Kaiser Permanente

Review: on 12/16/2014 I was seen at the emergency room at this Kaiser location by Offerman, [redacted] (M.D.) I was Evaluated for: Abdominal pain. Gallstone attack. I was told that I will be called to make an appointment for a surgery and will be given medicine. Nothing happened after that day. I never received any follow up call for appointment setup, etc. When I called Kaiser to check they told me the doctor will follow up but it has been over 7 months now. I was billed almost $2600 by the hospital for staying few hours at the hospital. I have basic Kaiser coverage from covered ca therefore my insurance didn't cover a lot. I called Kaiser member services many times asking them to reduce my bill or setup a payment plan for me because I work at minimum wage and can't come up with that amount at once. Kaiser never helped me with anything. I tried to pay little monthly. I also submitted a financial help application form to Kaiser but didn't receive any reply. it took me so much time and effort to get all documents to file this paperwork for financial help. this is the worst hospital service I have ever seen or heard about. Now they have given my overdue $2455 bill to USCB collection agency. I really don't want my credit to be affected due to this. please help me reduce my bill so I can pay it at once. My client # with uscb, los angeles is 3-2152. Please help me with this.Regards,[redacted]Desired Settlement: Please reduce my bill that is overdue so I can pay it.

Review: I was at the [redacted] Medical offices at Kaiser Permanente for a routine maternity visit, my 20 week ultrasound. I was denied service when I showed up with my 18 mo old son who was quiet and contained in his stroller at the time. The reason being "it is our policy that we are to have complete silence while we perform the scan without distractions so we don't miss something". These were the technician's exact words. I explained that I am the patient and I will take my chances. I assured her that he will be good while in the stroller and possibly even fall asleep as he was due for his nap. She refused so I asked if someone else who felt more competent in their job would perform the scan and wouldn't mind the child in the room. NO technician would do the scan. They had me wait with no explanation as to what was happening. After some time, a representative from Member Services approached me saying she is here to "advocate on my behalf" and went through the options so I could be seen that day. She suggested that if he fell asleep, I would be able to wheel him in and get scanned. She left to verify this with the technician. She returned saying, "bad news, the schedule is all booked, you will have missed your appointment window if you wait for him to fall asleep." At which, point, after waiting for an hour to be seen, I left the room and arranged for my mother to supervise my boy. When I returned 10 minutes later, I was sent into the exam room where the scan had started until a knock on the door stopped the scan short and I was threatened if I didn't leave that they would call the police. I was in shock but scraped off the ultrasound gel from my stomach and left the room. The police had called me later that day anyway -- harassing me to tell them my side of the story and when I told them there was NO story, they showed up at my house. All in all, this experience has cost Kaiser my business and cost me my emotional health as I left the facility in tears. Adding the involvement of the police not only undermines my authority as a Licensed Marriage and Family Therapist since 2006 but also added an element of trauma for my boys who experienced their mother in tears and a knock at the door by the police. This experience has left me shaking and aggravated and scared to ever go back to Kaiser again.Desired Settlement: In addition to a refund, I would like my medical records forwarded to me as soon as possible. I have only been with Kaiser since December 1, 2013. Today is December 18th and have to stay on for the duration of the month, otherwise I am uninsured medically. I am requesting a full month refund however since they have made it impossible for me to maintain coverage with them. I will only be able to obtain new medical insurance effective January 1st. The deadline to submit an application for new insurance is Dec 24th and with the holidays approaching I am inconvenienced in a huge way to get this done on time.

Business

Response:

January 23, 2014

Dear **. [redacted]:

This letter is in response to your inquiry dated December 27, 2013 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted], The inquiry was received on January 3, 2014.

**. [redacted] expressed dissatisfaction with her visit to the [redacted] Medical Center's Radiology Department on December 18, 2013. In addition, **. [redacted] is requesting that the Health Plan terminate her policy effective December 18, 2013 and refund her the December 2013 premium.

Complaints are thoroughly documented, investigated and resolved by the entire Member Services team through coordination with appropriate departments, This coordination may involve communication with Senior Leadership to ensure complete closure of a member's concerns. We also have processes in place to escalate a member's concern to Physicians-in-Chiefs, Clinical Operation Managers, Department Leaders, Health Plan Managers and the Executive Leadership. 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,

In addition to the processes and actions described above, **. [redacted]'s letter was escalated to Dr. [redacted], Regional Medical Director for Imaging Services and **. [redacted], Radiology Supervisor for review and appropriate action.

Background Information of the Health Plan's internal investigation

When a member calls the appointment line for radiology services, there is a script to advise members that no children are allowed at the appointment or there must be another adult there at the appointment to accompany the minor.

According to **, [redacted]'s discussion with the Radiology staff, **, [redacted]'s son was not sitting quietly in his stroller. The young child was walking around the exam room.

The radiology technician informed **. [redacted] that it is a safety issue for her young child to be running around the exam room with all of the wires and equipment; therefore, it would be best for her to reschedule her appointment when she had a babysitter, **, [redacted] became upset and she used profanity to address the lead technician and front desk staff. The staff called security to intervene,

**. [redacted] left the Medical Center and returned in 15 minutes indicating that she found a babysitter for her son.

The technician proceeded with the exam. During **. [redacted]'s exam, another member reported to the Medical Center's security guard that there was a child left atone in a car in the parking lot The staff interrupted **. [redacted]'s exam to inquire if that was her child and informed her that they would call the police to report the incident. The Medical Center staff called the police to report that a young child was left alone in a car.

" Additional Questions:

1. Was this member billed for a service that she never received?

The Health Plan did not bill **. [redacted] for date of service December 18, 2013,

2, How is she able to obtain her medical records?

**. [redacted] must complete a request form for her medical records and return it to the Healthcare Information Management Services Department (HIMS-Medical Records) at the [redacted] Medical Center, I have enclosed a copy of the medical release form for **. [redacted]'s convenience.

3, It appears that the member would like her coverage cancelled on December 18th.

On December 19, 2013, the Health Plan received a termination notice from **. [redacted], requesting cancellation of her health care coverage effective December 31, 2013. We complied with her request.

4, **. [redacted] is requesting a full refund of her December 2013 premium,

**, [redacted]'s request was forwarded to the Membership Administration Department for review. Regrettably, we are unable to comply with **. [redacted]'s request to waive and refund her December 2013 premium.

If you and/or **. [redacted] have any additional questions, please contact [redacted] at ###-###-####.

Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: I find the letter from Kaiser full of discrepancies. Firstly, please ask for the script when I called to book the appointment because they did not mention kids were not allowed. This was my third pregnancy and I was never told by any health care provider that I would be denied medical attention because I have my kids with me. Secondly, perhaps they are mistaking me with another patient because my time in the waiting room was the only time I had my son with me and he was strapped in his stroller the ENTIRE time. It was his nap-time and he was asleep, therefore not walking around or even making a peep! I was in the exam room alone while he was in the car with my elderly mother. Not ideal but given no other choice it was my only option and I wasn't breaking any rules doing so. Thirdly, profanity is subjective. Perhaps after being adamantly denied medical attention while 4 months pregnant with a history of high-risk pregnancies, I felt the need to be assertive and that meant being unkind and loud but profanity? that does not sound like me no matter how irate and hormonal I may have been.

Review: the company has processed 2 payments of an unauthorized bank debit of a canceled old health care plan.the payments taken out of my checking account caused my account to go into a negative balance.to resolved this matter using telephone calls and personal

visit to office,,they did not respond to the problem in a timely matter.my checking account had ample supply of funds before the money was taken out.Desired Settlement: looking for refund to my checking account that has been damaged.

Business

Response:

February 7, 2014

Dear **. [redacted]:

This letter is in response to your inquiry dated January 23, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted], **. The inquiry was received on January 30, 2014.

**. [redacted] stated that the Health Plan deducted two premium payments totaling $2,200 from his bank account. **, [redacted] is requesting that the Health Plan reimburse him the funds that were deducted.

According to our Membership Administration Department, the payments were deducted from **. [redacted]'s account in error. The Health Plan contacted **. [redacted]'s bank to report the error and requested the money be credited to his account.

**. [redacted] contacted the Health Plan on January 18, 2014 regarding his reimbursement January 31, 2014, the Health Plan issued a refund check to **. [redacted] in the amount of $2,200.

We regret the inconvenience that this situation has caused. If you and/or **. [redacted] any additional questions, please contact [redacted] at ###-###-####.

Sincerely

Review: On December 31st 2013, my credit card expired, and the odyssey I have been on rivals any of the Greek epics.

Since that fateful night, I have been on the phone with Kaiser Permanente exactly 5 times, wasting nearly 7 hours of my life. In those seven hours I could have been doing anything. Literally, anything would have been better than the terrible hold music and the compartmentalized department characters I've dealt with. Moreover, and in an attempt to prevent spending time on the phone with them, I decided to write an email and try the whole modern, interactive, cutting edge KP.org. Alas, their marketing was nothing but games. I didn't receive a reply in two weeks.

When I called after two weeks of concern (2/24/2013) about my possible non-health covered life, their respond to the no reply was, "uh, we're super busy, so we didn't reply to it yet"

My response to their response, "really, it's been two weeks...? You literally could have email me what you just said, and it would've been better than having to call you. So, why didn't you charge my credit card for January and February?"

The woman on the phone, "Your card expired, it happens all the time. You need to pay $570 to cover last month and this month."

Me, "Cool, here is the card number [.............]"

Woman, "Good, charged, your now going to be reinstated."

Fast forward to April 8th.....whooosh....

Me, "So, I still have not heard anything about my reinstatement from March 27th. Whats going on?" [redacted], "You're not covered. You need to pay $230 to become covered again. Do you want to go to the payment line?"

Okay, since from that moment when I paid the original $570 and my original reinstatement: they have refunded me $230 for overpayment and input reinstatement request (3/11/2014), not given me coverage again and then another input another reinstatement request (3/27/2014),not given me coverage and then told me that I have to pay $230 for another reinstatement #3 (4/8/2014).

Yes, that was a confusing paragraph you just read, because this is a confusing story and I want you to understand why I am complaining.

It is laughable that a multibillion dollar business can have such a terrible member services and billing department. Really, if they increased their investment and training into these departments the customer wouldn't hate them (like me), they would save money by not having their staff on the phone for 7 hours to LET someone give then money, and finally they would become a better company because happy customer and happy employees (not dealing with the likes of me) promote innovation and loyal patronage.Desired Settlement: I want [redacted] to call me personally and apologize for wasting my time. Then, offer to take me golfing for 7 hours at my course of choice and listen to my ideas for his company; perhaps offer me a job as next CEO.

Business

Response:

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,

Review: On 8/28/12 I visited [redacted] for a surgical consult for what I thought would be a simple problem. She said it wasn't what I thought, and that it was something else that would require surgery. I was supposed to call them to make an appointment if I didn't hear back from them. I never heard back from them, and I called about 20-30 times at different times and on different days. No one answered. I then got a call on 3/6/13 saying they had a space for me sometime in April. I couldn't do it then, and that I could only do it 3/16/13-3/22/13 or after May 24, 2013. They said they would call me when they would schedule May's surgeries (they said that last year and never called back until this year). In the time that I was waiting for [redacted]'s call, I emailed my general physician to ask what I should do, and I asked her to remind [redacted] (which she did). I also went to a specialist on 10/11/12 who said I didn't need surgery nor did she see what [redacted] saw, and that my problem was what I originally thought it was. I then called member services twice on 3/7/13 to see if I could meet with a female doctor outside of Kaiser since [redacted] can't see me until the end of May (and since this is a problem that's been going on for a year). Membership services said I couldn't see any doctor except their own doctors unless my primary doctor referred me. I explained to them that my primary doctor said she would refer me, but I need a name of the doctor to refer to. The first time I called Membership services they gave me three numbers of outside surgeons that were female. Not one of them had a female surgeon and some weren't even surgeons. On the second phone call to Membership services, they said they would most likely deny the referral in any case and if I would like I could put in a complaint. The problem is that Kaiser doesn't have many female surgeons. In fact [redacted] is the only one in the [redacted] county area. The next closest ones are in [redacted]. All of these places are about 40 min from me by car. It's going to be a painful trip back from the doctor, not to mention the rechecks and any possible complications, which is why I would rather have the surgery close by. Considering I have been paying 450/month since Aug, I could have paid for the surgery myself and still had a lot of money left over. I shouldn't be paying for a service and not receiving a service. I feel like I was strung along.Desired Settlement: I need to be fixed ASAP. A vague statement of "we'll call and schedule you for May" is not acceptable since this was a problem that started last summer. Either give me a definite date, or ideally schedule me for surgery sometime between 3/16/13-3/22/13 with either [redacted] or an outside female surgeon.

