Kaiser Permanente San Diego

Review: I have had several surgeries on my knee and I am having issues with it now I have tried since feb 3 to contact my dr with no luck I was advised to go to Er which I did and was directed to go contact my Ortho dr once again. I tried calling again and had no luck again I tried calling member services and was told there was nothing they could do to help me because they did not have access to appointments. I am paying on a monthly basis for health insurance and I would like to have the ability to see a dr if needed. I have related to everyone I have spoken to that my knee is now swollen and very painful and aim unable to walk on it. I don't feel that I need to pay elsewhere for services that I should be getting from Kaiser. I tried asking severL people what the protocol for a call was and the lady I spoke to in member services stated that it is what ever date they have available I then proceeded to ask her if they did not have someone to screen the calls and she said yes but no one seem to be screening my call. I honestly don't think that walking on a swollen leg with popping and grinding sounds and painful is anywhere near normal. Please help I just want better patient service thank you.Desired Settlement: Better patient service, they might not care but it is my leg. At least a phone call would be nice with directions as to what I can do to help with the discomfort.

Business

Response:

Member filed grievance with the Health Plan on 02/06/2014. This case has a 30 day time frame for

Review: My membership was cancelled effective 06/01/14. However an unauthorized EFT was debited from my checking account on 07/01/14, for $338.58. When I contacted Kaiser Permanente to advise of their mistake, the member services representative advised that they (billing section) "forgot to turn off the auto-debit, that's all". This mistake created $105 in NSF charges and 2- transactions to decline in my checking account. A claim was filed with Wells Fargo Bank (#[redacted]), and provisional credit was allowed on 07/03/14, for the $338.58. A non-medicare grievance was filed ([redacted]) with Kaiser Permanente on 07/02/14, as this was the second unauthorized transaction debited from my account. On 07/10/14, Kaiser Permanente incorrectly credited my checking account $313.58, not $338.58, $25.00 short of monies owed. As of today, 07-21-14, no one from Kaiser Permanente has contacted me via email, nor phone, since 07-03-14 when the grievance was filed, and monies are still outstanding.Desired Settlement: Desired Settlement:

a refund of all monies due, a letter to my financial institution stating this was Kaiser's error, and an apology letter to myself as this has created a severe financial hardship for me and will negatively reflect on my credit history.

Business

Response:

The Heath Plan is in receipt of this compliant. Due to the privacy of the information for the member only, limited details will be given. The refund was sent on 7/21/14. The case was reopened today to contact the former member, as the case was closed without connecting directly (voice mail was full). All details will be explained via the phone or in writing to the member (former member) directly.

Review: I was laid off from my job on 2/28/14. I applied for medicaid on 3/11/14, but was unsure whether I would be eligible, so I purchased the Kaiser Gold plan (KP CO Gold 0/20) on Connect for Health Colorado (the "Exchange") on 3/14/14 so that I would have medical benefits on 4/1/14 as required by law. NOTE: I had to be enrolled in the plan by 3/15/14 to receive benefits on 4/1/14 and thereafter; therefore the premium had to be paid before month end for the benefits to be active 4/1/14. I sent a check in the amount of $287.64 for the first months premium, which was debited from my account on 3/21/14 in the full amount. I was then later approved for medicaid. I canceled my Kaiser health benefits on 3/31/14 through Connect for Health Colorado. Kaiser continues to deny receiving any cancellation request; however, I have verified numerous times with numerous agents with Connect for Health Colorado that the cancellation has been submitted. I have also called Kaiser with a Connect for Health Colorado agent on the phone to try and address the situation, with no resolution. Kaiser continues to deny any cancellation request has been received, and continues to deny a refund of my first months premium.Desired Settlement: A full refund of $287.64.

Business

Response:

The Health Plan is in receipt of the compliant. The compliant was routed to our Colorado KP office. As of today, the refund has been sent for processing and refund to be sent directly to the member. The timeframe is 30-45 days for member to receive the refund.

Consumer

Response:

First off, thank you for your assistance regarding this matter, I appreciate your help, as I attempted to resolve this issue numerous times with kaiser without resolution.

