Kaiser Permanente of Colorado

March 16, 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 March 15,
2016, forwarding the rebuttal to our original response provided on March 10,
2016, on behalf of our member,
[redacted]. The member is advising that the refund has not yet been
received, as well as requesting that Kaiser Permanente (KP) pay his bank fee
caused by monies we had withdrawn in error.
We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction.
I’ve confirmed with the Member Issues Resolution Team (MIRT)
that the $344.32 refund was corrected by our billing system (HPS) on 3/11/2016.
I have requested that MIRT outreach HPS to inquire as to where in the process
the member’s refund currently is. Mr. [redacted] is welcome to contact me directly
at the bolded phone number listed below for an update.
In regards to the overdraft fee incurred by this issue, I’d
be happy to pay for that. Please request that Mr. [redacted] provide me with proof
that the $12.50 charge was caused when KP deducted the monies from his account.
He can attach it to this case, email it to me directly at [redacted] or fax it to (303)
338-3220.
The member’s communication is appreciated, as it allows us
to try to remedy this entire situation. Please apologize to the member again
for his expressed dissatisfaction and continued inconvenience caused.
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

October 18, 2017                             [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 October 10, 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. The Customer Experience team formally completed [redacted]’s complaint request on September 13,2017. A formal second review of his concerns was then completed on October 2,2017.   Research confirms that the 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, as 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.   There are no further reviews of [redacted]’s request available through Kaiser Permanente. [redacted]’s review rights, both written and verbal, related to this matter have been exhausted.    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.       Sincerely,     [redacted]
[redacted]
[redacted]

May 3, 2017[redacted]...

[redacted]Complaint Case # [redacted]Consumer: [redacted]Case Opened: April 1, 2017 Dear Mr. [redacted],This is in response to your email received on April 27, 2017, forwarding concerns on behalf of our member, [redacted], regarding charges billed of $81.53 for the Bone Density Study completed January 17, 2017, and $175.55 for the ultrasound completed January 26, 2017.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Ms. [redacted]’s spouse has disputed charges as he feels the charges are unwarranted because the services were ordered during Ms. [redacted]’s preventive visit on January 12, 2017.  Mr. [redacted] states services are mandated by law to be provided at no cost to the Health Plan subscriber.  The concerns have been formally documented and shared with the appropriate managers and physician leaders of our program. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. In addition, we have further reviewed Mr. [redacted]’s concerns related to the charges from January 17, 2017 and January 26, 2017.  Kaiser Permanente offers specific preventive tests at no cost to detect certain diseases early.  If the physician orders a test because of an existing health condition, the test is no longer preventive.  The Bone Density Scan was ordered to treat Osteoporosis, as Ms. [redacted] was previously diagnosed.  We are unable to waive the charge of $81.53 billed for the Bone Density Scan.  One mammogram is provided annually at no charge.  We verified an initial screening mammogram was completed January 12, 2017.  No charges were billed for this service based on her preventive benefit.  The tissue density lowered the sensitivity of the mammogram requiring additional evaluation.  A second mammogram exam was completed on January 26, 2017.  We confirmed no charges were billed to Ms. [redacted] for the second mammogram.  The additional mammogram yielded the same result as the first due to the tissue density.  The diagnostic ultrasound was completed to confirm there were no abnormalities.   Kaiser Permanente is offering a one-time service gesture to waive the charges of $175.55 for the ultrasound completed January 26, 2017.  It may take one or more billing cycles for this amount to be adjusted off the account.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]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 [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]Member Experience

May 11, 2017
 
 
[redacted]
 
 
 
Complaint Case #               [redacted]
Consumer:                            [redacted],
[redacted]  
Case Opened:                      April
17, 2017
 
 
Dear Mr. [redacted],
 
This is in response to your email received on May 4, 2017,
forwarding the rebuttal to our original response provided on April 24, 2017, on behalf of, [redacted]. The
member replied stating that he does not accept Kaiser Permanente’s previous
response advising that his requested refund was not honored. Mr. [redacted]
continues to ask that KP refund the premium paid, as one representative
informed that he had 60 days to submit the required documentation reflecting
proof of another health insurance.
 
We value the
opportunity to review and respond to the grievance. We also apologize for the
member’s dissatisfaction.
 
I submitted the details of the 2nd review request
to our Membership Administration Department asking for reconsideration of the
decision made to not refund the premium payment Mr. [redacted] had paid prior to
canceling the plan. After additional review, the requested refund has been
honored. The 2016 plan now reflects in our membership system as cancelled/never
active. Please advise Mr. [redacted] to allow up to 2 weeks for the expedited
refund check in the amount of $1,114.23 to be processed, mailed, and received.
 
