Kaiser Permanente

February 23, 2016[redacted]Complaint Case #           [redacted]Consumer: [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 issues. I sincerely apologize for the delay in response, as it was just forwarded internally from to me today. We 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 Manager. I 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, 2015. Being that the previously experienced issues have not been resolved as of yet, I have opened a Second Review complaint. I encourage Ms. [redacted] to contact me directly, as to follow through with the posted case and planned action. I 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 plan. MIRT has advised that the reinstatement should occur by tomorrow. Again, 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 situation. Ms. [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 2500 South Havana StreetAurora, Colorado  80014Written 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 [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,Tina M. B[redacted]Complex Case Resolution SpecialistMember Experience

March 12, 2015Dear [redacted]:
This letter is in response to your inquiry dated January 30, 2015 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. The inquiry was received on March 12, 2015.
Please note that...

the inquiry was forwarded to our office on March 12, 2015 by [redacted] of the San Diego, CA Revdex.com. The Revdex.com of Metro W[redacted] DC & Eastern Pennsylvania?s letter was mailed to the incorrect address. The letter was mailed to Kaiser Permanente, 1221 Mercantile Lane, Largo, MD 20774. The correct mailing address is Kaiser Permanente, 2101 E. Jefferson St., Rockville, MD 20852.[redacted] is requesting that the Health Plan cease and desist the premium billing statements because he does not have coverage with Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
On February 6, 2015, Ms. Keyla W[redacted], Senior Communications Specialist of the Appeals and Correspondence tried to reach Ms. Emily C[redacted] and/or Chrissy K[redacted] at the phone number (###-###-####) listed in the complaint letter to the Virginia Bureau of Insurance. Ms. W[redacted] left a detailed message requesting additional information to properly investigate the concerns stated in the complaint letter to the Virginia Bureau of Insurance. Ms. W[redacted] left a second message on February 10, 2015.
Unfortunately, the Health Plan is unable to honor the request to cease the billing statements because we are unable to identify the complainant in the system. Health Plan would need copies of the premium billing statements to investigate the concerns stated in the letter.
If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.
Sincerely,
Daisy S
Senior Manager, Member Services

[redacted]




Nov 4 (1 day ago)










toinfo,me




 
Good Afternoon,
 
This email is to inform Revdex.com; that I have finally received the check of $10.00 from Kaiser.
 
Thank you for you time and attention in this matter.
 
V/r,
[redacted]

Thank you for contacting us.   Our Member Services Department will review and address the concern and followup with the member directly.  Take Care,[redacted]

November 12, 2015
Dear [redacted]:This letter is in response to your inquiry dated October 30, 2015 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]...

[redacted] stated that in her complaint that in February 2015 she contacted the Health Plan regarding her eligibility status. She indicated that the Health Plan informed her that her coverage terminated in December 2014. [redacted] stated that she purchased individual coverage in March 2015 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 group. This group plan became effective June 19, 2009.•On January 28, 2015 the employer group notified the Health Plan to retroactively terminate [redacted]'s health insurance coverage effective December 5, 2014.•On February 20, 2015 the Health Plan received an individual application from [redacted] requesting coverage effective March 1, 2015. The Health Plan enrolled her in an individual plan.
• On March 28, 2015 the Health Plan received a reinstatement request from the employer group to reinstate the member effective December 5, 2014 with no break in coverage.• On June 9, 2015 [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 coverage. Regrettably, the Health Plan is unable to honor [redacted]'s request. Her employer group coverage was terminated based on the information received from the employer. Unfortunately, because employers may terminate employees retroactively, appearing "active" in our system may not accurately reflect a member's status. Only 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 T.
Director, Appeals and Correspondence

The Plan contacted the member on 8/5/16 to acknowledge receipt of her concern and will provide resolution directly to the member within 30 days.

