Owens Originals, Inc.

Initial Business Response /* (1000, 6, 2015/12/02) */
December 2, 2015
[redacted]
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXX
Consumer: [redacted]
Case Opened: November 25,...

2015
Dear Ms. [redacted]
This is in response to your email received on November 26, 2015, forwarding concerns on behalf of our member, [redacted], regarding a disputed December 26, 2015 service charge. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
I confirmed that Ms. [redacted]'s concerns were appropriately documented and shared with Lone Tree Medical Office Obstetrics and Gynecology Department leadership. The member's initial complaint was filed on September 24, 2015, and the notification included the department Chief.
Please apologize to Ms. [redacted] for any miscommunication that may have occurred with the provider at her visit, and ultimately, resulted in a charge for a test that was not related to her clinical care needed. Though the disputed charge was appropriately billed in accordance with the member's Evidence of Coverage, Kaiser Permanente has removed the outstanding balance. As of today, the member's account has a $0 balance. Should there be any additional questions, please do not hesitate 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 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] M. [redacted]
Complex Case Resolution Specialist
Member Experience
Initial Consumer Rebuttal /* (2000, 8, 2015/12/11) */
(The consumer indicated he/she ACCEPTED the response from the business.)

December 13, 2016[redacted]Complaint Case #           [redacted]Consumer: [redacted]   Case Opened: December 9, 2016 Dear [redacted],This is in response to your...

email received on December 9, 2016, forwarding concerns on behalf of our member, [redacted], regarding his daughter’s referral to a specialist.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Although [redacted] has signed paperwork allowing communication with Mr. Owens, the Case Resolution Department must receive an Appointment of Representative.  The member and the appointed representative must both sign an Appointment of Representative form or submit equivalent documentation, before we can proceed with this request.  The Appointment of Representative form has been sent to Mr. Owens to complete at his earliest convenience.  If we do not receive the Appointment of Representative form or equivalent documentation within 30 days, we will close this request.  Once we receive the Appointment of Representative form or equivalent documentation, we will start processing the request within the timeframe set out by federal regulations. 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 SpecialistCustomer Experience

May 10, 2016
*
[redacted]
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               ...

11417689
Consumer:                             [redacted]
Case Opened:                       April
27, 2016
Dear Ms. [redacted],
This is in response to your email received on April 29,
2016, forwarding concerns on behalf of our member [redacted] and current
premium payment account 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 Mr. [redacted]
concerns with the appropriate Consolidated Service Center/On-Exchange Issues
Department leadership. The case has been assigned to the Member Issues
Resolution Team (MIRT), whom I have been communicating with directly.
Mr. [redacted] is confirmed in Kaiser Permanente’s (KP) system
to have health plan coverage from December 1, 2015 through current. MIRT is
working with our third party vendor (HPS) to ensure that all of the information
reflected in the HPS billing system (SLP) is accurate and the same as KP’s
system. I am sincerely sorry for any frustration and inconvenience that may
have been caused to Mr. [redacted] by this overall matter. I ask that he please
allow MIRT and HPS some time to follow through accordingly. Please encourage
Mr. [redacted] to contact me directly for progress updates, as well as to discuss
any additionally related issues that might 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
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

January 31,
2017
[redacted] [redacted]
Member ID
Number: [redacted] [redacted]
Dear Mr.
[redacted],
Kaiser
Permanente’s Customer Experience Department received your submission to the
Revdex.com on...

January 10, 2017. 
Based on the concerns expressed in your submission, a second review of
your previously filed complaint has been completed. 
I am very
sorry that you have had a frustrating experience with us.  We take your dissatisfaction very seriously
and appreciate being able to review and respond to your concerns. I have reviewed the initial grievance filed
with the Member Services Contact Center on July 28, 2016.  I have confirmed your grievance was
appropriately documented and shared with the appropriate managers and physician
leaders of our program.
On January 20,
2017, Kaiser Permanente’s Membership Administration Department confirmed that Kaiser
Permanente’s membership system has been corrected; [redacted]’s coverage now
reflects active from December 4, 2015. 
An audit of
claims for services [redacted] received in 2015 has also been completed.  Kaiser Permanente’s Claims Department
determined a Health Insurance Claim Form (HICF) was not received from the
provider for services provided to [redacted] by [redacted].  I contacted the provider
requesting this form, and Kaiser Permanente received a HICF on January 27, 2017,
reflecting the appropriate claim information for services provided to Bailed on
December 4, 5, and 6, 2015.  This form
was submitted to the Claims Department for processing.  I will continue to monitor processing and
notify you once completed. 
If you have
any questions or concerns regarding the final decision of this complaint, you
may contact me directly at [redacted].  In the event you have a new concern, please
contact the Member Services Department at [redacted]
or toll free at [redacted].  Deaf, hard of hearing, or speech impaired
people who use a TTY may call [redacted].
Sincerely,
[redacted]
Kaiser
Foundation Health Plan of Colorado

