Owens Originals, Inc.

March 2,
*** ***
*** *** *** *** ***
*** ** *** *** ***
*** *** ***
Complaint Case # ***
Consumer: *** ***
Case Opened: 02/22/
Dear Mr***,
This is in response to your follow up email received on March
2, forwarding concerns on behalf of our member; *** *** regarding
charges of $billed to the member on February 22, We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction
In regards to the quote provided to the member on January
18, There has been additional feedback provided from the Member Services
Contact Center. The member was advised
that she would be billed, $161.48.
The member was not advised that estimates quoted to our members are
subject to changed Based on this
information, I am going to honor the member’s requestThe amount of $
will be adjusted off for service date January 19, 2017, leaving her with a balance of $for the office visitPlease allow at least one billing cycle for
this process to be completed
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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11083952, am waiting to hear back regarding their review of the call records
Sincerely,
*** ***

Initial Business Response /* (1000, 9, 2015/10/28) */
October 28,
*** ***
Trade Practices Specialist
Denver/Boulder Revdex.com
*** *** XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: *** ***
Case Opened: October 12,
Dear Ms
***
This is in response to your email received on October 13, 2014, forwarding the concerns on behalf of our member; *** ***
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 way
On October 9, 2015, Mr*** contacted Kaiser Permanente's Member Services Contact Center and filed a formal concern requesting Kaiser Permanente correct his enrollment in our Bronze 4500/health plan as he was enrolled in this health plan from January 1, 2014, through September 30, He also filed a subsequent complaint with the Revdex.com (Revdex.com), which we received October 13, He still needed a corrected 1095A tax form prior to filing your taxes on October 15, He has been trying to resolve the issue since May to no availHe expressed frustration in trying to remedy this concern and obtain the documentation needed
As part of the formal complaint process, I documented Mr***'s concerns and reviewed them with Kaiser Permanente's California Service Center OnExchange Operations Manager and Kaiser Permanente's Member Services Contact Center Operations ManagerBased upon further review of the available documentation, below is a summary of the events related to your coverage:
From October 27, 2014, through August 12, 2015, Kaiser Permanente's Member Services Contact Center Tier Team requested the corrected coverage information to remedy the coverage from Connect for Health ColoradoPlease note that Kaiser Permanente cannot make any changes, including enrollment or cancellation, to a health plan purchased through Connect for Health Colorado without Connect for Health Colorado's authorization and documentation
Kaiser Permanente's Member Services Contact Center call records document Mr*** initiated contact on June 25, 2015, requesting assistance for a corrected 1095A tax formSince this time, he has consistently and routinely contacted Kaiser Permanente regarding this issue until the present day
On August 20, 2015, Kaiser Permanente's Member Services Contact Center escalated his request for a corrected 1095A tax form
On August 25, 2015, Kaiser Permanente received the necessary information to correct his coverage from Connect for Health Colorado as follows:
Connect for Health Colorado Exchange ID#: XXXXXXXXXX
Member: *** ***
Effective Dates: 1/1/2014-8/31/
Total Premium: $
Advanced Premium Tax Credit (APTC): $
Member's responsible amount: $
Effective Dates: 9/1/2014-9/30/
Total Premium: $
Advanced Premium Tax Credit (APTC): $
Member's responsible amount: $
As Mr*** may already be aware some of our members who were enrolled with Kaiser Permanente through Connect for Health Colorado received incorrect 1095A forms and there was a delay in processing the corrected 1095A forms
Kaiser Permanente partnered with Connect for Health Colorado in order to provide our members with a corrected 1095A formIt is a two-step processKaiser Permanente corrects the information for the 1095A form through a Special Tax Unit and the Special Tax Unit sends the corrected information to Connect for Health ColoradoPlease be aware that according to the Affordable Care Act (ACA), Connect for Health Colorado is required to send the 1095A tax form to individuals who enrolled in qualified health plans on the Exchange
The documentation provided by Connect for Health Colorado was not received in enough time to fully remediate Mr***'s account and meet the deadline for Connect for Health Colorado's last 1095A tax form production
Unfortunately, Connect for Health Colorado ceased production on correcting 1095A tax forms in early September and Mr***'s request for a corrected 1095A tax form was requested during this time frameI contacted Connect for Health Colorado's Carrier Research Team on his behalf and confirmed they are unable to do a manual corrected 1095A tax form for Mr*** as there was no guarantee that the Internal Revenue Service (IRS) would have the same information that was already providedIf Mr*** has concerns around the timing of filing his taxes, he may want to seek help from a tax professional regarding options
On October 28, 2015, a call was placed to Mr*** to talk about possible options for resolution, we are awaiting his call back
If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX
Sincerely,
*** ***
Complex Case Resolution Specialist
Case Resolution Team
Customer Experience Department
Kaiser Foundation Health Plan of Colorado
Initial Consumer Rebuttal /* (2000, 11, 2015/11/08) */
(The consumer indicated he/she ACCEPTED the response from the business.)
A representative from Kaiser Permanente contacted be and helped to resolve my situationThey have now updated my information and I will be able to received a corrected 1095-AThe case resolution specialist, *** has been very helpful and apologized for the delay in getting the matter resolved

