Owens Originals, Inc.

February 12,
*** ***
Dispute/Helpline Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: February
11,
Dear Ms***
This is in response to your email received on February 12,
2016, forwarding concerns on behalf of our member, *** ***, regarding
documents which he has been trying to retrieve from Kaiser Permanente (KP). We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction
We have formally documented and shared *** concerns
with the appropriate Member Services Contact Center (MSCC) Department
leadershipI reviewed the January 20, call documentation, and was able to
confirm that the MSCC representative intended to mail him his Evidence of
Coverage (EOC) packetPlease apologize to the member for inconveniently being
mailed the EOCToday, February 12, 2016, I did personally print/mail Mr
*** his requested EOCShould he not received the packet within a
week, he is welcome to contact me directly for follow through
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

March 1,
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: February
16,
Dear Ms***
This is in response to your email received on February 17,
2016, forwarding concerns on behalf of our member, *** ***,
regarding incorrect plan termination and an effective date discrepancy for
***. We value the opportunity to review and respond to her grievance and
apologize for the member’s dissatisfaction
We have formally documented and shared Mrs***’s complaint
details with the appropriate Consolidated Service Center/On-Exchange Issues
Department leadership, to include the overseeing managerI am very sorry for
any frustration and concern that may have been caused by the member’s healthcare
coverage issues experiencedThe problems between Kaiser Permanente (KP),
Connect for Health Colorado (C4), and our third party billing vendor (HPS) are
known to executive leadership, and they are continuously being analyzed/worked
onUnfortunately, some of our members who purchased their coverage through C4,
reported not having been advised of a possible termination until actually
termed
I submitted a case with the Member Issues Resolution Team
(MIRT, as they specifically handle Cplan issues by communicating with Cand
HPS accordinglyUltimately, Mrs*** has been reinstated without a
coverage breakAdditonally, her dependent, ***, is now showing to be
effective as of 6/8/Again, I am sincerely apologetic for these problems
that have occurredUnfortunately, those
member that deal with these types of plan problems, sometimes have other
situations ariseThe most efficient method in resolving such issues, is for
the member to deal with only one person that is already aware of the details
and capable of properly outreaching MIRT for the needed assistancePlease thank
Mrs*** for being a valued KP member, and to please contact me
directly with any additionally related questions
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 (303) 338-
Also, you may contact Member Services:
Denver/Boulder members may call 303-338-3800, 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 303-338-3820.
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

August 16,
*** ***
*** *** *** *** ***
*** ** *** ***
***
*** *** ***
Complaint Case # ***
Consumer: *** ***
Case Opened: 08/2/
Dear *** ***,
This is in response to your email received on August, forwarding
concerns on behalf of our member; *** *** regarding his
request for reinstatementWe 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 leadership
Research indicates that *** ***’s coverage with Kaiser
Permanente was terminated May 31, for non-payment*** ***’s May premium of $was
not received until July 05,
Kaiser Permanente has approved *** ***’s request for
reinstatement. A reinstatement bill was
mailed to the member on August 11, 2017.
The total premium payment due is $for April through September. This payment is due by September 11,
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 ***
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,
*** ***
*** *** *** ***
*** ***

February 29,
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: February
22,
Dear Ms***,
This is in response to your email received on February 22,
2016, forwarding the rebuttal to our original response provided on February 13,
2016, on behalf of our member, *** ***The member is requesting
that his health plan premium account discrepancies, invoice errors, and wife’s
inaccurate service charges be fixed
We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction
Being that Mr*** Kaiser Permanente (KP) health
coverage was purchased through Connect for Health Colorado, all billing must go
through our third party vendor (HPS)I assure you that Mr*** coverage
was correctly reinstated, and the remaining technical issues have been forward
to HPS, as to ensure that the account numbers and mailed invoices reflect accurately
KP has this request escalated to HPSThe
Member Issues Resolution Team (MIRT) continues to follow the case progress and provide
me with updatesI am very sorry that the remaining issues have not being
resolved in a timelier manner, and this is a known issue diligently being
analyzed by KP leadership
I submitted for a full account audit for *** ***
and *** ***I was advised that there are not any overages found on the
account; please see the attached account audit for more details
I would be more than happy to personally follow through with
Mr*** until the account issues are satisfactorily resolved, and he is
receiving accurate invoice statementsI am also able to provide Patient
Financial Services (PFS) or Claims Department phone numbers, should further
assistance be needed with billsAgain, my sincere apologies for any
frustration caused to Mr***, and I do hope that he will choose to
contact me directly for his health plan questions/concerns moving forward
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 wayIf 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

