacted] of Colorado Health Sciences Center, DenverPlease note, I do not feel well and ask that this complaint serve as an example for others with PSC.  Again, all my treatment providers have been in Denver.  Kaiser requires me to go to Denver for even basic care.  I am not certain who Kaiser is attempting to refer me to, since they refuse to identify the provider they say is a PSC specialist, but I must again state that the PSC Foundation clearly identifies only 2 places in Colorado.  [redacted] and [redacted] both in Denver.  I ask that I get to see the PSC specialist soon.  As the PSC foundation notes, those of us with PSC must be persistent in advocating for care.  Kaiser needs to support those of us with this rare disorder.  Thanks for your time and attention. ------------------------------------PLEASE READ THIS INFORMATIONFIND A SPECIALISTBecause PSC is a rare disease, most family and internal medicine physicians do not see or treat many patients with the condition. Indeed, you may be misdiagnosed at first, even by a gastroenterologist, as most do not have expertise in PSC. Many PSC Partners Seeking a Cure members report having been told their symptoms were “in their head” and/or that they had other digestive diseases until the diagnosis of PSC was ultimately confirmed. Our members have had to educate themselves and sometimes their doctors about PSC. They and caregivers have had to be persistent in advocating for themselves.Major PSC research centers in North America are listed below.  In contacting one of these PSC research centers, or any medical facility, it is important to recognize that not all clinicians will have substantive knowledge of PSC. Accordingly, and to the extent possible, individuals contacting these centers should specifically look for and request providers/hepatologists who have a dedicated interest and expertise in PSC. Adult [redacted]
[redacted]
[redacted]
[redacted]
[redacted] of Colorado Health Sciences Center, Denver [redacted]
[redacted]
[redacted]
 Sincerely,[redacted]

Dear [redacted],
 
This is in response to your email received on July 18, 2016,
forwarding concerns on behalf of our member, [redacted], regarding an incorrect
bill for services and difficulty in having the...

issue resolved with Kaiser
Permanente.  We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
 
Mr. [redacted]
explained he is continually receiving a bill from Kaiser Permanente in the
amount of $20 for services rendered on June 13, 2016.  Mr. [redacted] states he has already paid the
$20 and when attempting to have the charge removed from his account, Kaiser
Permanente staff have not been helpful.
 
We have formally documented and shared [redacted]’s concerns
with the appropriate leadership, to include the Patient Financial Services Department
supervisor. Please apologize to the member, on behalf of Kaiser Permanente
(KP), for any frustration that may have been caused by this overall matter.
 
Additionally, review
confirms the June payment of $20 was received by Mr. [redacted] and funds were not
posted appropriately to his account.  Mr.
[redacted]’s account has been corrected and he will no longer receive invoices for
the $20 charge.
 
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:
 
[redacted]
[redacted]
[redacted]
[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 ###-###-####.
 
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 [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 Specialist
Customer
Experience

December 13, 2016[redacted]
[redacted]
[redacted]
[redacted]
[redacted]Complaint Case #           [redacted]Consumer: [redacted]   Case Opened: December 9, 2016 Dear [redacted],This is in response to your...

email received on December 9, 2016, forwarding concerns on behalf of our member, [redacted], regarding his daughter’s referral to a specialist.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Although [redacted] has signed paperwork allowing communication with Mr. Owens, the Case Resolution Department must receive an Appointment of Representative.  The member and the appointed representative must both sign an Appointment of Representative form or submit equivalent documentation, before we can proceed with this request.  The Appointment of Representative form has been sent to Mr. Owens to complete at his earliest convenience.  If we do not receive the Appointment of Representative form or equivalent documentation within 30 days, we will close this request.  Once we receive the Appointment of Representative form or equivalent documentation, we will start processing the request within the timeframe set out by federal regulations. 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

September 29, 2016
 
                         
[redacted]
[redacted]
[redacted]
[redacted]...

[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:          [redacted]
Case Opened:        [redacted]
 
Dear [redacted],
 
This is in response to your email received on September 15, 2016 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.
 
We have formally documented and shared [redacted] grievance with the appropriate leadership.
 
The member states that if he had the procedure completed within the Kaiser Permanente network, his out of pocket costs would have been approximately $2,790.00. The member at the time of services was on a DHMO plan with a $500/Individual deducible and a 20% Coinsurance for Outpatient surgery at designated outpatient facilities (Subject to medical Deductible; Applies to Out-of-Pocket Maximum).
 
The review of the charges are as follows for [redacted]
Facility charges:    $3,186.20
             $474.15- Deducible
             $2,712.05- Co-insurance
Professional charges: $659.74
                                 $13.56 Deducible
                                 $646.18- Co-insurance
I have contacted [redacted] Patient Account Services and has confirmed the member currently has an outstanding balance of $2,686.20. The member has made a $500.00 payment.
 
 
 
 
 
The leadership as agreed to pay the difference between his charges for the outside provider and his quoted $2,790.00. I will issue a payment directly to [redacted] in the amount of $1,055.94. This is a onetime only good will gesture.
 
The member was advised on the referral letter that was mailed on February 22, 2016 the following information:
 
You are responsible for payment of the applicable copayment(s) or coinsurance. Please refer to your Evidence of Coverage, Plan Document or Federal Employees Health Benefits Program Brochure as it applies to you for how much you pay for services or contact Member Services.
 
 
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]

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. The aforementioned credit has been applied. Thank you for your assistance. 
Sincerely,
[redacted]