Owens Originals, Inc.

March 30,
*** ***
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: March
16,
Dear Ms***,
This is in response to your email received on March 16, 2016,
forwarding concerns on behalf of our member, *** ***, regarding the
healthcare coverage intended to be enrolled in for 2016. We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction
We have formally documented and shared Mr*** concerns
with the appropriate Consolidated Service Center (CSC)/KPIF-Off Exchange Issues
Department, to include the managerI am sincerely sorry for any frustration
that may have been caused by this overall matterPer further discussion with
the member’s wife, I’ve been advised that the member chose to enroll directly
with Kaiser Permanente’s (KP) Membership Administration Department for his
healthcare coverage, in an attempt to avoid the previously experienced issues
with his plan purchased through Connect for Health Colorado (C4)
Unfortunately, the assisting KP representative checked an incorrect box on the
application, which resulted in missing open enrollmentConsequentially, Mr
*** is requesting that KP allow for coverage preferably back to January 1,
2016, or at least back to the February 1, date that he had been initially
informed would be his enrollment date
I submitted Mr*** benefits enrollment request
accordingly to the CSC-KPIF Membership Administration Department, along with a
detailed explanation of the circumstances pertaining to his attempt to enrollUnfortunately,
the department has not yet made the reinstatement decisionThe call between
the member and the assisting enrollment representative was ordered, as to allow
for a thorough review of the communicationThe department will advise once
reviewed and of the decision madePlease thank Mr*** for his patience
with this matter, and assure him that I will be calling immediately upon
receiving the necessary feedbackMy time estimate is no later than Monday April
5, 2016, and I welcome the member to contact me with any questions or is he is
seeking an update
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 Permanente
Member Services
South Havana
Street
Aurora,
Colorado
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within calendar days of
the receipt of the member’s requestWe may extend this timeframe up to an additional
calendar days at the member’s request or if there is a need for additional
information and the delay is in the best interest of the member.
If the Revdex.com or the member has any questions, please contact me
at *** ***
Also, you may contact Member Services:
Denver/Boulder members may call ***, toll free at 1-800-632-9700,
between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired
members who use a TTY may call ***.
Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874. You may also contact our department through
our Web site at kaiserpermanente.org
Please thank
our member for their understanding in this matterWe know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ** ***
Complex Case
Resolution Specialist
Member
Experience

December 31,
*** ***
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: December 18,
Dear Ms***
This is in response
to your email received on December 21, forwarding concerns on behalf of, *** ***, regarding an incorrect premium deductionWe value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
Ms*** explained her dissatisfaction with $being deducted from her account in errorShe states that the requested refund has been addressed, though the much needed money would take a lengthy 6-weeks before receiving
I am very sorry for the understandable frustration experienced, and for the expressed inconvenience causedI have thoroughly researched this matter and have additional questions, as to ensure that Ms***'s complaint is appropriately filed and she is satisfactorily assistedI called Ms*** on December 28, 2015, and on December 31, 2015, though I've regretfully been unsuccessful at connecting with her
I'd be more than happy to file the formal complaint on behalf of Ms***, as well as follow through until the discussed refund issue is completely resolvedPlease ask the member to contact me directly, should she seek to move forward with this caseAgain, additional information is necessary for clarification purposesI look forward to further discussion with Ms***, as quality customer service is my goal
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to:
Kaiser Permanente
Member Services
South Havana Street
Aurora, Colorado
Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member
If the Revdex.com or the member has any questions, please contact me at *** ***
Also, you may contact Member Services:
Denver/Boulder members may call ***, toll free at 1-800-632-9700, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call ***
Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-You may also contact our department through our Web site at kaiserpermanente.org
Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ** ***
Complex Case Resolution Specialist
Member Experience

March 20, *** *** *** *** *** *** ***
*** ** *** *** ***
*** *** *** Complaint Case # *** Consumer: *** *** Case Opened: 02/20/ Dear Mr***, This is in response to your email received on March 20, forwarding concerns on behalf of member; *** *** regarding his concern regarding Kaiser Permanente (KP) not providing the correct premium billing statements for his health planWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Mr*** grievance with the appropriate leadership Based on the review, Mr***s new policy that was created on March 6,(***)The members new policy reflects paid through March 31,There are no past due balances, accurate statements have been mailed out to the member and the old account (***) has been termed In addition, the members broker contacted Kaiser Permanente on March 8,where he was advised that the new policy plan was created on March 6,and the payments made from the old terminated plan (***) were transferred on the same dayThe broker was advised to let the member know that he needs to allow time for the KP.Org system to update The member does not show any lapse in coverage in our membership or billing systemAs part of the formal complaint process, I documented the members concerns and reviewed them with the Kaiser Permanente’s California Service Center OnExchange Operations Manager Kaiser Permanente Customer Experience Department is not able to address requests for compensation. Addressing requests for compensation is outside the operations of this department. Kaiser Permanente Customer Experience is available to formally document and share grievances related to care and services with appropriate leadership. If the Revdex.com or the member has any questions, please contact me at ###-###-#### Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-####. Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call ***. You may also contact our department through our Web site at *** Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, *** *** Complex Case Resolution Specialist Member Experience