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 [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 his patience while resolving this matter. I’d also be happy to
assist Mr. [redacted], should he have any additionally related question/concerns.
 
 
 
Sincerely,
 
[redacted]

August 16, 2017
                         ...


                         
[redacted]      
[redacted]
                                  
 
Complaint Case #              [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      08/10/2017
 
Dear [redacted],
 
This is in response to your email received on August 8, 2017
forwarding concerns on behalf of; [redacted] regarding her
request for Kaiser Permanente to provider her father’s medical records. We value the opportunity to review and respond
to their grievance and apologize for the member’s daughters dissatisfaction.
 
We have formally documented and shared [redacted] grievance
with the appropriate leadership.
 
Based on review, the daughter, [redacted], has
been contacted directly from our Health Information Services release of
information department on several occasions. Each time it has been explained
that the “Collection of Personal Property by Affidavit” will not suffice for
obtaining her father’s medical records.  [redacted] is on the death
certificate as Informant for her mother; however, we have nothing allowing us
to release records for the father.  She has been instructed to go to the
courts and be appointed his personal representative in order to be able to obtain
her father’s medical records. 
 
Kaiser Permanente is unable to release information
without the appropriate required documents.
 
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]

Complaint: 11155486
I am rejecting this response because:I have not received the refund yet. 
Sincerely,
[redacted]

March 7, 2018                           ...

                          [redacted]      
[redacted]
[redacted]
[redacted]                                      Complaint Case #              [redacted]                                   ...⇄ Consumer:                            [redacted] Case Opened:                      02/20/2018   Dear Mr. [redacted],   This is in response to your email received on February 20,2018 forwarding concerns on behalf of member; [redacted] regarding his concern regarding Kaiser Permanente (KP) not providing the correct premium billing statements for 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. [redacted] grievance with the appropriate leadership.   Based on the review, Mr. [redacted]s account was on a Failed bill report the root cause for the member not being billed timely. The system has been addressed and to prevent further issues a new policy was created for the member to speed up the process to resolve the member's issue. I do see that the bill went through smoothly on the new policy for the month of March. I have confirmed that there are no past due letters. And the account has a net due of $0.00 and New policy [redacted]     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 [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

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]

Initial Business Response /* (1000, 6, 2015/11/19) */

November 19, 2015
[redacted]
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: [redacted], [redacted]
Case Opened: November 4,...

2015
Dear Ms. [redacted]
This is in response to your email received on November 4, 2015, forwarding concerns on behalf of our member, [redacted], regarding an awaited healthcare premium refund. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
The member case scenario has been forwarded to our Consolidated Service Center/KPIF Department that assists with issues pertaining to plans purchased through Connect for Health Colorado. The details were thoroughly researched, as to confirm the refund amount due back to Mr. [redacted].
The payment premium calculation confirms that the member is due a refund of $768.39, once the correct termination date is reflected of April 30, 2015. Kaiser Permanente (KP) has submitted to the Connect for Health Colorado vendor that the December 31, 2015 end date be appropriately changed. Once the termination date is corrected, the requested refund will process. Unfortunately, KP is not able to provide a date as to when this will be complete, though I welcome the member to contact me directly for progress updates.
Please apologize to the member for any consequential inconvenience and frustration experienced. Should any related issues or concerns arise pertaining to Mr. [redacted]'s plan, I'd be happy to personally assist, as to avoid continued inconsistent information being provided.
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
[redacted] Street
Aurora, [redacted] 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 /* (3000, 8, 2015/11/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
There is still no resolution in sight. I have been given this answer for months...they admit they owe a refund but give every excuse out there as to why they can't send me a refund. They have been holding onto almost 800 dollars, of my money, for 6 months. Its not theirs and they need to issue the refund check immediately or my next step is to hire an attorney. I've contacted connect for health Colorado on multiple occasions and they have confirmed that they have sent the correct termination date to kaiser months ago.
Final Business Response /* (4000, 10, 2015/12/04) */
December 4, 2015
[redacted]
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
[redacted] Box XXXXX
[redacted] Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: [redacted], [redacted]
Case Opened: November 18, 2015
Dear Ms. [redacted]
This is in response to your email received on November 18, 2015, forwarding the rebuttal to our original, on behalf of our member [redacted]. The member is requesting a more immediate refund of premiums be received.
On December 4, 2015, the Member Issues Resolution Team (MIRT) advised that the Mr. [redacted]'s expected refund will go out early next week. There was a delay with the Kaiser Permanente Finance Department, due to a new procedure being implemented to handle the influx of recent refund requests. Please apologize to the member for the inconvenience experienced, and he is welcome to contact me with any further questions or concerns relating to this matter.
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
[redacted] South [redacted] Street
[redacted] 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