July 27, 2016[redacted] Dispute Resolution Specialist [redacted]@denver.Revdex.com.orgPhone: [redacted]Complaint Case #                 [redacted]Consumer:                             [redacted]
[redacted]Case Opened:                       June
14, 2016Dear Ms. [redacted],This
is in response to your email received on June 28, 2016, forwarding concerns on
behalf of our member; [redacted]. The member noted above expressed their continued concerns
regarding the cancellation of her health plan. 
Therefore, our member has
requested a second review of their initial grievance and that we reconsider
allowing Ms. [redacted] to reinstate health plan coverage.I regret our member’s continued dissatisfaction, but I value the opportunity you have given me
to review and respond to their continued concerns. Reviews
of our member’s grievance and the management of out member’s initial concerns
expressed to our Member Services liaison team have been completed. As follow up to our member’s concerns, I have confirmed that
our Member Services liaisons have formally documented our member’s grievance
appropriately and shared it with the appropriate managers and physician leaders
of our program. Furthermore, I am unable to honor the request for
reinstatement.  I have reviewed Ms.
[redacted]’s Evidence of Coverage regarding premium payments.  The contract provides the following
information regarding dues and grace periods: Payment of DuesDues must be paid and received in advance. You must then pay
the correct amount before the beginning of a month to have coverage for that
month. If you do not pay in time, we will send you a notice that you are in
default. You then have a grace period in which to pay your Dues without loss of
membership. If you do not pay within the grace period, we will terminate your
membership. OnlyMembers for whom we have received the correct amount are
entitled to benefits under this Membership Agreement.Grace PeriodsIf we are not receiving an advance payment of premium tax
credit on your behalf, we will provide a 31-day grace period for payment of any
Dues other than the first month’s Dues. We will send written notice stating
when the grace period begins. If we do not receive your Dues by the end of the
grace period, we will terminate your membership so that it ends at 11:59 pm on
the last day of the grace period. We or providers may bill you as a non-Member
for any Services you received after your last day of membership.Again, I thank the Revdex.com and our member for the time you both
took to share these continued concerns, since
member 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 Revdex.com or our member has any questions, please contact
Member Services: Denver/Boulder members may call [redacted], toll free at 1-800-[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 1-888-[redacted] or deaf, hard of hearing or speech-impaired members
who use TTY may call 1-800-[redacted].  You may also contact our department through
our Web site at kaiserpermanente.org.We thank the Revdex.com and the
member for given Kaiser Permanente another opportunity to research this matter. Sincerely, [redacted]Kaiser PermanenteComplex Case Resolution SpecialistCustomer Experience

November 8, 2016[redacted]Dispute Resolution SpecialistDenver/Boulder Revdex.comP.O. Box 48179Denver, Colorado 80204Complaint Case # [redacted]Consumer:  [redacted]  Case Opened: October 18, 2016Dear [redacted]This is in response to your email received on November 7, 2016, forwarding the rebuttal to our original response provided on November 1, 2016, on behalf of our member, [redacted]. The member is advising that the services in question were not completed, and therefore she should not have to pay. We value the opportunity to review and respond to the grievance. We also apologize for the member’s dissatisfaction.I’ve confirmed the procedure was completed and was appropriately billed.  A one-time gesture will be offered to remove the charge of $15.60 off the account, as mentioned in the initial response.  [redacted] and I had the opportunity to speak this afternoon about the procedure and subsequent bills she received.  Should [redacted] have further questions regarding her concerns, she is welcome to call me at 303-338-3757.  The member’s communication is appreciated, as it allows us to try to remedy this entire situation. Please 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 PermanenteMember Services [redacted]
[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 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 SpecialistCustomer Experience