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
However, I want to be clear that I did not receive any mail as documented in the company's responseI further more requested proof of such mailing and received nothingI did not receive any email or voicemail or any other communications until after they cancelled the policyThe company's communications are highly suspect and procedures should be modified to protect the customers rightsI was on the phone with the billing department reps that also were unaware or just failed to communicate the issues! Why and how is that possible?How do health care providers get away with this kind of treatment of people that depend o their services? ,
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is somewhat (barely) satisfactory to me
It took me two formal complaints and numerous phone calls to get these people to do anythingFirst of all, I never disputed my spouses' correctly billed charges, so mentioning that in their response just shows how absurd Kaiser isAnd as far as this goes: "the preventive labs for service date November 16, and December 2, and been reviewed and determined that they were all preventive and ordered as screening labs." THESE were plan-covered lab tests for the physicals for both of usHow should I put it in even simpler terms? Kaiser's billing system never issued a separate bill for these plan-covered chargesThese plan-covered charges were never sent to me or appeared on any previous billsMy payment was applied to plan-covered lab tests for physicals even though there was no outstanding bill for themKaiser is yet explain how that happened - why did their billing department decide to apply my payment to plan-covered lab tests for physicals for which I never received a bill? I personally think that Kaiser does this all the time, and the amount of push back I got only indicates a fraudulent and broken system
Sincerely,
*** ***

Initial Business Response /* (1000, 6, 2015/08/18) */
August 18,
*** ***
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: ***, ***
Case Opened: August 13,
Dear Ms***
This is in response to your email received on August 14, 2015, forwarding concerns on behalf of our member; *** ***, regarding a regarding a refund she is seeking for reproductive services receivedWe value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
This case was filed as an initial grievance with Kaiser Permanente (KP) on July 21, 2015, and the Case Resolution Specialist mailed a response letter to Ms*** on August 6, I have ensured that the member's concerns were appropriately documented and shared with the Skyline Medical Office leadership, to include the Nurse Manager and Director of Women's Health Services
Please offer my sincere apologies to Ms*** for her continued frustration experienced as a result of the Skyline Medical Office Obstetrics/Gynecology-Reproductive Department closureThe KP Case Resolution Team is unable to address her reimbursement request for costs incurred/paid during her time as a patient in the departmentFor refund consideration, her specific charge refund request(s) must be outlined and submitted via the process stated in her August 6, response letterShould the member require an additional copy of that letter to be mailed to her, please ask her to contact me directly at the number listed belowAgain, I am sorry for how this has made the member feel, and I am available to answer any related questions
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to:
Kaiser Permanente
Member Services
South Havana Street
Aurora, Colorado
Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member
If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX
Also, you may contact Member Services:
Denver/Boulder members may call 303-338-3800, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX
Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org
Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ** ***
Complex Case Resolution Specialist
Member Experience

