Kaiser Permanente

April 24, Dear **, ***:This letter is in response to your inquiry dated April 10, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of ** [redacted] The inquiry was received on April 17, 2014.** [redacted] has raised various concerns in his complaint.** [redacted] stated in his complaint that he was informed by Kaiser that his individual plan would expire on December 31, ** [redacted] also stated that he was advised that he would need to apply for new coverage under the District of Columbia Health Insurance Marketplace (DC Health Link) websiteAdditionally, ** [redacted] indicated that on February , he received a bill in the amount of $for his policyHe paid the bill but he is requesting a refund of the $overpayment.According to our records, the Health Plan did not receive a cancellation request from ** [redacted] to terminate his individual coverage.According to ** [redacted] s Evidence of Coverage, under Section , Page Termination and Transfer of Membership, If a Member terminates membership with Health Plan for any reason, Health Pan requests that such Member send written notification of intent to terminate membership, including date of termination, to Health Plan."Upon receipt of the complaint from the Government of the District of Columbia, the Health Plan terminated ** [redacted] s individual coverage effective December 31, On April 1, the Health Plan sent a refund totaling $to ** [redacted] .** [redacted] also stated that he contacted the Health Plan on February 15, to terminate his individual coverage because he is eligible for Medicare.Since ** [redacted] applied for coverage on the DC Health Link website, he must also request cancellation of his individual policy through the websiteOnce ** [redacted] notifies DC Health Link of his cancellation request, they will contact the Health Plan to terminate his policyUpon receipt of the notification from DC Health Link, the Health Plan will terminate the individual coverageI am pleased to inform you that the Health Plan received the Cancellation notice from DC Health Link and ** [redacted] s coverage terminated effective February 28, as he requested.Please be advised that complaints are thoroughly documented, investigated and resolved by the Member Services team through coordination with appropriate departmentsThis coordination may involve communication with senior leaders to ensure complete closure of a members concernsWe also have processes in place to escalate a members concern to the relevant physicians-in-chiefs, clinical operation managers, department leaders, Health Plan managers and the executive leadersIn addition, reports of member concerns are shared on a regular basis with our Senior executivesThese reports contain specific comments shared by our members regarding their experiences.On behalf of the Health Plan, I apologize for the inconvenience this matter has caused ** [redacted] ,If you andor ** [redacted] have any additional questions regarding this inquiry, please contact [redacted] at ###-###-####.Sincerely,

November 12, Dear [redacted] :This letter is in response to your inquiry dated October 30, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of [redacted] The inquiry was received on November 2, 2015.*** [redacted] stated that in her complaint that in February she contacted the Health Plan regarding her eligibility statusShe indicated that the Health Plan informed her that her coverage terminated in December [redacted] stated that she purchased individual coverage in March but her coverage cancelled [redacted] would like to confirm her eligibility status with the Health Plan.According to the Health Plan's records, [redacted] is covered under an HMO Plan through her father's employer groupThis group plan became effective June 19, 2009.•On January 28, the employer group notified the Health Plan to retroactively terminate [redacted] 's health insurance coverage effective December 5, 2014.•On February 20, the Health Plan received an individual application from [redacted] requesting coverage effective March 1, The Health Plan enrolled her in an individual plan• On March 28, the Health Plan received a reinstatement request from the employer group to reinstate the member effective December 5, with no break in coverage.• On June 9, [redacted] 's individual coverage terminated due to nonpayment of premiums[redacted] paid the outstanding premium balance for her individual coverage[redacted] is requesting a refund of the premium payments for her individual coverageRegrettably, the Health Plan is unable to honor [redacted] 's requestHer employer group coverage was terminated based on the information received from the employerUnfortunately, because employers may terminate employees retroactively, appearing "active" in our system may not accurately reflect a member's statusOnly the employer group has the correct information.The Health Plan enrolled [redacted] in an individual coverage plan based on her enrollment applicationIf you and/or [redacted] have any additional questions, please contact Keyla W [redacted] at ###-###-####.Sincerely,Cheryl TDirector, Appeals and Correspondence

Where do I get the HIPAA release form you requestedIThank you,*** ***

February 6, 2018Dear *** ***:This letter is in response to your inquiry dated February 2, to Kaiser FoundationHealth Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** ***
***.*** *** stated that she received an invoice for $but did not receive
anyservicesOur records show that she was seen at our Falls Church Medical CentersInternal Medicine on January 18, 2018.*** *** is covered under the Virginia Bronze $5,500/$50/Dental PlanShe mustmeet a $5,deductible for non-preventive services before the Health Plan pays herbene?ts.*** *** may be eligible for ?nancial assistance by contacting the Medical FinancialAssistance and ?nancial Counseling Unit at ###-###-####If she is not eligible for?nancial assistance, she may be eligible for a reduced payment or payment planIf sheis interested, she may contact our Patient ?nancial Services Department at ***
***.If you and/or *** *** have any additional questions, please contact me at ***
***.Sincerely,Cathleen M Appeals & Resolution SpecialistAppeals and Correspondence Department