Complaint: [redacted]
I am rejecting this response because it says Kaiser will be issuing a refund within 1-3 business days without any further detail. This does not include when we will be receiving the refund or how we will be receiving the refund (bank transfer? overnight delivery? first class mail?). Is there any type of tracking information to ensure receipt? Since we have already been waiting several months, this does not solve the issue of confirming that a refund has been issued and no sense of urgency in getting the refund back to us. Additionally, when we spoke to someone over the phone earlier this month, they advised that the refund was already issued and will take 4-6 weeks to receive in the mail.  When the business then states that a refund will be issued within 1-3 business days, this is another example of giving me different information each time we try to resolve this matter. Was the previously given statement by the business misinformation? Is this a different check that will be issued more urgently?  I'm more confused and still don't have the refund due to us. 
Sincerely,
[redacted]

September 28, 2016
 
                         
[redacted]
Revdex.com Serving Denver/Boulder
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      [redacted]
 
Dear [redacted]
 
This is in response to your email received on September 26,
2016 forwarding concerns on behalf of our member; [redacted] regarding
charges billed to the member for date of service April 19, 2016. We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
We have formally documented and shared [redacted] grievance
with the appropriate leadership.
 
Research indicates a $20 copayment was appropriately applied
to service date April 19, 2016.
 
The member was schedule for an office visit on December 29,
2015 at the Westminster Medical Office, Primary Care Department.  The visit was scheduled for symptoms of a
sinus infection with 20 minutes alloted for the visit.  The member was appropriately billed a $20
office visit copayment per her employer group Health Maintenance Organization (HMO)
health plan. The member was seen at treated on April 19, 2016 for a different
issue and charged appropriately.
 
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

August 16, 2017
                         ...


                         
[redacted]      
[redacted]
[redacted]
[redacted]
                                  
 
Complaint Case #              [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      08/10/2017
 
Dear [redacted],
 
This is in response to your email received on August 8, 2017
forwarding concerns on behalf of; [redacted] regarding her
request for Kaiser Permanente to provider her father’s medical records. We value the opportunity to review and respond
to their grievance and apologize for the member’s daughters dissatisfaction.
 
We have formally documented and shared [redacted] grievance
with the appropriate leadership.
 
Based on review, the daughter, [redacted], has
been contacted directly from our Health Information Services release of
information department on several occasions. Each time it has been explained
that the “Collection of Personal Property by Affidavit” will not suffice for
obtaining her father’s medical records.  [redacted] is on the death
certificate as Informant for her mother; however, we have nothing allowing us
to release records for the father.  She has been instructed to go to the
courts and be appointed his personal representative in order to be able to obtain
her father’s medical records. 
 
Kaiser Permanente is unable to release information
without the appropriate required documents.
 
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]

April 2, 2016
[redacted]
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #               11238060
Consumer:                            [redacted] 
Case Opened:                      March
16, 2016
Dear Ms. [redacted],
This is in response to your email received on April 1, 2016,
forwarding the rebuttal to our original response provided on April 1, 2016, on behalf of our member, [redacted]. The member is seeking an immediate
decision from Kaiser Permanente (KP), as to whether his 2016 healthcare plan
reinstatement request will be honored.
We value the opportunity
to review and respond to their grievance and apologize for the member’s
dissatisfaction.
The KP Membership Administration has now been able to review
the retrieved call recording, between the member and KP representative
assisting with the initial 2016 enrollment. The emailed response received from
the Membership Administration Team Lead is as follows:
RE: [redacted]
This request was further reviewed by upper management, and I am
pleased to inform you it was approved. Prospect will have the option to choose:
Open Enrollment, which will
give an effective date of 3/1/16. Requirements: a new completed/ signed
application and binder payment through current month (April)Special Enrollment Period,
with an effective date of 2/1/16: Requirements: a new completed/ signed
application and binder payment through current month (April)Please review with prospect
which options he prefers.   Once a
response is received, we will email you an application and provide you a secure
fax # where the application can be faxed. I have contacted the
member’s wife, [redacted], and communicated this information, and I will be further
assisting the family with the enrollment process. Please thank Mr. and Mrs.
[redacted] for their patience with KP, while we were reviewing/considering the
reinstatement of Louie and his dependents. I am also sincerely sorry for any errors
or misunderstandings that may have been caused this inconvenience 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:Kaiser PermanenteMember Services 2500 South Havana
StreetAurora,
Colorado  80014Written 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

February 18, 2016
[redacted]
Dispute Resolution/Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #              ...