May 1,
*** ***
*** *** *** *** ***
*** *** ***
*** *** ***
Complaint Case
# ***
Consumer: *** ***
Case Opened: April
3,
Dear Mr***
This is in response to your email received May 1,
advising that a reply email had not yet been received regarding our member,
*** ***, and his concerns submitted to the Revdex.com on April 3, Unfortunately, we haven’t any record
of receiving the previous Revdex.com due to changes in our notification preferences
that we were not aware ofWe have since confirmed with you that our preference
has been changed back to email formatWe
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction
Mr*** is
requesting reinstatement in his healthcare plan purchased through *** *** *** *** (***), due to his auto-payment unknowingly discontinuing
We have formally documented and shared Mr***’s concerns with the
appropriate Consolidated Service Center/On-Exchange Issues Department leadership,
to include the Department ManagerPlease apologize to the member for any
experienced frustration, on behalf of Kaiser Permanente (KP), by this issue in
which I’ve additionally assisted him withOur Membership Administration Case
Excellence (MACE) team assists with issues specific to plans purchased through
*** *** *** *** (***)They had previously concluded their
research with the decision that Mr***s plan reinstatement request would
not be honoredHowever, almost immediately upon receiving my response letter,
Mr*** contacted me via telephone confused about the letter details
conflicting with his reinstated status; he had received a premium invoice and
was able to utilize services on his KP.Org accountI confirmed in our
membership system that Mr*** was in fact reflecting to be reinstated
for without a break in coverage and immediately outreached the MACE
Analyst whom assisted previously for an explanationAdditionally, I again
requested that we reconsider the decision pertaining to Mr***’s
request, especially due to the current eligibility status showing in our
systemsThe MACE Analyst researched what occurred and advised that a different
KP department had also submitted a reinstatement request on behalf of Mr
***, and that request was approved
I contacted Mr*** via telephone on May 1, 2017,
apologizing again for this overall scenario, advised that the reinstatement has
been completed, and assured that MACE would ensure that no further
communication was needed with ***I also asked Mr*** to contact me
directly should any additionally related issues arise
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 Permanente
*** ***
*** *** *** ***
*** *** ***
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within calendar days of
the receipt of the member’s requestWe may extend this timeframe up to an additional
calendar days at the member’s request or if there is a need for additional
information and the delay is in the best interest of the member.
If the Revdex.com or the member has any questions, please contact me
at *** ***
Also, you may contact Member Services:
*** members may call ***, toll free at ***,
between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired
members who use a TTY may call ***.
*** *** members please call *** or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-521-4874. You may also contact our department through
our Web site at kaiserpermanente.org
Please thank
our member for their understanding in this matterWe know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ** ***
*** *** *** ***
*** ***

May 11,
*** ***
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: April
29,
Dear Ms***,
This is in response to your email received on April 29,
2016, forwarding concerns on behalf of our member, *** *** and her father
*** ***The member and her father continue to express dissatisfaction
with *** billed amount of the claim for services received on November 23,
Being that this matter has been addressed as an initial
complaint as well as a 2nd review, I am treating the current case as
a 3rd reviewThe issue remains to be disagreement with the $“not
covered” for *** to be seen by Dr*** ***
I have confirmed that the details of this complaint have
been documented and shared with the appropriate department leadersThe 2nd
review response letter was mailed to the member on May 5, 2016, advising that
the disputed cost will remain as member responsibilityThe denied claim was
reprocessed and the member billed the allowed $306.21, which went toward the
deductibleThe Member Service Contact Center (MSCC), as well as any other
Kaiser Permanente (KP) department is able to submit any claim believed to be
processed incorrectly to the Claims Department via internal processFrom the
emailed feedback that the member received from the MSCC, the representative
believed that the November 23, should’ve been processed as a specialist
copay and submitted the case to the Claims DepartmentThe Claims Department
review concluded that the disputed claim was processed correctly towards the
member’s deductible and an explanation provided; the service was received at an
outpatient hospital setting (Children’s Hospital), which is subject to
deductible
KP will not be reprocessing the claim, and the $
remains as member responsibility per Ms*** Evidence of CoveragePlease
note that all internal grievance options offered by KP in regards to this
concern have been exhaustedI am sincerely sorry, as I realize that this is
not the resolution that the member and her father were seekingShould you have
any additional comments or questions that I may answer, please do not hesitate
to contact me directly at the phone number listed below
Sincerely,
*** ** ***
*** ***
Complex Case
Resolution Specialist
Member
Experience

October 31, 2016*** ***Dispute Resolution SpecialistDenver/Boulder Revdex.com*** *** ***
*** *** ***
Complaint Case # ***Consumer: *** *** Case Opened: October 15, 2016 Dear *** ***,This is in response to
your email received on October 18, 2016, forwarding concerns on behalf of our member, *** *** regarding the billing for services she received August 10, 2016, and August 29, We value the opportunity to review and respond to her grievance and apologize for her dissatisfaction.*** *** expressed her dissatisfaction with the care she received, stating the service provided was not needed, and therefore caused unnecessary pain and time off work Additionally, when contacting Kaiser Permanente, *** *** did not receive the response she expected in filing a complaint *** *** requested that the bill totaling $be adjusted off her accountWe have formally documented and shared *** ***’s concerns with the appropriate physician leadership, to include the chief of OB-GYNPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. After review, I am unable to honor the request for waiver of charges associated with the visit on August 10, 2016, totaling $ This amount applied to the benefit appropriately based on the Evidence of Coverage in effect at the time service was received, and will remain your financial responsibility.However, I am able to adjust the amount of $for the visit August 29, off the account This may take more than one billing cycle to reflect on *** ***’ account I have confirmed no additional charges were billed for this date of service Please ask *** *** to review the response and contact me directly, if she has any related questionsAgain, please express my sincere apologies for her consequential frustration, as I realize that this is not the resolution she was seeking.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 *** *** *** ***
*** *** ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at *** ***.Also, you may contact Member Services: Denver/Boulder members may call ***, toll free at ***, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call *** Colorado Springs members please call *** or deaf, hard of hearing or speech-impaired members who use TTY may call *** You may also contact our department through our Web site at kaiserpermanente.org.Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely,*** ***Complex Case Resolution SpecialistCustomer Experience