I signed my family up for health insurance with Kaiser Permanente COlorado approximately a year ago. I am paying a monthly premium of approximately $950. About six months ago, Kaiser states they made a change to their billing company. During this time they threatened to cancel my insurance for non payment of premiums. I submitted al of the necessary documentation, including cleared checks, to show that all payments had been made. Since then, we are constantly told our insurance has been terminated although we are current in our payments and have proven that past payments were made. Each time a call is made to Kaiser, they will say that it has been corrected. When we took our child to receive care, I was told I have to pay the entire amount out of pocket, which I did, and they would reimburse me when it gets resolved. Today, my wife called in to check about being reimbursed for the out of pocket payment and she was told we were terminated yet again. I have called an attorney....

April 24, 2014
Dear **, [redacted]:This letter is in response to your inquiry dated April 10, 2014 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 2013 individual plan would expire on December 31, 2013. **. [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) website. Additionally, **. [redacted] indicated that on February , 2014 he received a bill in the amount of $302.09 for his 2013 policy. He paid the bill but he is requesting a refund of the $302.09 overpayment.According to our records, the Health Plan did not receive a cancellation request from **. [redacted] to terminate his 2013 individual coverage.According to **. [redacted]s 2013 Evidence of Coverage, under Section , Page 6.1 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 2013 individual coverage effective December 31, 2013. On April 1, 2014 the Health Plan sent a refund totaling $302.09 to **. [redacted].**. [redacted] also stated that he contacted the Health Plan on February 15, 2014 to terminate his 2014 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 2014 individual policy through the website. Once **. [redacted] notifies DC Health Link of his cancellation request, they will contact the Health Plan to terminate his policy. Upon receipt of the notification from DC Health Link, the Health Plan will terminate the 2014 individual coverage. I 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, 2014 as he requested.Please be advised that complaints are thoroughly documented, investigated and resolved by the Member Services team through coordination with appropriate departments. This coordination may involve communication with senior leaders to ensure complete closure of a members concerns. We 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 leaders. In addition, reports of member concerns are shared on a regular basis with our Senior executives. These 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,

October 6, 2014
Dear [redacted]: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 [redacted]. You Stated in your complaint that you previously submitted an inquiry to the...

Health Plan but there was no response. Please note that there is no record of receipt of the above referenced complaint prior to September 8, 2014.On September 17, 2014 the Health Plan received a complaint from your office regarding [redacted] under case number [redacted]. The Health Plan responded to the complaint on September 26, 2014. On October 7, 2014 the Health Plan received a letter from your office stating that the case has been closed as resolved.Should you have any additional questions please feel free to contact me.Sincerely,Keyla W
Senior Communications Specialist Member Services

Thank you for sharing this concern with us.  We will have this issue investigated through our Member Services team and will notify the member of the resolution in writing.   Thank you.

I am very mad at Kaiser, I had enroll for the gold plan on the last day of enrollment and got approve days before new years 2018. Once approve I cancel the Bronze plan that I had. I decided to cancel the new Gold plan 4 or 5 days before the coverage began. They put the request for the cancelation and told me that if I had enroll in automatic payments they would refund me for any payment That went through which was $489 dollars. When I called back to make sure that my plan was cancel, they told me that it was not active and there was a cancelation request note and should not be worried about it, and expect my refund in the next 3 to 4 weeks. Well, since I was not receiving any mail that my plan was cancel I decided to call again a make sure that my plan was no active and once again, they assured me that it was cancel and they did saw that I had called before and said that this was my 3rd cancelation request and I had nothing to worry about,but that they thought it was weird that they had not resolve my cancelation request yet because I cancel the plan before it even started , once again, I had nothing to worry and I was going to get my refund back. Then again I had to call one more time and they said this time that my gold plan was bot cancel and my bronze plan was active too, when they told me that I told them that I had call before and confirm that both plans were cancel and not active, she put me on hold, after a while she came back and told me that indeed both plans were cancel before new years2018 and put me on hold again, but this time her supervisor took over and with a very imperative voice told me that the gold plan was cancel since it never started and the broze plan terminated since it was used. Then assured me that my refund will be on my account after 4 week.