I was contacted by "[redacted]" in customer service on 7/15/14 @ 3:48pm mst. [redacted] left a voice message (which I have retained) explaining that processing of the refund has been initiated, but could take 30-45 days upon receipt of her voice message on 7/15/14. Today (8/12/14) is day 28, and no refund has yet been received. However, I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me, as long as the company (kaiser) fulfillis this agreement to process a refund in full. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Kind regards,

Review: Kaiser Permanente has failed to provide sufficient service and treatment for my anxiety disorder and after months of numerous attempts to see a specialist, they refuse to issue correct treatment for my depression, anxiety, and insomnia. I have seen several of their so-called specialists, and they refuse to prescribe any kind of effective medication and when I ask about one I feel may work, they simply say they wont prescribe it or it is not covered by the plan. They are poor at communicating with the patient with regards to appointments and will cancel a patient's appointment set for a waiting period of a month in advance due to wait times and then cancel it without the patient's knowledge, thus impacting the quality of care. When the patient spends 45 minutes on the phone just to get through to someone who can assist, they inform the patient that their appointment was cancelled and that they cannot help them. After scheduling an emergency appointment with an available specialisit, the patient arrives to the facility only to be then told in person that the specialist cannot help them because the specialist is currently treating someone whot he patient personally knows, which makes no sense from a treatment perspective. The patient has paid a co pay and services were refused to be rendered. The patient was forced to leave the facility for a third time without any treatment and the quality of the patients life has drastically takena turn for the worse as a consequence of the systematic fauilures built into the Kaiser patient care system. It has proven to be nothing less than a cruel joke.Desired Settlement: I wish to receive a refund of my Co Pay as I received no services in return for my payment other than being told that "I cannot help you at this time" I also wish to receive a written apology for the egregious inconveniences I have incurred as a result of their failure to provide adequate healthcare. Most importantly, I wish to receive the correct treatment I have been persisting so long to receive.

Business

Response:

The health plan is in reciept of complait. We will waive/pay the $15. This will be completed in 30 days or less.

Review: I canceled my policy way over a month ago. I have waited weeks for the refund. I was told it would be sent on 4/12. I just called today and they acted like they never heard of this and that I have to wait another 6 to 8 weeks. This is not acceptable. It doesn't take 6 to 8 weeks to cut a check.Desired Settlement: my refund!!

Business

Response:

We worked directly with our patient, she received her refund and is satisfied with the resolution of her concern. Thank you.

Review: On 9/10/2014 I went into the Urgent Care on Otay Mesa. I paid my $50.00 copay and due to them not having a cat scan at the time. I was told I would need to go to the ER to use the cat scan due to them not having one at that time. I asked if it would cost to do that and they had said no because it is still considered an ER visit. The urgent care called ER to let them know I would be there to get the cat scan. I arrived at the ER and after waiting for over 5+ hours I was told I had to pay $150.00 after I already done the cat scan. I told them that this was incorrect due to me verifying that I was coming in from urgent care and was told to them that this will be considered an urgent care visit due to them not having the equipment at that time. I am very upset because after telling them that I was NEVER admitted in the ER they still charged me for as if I was. I signed documents for the urgent care ONLY and NEVER for the ER and after urgent care telling the ER it is still a visit from urgent care they still charged me. I was NEVER in a bed our in a room. So I am requesting they refund my $150.00 back to my account as I should have never been charged. I am very upset due to this charge I was unable to get all my medication that was needed, out of the 5 I only could afford 2 and still greatly need to buy the other 3 due to my diverticulitis.Desired Settlement: Please refund the $150.00 that was charged to my debit card.

Business

Response:

The Health Plan is in receipt of this complaint from Revdex.com.

Patients wife called Kaiser to file a complaint about this issue 09/11/14 (same day as they filed with Revdex.com). Case #XXXis in process at Kaiser. The Case Manager [name] spoke with Mrs. [redacted] 09/16/14, explained Advocate On Record will be needed since she filed complaint. Member was sent the AOR to complete.

Once the AOR is received back, we will review complaint.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I did receive the paper to allow my wife to handle all of my medical and billing information. It was mailed out on Monday and takes 1 business day to get to the mailed location. She has yet to hear any information in regards to the issue and truly disappointed in the service and after talking to my wife, she explained that the ER manager was completely RUDE to her when trying to find who to discuss the issue. The ER manager said she was putting her on hold and completely transferred her to the main lines to ignore her. She is a manger for a reason if she can not handle it she needs to step down!!! This happened on September 11 at around 10:00pm if needed to be noted. In the end we still have not been contacted!!!

Regards,

Business

Response:

AOR was received on September 23, 2014, and a voice mail was left for the advocate on September 26, 2014. The Acknowledgement letter was mailed to the advocate on September 27, 2014. Case is still under review. Please refer to both voice mail and letter of how to contact the Sr. Case Manager assigned to the case.

the Health Plan has left voth voice mail and mailed a letter. This case will not be reviewed via the Revdex.com as the Health Plan has an open grivence. Please contact us directly.

Review: I was approved for, and paid for, a Kaiser health insurance plan through Covered CA in December 2014. I was briefly, and mistakenly, signed up for an Individual KP health plan instead in January, due to a Covered CA website error. Then I canceled my extra Kaiser plan in February 2015, as soon as I could. I had already paid for 2 months of that coverage- $561.01 each month- which I had to pay in order to have health insurance. It is now mid-April, and I have not received my refund of $1122.02. I have called many times to follow up- please see attached documentation. I have been hung up on, I have been promised a check next week, I have been given confirmation numbers, I have talked to Supervisors. Still I have no check, or refund to my bank account. I NEED THIS MONEY BACK. IT IS A LOT OF MONEY.Desired Settlement: I want my full refund of $1122.02, plus 5% interest per month they have been withholding my refund. That's more than 3 months, so the additional interest total is $168.