Initial Business Response /* *** ** *** */
June 25,
*** Adams
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: ***, ***
Case Opened: June 17,
Dear MsAdams,
This is in response to your email received on June 23, 2015, forwarding concerns on behalf of our member, *** ***, regarding premium bills received in the amount of $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***'s concerns with the Consolidated Service Center Medicare Issues Department, to include the Operations ManagersI have reached out to Kaiser Permanente's Medicare Issues Department explaining Ms***'s dissatisfaction with being billed for $premiums, though her premium is $The case research is concluded with the following account information provided:
The member was issued a refund for overpayment of $received on December 22, However, the member also requested that the payment be refunded back to the credit card by their Credit UnionThis had left a $balance on the member's accountCurrently, the member's Kaiser Permanente account is paid in full, and her balance for is $
The member's dunning cycle has been resetThis will stop the sending of dunning noticesPlease apologize to the member for any frustration or confusion that may have been caused to her by this matter, and I hope that the resolution is satisfactory
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate *** Our goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to:
Kaiser Permanente
Member Services
*** South Havana Street
Aurora, Colorado XXXXX
Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member
If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX
Also, you may contact Member Services:
Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX
Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org
Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** MBrown
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* *** ** *** */
(The consumer indicated he/she ACCEPTED the response from the business.)

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11417689, and find that this resolution is satisfactory to me
Sweet Mother of God, it looks like it's actually fixed! I'll have to wait until the end of the month to see if my credit card is automatically billed I'm hoping that if there's any problem with that, it should be much easier to fix
Sincerely,
*** ***

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

April 11,
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: March
28,
Dear Ms***,
This is in response to your email received on March 28, 2016,
forwarding our member, *** ***, newly submitted complaintThe member continues to wait for him
and his wife’s health plan premium account discrepancies and invoice errors to
be fixed, so that they will stop receiving termination letter
The member
is upset, as he had closed his last case with the Revdex.com, in “good faith” that I
would ensure that the issues are fixedMeanwhile, he has received letters
threating to term the plan, which is understandably concerningPlease advise Mr*** that their plan is
effective:
GROUP SGR RL
ST EFF END
80001 AA
AC
427-4030-*** AA
424-4030-*** BB
Additionally, I had never closed the case and been
continuously working with MIRT ((KP’s Member Issues Resolution Team) to fix all
of the problems that are causing the described letters to be automatically
generated/mailedThat being said, HPS (our third party billing) states that
they are still working on the account problemsHPS is quite aware that this is
an escalated matter and have informed us that a technical issue appears to be
keeping them from resolving the issuesLeadership from MIRT and HPS are
involved, but the account discrepancies are still reflectingWhat I can assure
the member of, is that any issues that may arise while HPS is working to
correct the account details will be fixed
I realize that this is frustrating for Mr***, as it
has been for MIRT and myself, as well, not being able to immediately assist him
satisfactorilyFor this lacking timeliness, I am sincerely sorry, and MIRT
will continue to provide me with frequent updates that they receive from HPS
Please encourage Mr*** to contact me, as I will relay the information
and work the case until completely resolved
Sincerely,
*** ** ***
*** ***
Complex Case
Resolution Specialist
Member
Experience

February 3, 2017*** *** *** ***
*** ***
*** *** ***
*** *** ***Complaint Case # ***Consumer: *** *** *** Case Opened: January 30, 2017 Dear Mr***,This is in response to your
email received on January 30, 2017, forwarding concerns on behalf of our member, *** *** ***, regarding compliance regulations, falsified documentation surrounding employment, discrimination and retaliation We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Ms*** stated compliance laws were violated, and documents surrounding termination of employment were falsified Additionally, Ms*** explained she experienced discrimination and retaliation Kaiser Permanente Customer Experience is available to formally document and share concerns with the appropriate leadership We have documented and shared Ms***’s concerns with the appropriate Human Resources leadership, to include the Senior Manager of Recruiting and Workforce Planning Further investigation is at the discretion of the Human Resources department, and is not shared with this team as employee files are confidential Please apologize to Ms***, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. 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:*** ***
*** ***
*** *** *** ***
*** *** ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at *** ***.Also, you may contact Member Services: Denver/Boulder members may call ***, toll free at ***, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call *** Colorado Springs members please call *** or deaf, hard of hearing or speech-impaired members who use TTY may call *** You may also contact our department through our Web site at kaiserpermanente.org.Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely,*** ***Complex Case Resolution SpecialistCustomer Experience

