Owens Originals, Inc.

October 27, 2016*** ***Trade Practice SpecialistDenver/Boulder Revdex.com*** *** ***
*** *** ***Complaint Case # ***Consumer: *** *** Case Rebuttal Opened: October 5, 2016Dear *** ***,This is in response to your email received on October 5, 2016, forwarding the 2nd rebuttal to our response provided on October 4, 2016, on behalf of our member, *** ***The member advised that he finally received his awaited premium refundHowever, *** *** received an invoice showing the amount refunded as again due, and he is requesting immediate confirmation that the remaining balance is $0.We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction.As of October 21, 2016, the Member Issues Resolution Team (MIRT) Business Analyst working this case confirmed that the November invoice should be disregarded, as the billing/cash adjustment applied after the invoice was mailed to *** ***The net balance due was a $service fee which was reversed.Please ask the member to keep this letter as documentation that the July 31, termed plan remains at a $balance dueMIRT advised that our third party billing, HPS, will mail a final invoice within weeks after completing the $adjustment within their system; an invoice cannot be processed any sooner.Please apologize to *** *** for the frustration experienced throughout this matter, as well as thank him for his continued patienceShould there be any additionally related questions, I may be contacted directly at (303) 338-Sincerely,*** ** ***Complex Case Resolution SpecialistMember Experience

Revdex.com:
At this time, 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 26,
*** ***
Trade Practice Specialist
Denver/Boulder Revdex.com
P.OBox
Denver, Colorado
Complaint Case #
Consumer: *** *** **
Case Opened: April
19,
Dear Ms***,
This is in response to your email received on April 21, 2016,
forwarding concerns on behalf of our former member, *** ***Mr*** wife,
*** submitted an email explaining that they her husband is being billed by a
collections agency for date of service September 10, She disagrees with
the charge, being that the copay was paid at the time of serviceAdditionally,
a general bill or past due notice was never received prior to the collections
letter
We value the
opportunity to review and respond to this matter and apologize for their
overall dissatisfactionI’ve outreached the Kaiser Permanente (KP) Patient
Financial Services Department for further research and clarification of the
collections billI’ve been advised that the $copay was paid for Mr*** September 10, office visit with *** ** ***, PA., at Westminster
Family PracticeThe member had an x-ray following that visit, which billed out
for $Per the member’s Evidence of Coverage, the x-ray was billed
appropriately towards the plan deductible:
DEDUCTIBLES
The
following Deductibles apply under your plan:
Embedded
Medical Deductible:
$500/Individual
per year
$1,500/Family
per year
Does not
apply to Out-of-Pocket Maximum
X-ray,
Laboratory and Special Procedures You Pay
Diagnostic
and therapeutic X-rays
(Subject to
medical Deductible; Applies to Out-of-Pocket Maximum)
30%
Coinsurance
The bill is documented as having been mailed to the address
we have on file for the member from his group plan employer:
WCR
Kennesburg, CO
Our Health Connect system shows the member’s address as
being in Fort Lupton, which is a system that can be changed by KP staff
However, our Membership Administration system shows the Keenesburg address, and
this information can only be changed by the submitted request from the group
plan employer
I am very sorry for any frustration that may have been
caused to the member and his wife by this overall matterPlease encourage them
to contact me directly, should they have any additionally related questions
Sincerely,
*** ** ***
*** ***
Complex Case
Resolution Specialist
Member
Experience