December 14, 2017 *** ***
*** *** *** *** ***
*** ** *** *** ***
*** *** *** Complaint Case # *** Consumer: *** M ***Case Opened: 11/28/2017 Dear Mr***, This is in response to your email received on December 8, forwarding concerns on behalf of member; *** M *** regarding his rebuttal regarding Kaiser Permanente (KP) not renewing outside providers for chiropractic careWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction. Based on the review, Mr*** received a call from the Regional Director of Complementary Medicine Services on Wednesday, December 13, During the call, Mr*** scheduled an appointment in the Complementary Medicine (CCM) departmentHe was provided the CCM direct phone number, the Business Office Assistant's name and the Highlands Ranch medical office addressMrFlora expressed he was happy that the CCM chiropractor will be able to view his records and was satisfied with the plan. 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 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 SpecialistMember Experience

Complaint:
I am rejecting this response because:Although a lot more long-winded, this is basically EXACTLY the same response I've gotten from Kaiser the last times I've talked to them over the last months (now months) That is, "We've escalated the problem Give it some time to work its way through the system Call us back in 7-business days." That has accomplished absolutely nothing so far Why would I believe it's different now?I gave you the criteria for success in the original problem complaint in the "Desired Outcome" section I should be able to log in to my Kaiser account and see that my "Paid thru" date is the end of the current month It still shows 11/30/ I also want the premium payments to be automatically charged to my credit card As of the latest premium, that hasn't happened.I can't accept a response that says, "We're working on it" I've been down that road An acceptable response would be, "It's fixed You can log in and verify".Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:I DO NOT accept Kaiser's response - because my account is STILL not fixed On Kaiser's Web site - it continues to show my policy has been terminated, is past due, my premium payments are NOT appropriately applied, I am receiving frequent "Termination Notices", (falsely stating they are "per my request"), and I have not received billing statements for several months.In addition, today I learned that Kaiser provided information to *** *** *** *** indicating that my December was cancelled due to non-payment --> even though I have multiple documents from Kaiser showing full payment and even a certificate of Coverage This has resulted in a delay in issuance of my tax forms, thereby further delaying my substantial tax refund Kaiser should pay me interest for every day that this tax refund continues to be delayed
Sincerely,
*** ***

July 12,
*** ***
*** *** *** *** ***
*** ** *** *** ***
*** *** ***
Complaint Case # ***
Consumer: *** ***
Case Opened: 07/03/
Dear *** ***,
This is in response to your email received on June 03, forwarding
concerns on behalf of member; *** *** regarding his
request for Kaiser Permanente to refund her the amount she was overcharged for
her prescription
We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction
We have formally documented and shared *** *** grievance
with the appropriate leadership
Based on review, The Pharmacy Supervisor
spoke with *** *** at length to listen to her concernsIt has been
identified that there were several service breakdowns in this case, none of
which are acceptableKaiser Permanente supervisor took ownership for her
interactions with the staff and assured her they are being addressed appropriately
*** *** was appreciative of the callLastly, the supervisor obtained *** *** card number to process the refund today
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 matterWe know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente
Sincerely,
*** ***
*** *** *** ***
*** ***

