Kaiser Permanente

This letter is in response to your inquiry dated March 17, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan), on behalf of the complainant, *** ***.*** *** indicates in her complaint her concern regarding her visit to the Tysons Corner Urgent Care Center
on date of service March 15, *** *** stated her concern and panic with the incorrect diagnoses initially conveyed to her by the radiologist.Given *** ***'s complaint concerns, a copy of her complaint was forwarded to the Chief of Tysons Corner Urgent Care Medical Center, the Physician In Chief and the Executive Consultant of Kaiser Permanente's Northern Virginia Service Area for review and follow-upPlease be assured that we take these concerns seriously and this matter was thoroughly reviewed.The Executive Consultant informed us that he contacted *** *** and discussed this matter with her and that it is currently being addressed*** *** informed our Executive Consultant that she had submitted her complaint to the Revdex.com prior to his contacting her and their discussion If you and/or *** *** have any additional questions regarding this inquiry, please Contact Ella L*** at ###-###-####,Sincerely,Cynthia W*** Manager, Appeals and Correspondence

We also received an email from Mr*** and have sent his complaint to our Compliance Officer for handlingI will notify of outcome as soon as Compliance Officer has completed her review

Thank you for bringing this issue to our attentionA consultant from our Member Services Department will contact you directly to investigate and address your concernsThank you

This letter is in response to your inquiry dated February 12, to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc(Health Plan), on behalf of the complainant, *** ***.Ms*** states in her complaint that the Health Plan denied her claim for services rendered at
*** Hospital on November 3, 2015.We have reviewed this matter and our findings and responses are indicated below:• Claim for services rendered at *** Hospital on November 3, was denied for no authorization• *** Hospital is a participating provider with the Health Plan, therefore this provider cannot bill our member.• *** Hospital will be contacted and informed that as a participating provider with the Health Plan, they cannot bill Ms***.• Ms*** filed an appeal with the Health Plan on February 3, Ms*** will receive the appeal decision under separate cover. *** did not bill Ms*** according to the Patient Accounts Department.If you and/or Ms*** have any additional questions regarding this inquiry, please contact Keyla W*** at ###-###-####. Sincerely, Cheryl T*** Director, Appeals and Correspondence

Hello, My name is *** *** *** and I am writing to let you know that I have receive a confirmation number for my refund from Kaiser PermanenteI am pretty sure it was because of your prompt action they finally decided to refund me my moneyThank you very much for all your
help. *** *** ***

Hello, My name is *** *** *** and I am writing to let you know that I have receive a confirmation number for my refund from Kaiser PermanenteI am pretty sure it was because of your prompt action they finally decided to refund me my moneyThank you very much for all your
help. *** *** ***.

Hi ***, Our Member Services team advised the member how to proceed on November 6, 2017 by telephone. In addition, our Georgia Member Services called the member on November and November and left messages for the member. We believe she’s been informed how to proceed with her issue. Please update the Revdex.com case from unresolved If I can assist further please let me know Take Care, *** ***Executive Leadership Escalations

We don't understand why the Medical Doctors listen put what we say on our chart but don't do test to find out what's going on and why we are in pain or what is making our knee's swell. Why excessive sweating of head and neck when its not hot. Finding causes can lead to helping.
We pay our $218.00 a month all our co-pays and that's it. Take the money and do nothing. Quality of life means nothing to Kaiser MD saving Kaiser money does. The hell with the person that is suffering.
All about preventive care so if you get something wrong they won't help you. Even if you are willing to pay the co-pay its not enough. The Doctors work for Kaiser and not the people that count on them for medical help. What good is going to see your MD just to pay the co-pay and leave. It's all about the money. They let you come in free once a year and take your blood pressure FREE$ they already have $2,600.00 and many have a blood pressure machine. Please try and do what's right. Did you become MD's just for the $$$$ or to heal people?

This concern is under reviewThe patient will be contacted directly regarding next steps

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

Hi ***, ? Our Member Services team advised the member how to proceed on November 6, 2017? by telephone.? In addition, our Georgia Member Services called the member on November and November and left messages for the member.? ? ? ? We believe she’s been informed how to proceed with her issue.? Please update the Revdex.com case from unresolved? ? If I can assist further please let me know ? Take Care,? ? *** ***Executive Leadership Escalations?