January 12, *** *** Dispute Resolution & Helpline Specialist Denver/Boulder Revdex.com *** *** *** Denver, Colorado Complaint Case # ***
Consumer: *** *** Case Opened: December 23, Dear Ms***, This is in response to your email received on December 24, 2015, forwarding concerns on behalf of our member, *** ***, regarding the termination of her Kaiser Permanente (KP) healthcare plan purchased from Connect for Health Colorado (C4). We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfactionAdditionally, I have noted that a case response was emailed to the Revdex.com on January 6, 2016, though I am unable to locate it as being attachedI am very sorry for the inconvenience of awaiting information about this issueThe Case Resolution Team has formally documented and shared Ms***’s concerns with the appropriate leaders at the Consolidated Service Center/KPIF Plans purchased via C4; notification includes the Operations ManagerPlease sincerely apologize to the member for the frustration experienced with this matter thus farCoverage has been reinstated from the date of January 1, through currentThe premium payment breakdown is as follows: 06/01/- 12/31/2014, $x 7mos = $1,01/01/- 12/31/2015, $x 12mos = $3,2014/Total Premium: $4,Member Actual Paid: $4,Member Balance Due for 2015: $Member Balance Due for 2016: $Member Grand Total Due: $Payment can either be mailed or called in to: Kaiser Foundation Health Plan, Inc** *** *** City of Industry, CA *** *** Now that coverage is reflecting accurately, I have submitted for an audit of claims during the cancelled time frame of October 1, through the end of As I am not able to provide an explanation as to why this cancellation occurred without the member receiving any mailed information, I assure you that such issues are being addressed accordingly between KP, C4, and our third party billing vendorThe member’s patience throughout has been much appreciated, as she is a valued KP memberThe Explanation of Benefits (EOB) for any reprocessed claims will be mailed to the member’s homeShould any further questions arise for Ms***, please ask her to contact me, as I will gladly be her direct contact for any future plan issuesThe 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 *** *** *** *** 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-***, 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-*** or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-***. 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 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
Sincerely,
*** ***

Complaint:
I am rejecting this response because:Most of the serious issues for my original complaint still existI will not accept an explanation of the circumstances that Kaiser finds itself in as a resolution to the issueGiven Kaiser's record in my case, every issue needs to be resolved before any acceptance occursThe issues as I see them now:I received a notice in the mail on Saturday, Feb 20th, and dated February 12, 2016, that says my coverage will be terminated if a payment of $3,isn't received by March 14th, I find myself right back where I was in December of with this issueKaiser has been aware of these erroneous charges for at least two months, has agreed, and said these incorrect charges would be removed prompltyDemanding payment for monies not owed, with the threat of termination, seems to be fraudulent to me at this pointThis issue needs to be fixed immediatelyThis is my second written complaint for this issueMy wife, ***, still has an active bill on her account for services rendered that do not reflect charges as per our policyThe guarantor Acct # is 1061328, and her health record number is The amount total amount billed is $My estimate for services due should be equal to or less than $Any and all bills needs to be corrected to reflect our insured status in and immediately. Billing amounts and dates on my account do not reflect actual payments made, though the total is correctPlease correct this. My current bill on the kaiser site has a due date of 2017.Thank you for your prompt attention, and resolution of these issues
Sincerely,
*** ***