Business

Response:

See attachment or check attachment tab.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: My family has Kaiser health insurance plan. In 2013, there were several instances where we had lab work done and received a bill in mail to pay our portion of cost of service. I promptly paid all bills on time. I have requested kaiser several times to send me a statement or receipt to show that I have paid my bills. I need receipts to get reimbursed from my heath-care savings plan. One would think that getting receipts for payments already made would not be a problem, but it's been a very frustrating experience for me. Upon calling Kaiser's billing department, I was instructed to go to a local office and fill in forms for release of records. I went to local office and completed all forms as instructed. When I didn't receive receipts for payments made for lab work, I called billing dept again. They again instructed me to go to local office and request receipts from there. I went back to the local office and explained what I was looking for and was told that they did not keep any receipts for lab work payments. I was instructed to contact kaiser's billing department over phone. When I called billing dept, they again asked me to go to the local records office and this cycle of frustration continues.Desired Settlement: I am just trying to get receipts for payments that I have already made in 2013 for lab work so that I can claim those from my health-care savings account. I will really appreciate if I can get those receipts promptly to allow me to submit those for reimbursements from my healthcare savings account.

Business

Response:

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.

Please note that in May 2014, the Health Plan received a complaint from the Virginia Bureau of Insurance regarding [redacted]'s request for receipts related to the medical care he received in 2013. Please find enclosed a copy of the Health Plan's response to the Virginia Bureau of Insurance that informed [redacted] on how to obtain the requested information.

Should you have any additional questions please feel free to contact me.

Sincerely,

Review: I have been calling Kaiser Permanente for over a year now about a 500+ dollar refund. The balance that was on my account after I canceled my membership. Now I have spoken to over 20 different employees and multiple managers inquiring about the refund of my balance. Initially I was told to wait 6-8 weeks for the refund to be issued. Then when I call back after the 6-8 weeks they tell me check was never issued and I have to wait another 6-8 weeks. Then they say they will send it right away and I should receive it within 7- 10 days and of course when I call back it wasn't sent again.... again... and again. There seems to be a huge disconnect between the people I speak with on the phone in their member services department and their billing department. Many of the times I called they said that they couldn't get a hold of anyone in the other department unfortunately it looks like you will have to call back tomorrow. I don't know whats going on but it needs to be addressed. A business shouldn't be allowed to hang on to a customers money for over a year and make up a different excuse every time they call. Over the course of the past year I have been more than understanding of the situation and I have givin kaiser the opportunity to fix the issue to no success.

Account Information Number [redacted]Desired Settlement: 1. I would really like to get my refund.

2. I hope that kaiser takes this compliant seriously and addresses the issues within their organization on issuing refunds.

3. Apology/compensation for over a year of frustration as a customer.

Business

Response:

See attachment or check attachment tab.

Consumer

Response:

Complaint Detail

Review: I currently pay a health insurance premium to Kaiser Permanente (KP) in the amount of $100 every two weeks. On 7/22/13, my son [redacted], ** had a 15 min. visit which total $119.00 and KP billed me for $20. On 7/23, my son had a visit for 45 min in which that was $269. KP says I owe $30. I dont agree with these charges and KP needs to adjust my bill. What is the purpose of me paying a bi-weekley premium if I still have to come out of pocket. I feel KP's billing practices are incorrect and I have been over charged. I expect KP to send me a bill with a $0 balance. Patient: [redacted], **, Medical record # [redacted], date of birth, 12/27/2001. I have been over charge and KP's billing practices are a wrip off..Desired Settlement: I'M REQUESTING KP ADJUST MY BILL TO REFLECT A ZERO BALANCE AND ALSO SEND ME A BREAKDOWN OF HOW THEY WERE ABLE TO CHARGE ME $388 FOR A 1 HOUR VISIT WITHIN TWO DAYS.

Business

Response:

See attachment or check attachment tab.

Review: I cancelled my membership with Kaiser Permanente on 7/23/14 by faxing a letter to membership services as instructed by Kaiser over the phone. I followed up with Kaiser over the phone on 8/14/14 because I was still receiving monthly bills in the mail from Kaiser. Amanda from Kaiser says "cancellation is in process. Kaiser will notify MD Health Connection first and then they will process it and update me". I receive a letter from Kaiser that includes a "Health Insurance Coverage Certificate" that states my insurance coverage began 05/01/14 and ended 07/23/14. I still continued to receive monthly bills, so on 9/4/14 I called Kaiser again. Spoke with Lori and Byron. Byron admitted that Kaiser has made an error by giving me incorrect information. Byron said that I was supposed to also contact MD Health Connection (Exchange) to inform them I want to cancel my membership. I was never told this back in July. I called MD Health Connection on 9/4, but they can only cancel the plan beginning 10/1/14. This is a problem because I do not feel responsible for any payments past 7/23/14. Byron started a case investigation #[redacted] but then said it is out of his hands (in billing department) and up to membership services from here. I waited 20 minutes to connect with membership services and could hold no longer. On 9/18, I spoke with supervisor Taneka. I explained the whole story and Taneka said she will investigate the matter and return my call shortly. She never called me back. On 9/23/14, I spoke with Art in membership services (in California he says) who was able to contact Taneka. Art said Taneka would contact me on my cell before end of business hours today. It is past 5:30pm and I have not received any calls from Kaiser or Taneka. I am frustrated with extremely long hold times over the phone, the need for multiple follow-up calls, but to no avail.Desired Settlement: I do not feel responsible for any payments after 7/23/14. I have followed all initial instructions on how to cancel my membership with Kaiser. I even have written proof from Kaiser stating my coverage has ended as of 7/23/14. Please let me know what I owe up until 7/23/14 so that I may pay that balance. After my account has been brought to $0, I would like a letter from Kaiser stating my balance is $0 and nothing further is owed.