Complaint: 11138497
I am rejecting this response because:Once my premium billing discrepancy is resolved, I will consider the matter closed. Please reference letter dated March 7, 2016. Also, [redacted] birthdate is JUNE 9, 2015. It is not spelled [redacted], and he wasnt born on June 8 2015 (last letter) or September 9, 2016 (this letter). Thanks, 
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.
Sincerely,
[redacted]

November 14, 2016[redacted]Dispute Resolution SpecialistDenver/Boulder Revdex.com[redacted]
[redacted]Complaint Case #           [redacted]Consumer: [redacted]   Case Opened: October 30, 2016 Dear [redacted],This is in response to your...

email received on October 31, 2016, forwarding concerns on behalf of our member, [redacted] regarding the bill she has received for services July 8, 2016.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.[redacted] stated she is being billed for a spirometry that was not completed.  The dealings [redacted] had with the Case Resolution Team have not resulted in the charges being adjusted off her account.We have formally documented and shared [redacted]’s concerns with the appropriate Patient Financial Services leadership, to include the Department Manager.  Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. Additionally, we have communicated with the Nurse Manager of the East Medical Offices Internal Medicine Department.  The Nurse Manager was able to confirm that the physician ordered the spirometry, but it was not completed.  Charges related to the spirometry on July 8, 2016, totaling $113.11 will be adjusted off the account, and no longer be [redacted]’s financial responsibility.  It make take up to two billing cycles for the adjustment to reflect on the bill.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]  [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 ###-###-####, 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 ###-###-####.  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

Complaint: [redacted]
I am rejecting this response because:I DO NOT accept Kaiser's response - because my account is STILL not fixed.  On Kaiser's Web site - it continues to show my policy has been terminated, is past due, my premium payments are NOT appropriately applied, I am receiving frequent "Termination Notices", (falsely stating they are "per my request"), and I have not received billing statements for several months.In addition, today I learned that Kaiser provided false information to [redacted] indicating that my December 2017 was cancelled due to non-payment --> even though I have multiple documents from Kaiser showing full payment and even a certificate of Coverage.  This has resulted in a delay in issuance of my tax forms, thereby further delaying my substantial tax refund.  Kaiser should pay me interest for every day that this tax refund continues to be delayed.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:I feel that if part of the surgery had to be performed again (which it did) I shouldn't be liable for the charges. Also, if a company's employees (more than one) give incorrect information, the customer should not be the one to suffer as a result.
Sincerely,
[redacted]

September 28, 2016
 
                         
[redacted]
Revdex.com Serving Denver/Boulder
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      [redacted]
 
Dear [redacted]
 
This is in response to your email received on September 26,
2016 forwarding concerns on behalf of our member; [redacted] regarding
charges billed to the member for date of service April 19, 2016. 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 a $20 copayment was appropriately applied
to service date April 19, 2016.
 
The member was schedule for an office visit on December 29,
2015 at the Westminster Medical Office, Primary Care Department.  The visit was scheduled for symptoms of a
sinus infection with 20 minutes alloted for the visit.  The member was appropriately billed a $20
office visit copayment per her employer group Health Maintenance Organization (HMO)
health plan. The member was seen at treated on April 19, 2016 for a different
issue and charged appropriately.
 
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

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 never saw any documentation (billing, not just a recap of my annual charges from K/P) showing a credit had been applies to my billing from K/P. I checked my records and I did not receive a billing for date of service June 2017, so it looks like they gave me the refund with out telling me. How was I supposed to know? Thank you for your help in clearing this up.
Sincerely,
[redacted]