January 22,
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: January
9,
Dear Ms***,
This is in response to your email received on January 12,
2016, forwarding concerns on behalf of our member, *** ***The member’s
issue is regarding Kaiser Permanente assistance needed for prescription
medication reimbursement from an outside insurance carrier for the date of
August 6, We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction
Ms***s initial grievance was filed within the Case
Resolution Department on December 8, Please apologize to the member that
the response received from the Case Resolution Specialist (CRS) was not within
our timely day fashion
The member’s grievance details have been appropriately
documented and shared with the Aurora Centrepoint Pharmacy leadershipThe CRS
did not receive the emailed assistance requested, and I’m very sorry for the
inconvenience that the wait has ultimately caused Ms***The Pharmacy
Supervisor has advised that the receipt copy for the medication provided should
suffice as payment proof needed for reimbursement by the insurance carrierThe
CRS, *** ***, left the member a telephone message with explanation on
January 15, 2016, and mailed a response letter with the prescription medication
receipt copy enclosedPer the member’s Revdex.com request, the following information
is being provided pertaining to the August 6, date, in which she had
called and spoken with an AACC Advice Nurse:
Diagnoses
CAUSE OF INJURY, CAT
BITE, INIT
- Primary
ICD-9-CM:
E
ICD-10-CM:
W55.01XA
Should Ms*** be additionally in need of any further
information, please ask her to contact me directly
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

November 14, 2016*** ***Dispute Resolution SpecialistDenver/Boulder Revdex.com*** *** ***
*** *** ***Complaint Case # ***Consumer: *** *** Case Opened: October 30, 2016 Dear *** ***,This is in response to your
email received on October 31, 2016, forwarding concerns on behalf of our member, *** *** regarding the bill she has received for services July 8, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.*** *** stated she is being billed for a spirometry that was not completed The dealings *** *** had with the Case Resolution Team have not resulted in the charges being adjusted off her account.We have formally documented and shared *** ***’s concerns with the appropriate Patient Financial Services leadership, to include the Department Manager Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. Additionally, we have communicated with the Nurse Manager of the East Medical Offices Internal Medicine Department The Nurse Manager was able to confirm that the physician ordered the spirometry, but it was not completed Charges related to the spirometry on July 8, 2016, totaling $will be adjusted off the account, and no longer be *** ***’s financial responsibility It make take up to two billing cycles for the adjustment to reflect on the bill.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

Complaint: ***
I am rejecting this response because:Accepting an appointment at a distant clinic next year does NOT change the facts of this disputeKaiser implemented a policy specifically designed to reduce the availability of chiropractic benefit use by their members, regardless of the spin they try to explain it awayIt’s nonsensical to assume that the availability and convenience of local chiropractic care will remain even remotely constant when downgrading from dozens/hundreds of local chiropractors to the FIVE available for the entire Denver metro areaDuring my phone call with Melissa, regional manager (?), I expressed these thoughtsWe discussed the degradation of immediate local serviceThe driving distance issue alone invalidates their proposition Had Kaiser implemented their plan by providing care at ALL Kaiser clinics, it may have been palatable, regardless of my distaste at losing my local expert I accepted her scheduling an initial appointment to ensure that I continue to use my benefits, regardless of their intent to deny me the benefits I’ve purchasedIt’s amazing to think that Kaiser could use the specious reasoning that accepting an appointment would invalidate my justified anger as their scheme I have had a second contact with the Insurance Rep at United ***, and will continue to advocate for a judgement from UAL that this underhanded change by Kaiser does not adequately meet the requirements of United *** employeesTop of my list of recommended solutions is for UAL to direct Kaiser to implement an option for members to retain their current chiropractic care similar to previous year availability.
Sincerely,
*** ***