Complaint: [redacted]
I am rejecting this response because: I have to include actual information from the PSC Foundation.  Again, you note Kaiser failed to actually name a single provider specifically.  That is because, one of the only appropriate and listed PSC treatment facility, is [redacted] as my Kaiser primary originally referred me.[redacted] of Colorado Health Sciences Center, DenverPlease note, I do not feel well and ask that this complaint serve as an example for others with PSC.  Again, all my treatment providers have been in Denver.  Kaiser requires me to go to Denver for even basic care.  I am not certain who Kaiser is attempting to refer me to, since they refuse to identify the provider they say is a PSC specialist, but I must again state that the PSC Foundation clearly identifies only 2 places in Colorado.  [redacted] and [redacted] both in Denver.  I ask that I get to see the PSC specialist soon.  As the PSC foundation notes, those of us with PSC must be persistent in advocating for care.  Kaiser needs to support those of us with this rare disorder.  Thanks for your time and attention. ------------------------------------PLEASE READ THIS INFORMATIONFIND A SPECIALISTBecause PSC is a rare disease, most family and internal medicine physicians do not see or treat many patients with the condition. Indeed, you may be misdiagnosed at first, even by a gastroenterologist, as most do not have expertise in PSC. Many PSC Partners Seeking a Cure members report having been told their symptoms were “in their head” and/or that they had other digestive diseases until the diagnosis of PSC was ultimately confirmed. Our members have had to educate themselves and sometimes their doctors about PSC. They and caregivers have had to be persistent in advocating for themselves.Major PSC research centers in North America are listed below.  In contacting one of these PSC research centers, or any medical facility, it is important to recognize that not all clinicians will have substantive knowledge of PSC. Accordingly, and to the extent possible, individuals contacting these centers should specifically look for and request providers/hepatologists who have a dedicated interest and expertise in PSC. Adult [redacted] of Colorado Health Sciences Center, Denver [redacted]
 Sincerely,[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
I never saw any documentation (billing, not just a recap of my annual charges from K/P) showing a credit had been applies to my billing from K/P. I checked my records and I did not receive a billing for date of service June 2017, so it looks like they gave me the refund with out telling me. How was I supposed to know? Thank you for your help in clearing this up.
Sincerely,
[redacted]

Dear [redacted],
 
This is in response to your email received on July 18, 2016,
forwarding concerns on behalf of our member, [redacted], regarding an incorrect
bill for services and difficulty in having the...

issue resolved with Kaiser
Permanente.  We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
 
Mr. [redacted]
explained he is continually receiving a bill from Kaiser Permanente in the
amount of $20 for services rendered on June 13, 2016.  Mr. [redacted] states he has already paid the
$20 and when attempting to have the charge removed from his account, Kaiser
Permanente staff have not been helpful.
 
We have formally documented and shared [redacted]’s concerns
with the appropriate leadership, to include the Patient Financial Services Department
supervisor. Please apologize to the member, on behalf of Kaiser Permanente
(KP), for any frustration that may have been caused by this overall matter.
 
Additionally, review
confirms the June payment of $20 was received by Mr. [redacted] and funds were not
posted appropriately to his account.  Mr.
[redacted]’s account has been corrected and he will no longer receive invoices for
the $20 charge.
 
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:
 
[redacted]
 
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the
member. 
 
If the Revdex.com or the member has any questions, please contact me
at ###-###-####.
 
Also, you may contact Member Services:
 
Denver/Boulder members may call ###-###-####, toll free at ###-###-####,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call ###-###-####. 
 
Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
  
 
Sincerely,
 
 
[redacted]
Complex Case
Resolution Specialist
Customer
Experience

January 26, 2016
Revdex.com
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11083952
Consumer:                             [redacted]
Case Opened:                       January
12, 2016
Good morning,
This is in response to your email received on January 13,
2016, forwarding concerns on behalf of our member [redacted], regarding
the termination failure of his KPIF/Off-Exchange healthcare plan.  We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
We have formally documented and Mr. [redacted]’s complaint
details with the appropriate Consolidated Service Center/KPIF Membership
Administration Department, to include the overseeing Manager. My sincere
apologies for the frustration Mr. [redacted] has expressed pertaining to the
matter.
The Membership Administration Department has agreed to retro
the health plan cancelation to reflect December 31, 2015. I realize that the
member is seeking a cancelation date of October 31, 2015, as he has been
attempting to cancel for some time now. Though we are unable to locate any
previously submitted cancelation forms, the member has explained to me that he
did in fact fax them to the number that a Kaiser Permanente employee had
provided him with. I am currently in the process of reviewing calls between the
member and the Member Service Contact Center, as well as with the Membership
Administration Department. Should I find any misinformation provided, I will
submit the retro date change request according to the information he was given
and contact him immediately. Again, I am very sorry for this inconvenience, and
Mr. [redacted]’s is encouraged to contact me 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
2500 South Havana
Street
Aurora,
Colorado  80014
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the member. 
If the Revdex.com or the member has any questions, please contact me
at ([redacted].
Also, you may contact Member Services:
Denver/Boulder members may call [redacted], toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
Colorado Springs members please call 1-888-681-7878 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 matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