December 8,
*** ***
*** *** *** *** ***
*** ** *** *** ***
*** *** *** Complaint Case # *** Consumer: *** M *** Case Opened: 11/28/ Dear Mr***, This is in response to your email received on November 28, forwarding concerns on behalf of member; *** M *** regarding his concern regarding Kaiser Permanente (KP) not renewing outside providers for chiropractic careWe 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*** received notice of the chiropractic changes from Member Communications back in June The chiropractic network changes are meant to improve integration of the member's medical care, provide quality oversight of services, and aligns with the KP model of careIn regarding to the members statement: "don't even have the copay rates available” the benefit is not changing unless the employer group makes a changeAgain, this change was made known to KP members and employers back in June 2017, providing a months’ notice 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11137943, and find that this resolution is satisfactory to me
Sincerely,
*** ***

March 16,
*** ***
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 March 15,
2016, forwarding the rebuttal to our original response provided on March 10,
2016, on behalf of our member,
*** ***The member is advising that the refund has not yet been
received, as well as requesting that Kaiser Permanente (KP) pay his bank fee
caused by monies we had withdrawn in error
We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction
I’ve confirmed with the Member Issues Resolution Team (MIRT)
that the $refund was corrected by our billing system (HPS) on 3/11/
I have requested that MIRT outreach HPS to inquire as to where in the process
the member’s refund currently isMr*** is welcome to contact me directly
at the bolded phone number listed below for an update
In regards to the overdraft fee incurred by this issue, I’d
be happy to pay for thatPlease request that Mr*** provide me with proof
that the $charge was caused when KP deducted the monies from his account
He can attach it to this case, email it to me directly at *** or fax it to (303)
338-
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 caused
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

Initial Business Response /* (1000, 7, 2015/11/23) */
November 23,
*** ***
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: ***, ***
Case Opened: November 11,
Dear Ms***
This is in response to your email received on November 11, 2015, forwarding concerns on behalf of our member, *** ***, regarding discrepancies of her 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
We have formally documented and shared Ms***'s concerns with the appropriate leaders at the Consolidated Service Center/KPIF Issues Department, to include the ManagerI additionally requested an account audit and complete research of its details from the Kaiser Permanente (KP) Member Issues Resolution Team in CaliforniaThe investigation concluded with the member having Exchange IDs in errorThe missing payments for $($x 2) have been located in one of the wrong accounts and been transferred over accordinglyThe accurate and currently active health plan account is Exchange ID# XXXXXXXXXX, and it now shows to be paid in full
Please sincerely apologize to the Ms*** for the issues experienced with her plan thus far and for the consequential inconvenience causedKP and Ccontinue to work with our new third party vendor to resolve all problems arising and affecting member's accountsOne of the occurring situations is that the systems must all ultimately reflect the same benefit detailsWhile this action (which has often taken longer than initially expected) is being processed, varying information is being provided to our members from different individuals referencing a different systemThis has caused a great deal of confusion, and I would like to offer the member my personal assistance with any further questions or concerns that may present with her health planI believe that this will limit contradictory information being given and hopefully lessen the frustration as wellPlease advise Ms*** that I may be contacted directly by calling (XXX) XXX-XXXX, and thank her for her continuing to be a valued KP member
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 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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11129150, and find that this resolution is satisfactory to me; pending follow up on the actions outlined by MsBrown with Kaiser
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
I do however have a couple additional questionsI have left a message for *** thank you
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:I feel that if part of the surgery had to be performed again (which it did) I shouldn't be liable for the chargesAlso, if a company's employees (more than one) give incorrect information, the customer should not be the one to suffer as a result
Sincerely,
*** ***