Dear Ms***,
This is in response to your email received on May 17, 2016,
forwarding concerns on behalf of our member, *** ***, regarding an awaited
premium refund. We value the opportunity to review and respond to their grievance and
apologize for the
member’s dissatisfaction
We have verified that Mr***’s concerns have been
documented and shared with the appropriate Membership Administration Department
leaders, to include the ManagerI have additionally filed a complaint regarding
our member’s customer service experience, as he should’ve been contacted by a
Case Resolution Specialist to further discuss the initial complaintThis
notification includes the Customer Experience SrManager and Case Resolution
Supervisor
The Membership Administration provided their response to the
January binder/premium payment refund request, prior to the life event
resulting in family healthcare coverage changeThe cancel date has been
changed to December 31, 2015, and the $paid will be refunded back to the
original credit card used at the time of enrollmentPlease apologize to the
member for any frustration or inconvenience that may have been caused by this
overall matterAlso, I am available to assist, should any additionally related
questions 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
Member 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 Specialist
Member
Experience

February 13,
*** ***
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: January
28,
Dear Ms***,
This is in response to your email received on January 29,
2016, forwarding concerns on behalf of our member, *** ***, regarding
continuing issues experienced with his Kaiser Permanente (KP) healthcare plan
purchased from Connect for Health Colorado (C4). 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*** complaint
details with the appropriate Consolidated Service Center/KPIF, On-Exchange
Issues Department leadership, to include the overseeing ManagerI am very
sorry for frustration caused to Mr*** and his wife, as a result of
dealing with the same issues for such a lengthy period of time
C4, KP, and HPS (our third party billing vendor), all communicate
member problems with their accounts by way of a posted case and review of the
added notes by a representative of each partyFor KP, the Member Issues Resolution
Team (MIRT), is the case owner, and the Case Resolution Team (CRT) acts as the
liaison between our members and MIRT to provide members with relevant
information and case updatesI realize that the timeliness of resolving issues
that pertain to healthcare plans purchased through C4, have NOT been idealFor
this, I am sincerely apologetic, as I understand the urgency of needing to settle
issues affecting an individual’s healthcare insurance
MIRT has unfortunately been greatly affected in its ability to
resolve these cases quickly for reasonsThey are dealing around the clock
with more cases than ever planned for or expected; new MIRT representatives
continue to join the team in an attempt to resolve casesSecondly, they must
(via the posted case) outreach Cto confirm any eligibility/benefit discrepancies,
as KP is not able to change any information for plans purchased through C
until advised to do so by themAny monies issues are then communicated through
HPS, as they are responsible for correctly updating the billing systemThough
MIRT is able to ensure that KP’s system reflects eligibility, once confirming
the information with C4, they are unable to personally change monetary figures
None of this is an excuse for Mr*** inconvenienced by our processes, but
rather an explanation as to provide a clearer picture of the situationUpper
management is very aware of the excessive amount of problems that KP is
currently attempting to assist members with, and will hopefully come up with an
effective resolution, so that are members do not have to worry about persistent
account discrepancies
At this time, Mr*** reflects eligibility from
1/1/through current, and his wife Anna Mudale from 10/1/through
current:
GROUP SGR RL ST
EFF END RS RGN PL TP EN C CARR
AA AC
999999 NCXS
AA AC 123115 NCXS
427-4030-
***,***D AA
424-4030-
***
BB
MIRT noted in the posted
case on 2/4/a detailed summary of the founded issues, which appear to have
all stemmed from the incorrect addition of the member’s wifeMr***
account was at one time changed to the 10/1/effective date, and Mrs
*** at one time changed to a 1/1/effective dateMIRT is noted to having
requested for HPS to adjust the erroneous premium charges from 1/1/to
9/1/This is confirmed to have been updated accordingly on 2/9/2016,
though 2/11/notes that a bill/invoice adjustment is still required; MIRT
emailed HPS to update immediately
I ask that Mr
*** contact me directly for any related questions or concernsSometimes
members that have experienced previous plan issues have additional ones arise,
and I am able to view/communicate case updates/progressIn regards to any
claims that processed for the member or his wife, please ask Mr*** to
contact me if these have not been reprocessed
Again, my apologies
for the frustration and inconvenience caused to our member and his wifeI am
available to personally further assist
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
Tell us why here