October 19, 2017  
[redacted]       Complaint Case #               [redacted]...

Consumer:                            [redacted]   Case Opened:                      October 15, 2017     Dear Mr. [redacted],   This is in response to your email received on October 15, 2017, forwarding concerns on behalf of our member, [redacted], regarding payment of $59.08 made April 10, 2017, for services received March 20,2017.  Mr. [redacted] received information from Kaiser Permanente Customer Experience department August 1, 2017, advising charges for services on March 20, 2017, had been adjusted to show he owed $29.54, rather than $59.08, leaving a credit of $29.54.  Mr.  [redacted] has asked the refund in this amount be issued to him.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.   We have confirmed Mr. [redacted]’s previous concerns submitted to Kaiser Permanente were appropriately documented in our record keeping system and shared with leaders of our organization.   Research has confirmed Mr. [redacted] had an appointment June 5, 2017, which resulted in a charge of $29.54.  Since the credit on the account matched the amount due, the credit of $29.54 was applied to the charges due for services June 5, 2017.  We verified a bill was not mailed to Mr. [redacted] for services June 5, 2017, as the payment had been applied to the account and showed no balance due.  We have verified a refund is not due to Mr. [redacted].   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:   [redacted]   Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member.    If the Revdex.com or the member has any questions, please contact me at [redacted].   Also, you may contact Member Services:   Denver/Boulder members may call [redacted], toll free at [redacted], between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted].    Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted].  You may also contact our department through our Web site at kaiserpermanente.org.   Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.               Sincerely,     [redacted]

February 21, 2017
                         ...


                         
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      01/16/2017
 
Dear Mr. [redacted],
 
This is in response to your email received on February 17, 2017 forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to honor the cancellation date of December 1,2016 for the health plan purchased through [redacted]. In addition, correct and remove any past due balances for the months of December 2016 and January 2017. 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. [redacted]’s grievance with the appropriate leadership.
 
The member’s disenrollment has been updated to reflect a term date of November 30, 2016. The members billing for December 2016 and January 2017 premiums have been adjusted off to reflect a zero balance. Kaiser Permanente does not report past due premiums to any credit agencies.
 
 
If the Revdex.com or the member has any questions, please contact me at [redacted].
 
Also, you may contact Member Services:
 
Denver/Boulder members may call [redacted], toll free at [redacted], between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted].  You may also contact our department through our Web site at kaiserpermanente.org.
 