Initial Business Response /* (1000, 6, 2015/06/26) */
June 26,
*** ***
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: ***, ***
Case Opened: June 25,
Dear Ms***
This is in
response to your email received on June 22, 2015, forwarding concerns on behalf of our member, *** ***, regarding a refund request for services his wife received at *** *** *** and *** DepartmentWe value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
Unfortunately, an Appointment of Representative (AOR) form is required to be completed and placed on file, in order for Mr*** to speak on behalf of his wifeI have mailed the necessary document to Mrand Mrs*** and included a brief explanation letter including my contact informationThis will allow Mrs*** to call me directlyIf she would like to place the complaint in her name, I will be happy to follow through on the formal complaint process and monetary requestOtherwise, I will be able to reach out to Mr*** for further complaint and requested resolution clarification, upon receipt of the completed AORI am sincerely sorry that the member and his wife are experiencing the issues described, and I look forward to the opportunity to appropriately address the matter
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
*** *** *** ***
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,
*** ** ***
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (3000, 8, 2015/07/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
After receiving an email from Revdex.com asking me to respond, I called Kaiser (who still hadn't contacted either my wife or me) and spoke with *** *** While pleasant, *** *** said she still couldn't move forward with handling anything since she had yet to receive the AOR form
We completed this form and mailed it back to the address listed on the instructions the day after we received it in the mailI can almost guarantee that it is sitting in a pile somewhere in Kaiser's mailroom
*** *** spoke with my wife for a few moments on the phone, but did not offer any solution to our problem whatsoeverShe promised she will be back in touch with us, but obviously we cannot accept Kaiser's response so far, since they effectively have provided us none
It is difficult to say whether Kaiser simply has a policy of stalling in hopes that customers will simply get fed up and give up, or if their internal systems are so disorganized and slow that they honestly don't really know what is going on
As I was typing this, *** *** called againShe said that another woman was "working on" my wife's claim and we will hear back no later than days from the date of our initial complaintShe also said that the reason my first complaint was never addressed was that it was transferred over to my wife's health record, and that I should have been notified that that had taken place
So, to reiterate, we still have received no refund of any kind from Kaiser (nor any formal apology or offer to help us moving forward with treatments) and so I do not accept their response
Final Business Response /* (1000, 22, 2015/09/21) */
The Case Resolution Specialist assisting the member advised that she picked up the check here at Waterpark I in Aurora, yesterday August 19,
Again, I apologize for the overall inconvenience that has been causedPlease let me know if I may be of any further assistance relating to this matter
*** ** ***
XXX XXX-XXXX
KP Case Resolution Team
Final Consumer Response /* (2000, 24, 2015/09/22) */
(The consumer indicated he/she ACCEPTED the response from the business.)
The customer service has generally been slow and inconsistentHowever, we finally did receive a full refund

August 31,
*** ***
Revdex.com Serving Denver/Boulder
EFlorida Ave., Ste
Denver, Colorado
Complaint Case # ***
Consumer: *** * ***
Case Opened: ***
Dear *** ***,
This is in response to your email received on August 24, forwarding concerns on behalf of our member; *** * *** regarding his request to have a refund for the premium payment that was made for his policy through Connect for Health ColoradoWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction
We have formally documented and shared *** *** grievance with the appropriate leadership
Research indicates a refund has been approved and sent to member for $on credit card ending XXXX-*** on August 30,
Please note that Kaiser Permanente is allowed to make changes to member accounts only as provided and documented by Connect for Health Colorado. Kaiser Permanente cannot make any changes to a health plan purchased through Connect for Health Colorado without authorization from Connect for Health Colorado
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