April 24, 2014Dear *** ***:This letter is in response to your inquiry dated April 10, to Kaiser Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** ***The inquiry was received on April 15, *** is requesting that the Health
Plan provide him with a free reading of his CPAP machinePlease note that ***s health insurance coverage terminated effective July 31, 2013.On March 18, the Health Plan provided *** *** with a copy of his CPAP machine readingI have included a copy of the reading for your convenience. If you and/or *** *** have additional questions regarding this concern, pleas: contact *** *** at ***.Sincerely,

*** *** *** *** *** ** *** **
*** *** *** *** *** ***
*** *** *** ***
*** *** According to health plan records, the concerns were addressed in written correspondence to the member dated July 10, and August 3,
2017. Thank you, Susan C

I am rejecting this response because:No one has spoken to me about thisI guess I will just have to go to the insurance commissioner about Kaiser's practices.

RE: Complainant: *** ***ID#:***Member Number ***Dear *** ***:This letter is in response to your inquiry to Kaiser Foundation Health Plan of theMid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***Theinquiry was received on October 2, 2017.*** ***
expressed Concerns regarding access to Care and not being able to speak to anyone at the Kaiser Kensington Medical Center, regarding her procedure that was scheduled for June 29, 2017.According to our records, MsMeladi H***, Member Services Coordinator at the Kaiser Kensington Medical Center indicated that she spoke with *** *** and addressed her concernsOur records also indicate that MsJennifer S***, Kensington Medical Center Administrative Manager and MsCheryl P***, Supervisor, Kensington Medical Center Radiology Department also spoke with *** *** on July 19, and resolved all her Conerns.If you and/or *** *** have any additional questions, please contact Mariama Anderson at (***) ***

October 6, Dear *** ***:This letter is in response to your inquiry dated September 8, 2014, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***You stated in your complaint that you previously submitted an inquiry to the
Health Plan but there was no responsePlease note that there is no record of receipt of the above referenced complaint prior to September 8, 2014.*** *** stated in her complaint that the Health Plan collected payments for February and March totaling $*** *** is requesting a refund in the amount of $
The Health Plan searched our database and we do not have a member in our system with the name, *** ***We will need additional information, such as, a medical record number to research and resolve *** ***'s complaint.Should you have any additional questions please feel free to contact meSincerely,Keyla W
Senior Communications Specialist Member Services

Hello Miriam, This issue is currently under review in our Member Services department. A response will be provided to Mr*** by March 21, 2018. Thank you, *** ***

Complaint: ***
I am rejecting this response because: Per the attached letter from Daisey S*** dtd 9/26/14; I was to receive a check...I have NOT received the check from Kaiser This was under complaint #*** I filed a second complaint after Kaiser did answer the first complaint
Regards,
*** ***

Thank you for bringing this issue to our attentionOur Georgia region manager has reviewed the concern and advised they have outreached to the patient to assist them to the appropriate avenue for their appealThank you

May 14, Dear *** ***:This letter is in response to your inquiry dated May 5, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***The Inquiry was received on May 7, 2015.*** *** stated in his
complaint that he applied for health insurance coverage through the Maryland Health ConnectionHe also stated that he did not receive his health insurance identification cards.According to our records, *** ***'s coverage became effective February 1, On May 6, the Health Plan requested identification cards for *** ***He should receive them in the mail within 1-weeks from May 6th.On behalf of the Health Plan, I apologize for the inconvenience this situation has ** ***.If you and/or *** *** have any additional questions, please contact Keyla W*** at ###-###-####.Sincerely,
Daisy S
Senior Manager, Member Services

RE: Complainant: *** *** ID #: *** Member Number: ***Dear *** ***:This letter is in response to your inquiry to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***.*** *** stated in his complaint that his
insurance coverage was terminated and was not reinstatedHe further states that after the coverage was terminated, he made a payment of $and that the Health Plan did not refund his payment.Our records show that *** ***, was enrolled through the Maryland Health Connection effective January 1, The initial payment of $was received on January 11, *** *** did not make his payments for February and March Delinquent notices were sent to the *** ***'s address on fileA final notice was sent on March 7, informing him that a premium of $is needed to keep his coverage activeAfter not receiving any payment, a termination notice with an effective date of April 1, was sent to *** ***.MrHuffstetler, made a payment in the amount of $which was received on April 3, The payment was applied to his outstanding balance of $Since the payment received was less than his outstanding balance, *** *** is not entitled to a refundI have attached the relevant documentation for your review.If you and/or *** *** have any questions, please contact me directly at ###-###-####.Appeals & Resolution Specialist Appeals & Correspondence Department