March 1,
*** ***
*** *** *** *** ***
*** ** *** ***
***
*** *** ***
Complaint Case # ***
Consumer: *** ***
Case Opened: 02/18/
Dear Mr***,
This is in response to your email received on February 18,
forwarding concerns on behalf of our member; *** *** regarding
charges $billed to the member on January and February 12, 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 grievance
with the appropriate leadership
Research indicates $copayment was appropriately billed
for service dates December and 13th,
The member’s spouse, *** was seen and treated on December
07, at the *** Medical Offices, *** *** ***. Labs results were completed on December 13,
The member was appropriately billed for the procedure and labs per his benefit
planThese charges were dropped in after the December 20, statement was
closed out and mailed. The system
applied payments received on January 11, to some of these balances that
were not billed on the December 20th invoice. Feedback provided from our Patient Financial
Counseling department has advised that that this has been corrected. The payment received on January 11, have
now all been applied per the invoice received for $
In addition, 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 labsAn adjustment of $was
credited to the account for these services and $was applied to the
outstanding balance. The member will
receive a refund in the amount of $for the remaining credit on the
account
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 ***.
*** *** 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,
*** ***
*** *** *** ***
Member
Experience

March 10,
*
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** ***
Case Opened: February
25,
Dear Ms***,
This is in response to your email received on February 18,
2016, forwarding concerns on behalf of our member, *** ***, regarding
the incorrect premium amount being automatically deducted from his
account. 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/KPIF On-Exchange
Department leadership, to include the overseeing ManagerI am very sorry for
any frustration or inconvenience that may have been caused to Mr*** by
this overall matterA case has been posted with Kaiser Permanente’s (KP)
Member Issues Resolution Team (MIRT), as they assist specifically with issues
pertaining to plans purchased through Connect for Health Colorado (C4)Your
plan is currently reflecting as termed on February 29, MIRT was able to
confirm that our third party billing company (HPS) corrected the member’s
premium amount to the $that it should beOn March 9, 2016, HPS advised
that they are re-running the bill, which will result in a refund to process for
the member
I will continue to follow through with MIRT, until the case
has been satisfactorily resolvedPlease inform Mr*** that I am available
to contact personally, should he be seeking an update as to where the refund is
the processAgain, I am very sorry for the continued problems experienced, and
I am also happy to answer any additionally related questions
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 303-338-3800, 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 303-338-3820.
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

Complaint Case # ***
Consumer: *** ***
Case
Opened: 6/28/
Dear Ms***,
This is in response to your email received on June 29,2016, forwarding concerns on behalf of our member; *** *** regarding his request to have the charge of $to be waived for an MRIWe 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
Research indicates that the charge of $for November 20, was adjusted off on May 21, The charge for the original MRI on October 31, reflects as paidThe payment that Mr*** made was applied to the first MRIMr*** has no outstanding balance as of the date of this letter for the MRI’s in question
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 SpecialistMember Experience

Complaint: ***
I am rejecting this response because:I called Cand they are unable to change my term dateThis should not matter though as my new employer plan is also through Kaiser, so they received and August premium from my employerEither way, my refund should have been processed well before this issue of the term datesThe only reason these two separate issues are being conflated in because Kaiser dragged its heels so long on what should have been a simple refund for their errorIt is ridiculous that they would take 6-weeks to issue the refund after acknowledging that it was entirely their mistake for overcharging meI don't get 6-weeks to pay my premiums or medical bills
Sincerely,
*** ***