11118025
Consumer:                            [redacted]
Case Opened:                      February
2, 2016
Dear Ms. [redacted],
This is in response to your email received on February 3,
2016, forwarding concerns on behalf of, [redacted], regarding an awaited
refund of premium overpayment in 2015. We
value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
Appropriate Consolidated Service Center/On-Exchange Issues
Department leadership, to include the Manager, has been notified of Ms.
[redacted] continued issue in not receiving her requested refund. Please
apologize to Ms. [redacted] for the inconvenience caused and lack of resolution timeliness.
On February 3, 2016, I reviewed the account and opened a
case with our Member Issues Resolution Team (MIRT). MIRT specifically handles
issues relating to plans purchased through Connect for Health Colorado (C4). MIRT
communicates accordingly with C4 and our third party billing vendor, SLP, in an
attempt to solve member experienced problems. In this scenario, MIRT submitted
the refund to SLP on the same date that the case was opened. Up until today,
there was not an update provided as to where the refund stands in the entire
refund process. Just today, MIRT was able to confirm the following information:
-MIRT had initially requested a $652.98 refund from C4,
which was denied on 11/14/2015 (C4 needed more information).
-Per my outreach, MIRT again verified the refund amount due
and submitted the request to C4.
-The refund was approved, and a $652.98 check is now in line
to be issued and   mailed to the member
I realize that it is quite frustrating for the member to
have to wait so long for monies to be returned to her. Unfortunately, more
issues with On-Exchange purchased plans have presented than ever expected or planned
for. This is absolutely not the problem of Ms. [redacted], nor should it affect
her as it has. KP, C4, and SLP management continues to work through the
trending issues, as well as with bettering their communication process, which
is currently slowing down the reaching of satisfactory resolution for our
members.
Please assure the member that her refund has been submitted
and approved. I am also able to personally assist with reaching out for
updates, should she like to contact me directly. Please thank Ms. [redacted] for
her appreciated patience, and I will be following through with this case until
her refund is received.
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

May 11, 2017
 
 
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
 
 
 
Complaint Case #               [redacted]
Consumer:                            [redacted],
[redacted]  
Case Opened:                      April
17, 2017
 
 
Dear Mr. [redacted],
 
This is in response to your email received on May 4, 2017,
forwarding the rebuttal to our original response provided on April 24, 2017, on behalf of, [redacted]. The
member replied stating that he does not accept Kaiser Permanente’s previous
response advising that his requested refund was not honored. Mr. [redacted]
continues to ask that KP refund the premium paid, as one representative
informed that he had 60 days to submit the required documentation reflecting
proof of another health insurance.
 
We value the
opportunity to review and respond to the grievance. We also apologize for the
member’s dissatisfaction.
 
I submitted the details of the 2nd review request
to our Membership Administration Department asking for reconsideration of the
decision made to not refund the premium payment Mr. [redacted] had paid prior to
canceling the plan. After additional review, the requested refund has been
honored. The 2016 plan now reflects in our membership system as cancelled/never
active. Please advise Mr. [redacted] to allow up to 2 weeks for the expedited
refund check in the amount of $1,114.23 to be processed, mailed, and received.
 
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]
[redacted]
[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 kaiserpermanente.org.
 
Please thank
our member for his patience while resolving this matter. I’d also be happy to
assist Mr. [redacted], should he have any additionally related question/concerns.
 