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
Member Experience

February 28, 2016
*
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11137943
Consumer:                             [redacted]
Case Opened:                       February
15, 2016
Dear Ms. [redacted]
This is in response to your email received on February 17,
2016, forwarding concerns on behalf of our member, [redacted], regarding
lingering claim discrepancies.  We value the opportunity to review and
respond to their grievance and apologize for the member’s dissatisfaction.
We have formally documented and shared Ms. [redacted] concerns
with the appropriate Claims Department leadership, to include the Supervisor.
Please apologize to the member, on behalf of Kaiser Permanente (KP), for any
frustration caused by previously requesting assistance, yet never having the
issues satisfactorily resolved.
I also submitted for an account audit from 2012 through
current, which I have attached to the Revdex.com case for Ms. [redacted]. Each year benefits
are summarized, and 10 claims were reprocessed, as to go toward the Individual Deductible/OPM,
rather than the Family Deductible/OPM.
Should Ms. [redacted] have any remaining account
questions, please ask her to contact the Claims Department, as they will be
able to assist with audit clarifications, specific claim inquiries, and
requests to have any claim Explanation of Benefits (EOB) mailed. Please thank
Ms. [redacted] for her patience with this overall matter, as I realize that she has
been waiting for requested claim assistance and information for some time now. I
am also available, should the member like 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
2500 South Havana
Street
Aurora,
Colorado  80014
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an
additional 14 calendar days at the member’s request or if there is a need for
additional information and the delay is in the best interest of the member. 
If the Revdex.com or the member has any questions, please contact me
at [redacted]
Also, you may contact Member Services:
Denver/Boulder members may call [redacted], toll free at 1-800-632-9700,
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
Colorado Springs members please call 1-888-681-7878 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 matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case
Resolution Specialist
Member
Experience

October 12, 2016
 
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
[redacted]
 
 
Complaint Case #                [redacted]
Consumer:                             [redacted] 
Case Rebuttal Opened:       October
5, 2016
 
 
Dear [redacted],
 
This is in response to your email received on October 5,
2016, forwarding the rebuttal to our original response provided on October 4,
2016, on behalf of our member, [redacted]. The member is advising that Connect for Health Colorado (C4) will not
change his plan term date to July 31, 2016. He is requesting that Kaiser
Permanente (KP) initiate the term date change and immediately refund any monies
due back.
 
We value the
opportunity to review and respond to the grievance. We also apologize for the
member’s dissatisfaction.
 
The Member Issues Resolution Team (MIRT) Business Analyst
working this case has requested an escalated refund in the amount of $665.72,
which is expected to take 3-4 business days. The 7/31/2016 term date request
has been received by C4, and they are submitting the request on their end; the
account will still need to be worked on after the refund for billing and cash
adjustment are complete.
 
Please thank [redacted] for his continued patience. I
also encourage the member to call me directly with any additionally related
questions or for an update on this case.
 
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
[redacted]
 
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an additional
14 calendar days at the member’s request or if there is a need for additional
information and the delay is in the best interest of the member. 
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
Denver/Boulder members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
Complex Case
Resolution Specialist
Member
Experience

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

[redacted]
*
[redacted]       Complaint Case #               [redacted]...

Consumer:                            [redacted]   Case Opened:                      November 9, 2017     Dear Mr. [redacted],   This is in response to your email received on November 10, 2017, forwarding concerns on behalf of our member, [redacted], regarding the lack of communication he has received which has put his credit at risk.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.   Mr. [redacted] explained phone calls would not be returned over the last five months.  Direct calls have not been answered, and when calling the Kaiser Permanente Member Services Contact Center representatives were unfamiliar with the case and unable to assist.   We have formally documented and shared Mr. [redacted]’s concerns with the leadership of Kaiser Permanente’s Case Resolution Department. In speaking with Mr. [redacted] directly, I have had the opportunity to apologize to him for the frustration caused by this overall matter. Mr. [redacted] informed me of billing issues experienced after having a referral for care.  Despite the referral, he has received several bills that were not clear.  Upon contacting the provider of the services, I have requested the account be placed on hold to prevent any collection activity while the bills are being reviewed.  I will continue to work with Mr. [redacted] to resolve the billing concerns he has.       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 [redacted]   Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member.    If the Revdex.com or the member has any questions, please contact me at ###-###-####.   Also, you may contact Member Services:   Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-####.    Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted].  You may also contact our department through our Web site at kaiserpermanente.org.   Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.   Sincerely,     [redacted] Complex Case Resolution Specialist Customer Experience

May 3, 2017[redacted]...

