Kaiser Permanente of Washington

I am writing in response to your June 13, 2017 inquiry on behalf of Ms. [redacted]. ** received byKaiser Permanente.We understand Ms. ** submitted a complaint regarding the activation of her Individual & Family plancoverage for 2017. She states the plan was terminated several times and...

her account is still not setup correctly.We can confirm that Ms. **’s coverage has been reinstated effective to March 1, 2017 andpremiums are paid through April 30, 2017. We also confirm the account is delinquent and a balanceremains due of $391.65 for July 2017.Our review of the records and contact with Washington Health Benefit Exchange (WAHBE) on June22, 2017 again confirmed that the enrollment information for January 2017 did not include apremium tax credit for Ms. **. WAHBE confirmed that Ms. ** made several changes to herapplication information on January 31, 2017 and again on February 7, 2017 and resulted in approvalof tax credits toward her premiums effective for March 1, 2017 and a plan change from Individual &Family Gold plan to an Individual & Family Bronze plan. However, at the time of that approval,coverage had already terminated for non-payment as Kaiser Permanente had not received anypayment toward Ms. **’s 2017 coverage.Ms. ** made her first payment toward coverage on March 7, 2017. Ms. [redacted]’s bank initiated a VisaChargeback that completed with a void of this payment on March 22, 2017. A second paymentposted to the account on April 4, 2017 which paid for coverage January 1, 2017 to April 30, 2017. Noadditional payments have been received since April 4, 2017. Should Ms. ** need assistance withmaking payment, Member Services can be reached at 1-888-901-4636 Monday –Friday 8am to5pm. For questions regarding the eligibility or amount of tax subsidy for which she qualifies, werecommend she make contact with WAHBE at 1-888-923-4633.Thank you again for taking the time to bring this to our attention. If you have any questions regardingthis matter, you may reach me at 206-630-1573.Sincerely,Rebecca H**Health Plan Administration

Attached is the response the Group Health response to the members Revdex.com complaint 
 
 
Re:      Consumer:                  [redacted]...


            ID Number:                 [redacted]
            Revdex.com Number:             [redacted]
 
 
Dear Ms. [redacted]:
 
I am writing in response to your October 17, 2015 inquiry on behalf of Mrs. [redacted] who submitted an inquiry for her spouse, Mr. [redacted] that was received by Group Health Cooperative. 
 
We understand Mr. [redacted] has concerns about the billing received from Group Health due to his Overlake Hospital inpatient hospital admission on June 19, 2015.    
We apologize for the negative experience Mr. [redacted] encountered with our billing process. After careful review we found the admitted facility (Overlake Hospital) was contracted with Mr. [redacted] insurance, however our Group Health providers who were fulfilling their community call obligations during his admission were not. Our Patient Financial Department has adjusted the concerned amount, reducing it to the members anticipated responsibility of $67.46.  
 
Thank you again for taking the time to bring this to our attention. If you have any questions regarding this matter, you may reach me at 206-901-7362.
 
Sincerely,
           
Terri N[redacted]

I am writing in response to your August 3, 2016 inquiry on behalf of Ms. [redacted], requesting additional details from Group Health Cooperative in regards to her original complaint. Please provide a response addressing the consumers concerns regarding the time- frame of the billing process and how that may impact the businesses appeal process: Group Health billed Regance, 3 business days after Ms. [redacted] received services at our Olympia Medical Center-Urgent Care. Regance accepted the claim on May 30, 2015. Regance provided an explination of benefits (EOB) to Ms. [redacted]; at that point it was her responsibility to communicate with Regance to dispute or appeal. Regance did not communicate with Group Health after the initial billed date. Group Health billed the member 3 billing cycles (indicated in the previous response). Ms. [redacted] will need to communicate with Regence for further assistance in regards to the billing time frame and her appeals. Thank you again for taking the time to bring this to our attention.

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that while this resolution is satisfactory to me, their process to get this far will never be acceptable.  Aside from the fact they took about a full month to account for their own billing and payment records which should be available within minutes by a customer on their own account let alone to their own people, their final response still indicates they 1) still can't properly recite the actual problem I was asking them to solve and 2) show they still don't understand why their handling of this issue was a problem.  
As a reminder - I had asked for copies of my invoices for the October-December 2015 period along with records of my payments for each. They first said they don't have them, they did not bill me at that time. Thn they indicated they only had December. Then ten days later they indicated they had November too, but not October since that was not them, but the Health Exchange. Finally I get a page listing my payments and invoices which also include October, but was bizarrely described in an earlier phone call as "we have a payment, but we did not invoice you."  So now they are apparently taking in funds from customers that they did not actually invoice for.  
Their final response which repeats, once again, that they do not have records prior to October is consistent with what I have known all along and why I have always asked for records from October to December.  
And now, with prescription refills running WEEKS late due to a botched software upgrade, I'm fairly certain this company will not be my provider in 2017.Sincerely, [redacted]