Initial Business Response /* (1000, 6, 2015/12/21) */
December 21,
*** ***
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: ***, ***
Case
Opened: December 4,
Dear Ms***
This is in response to your email received on December 4, 2015, forwarding concerns on behalf of our member, *** ***, regarding issues pertaining to his health plan purchased through Connect for Health Colorado (C4)We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
Mr***'s concerns have been filed as a formal complaint through Kaiser Permanente's (KP) internal process, with notification to the Manager of the Consolidated Service Center for On-Exchange Issues DepartmentI have reached out to KP's Member Issues Resolution Team (MIRT) in California, as they specifically manage issues, such as experienced by Mr***, with On-Exchange plan detail discrepancies
Mr***'s account has been thoroughly reviewed, in an attempt to confirm as to why it does not reflect a $outstanding balance for the yearPlease sincerely apologize to our member, on behalf of KP, for the continued frustration and inconvenience caused by this matterMr*** and myself have also had personal conversation, in which I've been able to further explain that he has unfortunately been included with the members affected by receiving cancelation warning letters and inaccurate premium monies due advisementsThe member is aware of the change in third party billing vendors, though much of his frustration lies with the extended amount of time it has taken to resolve the consequential account errorsI have offered myself as a direct contact to provide case updates, as they are provided by MIRTThe communication between KP, C4, and our current billing vendor, HPS, are posted to the progress notes within the open caseI am in agreement that these cases are not being ideally resolved in a timely manner; KP and Care admittedly backlogged with needed fixes and assure that they are working as quickly as possible
The latest case review and summary update for Mr*** is as follows:
Breakdown coverage (case id F47K99)
03/01/to 12/31/
$x months: 8,
Total Premium: $8,
Member ACTUAL PAID: $9,
(In CONEXIS $6,+ $2,of additional payment in HPS)
***only $1,was transferred to HPS on 8/24***
CREDIT: $1,
Summary:
KP originally received the file from CExchange on 8/29/with an effective date of 2/1/When the effective date was changed to 3/1/15, KP did not receive the file from CExchange to update the billingTherefore, HPS still shows the member's incorrect effective date if 2/1/15, rather than the accurate effective date of 3/1/
Next Steps:
Requesting change effective date from 2/1/to 3/1/thru 12/31/in HPS
Missing payment of 5,from CNX to HPS account, requesting transfer payment of 5,to case id F47K
And then will request split payments of 1,toward case id J9304K
On 12/18/2015, MIRT requested HPS to update the member's coverageThis has not been accomplished thus farMeanwhile, I've been asked to advise the member to make sure that any payments made moving forward are toward the case ID J9304K (premium $512.85)This complaint will be filed, and I am opening a new case to follow through with the member, until all necessary changes are made to the member's account
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,
*** M***
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (2000, 8, 2015/12/23) */
(The consumer indicated he/she ACCEPTED the response from the business.)
It appears account information is being updated and correctedAs of today 12/23/both the and show "termed" on the Kaiser website dashboards that I have access to however it does appear that funds are being processed to correct thisThank you so very much

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,
*** ***

Complaint: ***
I am rejecting this response because: YOU CANT JUST SWEEP THIS UNDER THE CARPET AND HOPE IT GOES AWAY! YOU PEOPLE COST ME HOURS UPON HOURS OF MY TIME FOR THE ONLY REASON THAT YOU COULD NOT CORRECT MISTAKES ON YOUR ENDMONTH AFTER MONTH I HAD TO DEAL WITH YOUR PEOPLE WITH OUT ANY THING GETTING CORRECTED, OH YOU HAD YOUR MONEY IN FACT MORE THAN YOUR MONEY YOU HAD MINE TOO!! AND NOW I AM SUPPOSE TO SAY OH WELL THEY DONT DO CREDITS I GUESS I JUST NEED TO FORGET ABOUT ALL I WENT THROUGH AND MOVE ON.YA WELL THATS NOT GOING TO HAPPENYOUR COMPANY JUST DOESNT GIVE A DAMN DO YOU, YOUR ATTIUDE IS JUST DEAL WITHWRONG WRONG WRONG YOU NEED TO FIGURE OUT A WAY TO MAKE THIS RIGHT!
Sincerely,
*** ***

As of today 09/6/I still have not received a refund from KaiserI talked to them today they took Aug out of my refund which changed my new refund amount to $So I had already sent a payment in for Sept and I called in to make sure it was received and they said yes and we applied it to your Aug payment and you are now late on SeptSo then I contacted my case worker *** *** and she said since I turned it over to the Revdex.com she could not work this case anymore and the process to get my refund just got longerI asked her why she never returned any of my phone calls and again she said it was because I called the Revdex.com but I told her I had been calling way before I ever called the Revdex.com but she still claimed that reasonSo what happened to the refund in hours? Just like every thing else they have told me!!!!