February 23, 2016[redacted]Complaint Case # ? ? ? ? ? [redacted]Consumer: [redacted], [redacted] ? ? Case Opened: February 9, 2016? Dear Ms[redacted],This is in response
to your email received on February 23, 2016, forwarding concerns on behalf of our member, [redacted], pertaining to continued issues experienced with her healthcare plan purchased from [redacted] (C4)For future reference, please forward the Kaiser Permanente (KP) Colorado complaints directly to me, via email, as I am the KP representative managing Revdex.com issuesI sincerely apologize for the delay in response, as it was just forwarded internally from to me todayWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.We have formally documented and shared Ms[redacted]’s complaint details with the appropriate Consolidated Service Center/KPIF, On-Exchange Issues Department leadership, to include the overseeing ManagerI am very sorry for any frustration caused to Ms[redacted], as a result of dealing with her overall C4/KP plan issues, including the persisting problems with her enrollment/premium.? I located an initial complaint that was filed for the member on December 9, Being that the previously experienced issues have not been resolved as of yet, I have opened a Second Review complaintI encourage Ms[redacted] to contact me directly, as to follow through with the posted case and planned actionI assure you that I will personally assist Ms[redacted] with any current or arising plan related issues.The Member Issues Resolution Team (MIRT) has reviewed the case and submitted for urgent reinstatement of Ms[redacted]’s planMIRT has advised that the reinstatement should occur by tomorrowAgain, the member is welcome to call me for confirmation, as well as for updates regarding her account plan details (monies paid/due).? Please thank the member for her patience, and reiterate that I am happy to be her one go to person with this situationMs[redacted]’s feedback is valued, as is her allowing us to fix the existing problems.? 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? South Havana StreetAurora, Colorado ? 80014Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member? If the Revdex.com or the member has any questions, please contact me at [redacted].Also, you may contact Member Services:? Denver/Boulder members may call [redacted], toll free at [redacted], between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.? Sincerely,Tina MB[redacted]Complex Case Resolution SpecialistMember Experience? ?

Thank you for your email.  Our Member Services department sent a written response directly to the member on April 5, 2018.  Please let us know if we can assist further.  Thank you.

April 24, 2014Dear **. [redacted]:This letter is in response to your inquiry dated April 14, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc, (Health Plan) on behalf of **. [redacted] The inquiry was received on April 16, 2014.**, [redacted] stated that the Health Plan...

terminated his health insurance coverage on December 31, 2013 because his credit card expired. He also stated that he has spent many hours on the phone with Kaiser Permanents to resolve this matter.The Health Plan sent **. [redacted] letters on November 1,2013; November 22, 2013 December 1, 2013; and December 4, 2013 respectively notifying him that his credit card on file would expire. The letters also informed him that we would need to a new credit card number to continue his automatic monthly premium payments.On January 7, 2014 the Health Plan sent **. [redacted] a delinquent notice for the non-payment of premiums. The delinquent notices are used to inform members of arrears and that their account may be terminated after the expiration of a 31-day grace unless payment is received for the outstanding balance**. [redacted]'s coverage terminated effective February 10,2014. On February 24, 2014 the Health Plan received a payment in the amount of $542.14. The payment applied to the outstanding premium balance for January 2014 and February 2014 and a partial payment for the March 2014 premium.On February 27, 2014 the Health Plan mailed **, [redacted] a refund check in the amount of $230 for the February 2014 premium.According to the Membership Administration Department **. [redacted] was issued a refund in error. His policy has been reinstated with no break in coverage and current balance for May 2014 totals $383.86. ($150.86 for the outstanding premiums balance plus $233 for the May 2014 premium.)If you and/or **. [redacted] have any additional questions, please contact [redacted] at ###-###-####.Sincerely,

Our Member Services department outreached to the member by telephone on January 24th and in writing on January 26th to address the concerns. Please let us know if we can assist further. Thank you.

Thank you for bringing this issue to our attention. A consultant from our Member Services Department will review the correspondence and follow up directly with the member. I've also attached a link to preventative care services on the Kaiser Permanente website. ...

https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/nat/nat_preventive...⇄ Thank you.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

RE: Complainant: [redacted]ID #: [redacted]Member Number: N/ADear [redacted]:This letter is in response to your inquiry to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted]. The inquiry was received in the Appeals and...

Correspondence Department on September 28, 2017. Regrettably, there is no record of your complainant in our systems.If you and/or [redacted] have any additional questions, please contact Manama A[redacted] at ###-###-####.

May 14, 2015Dear [redacted]:This letter is in response to your inquiry dated May 5, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The Inquiry was received on May 7, 2015.[redacted] stated in his complaint that he applied for...

health insurance coverage through the Maryland Health Connection. He also stated that he did not receive his health insurance identification cards.According to our records, [redacted]'s coverage became effective February 1, 2015. On May 6, 2015 the Health Plan requested identification cards for [redacted]. He should receive them in the mail within 1-2 weeks from May 6th.On behalf of the Health Plan, I apologize for the inconvenience this situation has [redacted].If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy SSenior Manager, Member Services

Very bad costumer service. Even if the manager [redacted] is very unprofessional. She cut short my speech more than 3 times even if I told her that's very bad. But she just kept cutting short. I asked her to transfer to her manager or have her manager to call me so that I can file the complain against her bad service. But she refused. She feel very inpatient when I told her the issues I met in Kaiser. A very unprofessional costumer manager in Kaiser I met. How Kaiser can improve the service with the manager like [redacted]?