Complaint: [redacted]I am rejecting this response because:
I received a response from GHC last week on Wednesday, 11/16, indicating that they did find an additional invoice which they previously stated did not exist in their system. They indicated they had mailed copies of them (again), but they have yet to be received today on the 22nd (6 days later, or more time than it takes for a letter to reach Seattle from Boston), just as the previous mailing was never received. They still seem to be unaware of their own billing and payment for an additional month prior to the two they have now found, and I responded today sharing with them the exact dates of payment for all three months in question with the hope that somewhere within their corporate infrastructure, someone is versed enough in the use of computers to actually locate their own payments and invoices.  Optimism is low, at this point, to say the least.
Sincerely,[redacted]

Dear [redacted]:I am writing in response to your April 24, 2017 inquiry on behalf of Ms. [redacted] received byKaiser Foundation Health Plan of Washington.We understand Ms. [redacted] expressed frustration with a recent encounter for prescription with careteam personnel. She requested a formal complaint...

regarding the behavior she described as rudeand disrespectful and has requested contact back from supervisory level management regarding theincident.We can confirm that Kaiser Permanente has received and is working this complaint for Ms. [redacted].We have been in communication with the clinic management in regards to this incident. At this timewe can assure Ms. [redacted] that communication is continuing. While we are not at liberty to suggestany outcomes related to the employee or our internal investigation, we will update Ms. [redacted] withany information we can related to the review. We have confirmed management did make initialcontact with Ms. [redacted] on 5/3/2017 and have noted follow up will occur.Thank you again for taking the time to bring this to our attention. If you have any questions regardingthis matter, you may reach me at 206-630-1573.Sincerely,Rebecca H**Health Plan Administration

Dear Ms. [redacted]:I am writing in response to your June 16, 2016 inquiry on behalf of Mrs. [redacted] received by Group Health Cooperative.  We understand Mrs. [redacted] expressed frustration in regards to her Group Health Individual and Family monthly medical premiums not applying to the account...

correctly which resulted in coverage termination. After investigation it was found that the $2967.31 paid by Mrs. [redacted] applied to another members account in error. Additional investigation is being done to determine the root cause of the error, to ensure that it does not occur again.The full amount of $2967.31 has been applied to Mrs. [redacted]’s and medical coverage has been reinstated with no break.Again, we apologize for the negative experience Ms. [redacted] has encountered. This concern has been shared with our Membership Leadership team.  Thank you for taking the time to bring this to our attention Regards,Terri N[redacted]Health Plan Administration

Complaint: [redacted]I am rejecting this response because:
In the response letter, Group Health intentionally neglected one mistake made by their representative.It is true that I was informed that my previous group health coverage was terminated. In fact, obviously both I and the representative knew that. That's why I provided the new insurance card before taking the flu shot. The representative even contacted my wife via the phone to get her insurance card to double check the coverage of my insurance plan. After all such checking was done, I was informed to take the flu shot. If the representative was more responsible, she should tell me the right information. She could even tell me to check with my current insurance myself. However, she told me everything was fine and informed me to take the flu shot. I was totally misled by this wrong information provided by the Group Health representative.I called Group Health on Nov 9, 2016, but the representative on the phone simply ignored the above facts. That's why I filed a complaint through Revdex.com. It is totally unacceptable that the Group Health, a well known company, can just simply neglect the errors caused by their representatives.I further request the Group Health takes this case seriously and adjust the bill accordingly.
Sincerely,[redacted]

Response to [redacted] Revdex.com complaint - Please see attachment
 
 
 
Re:      Consumer:                  [redacted]...


            ID Number:                 [redacted]
            Revdex.com Number:             [redacted]
 
 
Dear Ms. [redacted]:
 
I am writing in response to your July 25, 2015 inquiry on behalf of Mr. [redacted] received by Group Health Cooperative. 
 
We understand Mr. [redacted] is requesting reimbursement of his $212.60 prescription copayment because he received the prescription from our Mail Order Pharmacy without notification that the cost was going to be more than anticipated.  
We apologize for the negative experience Mr. [redacted] may have encountered by being charged the amount of $212.60 to his credit card.  Our records indicate Mr. [redacted] was refunded the amount of $200 to his credit card on July 31, 2015. For future coaching opportunities I have shared this concerns with our Pharmacy Mail Order, supervisor.  
 
Thank you for taking the time to bring this to our attention. If you have any questions regarding this matter, you may reach me at 206-901-7362.
 
Sincerely,
           
Terri N[redacted]
Health Plan Administration

I am writing in response to your May 25th inquiry on behalf of Ms. [redacted], received byGroup Health Cooperative.We understand Mr. [redacted] expressed frustration in regards to being billed in full for servicesreceived in March. I have confirmed with our Membership Department as well as the...