Well, today I called and tolld me the they were not going to refund me the $489 dollars. I was so upset and told them that my plan was cancel before it even started, how can they keep my money for a service that they did not provide. They said that I hace to call the people that decide if they refund my money or not, I have to file a grievance form and they get to decide if the give my money back or not even though the did not provide the service. How is that legal, they dind’t even bother to contact me the whole time.
I expect answers and I am not letting go of this, even if I have to contact the Tv station in my area, Telemundo, Univision and Kron 4. Oh, and I will put a complaint at The Revdex.com.

Griselda Santos Galvan

Review: Kaiser sent a Notice of Pending Bad Debt, yet had never sent a bill prior to the notice.Requested Kaiser to send a bill, they sent a EOB that clearly states it is Not A Bill and no payment information is included.In contacting Kaiser a second time they said they do not bill me they bill the Kaiser Managed Health Saving Account, which for some reason did not pay although there are sufficient funds to pay this claim.Desired Settlement: Kaiser to remove any bad debt reporting and to allow payment to be received via US Mail by December 5, 2014.

Consumer

Response:

Where do I get the HIPAA release form you requested. IThank you,[redacted]

Business

Response:

For [redacted] - email sent to the patient (member) to validate if complaint is still open. We have no record of case filed as a formal grievance. Note received back on 12/23 to open complaint. Complaint was opened and acknowledgment sent. Direct outcome will be sent to patient (member) directly at no more than 30 day**

Consumer

Response:

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

Review: My name is [redacted] and I went to see my physician Dr [redacted] at Kaiser Permanente in Tracy CA on September 13, 2011.(the primary account number is [redacted], my husband acc # [redacted]) for a physical exam and a routine drug test for my new job. I dont know how she ordered the drug test but the bill came home a couple days ago and there were 2 drugs tests instead of one (I called Kaiser and the lady who does billing told me that was more than one drug test)for the amount of $95.00 and $665.00 and my co-pay is $59.00 and $413.00. Why would she order 2 drugs tests when I only ask one? I went to ask the other labs and everyone told me that a drug test cost between $35 and $65 maximum? They overcharged me for something that I didnt request. I contact Dr [redacted] and the only answer she gave me was "I didnt know money is a problem for you and it depends what kind of deductible plan you have" I still kept the emails she sent me. I told her the money is not an issue here the problem is you ordered some test drugs that cost me over $700.00. I have never ever in my life done a drug test that cost that much!!!!!!Desired Settlement: See Complaint Text

Business

Response:

Member was advised on 09/32/2011 (by KP Member Service Call Center) that she had not met her deductible and services were appropriately billed at full price. She did not file a grievance.

Consumer

Response:

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

Review: In November of 2013 I underwent a medical procedure. At the time of the procedure I was asked to pay a $50 co-pay which I was not able to pay at the time. Kaiser gave the OK to have this amount billed to me. Since then I have received multiple bills with different amounts far above the $50 I was told would be billed to me. At that time I was NOT advised that there would be any additional charges for services rendered. I am not receiving 3 separate bills that seem to total about $400. I have now been attempting to contact Kaiser's billing department at the number listed on the bills received to discuss what the bills are for and if I DO actually owe the money if I could set up a payment plan. I have been attempting to call for the past month however, everytime I call the number provided a recording comes on saying they are receiving high call volumes and to call back later and I am then disconnected. I am now receiving bills threatening that the account will be sent to collections if not paid. However, I refuse to pay a bill that I have questions about and cannot get them answered. As previously stated at no time during my visits to my doctor was I told that I would be billed any additional amounts other than my co-pay. It does not seem fair that they can bill me for services performed without telling me anything in advance or that they threaten collections when I am unable to contact them. If they have such high call volumes maybe they should hire additional people or have an option to leave a message but, they do not.