Business

Response:

October 8, 2014Dear [redacted]:This letter is an interim response to your inquiry dated September 24, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. This inquiry was received on September 29, 2014,[redacted] stated in her complaint that she contacted the Health Plan to ask how to cancel her policy. [redacted] was informed to fax a cancellation request to the Health Plan. According to [redacted], She later found that the information that received was incorrect. She is requesting that the Health Plan cancel her health insurance coverage effective July 23, 2014.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 member's Concerns. We also have processes in place to escalate a member's concern to the relevant 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.In addition to the processes and actions described above, [redacted]'s letter was forwarded to Mr. Victor N[redacted], Operations Manager of the Member Services Call Center and a supervisor at the Maryland Health Connection Marketplace for review and appropriate action.The Health Plan is unable to process [redacted]'s termination request without approval from the Maryland Health Connection (Marketplace). Upon receipt of the approval from Maryland Health Connection, the Health Plan will honor the request and cancel [redacted]'s coverage. Please note that the Maryland Health Connection Marketplace does not cancel a member's coverage mid-month. [redacted]'s termination date will be effective July 31, 2014 instead of July 23, 2014.When we receive approval and the plan has been terminated, we will notify you by letter,I regret the circumstances that prompted [redacted]'s letter. At the same time we thank you for the opportunity to address her concerns.If you and/or [redacted] have any additional questions, please Contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy SSenior Manager, Member Services

Review: Kaiser Permanente allows members to enroll online, but when it comes to canceling or closing an account, they require written submission (by mail or fax), which represents an unreasonable burden. I have already left the country and was unable to provide written request before billing for this month. They also refused to suspend billing for this month, so now they have charged me a premium for the month of August, when I am no longer in the country (and will not return for many months; I also have alternate care now).Desired Settlement: I would like to be refunded for the month of August.

Review: This company wrote me in November that under the terms of the new ACA, my health insurance would be cancelled as of January 1, 2014. In the same letter they directed me to sign up for the health care via DC Health Link.

I signed up for new Kaiser insurance via DC Health Link prior to the Dec 15 deadline. Payment of the first month's premium was withdrawn almost immediately from the account. The new policy is more expensive.

On January 1, I noticed that Kaiser continued to charge me for my old healthcare plan.

I phoned them. They notified me that it was my obligation to terminate the plan for faxing them. I told them they had directed me in no uncertain terms to cancel the policy myself.

On February 1, I noticed that Kaiser continued to charge me for my old healthcare plan.

As the business that notified me that they were terminated services, it is up to them to terminate them.Desired Settlement: Kaiser should immediately cancel my old policy and refund me the payments they have taken out of my account.

Business

Response:

February 27, 2014

Dear **. [redacted]:

This letter is in response to your inquiry dated February 14, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted]. The inquiry was received on February 20, 2014.

**. [redacted] stated that the Health Plan deducted two premium payments totaling $138.10 each from her credit card account. **. [redacted] is requesting that the Health Plan reimburse her the funds that were deducted.

On February 11, 2014, the Health Plan issued a refund/credit to **. [redacted]'s credit card in the amount of $276.20.

We regret the inconvenience that this situation has caused. If you and/or **. [redacted] have any additional questions, please contact [redacted] at ###-###-####.

Sincerely,

Review: I was succefull in signing up for kaiser's Medicare Cost Plan. at the time I signed up for the cost plan I requestedParD(Pharmcy) benefits, also.

The part D benefit was not included.

I have called customer service 4 times and logged a complaint.

To date I have not been called or received a letter explaining any action at all.

I do not believe this how a 5 star plan should behave and intend to make a complaint to Medicare.Desired Settlement: I need kaiser to honor their promise of 5 star service and sing me up for both hospitalization and pharmacy benefits before Decemeber 8th.

if they do not and I have to pay a penalty for not signing up for Part D, I will have to seek legal action for damages(plus report them to Medicare)

Business

Response:

November 25, 2014Dear [redacted]:This letter is an interim response to your inquiry dated November 18, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted]. This inquiry was received on November 20, 2014.[redacted] stated in his complaint that he requested Medicare Cost with Part D coverage to become effective October 1, 2014, [redacted] indicated that he learned that he does not have Part D coverage, and he tried to resolve the error.According to our records, [redacted] requested Medicare without Part D coverage to become effective October 1, 2014. Exhibit A contains a copy of the enrollment application.On October 31, 2014 Health Plan received [redacted]'s plan enrollment change form requesting Medicare with Part D coverage to become effective January 1, 2015. Exhibit B contains a copy of the enrollment change application form.Upon receipt of [redacted]'s complaint from the Revdex.com, Ms. Evelyn R[redacted], Medicare Communications Specialist, contacted him on November 21, 2014 regarding his application for Medicare coverage. Ms. R[redacted] sent [redacted] a new application via [redacted] to be completed and returned immediately to process his request for Medicare Part D Coverage to become effective December 1, 2014 to avoid any penalties for not signing up for Part D coverage. We are awaiting the return of the application.I regret the circumstances that prompted [redacted]'s letter. At the same time we thank him for the opportunity to address his concerns,If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy S Senior Manager, Member Services

Review: I developed a health issue last August of 2013, and went to the doctors often since then to help continue to manage any pains. I have been a member for over 26 years with Kaiser, always paid my bills on time (and at the location if applicable). I had started to go to the [redacted] and [redacted], VA locations for "Urgent Care" (as my work gets out later than my main location ([redacted])) is open. I had AWFUL care numerous times at [redacted] to the point where I refuse to go there if I can help it. I have been told quite a few times by doctors when I'm there "why are you even here - there is nothing wrong with you." That angered me more than anything...when someone has pains, and I'm told there is nothing wrong with me. I had quite a few horrible appointments where I'd be called back and just sit in a room for 30 minutes+ (I have even had a case where I went in around 11:35 at night and waited and waited (over an hour) before getting up and walking out in disgust (to be called back and wait that long for a doctor to come in?)...

I started going to [redacted], and they weren't much better. A few decent doctors, but some bad ones - including one who I filed a formal complaint against who never greeted me, never examined me, just walked in, said "I read what you're in here for - you need surgery - I'll be right back with the paperwork." I was befuddled. I sent an email to my Gastroenterologist the next day, and he said "that doctor isn't correct, you do not need surgery. I examined you thoroughly" (and he did). So when the call came from the surgeon, I cancelled the appointment.

I was so disgusted numerous times with the care I was receiving from quite a few doctors (and there were at least 5 appointments (if not more) that I was absolutely disgusted with) so when I received a bill for $45 (3 co-pay charges ($15 each), I contacted Member Services and expressed to them that I shouldn't have to pay for services not rendered. I was not happy at all. Mind you, this is already after I had contacted Member Services each time I had bad care (and even specifically reported the doctor I was not pleased with (who recommended the surgery). The lady on the phone said "I completely agree - we will deal with this." I called again shortly after to follow up. They assured me it would be dealt with. I got another bill that told me to "pay upon receipt." Followed by a "Your account is in default. If you do not pay, we will send this to collections." I went to the [redacted] location and sat down with a Member Services employee and discussed this. She made a copy of the paper. She called someone who had said it's being processed and that I have nothing to worry about. She said "send a letter into the office in [redacted] and let them know." I did. Explained everything.