[redacted]Complaint Case # [redacted]Consumer: [redacted]Case Opened: April 1, 2017 Dear Mr. [redacted],This is in response to your email received on April 27, 2017, forwarding concerns on behalf of our member, [redacted], regarding charges billed of $81.53 for the Bone Density Study completed January 17, 2017, and $175.55 for the ultrasound completed January 26, 2017.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Ms. [redacted]’s spouse has disputed charges as he feels the charges are unwarranted because the services were ordered during Ms. [redacted]’s preventive visit on January 12, 2017.  Mr. [redacted] states services are mandated by law to be provided at no cost to the Health Plan subscriber.  The concerns have been formally documented and shared with the appropriate managers and physician leaders of our program. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter. In addition, we have further reviewed Mr. [redacted]’s concerns related to the charges from January 17, 2017 and January 26, 2017.  Kaiser Permanente offers specific preventive tests at no cost to detect certain diseases early.  If the physician orders a test because of an existing health condition, the test is no longer preventive.  The Bone Density Scan was ordered to treat Osteoporosis, as Ms. [redacted] was previously diagnosed.  We are unable to waive the charge of $81.53 billed for the Bone Density Scan.  One mammogram is provided annually at no charge.  We verified an initial screening mammogram was completed January 12, 2017.  No charges were billed for this service based on her preventive benefit.  The tissue density lowered the sensitivity of the mammogram requiring additional evaluation.  A second mammogram exam was completed on January 26, 2017.  We confirmed no charges were billed to Ms. [redacted] for the second mammogram.  The additional mammogram yielded the same result as the first due to the tissue density.  The diagnostic ultrasound was completed to confirm there were no abnormalities.   Kaiser Permanente is offering a one-time service gesture to waive the charges of $175.55 for the ultrasound completed January 26, 2017.  It may take one or more billing cycles for this amount to be adjusted off the account.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:[redacted] 
[redacted]Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member.  If the Revdex.com or the member has any questions, please contact me at [redacted].Also, you may contact Member Services: [redacted] members may call [redacted], toll free at [redacted], between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted].  [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted].  You may also contact our department through our Web site at [redacted]Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely,[redacted]Member Experience

August 22, 2017
 
                         
[redacted]
[redacted]
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                         [redacted]
Case Opened:                     08/13/2017
 
Dear [redacted],
 
This is in response to your email received on August 14, 2017
forwarding concerns on behalf of our member; [redacted] regarding her request
for an adjustment on her account in the amount of $334.62. We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction.
 
We have formally documented and shared [redacted]’s grievance
with the appropriate leadership.
 
Research indicates that [redacted] was billed $334.62 for non-preventive
services including diagnostic labs and X-ray’s ordered for a specific symptom
and or diagnosis, on July 12, 2017 at the [redacted] Medical Offices.  The preventive labs she also had were all processed
appropriately with no cost-share. The amount of $334.62, [redacted]’s
responsibility, was appropriately applied as her member cost-share, per her Deductible Health Maintenance Organization
(DHMO) health plan.
 
If the Revdex.com or the member has any questions, please contact me
at [redacted].
 
Also, you may contact Member Services:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at [redacted].
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
[redacted]
[redacted]

May 3, 2017
 
[redacted]
 
 
 
Complaint Case...

#                [redacted]
Consumer:                             [redacted]
Case Opened:                       April
4, 2017
 
 
Dear Mr. [redacted],
 
This is in response to your email received May 1, 2017
advising that a reply email had not yet been received regarding our member,
[redacted], and her concerns submitted to the Revdex.com on April 4, 2017. Unfortunately, we haven’t any record
of receiving Ms. [redacted]’s previous Revdex.com, due to changes in our
notification preferences that we were not aware of. We have since confirmed
with you that our preference has been changed back to email notification. We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
Ms. [redacted]
stated that she has been disputing two $29.86 charges billed for nurse visits
in primary care on 10/12/2016 and 1/16/2017. She also explained her belief that
a premium payment applied towards Kaiser Permanente (KP) services, which she
did not owe for. The member also advised that she paid for an appointment that
should’ve been a free preventive visit, as well as requested a review of
charges for her husband.
 