March 1,
*** ***
*** *** *** *** ***
*** ** *** *** ***
*** *** ***
Complaint Case # ***
Consumer: *** *** ***
Case Opened: 02/17/
Dear Mr***,
This is in response to your email received on February 17, forwarding concerns on behalf of member; *** *** *** regarding her request for Kaiser Permanente to process a claim for reimbursement in the amount of $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*** grievance with the appropriate leadership
I reviewed the member's claims for date of service 07/05/2016. The member submitted two separate claims for date of service 07/05/2016. However, the incorrect proof of payment was attached to the claims
I have retrieved the accurate information and resubmitted the claim in the amount of $to the Claims Department for reprocessing. The member will receive an EOB and payment within days. I have requested that the claim be reprocessed expeditiously considering that the member has been waiting for reimbursement
Thank you,
If the Revdex.com or the member has any questions, please contact me at *** ***
Also, you may contact Member Services:
Denver/Boulder members may call ***, toll free at ***, between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ***.
Colorado Springs members please call *** or deaf, hard of hearing or speech-impaired members who use TTY may call ***. You may also contact our department through our Web site at kaiserpermanente.org
Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ***
*** *** *** ***
*** ***

October 20, *** *** Dispute Resolution Specialist Denver/Boulder Revdex.com *** *** ***
*** *** *** Complaint Case # *** Consumer: *** *** Case Opened: October 5, Dear *** ***, This is in response to your email received on October 19, 2016, forwarding the rebuttal to our original response provided on October 18, 2016, on behalf of our member, *** ***The member is advising that he is unaware of when the refund will be issued, and how the refund will be received We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfactionI apologize differing information was provided when requesting information about the refund. I have confirmed with the Member Issue Resolution Team (MIRT) that the refund of $was issued by electronic funds transfer October 20, 2016, to the account it was deducted from. The member’s communication is appreciated, as it allows us to try to remedy this entire situationPlease apologize to the member again for his expressed dissatisfaction and continued inconvenience causedThe 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*** *** *** ***
*** *** *** Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member. If the Revdex.com or the member has any questions, please contact me at *** ***Also, you may contact Member Services: Denver/Boulder members may call ***, toll free at ***, between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ***. Colorado Springs members please call *** or deaf, hard of hearing or speech-impaired members who use TTY may call ***. You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, *** *** Complex Case Resolution Specialist Customer Experience

October 18, *** ***
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*** *** *** Complaint Case # *** Consumer: *** *** Case Opened: 09/18/ Dear Mr***, This is in response to your email received on October 10, forwarding concerns on behalf of *** *** *** regarding charges $billed to *** *** for emergency he treatment received on June 18, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared *** ***’s grievance with the appropriate leadershipThe Customer Experience team formally completed *** ***’s complaint request on September 13,A formal second review of his concerns was then completed on October 2, Research confirms that the feedback received from the Policy & Contract Administration Department, confirms that there is no coverage available to the member past their disenrollment date. *** ***'s new coverage would be responsible for the ER visit, as emergency room services would not fall under the scope of a post- operative visit. Kaiser Permanente cannot honor *** ***'s request to cover service date June 18, *** *** will need to supply the treating providers with his new carrier information There are no further reviews of *** ***’s request available through Kaiser Permanente*** ***’s review rights, both written and verbal, related to this matter have been exhausted. If the Revdex.com or the member has any questions, please contact me at *** *** Also, you may contact Member Services: *** members may call ***, toll free at ***, between a.mto p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ***. *** *** members please call *** or deaf, hard of hearing or speech-impaired members who use TTY may call ***. You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matter Sincerely, *** ***
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Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Dear *** ***, The attached letter is in response to the complaint filed by Kaiser Permanente member *** *** *** Kaiser Permanente's Coding Department has determined that services *** *** received on April 12, 2017, were appropriately coded as diagnostic rather than as
preventive, as *** *** was being seen for a specific medical concern and not for a preventive screening However, a one-time service gesture has been provided, and the charge of $(the cost of the PAP smear) is being adjusted from *** ***'s account *** *** remains responsible for the remaining outstanding balance on her account If you have questions or concerns regarding this matter, you may contact me directly at *** Sincerely, *** ***
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Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***