Business

Response:

Refund was processed today. I sent email to member to advise.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved. If I don't receive the refund within 7 days I'll be back in touch, thank you.

Regards,

Review: My therapist [redacted] at Kaiser Permanente informed me that I don't have to pay out of packets fees for outpatient group sessions and for the individual therapy because I was enrolled with the clinical case management program. Then I was still getting billed from Kaiser Permanente for all the group and individual therapy sessions that I had with the same therapist. I talked to the billing department and they refused to disputed and they advised me to talk to the therapist directly. I talked to the therapist "[redacted]" again and she said she misunderstood my health plan with kaiser and she was sorry for the wrong information. I am now liable for all the out of packets charges from kaiser and I'm so upset because they didn't fix the problem yet! I talked to the call center today and the representative was so rude and unprofessional. Her name is "[redacted]". I asked to speak to her supervisor and she refused to transfer me. She put me on hold for almost half an hour then she said she will transfer me to her manager voice mail. I left a voice mail for her manager "[redacted]" and never got a call back yet. I'm so upset with Kaiser Permanente unethical practices.Desired Settlement: They should provide false information when it comes to billing. I'm asking for all my money back.

Business

Response:

Kaiser Permanente received this complaint in June 2015. Since that time we have been working directly with Mr. [redacted] to resolve his concerns via our complaint/grievance process. Thank you.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

A person from Kaiser called [redacted] contact me via phone and email and she said she is addressing my problem and she will get back to me later. I tried to contact [redacted] several time and sent her an email and never heard from her back even after almost 10 days of emailing her she never even acknowledge receiving my email. The problem with Kaiser billing still occurring and no refunds was issued to me until now.

Regards,

Business

Response:

Second response from Kaiser Permanente regarding the case for [redacted]. We are working directly with Mr. [redacted] to resolve his concerns. Case was closed by KP 08/04/2015, resolution letter was mailed to Mr [redacted]. Thank you.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[I got a call from a person in Kaiser Permenante. This person left a voice mail on Tuesday. I called this person on Thursday and left a voice mail. I never got a call back. They sent me out a letter regarding this issues and they said that they will reembress only partial of this charges which might be $332 in the next few week. There was no time fram or specific date to reembress these charges. Just to let you know that these charges were covered by the medical program of San Diego. kaiser Permenante already got paid through Medical so they overcharged me for that amount from February 2015 until today's date. They never reembress any charges that happened from October 2014 until February 2015. They are just lying and not declaring the truth about these charges. They never solve the real issues.]

Regards,

Business

Response:

Details of complaint:- Complaint filed by member to Revdex.com in May 2015- Health Plan received in June 2015 and closed on Aug 5, 2015- Letter was sent to the member with the outcome of the case- Health Plan approved the reimbursement and mailed check to the member at end of August - We failed to update the Revdex.com website with the outcome, so it was left unanswered in error.

Review: I joined KP on 3/4/2014. Since then, I have had multiple issues when trying to set up appointments, being checked-in during an appointment, obtaining test results, contacting or attempting to send my Dr. information about my health. Apparently the issue is that I was given 2 Medical Record numbers. I have worked with Customer Services, Web Services, and the IT Department numerous times. Each time, I was assured that my issue was being worked on (records being merged into one Medical Record) and that I should continue to "give it a couple more days". I still am not able to see any of my test results, my appointments, my prescriptions, or contact my Dr. with important information. This issue has also affected the physicians during my appointments. They were unable to see what medications I was on or what the results from my last visits were. I have expressed to the physicians in person and on calls with support teams that not only is this an inconvenience to me but it also posses a health risk being that I or my physicians do not have access to the correct information about me, my visits, my test results, or my medications. This issue in itself, has also further affected my health by adding way more stress to trying to find solutions to my health problems.Desired Settlement: My Medical Record issue needs to be resolved so that I can log into myKP.org and see my correct information and have the ability to use the features as told I should have. I would also expect apologies from departments that I have dealt with who express little to no concern for me and provided no solution.

Business

Response:

Member filed a grievance with the Health Plan on June 11, 2014. This case had a 30 day time frame for processing with a resolution due to the member on July 9, 2014. The member was contacted on June 16, 2014, at which point the member did not wish to proceed with the grievance. A written resolution letter was sent to the member on June 16, 2014. The letter contains all applicable instructions for member to resubmit grievance. No further action is required from KP Member Services.