Product_Or_Service: medical procedure

Account_Number: guarantor acct# [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like them to call me to discuss the billing issue and if I do owe, set up a payment plan. However, ultimately I would like them to clear my account of any moneys due other than the $50 co-pay I was originally told would be billed to me. Or better yet even clear that due to their inability to allow patient contact with the billing department and their deceitful billing practices and threatening letters stating collections action will be taken.

Business

Response:

Member filed a grievance on 02/14/2014 requesting a waiver of $317.60. Case was reviewed and denied in writing on 03/05/2014. Charges were appropriately billed according to the member's deductible.

Review: During a routine visit for medication I was asked to take a drug test by the nurse practitioner [redacted]. I was told that it was a requirement for the [redacted] and there would be no cost. The next day I filed a complaint with Kaiser because the drug test is inappropriate and was told that the nurse practitioner [redacted] was wrong and that it is not a requirement for the [redacted] and that it is in fact a Kaiser policy that they drug test before prescribing certain medications. I passed the drug test and received a bill for $433. I should not be required to pay this bill because I was told that there would be no charge - I would not have subjected myself to something I don't agree with if I am also going to have to pay for it. This is our first and last year with Kaiser, had I known there was a charge for the test I would have just private payed with my previous psychiatrist. After receiving the bill, I did file a complaint with Kaiser over the bill and they summarily dismissed it saying the drug test is not covered under our health plan (it turns out that no plans cover drug tests because they are not medically necessary OR required by law as the nurse practitioner had claimed).Desired Settlement: They need to provide us with a refund for $433.00 because the nurse practitioner lied about the drug test being required under Federal [redacted] law (I have a letter from Kaiser saying just that) and because she specifically told me that there would be no cost. They also need to start having patients sign something that they understand that the drug testing is a Kaiser policy and that it is never covered under a health plan because it isn't medically necessary or required by law.

Business

Response:

For [redacted] - Patient filed a complaint directly with the Health Plan. The grievance was opened on 7/21/14The Acknowledgement letter was sent to patient (member) on 7/23/14The Resolution Letter was sent on 8/19/14 with a detailed response and outcome of the complaint. Due to protected health information the details of the outcome will not be given.Case was closed on 8/19/14

Consumer

Response:

I am rejecting this response because: the response I received did not address my complaint. My complaint was that the provider told me the drug test was required by the government and therefore would not cost me any money. The response from Kaiser was that the drug test is not required by law and is in fact a Kaiser policy. Kaiser then stated that the drug test is not covered under my insurance plan and so I was required to pay the bill. I actually had filed 2 complaints for this. The first complaint filed the next day after my appointment was in regards to the treatment I received by the nurse practitioner. I would have never taken the drug test if I knew I was to pay for it.

Review: There not giving me mine pass word TOO leave a email TOO mine Dr.Desired Settlement: Fire with No retirement & No EDD PAY.

Review: The main pharmacy at this location is horrible. Three hour wait times are the norm. You wait about a half hour just to check in your prescription. After this, a 1-2 hour wait is necessary until they put your name up on the board. Then, one must wait in a line for about an hour to receive the medication.Lines stretch out into the hallway of the building. I have been proactive in helping avoid the long waits by requesting my refill two days before it expired. This was in hope of them having it processed so I can pick it up on the day needed. They turned down my refill request stating that it was too early. This is for a common prescription, not a controlled substance.Other times, when speaking with a pharmacist about my concerns for them denying my request, after a doctor refilled it mind you, after curtly explaining her thoughts, she walked away from me before I was done questioning her. It is one thing to receive this service from a business where I can avoid them in the future. This is HEALTHCARE and I do not have a choice. I am a school teacher and have to use Kasier. I want an apology, an answer of what is being done to improve this, and a solution for me to avoid this problem. Life is too short to be sitting in a room with sick people for 3 hours at a time.Desired Settlement: I want a personal apology. I want an explanation of a plan to improve this.I want 3 month refills on my prescriptions. If I cannot have these, than I want Kaiser to pay for my prescriptions to be picked up at another pharmacy.