I got an letter back from some guy named Evral M[redacted]. A few days later I got a letter that said my account was now in collections. I was infuriated that Kaiser Permanente not only didn't listen to me, but the fact that they'd show utter disregard for someone who has been a member for over 26 years+ and paid all bills on time, and never late - and when I have a legitimate concern, they disregard it.

I kept calling Evral M[redacted]. He'd NEVER call back. I contacted the social media team from Kaiser Permanente to try and get his superior to call me...or someone who can deal with it. I was told to contact some person named "Oscar." So I did. He didn't call me back either, but a member of his team did. I kept calling Evral, who NEVER responded until I kept pressing for a response. He finally called me after nearly 9/10 attempts. He let me explain again and I expressed my discontent to the care to him. I was told I'd receive a decision within 30 days and that my account "wasn't in collections" (yet I have the paperwork that said it was).

Well I got the "decision" back which told me I should still pay. Even after bad care by quite a few doctors, and all the times I've informed them of it - I still have to pay for it? Not happy with that at all. So I've tried calling Evral M[redacted] back again. I've called him over 4 times again. And? NO RESPONSE AGAIN. He ignores returning phone calls.

I'm not the least bit happy at all with Kaiser Permanente's handling of this.Desired Settlement: I want my account OUT OF COLLECTIONS, want any damage to my credit to be fixed (I am NOT going to be taking a hit on my credit for the problems they did), and I want the $45 charge to be wiped off my account and stop charging me for that awful care.

Business

Response:

October 16, 2014Dear [redacted]:On behalf of Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan), I am responding to your letter which was received in the Appeals and Correspondence Department on September 23, 2014, In your letter you raised several issues regarding the service you have received from Kaiser Permanente since August 2013.You took the time to express your gratitude for the care and service you received from Dr. Nagui S[redacted] in the Family Practice Department our [redacted] Medical Center, We sincerely appreciate your kind words.We hold our employees in the highest esteem, and recognize that the true value of Kaiser Permanente lies in the dedicated professionals, like Dr. Nagui S[redacted], who serve our members every day. Your comments were shared with Dr. S[redacted] and the Dr.Vincent C[redacted], Service Chief for the Family Practice Department for the Northern Virginia Service Area.We appreciate your many years of membership with Kaiser Permanente and regret the circumstances that prompted you to contact us. You state you developed health issues in August 2013 and had several concerns with the service you received.The following is a list of your concerns and how they were addressed.According to your letter you expressed concerns with the service you received at the [redacted] Medical Center and the [redacted] Medical Center.• Given your concerns with the delay in waiting to be seen your letter was shared with Mr. Tim M[redacted], Clinical Operations Manager for the [redacted] Urgent Care Department. Please be assured that he has reviewed your concerns and will take appropriate follow-up actions.• Your letter was also shared with Dr. Artur T[redacted], the Service Chief for the Urgent Care Department for the Northern Virginia Service Area. He has reviewed your concern with the services your received in the urgent care department and made the appropriate recommendations,• In addition, you expressed concerns that you were not seen for the length of time documented on your August 26, 2014 statement of account. Our records show that you arrived in the Urgent Care Department, were triaged by the registered nurse and then saw Dr, Vincent N[redacted]. However, given your dissatisfaction with the amount of time documented your concern was also reviewed by Arthur T[redacted], the Service Chief for the Urgent Care Department for the Northern Virginia Service Area.You also expressed concerns that you spent an hour on the phone listening to music that was not appropriate.• Given your concerns with the time you spent on the phone, your correspondence was forwarded to Mr. Victor Nevilles, Operations Manager for the Member Services Contact Center for review and appropriate follow-up.We have thoroughly considered all of the available information related to your concerns. Based on our review of that information and the terms of your plan contract, we regret to inform you that the co-payments were appropriately assessed for your May 24, 2014, May 12, 2014 and July 10, 2104 office visits because services were provided. According to your Health Plan contract, a $15.00 co-payment is assessed for each specialty care office visit.We based our decision on the following benefit provisions of your Health Plan coverage document entitled; 2014 Group Evidence of Coverage (EOC), Signature Delivery Care System, Summary of Services & Cost Shares ([redacted]). I have enclosed a copy of the Summary of Cost Share document for your convenience.Kaiser Permanente is committed to providing quality care and services to all members. We believe that an important part of this commitment is establishing effective communication with our members. By sharing your experiences with us, you have allowed us the opportunity to review our current service delivery practices, which will help us to improve the way we deliver care and service to our members.Please accept our apologies for the inconvenience this matter has caused you. Should you have further questions or concerns regarding this matter, please contact me directly.Sincerely,Evral M. Communication Specialist Member Services

Review: I have been a member of Kaiser Permanente for almost past 6 years.

I did apply Auto-pay online payment months ago and had to wait 90 days to be activated but after 3 month still online pay wasn't working since I was rely to them I thought the payment would go thru just fine but it didn't and they terminate my plan due to not receiving payment for one month! Yes this is the truth and I only found out about it after I made a phone call to make an appointment. so I pay my dues and was looking for a better insurance which there are plenty out there and KP is just medium quality insurance provider compare to others since you only have to use their facility and their selected doctors.

I called the insurance agent to find me a good insurance the agent required me to get a termination letter from my former insurance provider so I would be able to apply for new insurance company so I called customer service 3 to 5 time so they finally had faxed me the letter and indicated me my insurance has been terminated by end of August!!!!!

So after I called customer service The lady over the phone told me in order to reinstate you have to wait at least till Dec so I looked for another insurance provider since I hate to stay without insurance to protect my health. However I received a payment of describes exactly as below

RETROACTIVE DUES AND CHARGES

ENROLLMENT 09/24/2014 $305.96

ENROLLMENT 09/24/2014 $305.96

ENROLLMENT 09/24/2014 $305.96

_____________________________

Total Now Due $917.85

_____________________________

I called customer service she explained this is my dues and I have to pay this amount whether you have used it or not! what the %*^~! how I have three unpaid payments and my account is still active but normally KP will terminate plans after not receiving one sinlge payment. I feel they were trying to rip me off as much as they could! So I mentioned I have the fax you have sent me regarding termination of my policy why do I get charge again since my account was terminated and I wasn't able to go see the doctors due to not receiving payment! The lady at customer service when I spoke to her over the phone on Nov the 3th she hung up on me I assume she had no answer regarding these multiple charges,Seriously If I cannot use their service how they allow themselves to charge me and send me bill I just do not understand this. These crooks love money and do any dirty and dishonest work in order to earn my hard earning money!