Ms.
[redacted]’s concerns have been documented and shared with appropriate Patient
Financial Services (PFS) Department, to include the Supervisor. Additionally, our
Medicare Team confirmed that Ms. [redacted] was Medicaid eligible in
January 2017, however, it was not assigned to a provider. Ms. [redacted]
was Medicaid eligible effective February 1, 2017 through current, and the
benefits are assigned to KP.
 
In regards to the
two nurse visits, PFS forwarded the matter to our Coding Department, and the
two $29.86 charges have been voided from Ms. [redacted]’s account. I can
also see that the member made a payment in the amount of $177.29. I’ve
outreached PFS inquiring what services the payment applied towards. If the date
of service was not processed according to the benefits on file, I will ensure
that they are and call the member to advise if any account credit/refund due. Should
the member like to have a detailed audit of her and/or her husband’s accounts,
please ask her contact the Member Service Contact Center (MSCC) with both of
their medical record numbers and submit the audit request(s) clarifying the
time frame in which she is seeking that the audit be conducted for.
 
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
[redacted]
 
Written requests will be reviewed by Member Services
Administration who will respond to you in writing within 14 calendar days of
the receipt of the member’s request. We may extend this timeframe up to an additional
14 calendar days at the member’s request or if there is a need for additional
information and the delay is in the best interest of the member. 
 
If the Revdex.com or the member has any additionally related questions,
please contact me at [redacted].
Also, the MSCC may be contacted by calling:
 
[redacted] members may call [redacted], toll free at [redacted],
between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired
members who use a TTY may call [redacted]. 
 
[redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call [redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.
 
Please thank
our member for their understanding in this matter. We know that they have a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me, under the condition that I be notified when they have completed processing the claim with their Claims Department. If I do not receive a notification that this claim has been successfully completed, I will reject the response because this is the same step we have been working on for months.
Sincerely,
[redacted]

Initial Business Response /* (1000, 5, 2015/08/28) */

August 28, 2015
[redacted]
Trade Practices & Helpline Specialist
[redacted]@denver.Revdex.com.org
XXX XXX-XXXX
XXX XXX-XXXXFax
Complaint Case # XXXXXXXX
Consumer: [redacted]
Case Opened: August 20,...