Complaint: ***
I am rejecting this response because the level of care provided by my current doctor is substandard as wellI have complained about a member of this care team thatinsisted that I have tests that were not required in addition to the current doctor was out on vacation and none of the staff were aware of thisIt should also be noted that my current doctor keeps insisting that I have tests done each time I come in and it is my choice if I want to have the tests doneIt should be noted that supposedly the director of clinic has reviewed my case however how can one review a case when you have not evenseen meIt should be noted it is my choice and my body as to the tests that should be goneKaiser has given me no medical proof thatthese tests should be done nor provided a list of complications if I don't or do the tests as wellI feel that the only reasonKaiser wants to have these tests done is just so they can collect money from my insurance companyIn addition what about the complaintsthat I have made about your staff dressing inappropriately on the job as wellI have called and complained about this well and nothing has been done except a notation madeThis is not a closed caseAlso why is this person writing to me when I was assigned to one personI should also add to the point that just to get a person to talk to is a minute wait in your call center which are unacceptable hold timesas wellAsk any call center manager and they would agreeI should also add that your mobile application is very poor as well
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: when I made the 12/29/appointment I told the scheduler I was sure I had a sinus infection and that I had all sorts of skin patches on my arms that I wasn't sure what they wereThat should have been allotted in their so called time frame as I indicated with making the appointmentMy doctor would have frozen them which doesn't take very long except a Kaiser employee had deleted our insurance out of their system! We are so done with Kaiser even my husband is tired of them not being responsible for their actions, he wrote them as well! His open enrollmentComes up in November so if this isn't resolved we will be finding new insurances! This isn't their first screw up!! I clearly needed stitches on 4-22-for a deep wound on my ankle they sent me home and didn't do anything, by the time I went back for recheck the following Wednesday the doctor was mad as it needed stitches! It's still healing after all these months and hasn't closed! Too bad I couldn't sue the it that sen me for that! Kaiser is a joke with incompetent doctors and staff! I hope that we can find another insurance come November! They can use their $rip off fee for butt wipe! They make me sick! Even the doctors can't remember what they do or say to their own patients! Maybe they should downsize in patient capacity or better yet hire more qualified staff!!
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11193296, and while I'm ultimately satisfied with the resolution, I am still very unhappy with the customer service I received throughout this entire processKaiser Permanente's response indicates that my case was in the process of being resolved when I filed this complaint with the Revdex.com, that my "case was already being worked within the Case Resolution Team"; I would like to point out that before I filed a formal complaint I tried to work with the Member Services Representatives, who 1) kept telling me that a resolution would be reached within 30-days (this was months or approximately days after I initially requested the claim be reprocessed) 2) had absolutely no idea how their insurance coverage worked (telling me that I had not reached my out of pocket maximum) 3) told me that a supervisor would call me back, when in fact, I never was able to speak with a supervisor even after requesting two times. The fact of the matter is that I requested on at least five different occasions that this claim be reprocessed, and it was not until I asked to file a complaint about each and every Member Services Representative that I spoke with from 11/3/2015-3/8/that my claim was even forwarded to the Case Resolution Team, this information is from one of the members of that team, who reported she only received my information after I made a complaint on 3/8/I genuinely feel like Kaiser was stalling in order to avoid paying the claim; whether that is truthfully what they were doing is impossible to know, but as a consumer that is certainly how it appeared. I will say that once I filed multiple complaints, my situation was resolved rather quickly, and that I appreciate.
Sincerely,
*** ***