I will continue to fight with them regarding these charges I will spread the word and leave KP a review on google as well as Revdex.com and [redacted].com regarding this fraud and I will want everyone know about it and recommend everyone to stay away from these people! Their customer service is rude and totally unprofessional and there is no way you can get in touch and meet up with someone in person! I warn you again to STAY FAR A W A Y!!!!!!!!!!!!Desired Settlement: I would want them to correct this error bill and send me a letter which shows the balance $0 and I want this happen as soon as possible!

Business

Response:

December 4, 2014Dear [redacted]This letter is in response to your inquiry dated November 20, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted], The inquiry was received on November 24, 2014.[redacted] stated that the Health Plan terminated his health insurance coverage in August 2014 due to non-payment, but he was still charged the monthly premium. [redacted] believed that he was enrolled in an automatic premium payment plan. He also stated that his coverage was reinstated in September 2014 but he does not know why he is responsible for the retroactive premiums.According to our records, [redacted]'s coverage became effective January 1, 2014 through individual direct pay plan. His monthly premium is $305.95.[redacted]'s account was not enrolled in the automatic premium payment plan. Since [redacted] was not set-up for the automatic premium payment plan, he would need to mail his premium payments to the Health Plan or call Member Services to make a payment. Premium payments are due on the first day of the month.Below, please find a table that explains [redacted]'s payment history for the 2014 Contract year:Bill Date Payment Period Premium Payment Transaction Balance Amount Amount Date1/1/14 January 2014 $305.95 $263 1/3/14/ $42.952/1/14 February 2014 $305.95 $263 2/10/14 $85.90 3/1/14 March 2014 $305.95 $391.85 3/11/14 $0 4/1/14 April 2014 $305.95 $0 N/A $305.95 5/1/14 May 2014 $305,95 $611.90 5/19/14 $0 6/1/14 June 2014 $305.95 $0 N/A $305.95 7/1/14 July 2014 $305.95 $0 N/A $611.90 8/1/14 August 2014 $305.95 $611.90 8/1/14 $305.95 June 2014 and July 2014 premiums9/1/14 September $305.95 $305.95 9/23/14 $305.95 2014 Aug 2014 premium 10/1/14 October 2014 $305.95 $0 N/A $611.90 11/1/14 November 2014 $305.95 $0 N/A $917.85 12/1/14 December 2014 $305.95 $0 N/A $1,223.80The Health Plan sent delinquent notices to [redacted] on February 7, 2014, March 7, 2014, April 7, 2014, and June 8, 2014 informing him that his premium payments were still outstanding. 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 period; unless payment is received for the outstanding balance. Exhibit A Contains a Copy of a delinquent notice.[redacted]'s coverage terminated effective July 31, 2014 due to non-payment of premiums.On August 1, 2014 the Health Plan received payment in the amount of $611.90 for the June 2014 and July 2014 outstanding premium balance.On September 23, 2014 [redacted] requested reinstatement of his health insurance coverage. The Health Plan honored the request and reinstated [redacted] with no break in Coverage.On that same day, he paid $305.95 for the outstanding August 2014 premium. [redacted] still had an outstanding balance for the September 2014 premium in the amount of $305.95.Please note that the Health Plan has not received notification from Mr, Babaei requesting termination of his health insurance coverage.To date, [redacted] has an outstanding premium balance totaling $1,223.80 for September 2014, October 2014, November 2014, and December 2014.The Health Plan sent a delinquent notice to [redacted] on November 6, 2014 informing him that his premium payments were still outstanding. If the premium balance of $1,223.80 is not received by December 8, 2014, [redacted]'s coverage will terminate due to non-payment of premiums.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy SSenior Manager, Member Services

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: I did enroll into auto payment and due to there system failure. I explained this to a representative and she was agree with me and she said she has heard from other customer which complained the same thing. I did not request to reinstate my account. It is very unfair to me. I was waiting for a month to hear back on hear now for that one month KP wants to charge me for a premium. I am willing to get a discount and pay it in full I still do not understand why should I even pay a penny for some service I did not even request or ever used it. I was dying from a withdraw of my medicine and I called customer service to make an appointment to see the doctor the representative told me my account is terminated and I cannot see the doctor but now KP wants to charge me the time I wasn't able to see the doctor it is totally unfair and unjust to me. I know KP is too hungry for the money so I am willing to take a discount and pay it off in full and will not be back ever to KP and will tell everyone to do so.

Regards,

Review: I was taken to Kaiser Permanente adult behavioral health after suffering a nervous breakdown. After the nervous breakdown I was suffering and still am suffering from psychiatric problems. I admit that I was acting in an erratic manner, but this was because I was in distress. When I met the person who was to handle my case the first thing she asked me was if I had ever been arrested by the police. I replied no, she then proceed to tell me that they would hurt me physically before asking me what the problem was. I hadn't done anything against her or Kaiser permanente. My experience has left me angry not only at Kaiser permanente, but also at the police. This experience repeats in my head on a daily basis and is affecting my recovery. I am hoping that by complaining the hurt feelings will go away and that this experience will stop haunting me.Desired Settlement: I would simply like an apology. I would like Kaiser permanente to give me the respect and dignity they claim to give to their customers.

Review: I am writing to complain that Kaiser Permenente Membership Services has failed to correct errors in policy administration and billing that have been ongoing from January 2014 to the present. These problems were exacerbated by a failure of Kaiser to communicate, requiring me to initiate all contacts at an under-served Member Services telephone number (###-###-####) that is always “receiving heavier than normal call volumes).

Description of the Review: In late 2013, Kaiser sent information indicating that my 2013 policy would be canceled effective December 31, 2013 and that it was necessary to enroll in a new policy that would begin on January 1, 2014. This change was necessitated by the Affordable Care Act (ACA). After reviewing the policy options described in the literature sent by Kaiser and online, I selected a plan for 2014 and telephoned the number provided with that material. When I called, I was informed that I could not enroll directly with Kaiser, but would need to use the [redacted] Exchange.