Dear [redacted], This is in response to your email received on August 7, 2016, forwarding the rebuttal to our original response provided on August 5, 2016, on behalf of our member, [redacted].  Ms [redacted] brought several points to our attention in her rejection of the response.  ·         Level of care provided by the primary care physician.  o   Tests were ordered that were unnecessary while her primary care physician was out of the office. o   Ms. [redacted] states it is her choice whether to complete tests ordered by physicians as no medical proof has been provided that the testing is needed. o   Concerns of billing the insurance company for medically unindicated testing have been brought up.  o   Ms. [redacted] is concerned with the director of the clinic reviewing her grievances when she has never seen the director of the clinic.  ·         Kaiser Permanente staff following dress code. ·         Concerned about responses from Kaiser Permanente when one person is to have been assigned to work with her.  ·         Wait times when calling the call center. ·         Quality of the mobile application. We value the opportunity to review and respond to the grievance. We also apologize for the member’s continued dissatisfaction. On August 8, 2016 I sent a letter to Ms. [redacted] stating I informed several members of her physician’s leadership team; Chief of Internal Medicine, Nursing Manager, and Medical Office Director of concerns related to her care.  The information provided to the leadership team addressed the issues of tests being ordered that were unnecessary.  Prior to this date Ms. [redacted] had expressed doubt about procedures recommended by her primary care physician.  At that time I communicated with the nurse manager who confirmed the testing was medically indicated.  The leadership team continues to discuss care needed by Ms. [redacted] and intend on partnering with her regarding her care.  Kaiser Permanente is not in the practice of billing insurance companies for unnecessary treatments.  The insurance company will not pay for services that are not medically necessary. Should Ms. [redacted] choose to select a new primary care physician, she may contact Kaiser Permanente Physician Selection Services at ###-###-#### to discuss selecting a different physician who is accepting new patients. The complaint Ms. [redacted] filed April 13, 2016 regarding a staff member’s attire and hair color was addressed with appropriate managers of the department.  Members are not notified of the outcome of any disciplinary action stemming from a complaint. I am the point of contact for Ms. [redacted]’s concerns.  My direct phone number is ###-###-####.  I have been in communication with Ms. [redacted] previously, both by phone and mailed correspondence.  New concerns that are submitted, whether by calling, emailing or through the Revdex.com are directed to me to address.  Ms. [redacted] is welcome to contact me directly at any time. Concerns of wait times at the call center will be addressed with the managers of the department.  Several avenues are available for communicating with Kaiser Permanente staff.  Use of kp.org is recommended for non-emergent, non-urgent questions and concerns – both for medical staff and member services.  In order to reach the physician specifically regarding care, Ms. [redacted] may call ###-###-####.  Again, I am available to assist Ms. [redacted] as well. Ms. [redacted]’s dissatisfaction with the mobile site has been communicated to the Manager of Digital Operations in June of this year. The member’s communication is appreciated, as it allows us to try to remedy this entire situation. 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 Member Experience

Complaint: [redacted]
I am rejecting this response because it says Kaiser will be issuing a refund within 1-3 business days without any further detail. This does not include when we will be receiving the refund or how we will be receiving the refund (bank transfer? overnight delivery? first class mail?). Is there any type of tracking information to ensure receipt? Since we have already been waiting several months, this does not solve the issue of confirming that a refund has been issued and no sense of urgency in getting the refund back to us. Additionally, when we spoke to someone over the phone earlier this month, they advised that the refund was already issued and will take 4-6 weeks to receive in the mail.  When the business then states that a refund will be issued within 1-3 business days, this is another example of giving me different information each time we try to resolve this matter. Was the previously given statement by the business misinformation? Is this a different check that will be issued more urgently?  I'm more confused and still don't have the refund due to us. 
Sincerely,
[redacted]

February 23, 2016
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #              ...