2015
Dear Ms. [redacted]
This is in response to your email received on August 20, 2015, forwarding concerns on behalf of our member; [redacted], regarding his July 8, 2015 [redacted] Saint [redacted]'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction.
We have formally documented and shared Mr. [redacted]'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. I have also reached out to St. [redacted]'s Patient Representative requesting additional research and feedback.
The KP MFC department does not have any documentation of Mr. [redacted] requesting/receiving a cost estimate for his July 8, 2015 procedure, nor do they have an employee by the name of [redacted]. I was also informed that, per MFC protocol, the member would've been advised to contact the hospital in which the procedure would be performed for any requested cost estimates.
The St. [redacted]'s Patient Representative put me in contact with their Medical Financial Counseling Supervisor, though she was also not able to locate any documentation of a cost estimate being provided. She did confirm, however, that St. [redacted]'s does typically contact patients prior to a scheduled hospital visit. The Supervisor also stated that Mr. [redacted] was initially checked in for his procedure as "inpatient" surgery; inpatient surgery falls under the $500/day member benefit. The procedure type changed to "outpatient", which she explained is usually due to coding changes prompted by physician driven orders. Outpatient falls under the 30% member responsibility benefit.
The member disputed July 8, 2015, Exempla Saint [redacted] procedure costs incurred were appropriately billed in accordance to the member's Evidence of Coverage (EOC), and I am unable to honor the member's monetary request. Please sincerely apologize to Mr. [redacted] on behalf of KP, as it is disappointing to have a valued member express frustration. The St. [redacted]'s MFC Supervisor provided me with the following contact, should Mr. [redacted] choose to further discuss this perceived cost misinformation issue or any additional concerns relative to this case:
Rose Bonet (Director of Patient Access-Exempla St. [redacted]'s)
(XXX) XXX-XXXX
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
[redacted]
Aurora, Colorado XXXXX
Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member.
If the Revdex.com or the member has any questions, please contact me at (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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org.
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (3000, 7, 2015/09/12) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Changing coding and verbiage of said stay overnight in the hospital after I was quoted a specific price in order to up charge the patient us very close to being illegal. This is what is referred to as a shell. Stating one thing to make a qualified decision and to budget for a procedure only to be lied to, cheated and over charged is unacceptable in any business, but in the new universal healthcare world is a crime.
Final Business Response /* (4000, 9, 2015/09/17) */
September 17, 2015
[redacted]
Trade Practices & Helpline Specialist
[redacted]@denver.Revdex.com.org
XXX XXX-XXXX
XXX XXX-XXXXFax
Complaint Case # XXXXXXXX
Consumer: [redacted]
Case Opened: August 20, 2015
Dear Ms. [redacted]
This is in response to your email received on September 15,2015 forwarding the rebuttal to our original response provided on August 28,2015 on behalf of our member; [redacted], regarding his July 8, 2015 Exempla Saint [redacted]'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction.
We regret his continued dissatisfaction. However, Mr.Bishcoff request for review of these concerns was completed on July 27, 2015 and again on August 28, 2015 when a final resolution was rendered. Therefore, he has exhausted all internal grievance options offered by Kaiser Permanente.
However, we have formally documented and shared Mr. [redacted]'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. In addition we had all calls that were made to our Member Services Department pulled and reviewed. The call completed by Mr.Bishcoff on July 6, 2015 at 8:46am was to cancel an appointment. The member did not discuss or request any cost estimates in regards to any upcoming procedures.
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
Sincerely,
[redacted]
Complex Case Resolution Specialist
Member Experience Department
Kaiser Foundation Health Plan of Colorado
Final Consumer Response /* (4200, 11, 2015/09/18) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The call on July 6 was NOT TO CANCEL AN APPOINTMENT. Kaiser is not telling the truth and will now cause me financial distress withhold get to declare bankruptcy due to you not honoring your price quote on July 6, 2016 in the afternoon. Not in the morning. I have repeatedly ask you to honor your quote and you repeatedly lie about the quote. How would I know all these details if I did not call? This is just a shame in the way you treat your members. I have not exhausted all my requests to remedy this matter because I was given the opportunity to appeal the August 28. 2015 decision which I sent a certified letter to the department, so that would be yet another questionable statement by Kaiser. Thank you Kaiser for taking care of your patients with such care.

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

August 31, 2016
 
                         
[redacted]
Revdex.com Serving Denver/Boulder
[redacted]
[redacted]...

[redacted]
 
 
Complaint Case #               [redacted]
Consumer:                            [redacted] [redacted]
Case Opened:                      8/17/2016
 
 
Dear Mr[redacted],
 
This is in response to your email received on August 18, 2016 forwarding concerns on behalf of our member; [redacted] [redacted] regarding her request to have a refund for $1200.00 for premium payment that was deducted from her 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 [redacted] grievance with the appropriate leadership.
 
Research indicates the correct refund amount based on premiums due verses premiums paid is ($777.70). A request was processed and the member should have her the fund returned to her in 72 hours based on her financial institutions posting policies. Please note the members’ 2016 policy currently has a correct balance due of $258.60.
 
If the Revdex.com or the member has any questions, please contact me at [redacted].
 
Also, you may contact Member Services:
 
Denver/Boulder members may call [redacted], toll free at [redacted], between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted]. 
 
Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted].  You may also contact our department through our Web site at [redacted].
 
Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
 
 
Sincerely,
 
[redacted]
Complex Case Resolution Specialist
Member Experience