Business

Response:

The Health Plan has received this complaint and it was logged on 2/10/15. The Health Plan has up to 30 days to respond in writing directly to the member/patient. The case is under review and the correspondance related to outcome will be sent directly to the member/patient.

Consumer

Response:

I am rejecting this response because: I received a phone call this afternoon in response to my complaint. I am grateful of the quick action taken by this business. After sharing my concerns with the woman who called me, there were no answers, or solutions given to the problem.She assured me that she will look into it and it could take up to 30 days to get a response.This is unsatisfactory because I will need a refill in 30 days, and I do not want to go through this process again.Thank you.

Review: I have requested online access to my son's (4 years old) online record/login and I have done everything they asked me to do. It's been a year now since I requested the online access in order to facilitate my son's needs in regards to his appointments. I have called them several times and spent hours on the phone and have followed their instructions but with no positive results. In addition, they have promised me on several occasions that they will take care of it for me and call me back with the solution. No call back with a solution was made to me and each time I called them back, I would have to explain everything from scratch. My son is autistic and having these simple basic options that are available to everyone with Kaiser Insurance would have made it much easier for us as parents. Recently, we have requested a government form (IHSS form) to be signed by my son's pediatrician (at Kaiser) in order for us to receive some services that we desperately need. That they have also dragged too long and we decided that we would take it to another doctor out of Kaiser. My son was born in Kaiser and continued to receive Kaiser Insurance, he was also diagnosed with autism at Kaiser. So I do not know understand their reasoning of taking so long to sign a simple basic form. Lastly, when we wanted to schedule an appointment with a gastroenterologist for my son, they told us that they would need to do a check-up with his pediatrician when my son was already seen by his pediatrician a few days prior and the pediatrician had no idea of what to do. We do not have the time or the energy to go around in circles till we can finally get what our child needs if we ever get it. Time is of the essence when dealing with autism, as such, no time should be wasted.Desired Settlement: Do not waste parents' time especially when they have a special needs child. Do not make false promises and drag everything to a point where parents just give up or should I say give in.

Review: Medicare made a mistake and informed Kaiser that my benefits had been cancelled. so Kaiser stop my benefits as well in 4/16 and when I tried to get a prescription filled is when I found out which was not until June/16 so after everything was restored it was in July/16 and now I get a bill for all the time I had no benefits with them. How can I be put in a position to receive a debt for something I did not have. And I have no money to pay 465. for services not provided.Desired Settlement: I will pay for this month and July but not for April May and June I did not have services

Business

Response:

The Plan contacted the member on 8/5/16 to acknowledge receipt of her concern and will provide resolution directly to the member within 30 days.

Consumer

Response:

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

Review: I am trying to find out what happened to a Kaiser Permanente refund that was supposedly sent to [redacted], my former bank.On January 1, 2014, I married a Kaiser employee and was subsequently given medical benefits. However, Kaiser mistakenly charged me a month's dues after I was accepted under my wife's policy. Kaiser agreed to refund the money. However, at that time, I also switched banks from [redacted] to [redacted]. On May 8th, 2014, Kaiser claimed that it sent the money to [redacted] and that the money was not returned. After calling Kaiser numerous times (about five times), I was told to contact [redacted]. After calling [redacted] many times, the [redacted] customer service agents will not disclose any information to me because I closed my account with them.I have called both Kaiser and [redacted], but both businesses blame the other side and they do not help me.What can I do?Thank you,[redacted]Desired Settlement: The amount of the refund is $390, the amount I paid for coverage.

Business

Response:

The health plan has issued a refund check to be paid directly to the member of $390

Consumer

Response:

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