11129150
Consumer:                            [redacted]
Case Opened:                      February
9, 2016
[redacted]
This is in response to your email received on February 10,
2016, forwarding concerns on behalf of our member, [redacted], regarding
the termination of his paid 2016 Kaiser Permanente (KP) healthcare plan
purchased through Connect for Health Colorado (C4). We value the opportunity to review and respond to this grievance and
apologize for the member’s dissatisfaction.
We have formally documented and shared Mr. [redacted] concerns
with the appropriate Consolidated Service Center/On-Exchange Issues Department
leadership team, to include the overseeing manager. I am very sorry for any
frustration that has been caused to Mr. [redacted] by this overall matter, as well
as for the time awaited for the enrollment issue to be resolved.
C4, KP, and HPS (our third party billing vendor), all 3
communicate member problems with their accounts by way of a posted case and
review of the added notes by a representative of each party. For KP, the Member
Issues Resolution Team (MIRT), is the case owner, and the Case Resolution Team
(CRT) acts as the liaison between our members and MIRT to provide members with
relevant information and case updates. I realize that the timeliness of
resolving issues that pertain to healthcare plans purchased through C4, have
NOT been ideal. For this, I am sincerely apologetic, as I understand the
urgency of needing to settle issues affecting an individual’s healthcare
insurance. 
MIRT has unfortunately been greatly affected in its ability
to resolve these cases quickly for 2 reasons. They are dealing around the clock
with more cases than ever planned for or expected; new MIRT representatives
continue to join the team in an attempt to resolve cases. Secondly, they must
(via the posted case) outreach C4 to confirm any eligibility/benefit
discrepancies, as KP is not able to change any information for plans purchased
through C4 until advised to do so by them. Any monies issues are then
communicated through HPS, as they are responsible for correctly updating the
billing system. Though MIRT is able to ensure that KP’s system reflects
eligibility, once confirming the information with C4, they are unable to
personally change monetary figures. None of this is an excuse for Mr. [redacted] being
inconvenienced by our processes, but rather an explanation as to provide a
clearer picture of the situation. Upper management is very aware of the
excessive amount of problems that KP is currently attempting to assist members
with, and will hopefully come up with an effective resolution, so that our
members do not have to worry about persistent account discrepancies.
MIRT reviewed Mr. [redacted] 2015 and 2016 account and
provided the following summarized audit:
Premiums due:
August – December 2015: $712.42 x 5 = $1,451.88 + CO
Assessment Fee October – December $3.75, TOTAL is $1,455.63
January – March 2016: $483.96 x 3 = $3,562.10 + CO
Assessment Fee January – March $5.40, TOTAL is $3,567.50
TOTAL due for 2015
& 2016: $5,023.13 (after below listed adjustments are made)
TOTAL paid by member
for 2015 & 2016: $4,439.97 (after below listed adjustments are made)
Balance due: $583.16
Next necessary steps include:
Change
2015 effective date from 9/1/2015 to 8/1/2015, as systems do not match.Balance
forward a payment that did not transfer from previous billing vendor (Conexis)
to current billing vendor (HPS).Reinstate member for 2016 plan immediately
*CASE HAS BEEN SUBMITTED AS URGENT*
I ask that Mr. [redacted]
contact me directly for the case updates as often as he would like, until
ultimately and satisfactorily resolved. Again, my apologies for the frustration
and inconvenience caused to our member, and I am diligently following up with
checking the status of this case daily.
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

July 27, 2016[redacted] Dispute Resolution Specialist [redacted]@denver.Revdex.com.orgPhone: [redacted]Complaint Case #                 [redacted]Consumer:                             [redacted]
[redacted]Case Opened:                       June
14, 2016Dear Ms. [redacted],This
is in response to your email received on June 28, 2016, forwarding concerns on
behalf of our member; [redacted]. The member noted above expressed their continued concerns
regarding the cancellation of her health plan. 
Therefore, our member has
requested a second review of their initial grievance and that we reconsider
allowing Ms. [redacted] to reinstate health plan coverage.I regret our member’s continued dissatisfaction, but I value the opportunity you have given me
to review and respond to their continued concerns. Reviews
of our member’s grievance and the management of out member’s initial concerns
expressed to our Member Services liaison team have been completed. As follow up to our member’s concerns, I have confirmed that
our Member Services liaisons have formally documented our member’s grievance
appropriately and shared it with the appropriate managers and physician leaders
of our program. Furthermore, I am unable to honor the request for
reinstatement.  I have reviewed Ms.
[redacted]’s Evidence of Coverage regarding premium payments.  The contract provides the following
information regarding dues and grace periods: Payment of DuesDues must be paid and received in advance. You must then pay
the correct amount before the beginning of a month to have coverage for that
month. If you do not pay in time, we will send you a notice that you are in
default. You then have a grace period in which to pay your Dues without loss of
membership. If you do not pay within the grace period, we will terminate your
membership. OnlyMembers for whom we have received the correct amount are
entitled to benefits under this Membership Agreement.Grace PeriodsIf we are not receiving an advance payment of premium tax
credit on your behalf, we will provide a 31-day grace period for payment of any
Dues other than the first month’s Dues. We will send written notice stating
when the grace period begins. If we do not receive your Dues by the end of the
grace period, we will terminate your membership so that it ends at 11:59 pm on
the last day of the grace period. We or providers may bill you as a non-Member
for any Services you received after your last day of membership.Again, I thank the Revdex.com and our member for the time you both
took to share these continued concerns, since
member 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 Revdex.com or our member has any questions, please contact
Member Services: Denver/Boulder members may call [redacted], toll free at 1-800-[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 1-888-[redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-[redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.We thank the Revdex.com and the
member for given Kaiser Permanente another opportunity to research this matter. Sincerely, [redacted]Kaiser PermanenteComplex Case Resolution SpecialistCustomer Experience