I began my attempts to use [redacted] on December 7, 2013. Problems with that website prevented me from enrolling for several weeks. I was contacted by **. [redacted] of [redacted] after my story appeared in a front page article in the [redacted] (~December 12, 2013). He and I worked together to resolve my enrollment problems. **. [redacted] informed me by email that he worked through his liaison person at Kaiser to address my problem. Finally, on December 31, 2013, I received a call from [redacted] at Kaiser who confirmed my enrollment and accepted my first month payment via credit card. [redacted] assured me that my new policy would go into effect on January 1, 2014 and that my **N would be transferred from my 2013 Kaiser policy. This was particularly important to me since I had had blood work done in late December and wanted to have access to the results. [redacted] never mentioned a need to cancel my 2013 policy and I assumed based on Kaiser's letter in early December that it was scheduled to expire on December

31. I have an email from Kaiser, acknowledging payment of the $462 premium for the first month of my 2014 policy.

On January 7, 2014 I received another email from Kaiser, informing me that my new policy was being processed and making no mention of any need on my part to cancel my 2013 policy. As far as I knew that policy had expired, based on the information I had received from Kaiser.

On February 4, 2014, I received an invoice in the mail from Kaiser dated January 31, 2014 with payment due February 1, 2014. The cryptic invoice indicated that the billing was for “Current Monthly Dues”. On the reverse of that bill, it stated “Failure to pay premium will result in termination for non-payment of premium.” Rather than risk cancellation of my policy, I immediately paid the bill ($302.09) online with my VISA card. I received an email acknowledgment of my payment the next day (February 5, 2014). Unknown to me at the time, this bill was for my 2013 policy which Kaiser had failed to terminate on December 31, 2013 as stated by them.

On February 7, 2014, I received another bill from Kaiser for $462.94 for the February membership premium. This was confusing since I had thought my February premium had just been paid. Clearly, something was wrong with Kaiser billing. But, rather than risk a problem with my insurance, I paid this bill immediately by mail with my check # [redacted] drawn on [redacted].

On February 15, 2014, I contacted Kaiser Membership Services at ###-###-#### and spoke with several representatives beginning with [redacted] as my call was escalated. The final person, [redacted], told me my 2013 policy had not been canceled, but that she would cancel it retroactive to December 31, 2013. She also assured me a refund for my erroneous payment of $302.09 was being requested and that a check would be sent to me in 6 weeks. When I inquired why it would take so long for a refund, she informed me that I had paid by check. I told her this was not true, that I had paid by credit card. She disagreed. Rather than argue the point, I accepted her word that the matter had been resolved and a refund would be forthcoming.

On Febraury 15, 2014, I sent a letter to Kaiser at the correspondence address listed on the back of my most recent bill following Kaiser's instructions for voluntary termination of a policy. I requested termination of my 2014 policy effective 11:59pm February 28, 2014. This was done because I was becoming Medicare eligible (due to age) on March 1, 2014 and had decided to change insurance companies. (I hope this does not come as a surprise to the reader?)

On March 5, 2014, I received another invoice from Kaiser dated February 28 with a due date of March 1. (note: I am at a loss to understand how Kaiser consistently expects payment before its customer receives the bill.) This bill showed no “current plan premium”, but instead a previous balance of $309.02. Six credits and debits appear on the bill, apparently reflecting attempts to correct the account. I called member services immediately. I was transferred from [redacted] to [redacted] to [redacted] and finally to [redacted] who described herself as the Manager of the Membership Administration Department. [redacted] insisted that despite my bill-in-hand to the contrary, my account had no balance due.

While having [redacted] on the line, a painful process requiring over an hour of my time, I inquired about having received no acknowledgment of my February 15 letter requesting termination of my 2014 policy on February 28, 2014. [redacted] told me there was no record of that letter ever having been received. She gave me a fax number to which I could FAX a copy of my letter (###-###-####) but said there was no way she or anyone else from Kaiser could acknowledge receipt of that fax. She suggested I call back in a few days to inquire.

I called Kaiser Member Services (###-###-####) again on March 10, 2014. [redacted] could not verify that a fax was received from me, but did indicate that my 2014 policy was still active. She also verified that the fax number I had used was correct. The call was escalated to [redacted]. who described her position as “management escalation”. She informed me that my original termination letter was scanned into the Kaiser system on February 19, 2014. She apologized that termination had not yet been “effected” and that the problem would be addressed. I was left to wonder why [redacted] had not been able to see that the letter had been received when I spoke to her on March 5, 2014. [redacted]. assured me that the 2014 policy would be canceled as requested and she also promised to call me back that same day (March 10). She never called me back to date.

On March 18, 2014, I received another bill from Kaiser (dated March 13, 2014) showing a previous balance of $302.09 with payment due April 1, 2014.

On March 19, 2014, I called the Kaiser Member Services again. This time I spoke to Jackie who assured me that my 2013 policy had been cancelled retroactively to December 31, 2013. I was escalated to [redacted] for the 2014 policy question. [redacted] now assured me that the termination letter had been received but had not been acted upon because termination had to be done through the [redacted] Exchange. This was new information to me. Why had Kaiser not shared this information for the past month? [redacted] gave me a telephone number (###-###-####) to call [redacted].

While I had [redacted] on the line, I inquired about my balance of $302.09 and failure to receive a refund of the $302.09 erroneous payment. [redacted] told me she had contacted but not heard back from Membership Accounting. When pressed for a date that I could expect this matter to be addressed she would not commit to any. She further informed me that since this was an inbound call center, they were not permitted to contact customers, but had to wait for customers to call them. Thus, [redacted].'s promise to call me was apparently outside of protocol. I asked who in Kaiser I could speak with to have a two-way conversation to resolve this matter. The answer was that Member Services was the right place to call.

After getting of the phone with [redacted], I discovered that the number she had given me was incorrect. It instead ###-###-#### connected me to an internal Kaiser help line operated by Connexus. They fortunately were able to give me the number for [redacted] (###-###-####).

I called [redacted] and spoke with [redacted] who submitted my request to cancel my 2014 Kaiser policy retroactive to February 28, 2014. [redacted] said she could not provide me with a confirmation, but that I should expect to hear from Kaiser. To date I have not heard from Kaiser.