Initial Business Response /* (1000, 6, 2015/07/01) */
July 1,
*** *** ***
*** *** *** ***
*** ***
*** *** XXXXX
*** *** XXXXX
Complaint Case # XXXXXXXX
Consumer: *** ***
Case Opened: June 17,
Dear
*** ***
This is in response to your email received on June 18, forwarding concerns on behalf of our member; *** *** regarding the billing of services from August 31,We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
We have formally documented and shared *** *** grievance with the appropriate leaders in the claims departmentThe member's claims are in the process of being corrected*** & *** *** had contacted our Member Services Call Center and requested the following to be completed
The new born claim should be effective under Mrs.***'s plan for the first daysThe new born was not showing covered the under *** *** plan for the first daysThis effected the member's accumulations*** *** states that his wife met the deducible on family accountUpon research we confirmed that the accumulations were not reflecting accuratelyThe following steps have been taken to correct the enrollment and claims errors:
The Newborn should have shown eligible from date of birth - 08/31/
Coverage now shows as the following:
Aurora Public School coverage: 8/31/XXXX-X/31/
Singing Hills Inccoverage: 09/01/XXXX- XX/30/
CHP + Coverage: 03/01/XXXX- XX/31/
Eligibility was corrected on June 12,
Claims were sent back for processing correctly for Date of Service August 31, on June 15, and in process of completion
Upon the claims being reprocessed, the member will receive a new explanation of benefits with his correct amount owed for services on August 31,
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
*** *** *** ***
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,
*** ***
Complex Case Resolution Specialist
Member Experience
Complaint Response Date bumped because: Holiday
Initial Consumer Rebuttal /* (3000, 8, 2015/07/10) */
(The consumer indicated he/she DID NOT accept the response from the business.)
*** *** I appreciate Kaiser's response, it does seem like they have finally started to analyze my claim and rectify the problemHowever, *** *** seems to be mistakenIn her second bullet point she claims that the bills have been resubmitted and are in the process of being correctedUnfortunately Kaiser continues their faulty billing as signified by another incorrect bill with a June 16th statement date*** *** also never mentioned whether the claim should be covered entirely under my wife's insurance and what insurance will be billed because the claim fell at the end of one insurance and the beginning of anotherThese questions need to be addressed and referenced with my insurance benefitsI also do not accept Kaiser's timelineThe original claim date was August 31,I had brought the errors to their attention multiple times each month since then, why is there a continued delay? The most recent bill I received threatened collections- Kaiser's continued delay is only endangering my credit, time, and livelihoodI would like a timeline on the EOB/BillI would also like a detailed account of my charges and what I already paidFinally, *** *** did not acknowledge my request for a meeting with a third partyThe meeting would help accelerate the process and allow a mediator to ensure follow throughPrevious communication with Kaiser directly proved futile and repetitiousElectronic communication allows for documentation but continues the slow processI appreciate your help in the matter and look forward to a conclusion, ***
Final Consumer Response /* (4200, 12, 2015/08/02) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Ms Davis, Thank you for your responseUnfortunately I can not accept the resolution at this timeMany of the EOB/Bills/credits you describe have not come through yetI still need to see the final billing of my daughters birth that also reflects the full amount of payments that I have madeBills that I have received in the last month do not show the adjustments that you mention or the payments (to Kaiser and to St*** that I have receipt ofAlso, I believe some of the charges that you mention continue to be inaccurateThe charge of $on 9/3/has been billed previously to my daughter and now to my wifeIn addition, this claim comes from a Home Health visit for my daughter that should be defined as preventative care and covered at no charge- this visit was not optionalThis continued issue can not be resolved until I receive the final EOB and bills to the issues that Kaiser claims to have addressedPlease address my new concerns and provide an update on when I should expect this matter to be resolved in your billing/claims departmentThank you, ***
Final Business Response /* (4000, 14, 2015/08/27) */
August 27,
Ms*** ***
Lead Trade Practices Consultant
Denver/Boulder Revdex.com
P.OBox XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: *** ***
Case Opened: June 17,
Dear Ms***
This is in response to your email received on August 17,forwarding a third rebuttal on behalf of our member; *** *** regarding the billing of services from August 31,We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction
We reprocessed his daughter's hospital claim on July 08, to pay $2,directly to Exempla Saint Joseph HospitalThe remaining balance of $was applied to the coinsurance, and will need to be paid directly to the hospitalI have mailed out a copy of the updated billing and Explanation of Benefits to the member
Note: Because the member's health plan's out-of-pocket maximum was not met, the remaining balance of $was applied to the coinsurance requirement and will need to be paid directly to Exempla Saint Joseph hospital
In accordance with Kaiser Permanente's well-newborn benefit, if the mom and the newborn are released from the hospital at the same time, the deductible is waived on the newborn's claimsWhen this occurs, if the mother of the newborn has not yet met the individual OPM, the charges for the newborn's hospital claims would apply to the mother's coinsurance
The member also indicated that Kaiser Permanente continues to charge him for the services that are covered or have already been paidI reviewed the most recent billing statement in the amount of $Please note that two of his daughter's claims, in the amount of $and $10.42, have been adjusted off the account as result of the claims auditAs a one-time service gesture to the member Kaiser Permanente has removed the remaining $charge from his accountThe account now has a zero balance
Claim Number XXXXXXXXXXXXXXXX for services provided to Mrs*** by *** *** on September 3, 2014, was processed on September 14, $was applied to the family deductibleWe have adjusted this claim off the members account as well
Please note, this concludes the members review rights regarding these specific complaint issuesIn the event the member would have a new concern, please have them contact the Member Services Department at XXX-XXX-XXXX or toll free at X-XXX-XXX-XXXXDeaf, hard of hearing, or speech impaired people who use a TTY may call XXX-XXX-XXXX
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
Customer Experience Department
Kaiser Foundation Health Plan of Colorado