I am rejecting this response because: Kaiser Permanente has not offered any solution and has only committed to look into the matter

November 12, 2015Dear *** ***:This letter is in response to your inquiry dated October 30, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of *** *** ***The inquiry was received on November 2, 2015.*** *** stated that in her
complaint that in February she contacted the Health Plan regarding her eligibility statusShe indicated that the Health Plan informed her that her coverage terminated in December *** *** stated that she purchased individual coverage in March but her coverage cancelled*** *** would like to confirm her eligibility status with the Health Plan.According to the Health Plan's records, *** *** is covered under an HMO Plan through her father's employer groupThis group plan became effective June 19, 2009.•On January 28, the employer group notified the Health Plan to retroactively terminate *** ***'s health insurance coverage effective December 5, 2014.•On February 20, the Health Plan received an individual application from *** *** requesting coverage effective March 1, The Health Plan enrolled her in an individual plan.• On March 28, the Health Plan received a reinstatement request from the employer group to reinstate the member effective December 5, with no break in coverage.• On June 9, *** ***'s individual coverage terminated due to nonpayment of premiums.*** *** paid the outstanding premium balance for her individual coverage.*** *** is requesting a refund of the premium payments for her individual coverageRegrettably, the Health Plan is unable to honor *** ***'s requestHer employer group coverage was terminated based on the information received from the employerUnfortunately, because employers may terminate employees retroactively, appearing "active" in our system may not accurately reflect a member's statusOnly the employer group has the correct information.The Health Plan enrolled *** *** in an individual coverage plan based on her enrollment applicationIf you and/or *** *** have any additional questions, please contact Keyla W*** at ###-###-####.Sincerely,Cheryl T.Director, Appeals and Correspondence

I have had direct contact with Kaiser and they have settled the open issues to my satisfaction pending receipt of the settlement that has been promised Please suspend my complaint unless you hear anything further from me Thanks for attending to this for me. ***Sent from my ***

We are very sorry to hear about the issues surrounding the dispencing of the medication in question
Upon further review, we have obtained approval to step outside of our process and refund the
monies in question. Please have Mr/Mrs *** contact *** *** at the phone number
below. She will
make the necessary arrangements to provide the refund. We have a couple different options on the way to
refund ths money, so it is best that they contact *** directly
Once again, we are very sorry for the confusion relating to this issue
If you have any quetions, please contact *** *** at *** *** ***
Thank you,
*** ***, MBAManager, Pharmacy Retail Operations
*** (office)

Dear Mr*** ***,
This message is being sent in response to the complaint filed with the Hawaii Revdex.com dated February 27, regarding your coverage cancellation in January
A review of your complaint has been conducted
According to our records, you declined
medical coverage in May of and retained dental coverage through the *** *** *** *** ***Kaiser Permanente did not receive a cancellation notice from *** in MayYour coverage was terminated in January 2015 after receipt of your cancellation notice from *** near the end of The cancellation affected your coverage back to May retro-actively
Please contact the *** *** *** *** for more information about your medical coveragePlease call our Kaiser Permanente Patient Financial Services Department at *** *** for any questions about bills or statements you received for services at a Kaiser Permanente facility
If you have any additional question, please do not hesitate to contact me
Sincerely,
*** ***
Manager, Customer Service
*** ***

This letter is in response to your inquiry dated January 6, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan) on behalf of Mr*** ***.Mr*** Stated in his complaint that that he applied for health insurance Coverage through the Maryland Health
Connection (Exchange)He also stated that he did not re-enroll for coverage for the contract year; however, he received a "Welcome letter" and new identification Card.The Maryland Health Connection changed their technology system which generated "Welcome back letters" and new identification Cards for all active membersMr***'s coverage with Kaiser Foundation Health Plan of the Mid-Atlantic States, Incis Currently activeHe must request termination of his health insurance coverage through Maryland Health ConnectionMr*** may file an appeal with the Maryland Health Connection (***) to request termination of his coverage effective December 31, If Maryland Health Connection honors his request, they will notify the Health Plan of the termination gateIf you and/or Mr*** have any additional questions, please contact Keyla W*** at ###-###-####Sincerely,Daisy S***
Senior Manager, Member Services