March 21, 2014, I received yet another bill from Kaiser (dated March 18, 2013) showing monthly premium $462.94 due for 3/1/14-3/31/14.Desired Settlement: Specific remedies sought:

1. Confirmation in writing from Kaiser that my 2013 policy that was carried into 2014 has in fact been canceled and that no balance is due on that policy.

2. Reimbursement for the $302.09 erroneous payment on that policy.

3. Confirmation in writing from Kaiser that my 2014 ACA policy has been canceled effective February 28, 2014 and that premium payments for the two months (January and February) are paid in full and that no further premiums are due.

Business

Response:

April 24, 2014Dear **, [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,

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Please see attachment or check attachment tab.

Regards,

Review: Kaiser collected payments for February and March of this year of 430$ they refuse to refund me the money even though membership was canceled in January. I have been calling them and getting nothing but excuses and run abounds since February. They have admitted they owe the money and paid half back for march but will not pay it back February even though they were sent statements and documentation they asked me for to verify coverage. All I can do is just sit back and take the fact they stole my money and feel they get to keep it.Desired Settlement: I would like my 219$ that they owe me

Business

Response:

October 6, 2014Dear [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.[redacted] stated in her complaint that the Health Plan collected payments for February and March 2014 totaling $430. [redacted] is requesting a refund in the amount of $219. The Health Plan searched our database and we do not have a member in our system with the name, [redacted]. We will need additional information, such as, a medical record number to research and resolve [redacted]'s complaint. .Should you have any additional questions please feel free to contact me.Sincerely,Keyla WSenior Communications Specialist Member Services

Review: I purchased the health insurance for my kid who is 4 years old. We tried to registered in kp.org/register with the medical-id. But the website didn't allow the registration but require the parents to have account in Kaiser. That's really unreasonable and caused so much inconvenience because we don't have account in Kaiser. Now I don't know how to manage the account for my kid e.g. find the doctor, setup/ cancel the appointment/ communicate with doctor by email etc.Desired Settlement: allow parents to register account for the kid and manage the account for them online

Business

Response:

May 23, 2014Dear **. [redacted];This letter is in response to your inquiry dated May 13, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of **. [redacted]. The inquiry was received on May 15, 2014.**. [redacted] stated in his complaint that his daughter, [redacted] has coverage under a child only plan through the Federally Funded Marketplace. **. [redacted] also stated that he was unable to register his daughter under the Health Plan's website, kp.org.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 member's concerns. We also have processes in place to escalate a member's 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.In addition to the processes and actions described above, **. [redacted]'s letter was forwarded to our technical support web manager for review and appropriate action.Children under 13 years of age are not eligible to register their own kp.org account. Parents access their children's information via their own kp.oro accounts. The Health Plan has adopted this policy to control the access of a minor's protected health information.Unfortunately, **. and [redacted] are not members of the Health Plan. We regret that we cannot honor **. [redacted]'s request to access his daughter's health information via the Health Plan's website, kp.org.We are constantly striving to make improvements for our members and this could be an enhancement at a later date to allow parents that are non-member to register and access their children's health information via kp.org.[redacted]'s primary care physician is Dr. [redacted] and he can be reached at ###-###-####.If you and/or **. [redacted] have additional questions regarding this concern, please contact [redacted] at ###-###-####.Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: 10012007

I am rejecting this response because:

Kaiser Permanente has awful service. I have been trying to get a prescription refilled for more than a month now. I have made multiple phone calls and tried using the online ordering process multiple times. At no point in time did Kaiser communicated that there was an issue with this until today. When I finally managed to speak to a customer service representative on the phone they could not figure out the problem at first. Also, their side of the system did not show updates I had made to my account about a month ago. I was transferred a few times before someone was finally able to resolve the issue. It should not be this hard to get a prescription mailed to me. The hoop jumping was simply ridiculous. This is a prescription that has serious withdrawal side effects were patients coming off it are supposed to be monitored by a doctor. The fact that I had to contact Kaiser every point of the way to get this resolved is ridiculous.

Review: I purchased health coverage from Kaiser Permanente through the DC Health Link marketplace at the end of 2013. On Feb 1st 2014 I started employment and had health coverage through my employer, so I called Kaiser to cancel my coverage. They were closed for the weekend, but I reached them on the next business day. I was told that I could not cancel coverage over the phone and must fax my request. I did this and heard nothing back. I called again two weeks later. I was told to fax again. I sent Kaiser a second cancellation request by fax. I heard nothing and forgot about it, foolishly assuming everything was finalized. I received no mail from Kaiser (billing or otherwise) for around 5 months. After this period Kaiser began billing me for insurance again. I called them immediately. I was told that I should contact DC Health Link to cancel the policy. The customer service advisor could see my fax on her system and could not explain why my coverage was not cancelled. I asked to raise a complaint. She took full details and said I would be called. I waited a month and heard nothing. During this time I asked DC Health Link to cancel my coverage from their end. I then called Kaiser again and was told that my complaint had been closed. I was told that the mistake was mine and that Affordable Care Act cancels cannot be cancelled by fax and only though the marketplace. I raised another complaint as I had been misinformed repeatedly by Kaiser staff and wanted assurance that my coverage was ceased and billing would be stopped. I raised this second complaint a month ago and have still heard nothing back - apart from yet another bill for another month of service plus arrears.

I have moved since taking and attempting to cancel this coverage. Kaiser may find me in their records under my previous address. I have told them that I have moved but they still send me bills to my old address in W[redacted] DC.Desired Settlement: I understand that the Affordable Care Act brought big changes and I was probably one of the first people Kaiser staff dealt with that wished to cancel. However, Kaiser Permanente have made an error here.

I want a single person to take ownership of this problem and call me so that we can ensure the service is ceased and the billing system is correct (that I owe no money and had my service cancelled in February).

Business

Response:

November 17, 2014Dear [redacted]:This letter is in response to your inquiry dated November 7, 2014 to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Health Plan) on behalf of [redacted] stated in his complaint that that he applied for health insurance coverage through DC Health Link. He also stated that he started employment on February 1, 2014 and he called the Health Plan to terminate his coverage.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 member's concerns. We also have processes in place to escalate a member's 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] must request termination of his health insurance coverage through DC Health Link. He may file an appeal with the DC Health Link ([redacted]) to request termination of his coverage effective February 1, 2014. If DC Health Link honors his request, they will notify the Health Plan of the termination date.If you and/or [redacted] have any additional questions, please contact Keyla W[redacted] at ###-###-####.Sincerely,Daisy SSenior Manager, Member Services