HealthBenefit Exchange (HBE) that Ms. [redacted]’s medical coverage termed March 1st as a result of hernotifying HBE of her increased income on February 3rd. She was advised that her subsidy of$314 was no longer in effect and her monthly responsibility was going to increase from $114.74to $428.74 effective March 1st. On March 3rd Group Health received a payment of $114.74, butnever received the balance of $314 to satisfy the total premium, because of this, coverage wastermed on April 14, 2016 retro back to March 1st.I confirmed in our data base that on March 25, 2016, 3:45pm, Dr. [redacted] apologized to Ms.[redacted] for the erroneous information (scheduled procedure and associated diagnosis) that wasmistakenly placed in her chart. In addition he advised that our staff checked to be sure that noneof Ms. [redacted]’s information was placed in the other patient's chart. There was nothing added to theother person's record. The records were not mixed up. The order intended for the other personwas simply absent from her chart. The schedulers had already caught the error prior to Dr.[redacted] speaking with Ms. [redacted]. He acknowledged the error and repeatedly apologized. I amgrateful that we have a policy that gives patients access to their charts, and that we have multiplestops in our system where data is checked.Thank you again for taking the time to bring this to our attention. Again we sincerely apologizefor the negative experience Ms. [redacted] encountered.Regards,Terri N[redacted]Health Plan Administration

Dear Ms. [redacted]:I am writing in response to your November 28, 2016 follow-up on behalf of Mr. [redacted] receivedby Group Health Cooperative.
We understand Mr. [redacted] expresses continued frustration that the invoice statements and paymentsaccount analysis from 2015 have not been received. Mr. [redacted] is enrolled on an individual & familyCore Silver HSA plan, purchased through the Washington Health Benefit Exchange (WAHBE). Weapologize for any inconvenience this may have caused.
We have again confirmed the documents requested by Mr. [redacted] were mailed to the following address:[redacted] Sammamish, WA 98074. This address agrees with both the account informationon file with Group Health and the address listed for the complaint.
We are unable to identify what may have prevented him from receiving those documents as requested.To ensure that Mr. [redacted] receive both the 2015 invoice statements and the payments account analysisas requested, he may reach me directly at [redacted] Monday thru Friday 9am-4pm. I will gladlymake arrangements for the documents to be received in another manner if convenient. We can certainlyfax them to him direct if he chooses.
We also understand Mr. [redacted] has continued concerns regarding premium invoices not received fromGroup Health for months prior to October 2015; we can confirm that Group Health began acceptingpremium payments from WAHBE enrolled members through the agreed payment vendor, Softheon,effective October of 2015. We did issue an invoice to Mr. [redacted] for his November coverage datedOctober 13, 2015. Any premium invoices issued prior to October 1, 2016 would have come directly fromWAHBE.
Thank you again for taking the time to bring this to our attention. If you have any questions regarding thismatter, please contact me.
Sincerely,
Rebecca H**Health Plan Administration

Complaint: [redacted]I am rejecting this response because: My only reply is that they were totally uncooperative when I tried to get them to provide information to my secondary insurer.  I had to get a copy of my transcript from my primary and send it to my secondary because GroupHealth would not provide information to my secondary insurer so that my total responsibility could be determined.  Instead of supplying the information to my secondary insurer, they sent me to collections--my first time ever in my 68 years.  Once I knew how much I actually owed, I paid it promptly.Sincerely,[redacted]

January 30, 2018Re: Consumer: [redacted] for daughter’s care/servicesID Number: [redacted]Revdex.com Number: [redacted]I am writing in response to your January 22, 2018 inquiry on behalf of [redacted] received byKaiser Foundation Health Plan of Washington.We understand [redacted] submitted a follow up to her complaint redirecting attention to theinteractions she experienced with Member Services for her concerns and benefit information. Sheshared that she expected all the representative needed to do was answer the questions and providethe health benefit information. Her interaction with the representative and her manager did notresolve the issue and [redacted] shares she felt that she was treated like a fool.Our review of the specified encounters with Member Services, did identify opportunity for improvedcommunication regarding [redacted]’s concerns. We acknowledge that the telephone interaction withthe representative was a lengthy and confusing experience for [redacted].We apologize that because Fraud Waste and Abuse had already contacted [redacted], Managementdid not make any additional call to confirm resolution of the issue.An additional level of Management completed a review of the interactions and coaching wascompleted to ensure a better customer experience in the future. We appreciate [redacted]’scommitment to sharing her feedback with us, and we apologize for not addressing this concern moredirectly in our prior response.Thank you for contacting Kaiser Permanente on behalf of [redacted]. Should you have anyfurther questions, regarding this matter, please feel free to contact me at [redacted]Sincerely,Rebecca H.Health Plan Administration