 
 
Sincerely,
 
[redacted]
[redacted]
[redacted]

January 29, 2018 [redacted]Revdex.com Serving Denver/Boulder 3801 E. Florida Ave., Ste.350 Denver, Colorado 80210Complaint Case #     [redacted] Consumer: [redacted]Case Opened: 1/19/2018Dear Mr. [redacted],This is in response to your email received on January 24, 2018, forwarding continued concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted], or [redacted] in Aurora, Colorado. 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] grievance with the appropriate leadership. Our Provider Relations Department has confirmed that there are two contracted physicians in the Southern Colorado region that are both Hepatology Specialist and treat PSC.  In addition, Children's Hospital will not start treatment for patients Mr. [redacted] age and would refer to adult hepatology.Mr. [redacted] rebuttal received on January 24, 2018 was submitted and accepted with Kaiser Permanente’s Member Appeals Department. On January 25, 2018, the Member Appeals Department sent Mr. [redacted] a written request for copies of his medicals records. An Authorization to Release Medical Records form was attached and must be completed and signed in order for us to obtain those records. The authorization form must be signed and dated by Mr. [redacted] or his authorized representative.  With this request Mr. [redacted]’s was also provided with his Member Appeals Analyst contact information for questions as it relates to his appeal.  Mr. [redacted]’s will receive separate correspondence with the decision of his appeal which will include the next steps if the decision is not in his favor. If the Revdex.com or the member has any questions, please contact me at (303) 338-3827.Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, 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 303-338-3820.  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,Suda P[redacted]Complex Case Resolution SpecialistMember Experience

January 23, 2018                           [redacted]Revdex.com Serving Denver/Boulder 3801 E. Florida Ave., Ste.350 Denver, Colorado...

80210  Complaint Case #[redacted]                                  �...⇄ Consumer:           [redacted]Case Opened:       1/19/2018 Dear Mr. [redacted], This is in response to your email received on January 19, 2018, forwarding concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted], or [redacted] in Aurora, Colorado. 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] grievance with the appropriate leadership.  Mr. [redacted] request for authorization to see a specialist at [redacted] in Aurora, Colorado for a second opinion was denied because services are available with a contracted Southern Colorado Kaiser Permanente provider. In addition, a new denial letter was generated on January 23, 2018 to reflect the correct diagnosis for this request. Mr. [redacted] appeal rights have been provided in the denial letter. Mr. [redacted] may appeal this decision in writing by sending his request to:Appeals ProgramKaiser PermanenteP.O. Box 378066Denver, CO 80237-8066Or you can fax the letter to:  1-866-466-4042  If the Revdex.com or the member has any questions, please contact me at (303) 338-3827. Also, you may contact Member Services:  Denver/Boulder members may call 303-338-3800, 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 303-338-3820.   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, Suda P[redacted]Complex Case Resolution SpecialistMember Experience

Complaint: 11238060
I am rejecting this response because: My wife and I have been patient from literally 12/16/15; following every step and advice given to us regarding my family and their coverage.  I did not want to accept the response by Kaiser and have this case closed as it is not resolved.  The response is what we have been receiving on all occasions 1/9/16, 1/27/16, 1/29/16, 2/1/16, 2/3/16 again on 2/15/16 and on this date we were given 30 days for resolution.  In notes by [redacted] on 2/15/16 was quoted "we need to get this turned around as this was no fault of your's Mrs. [redacted]".  [redacted] from California Rep for Kaiser took enrollment on 1/27/16 English was very broken heavy Spanish accent, clearly marked the wrong box when the same information had been given to her.  We were directed to enroll directly through Kaiser since the Exchange gave us no tax credit.  We followed advice and are in a worse situation.  My children are without Medical Coverage as I am too.  We don't feel that we need to wait even longer to get coverage.  Kaiser has taken so long that even our Certificates of Coverage are now VOID giving us a break in coverage WAY OVER 60 days from 12/31/15.  This has truly left our family in a detrimental position, causing a hardship emotionally and Financially especially if Kaiser rejects reinstatement.  My wife and I are losing sleep over this, we have never been without coverage in over 28 years.Kaiser on many occasions even reference conversation #S197665933 reassured by filing Grievance we would taken care within 30 days (3/24/16) if not sooner, now we have an even longer extension going into April.  My wife is prepared to pay full premiums dated back to 1/1/2016 to bring us current to meet premium requirements.  My kids need medications and visits, and the Believe Policy makes my family feel like we are in the wrong by the way of treatment rec'd in clinic.  I have a hernia I can't take care of and we have had kaiser for over 26 years.  Please help my family get coverage this is all we are asking, we applied within deadlines and gave payment via Credit Card, and the error was not ours.  We are not asking for extra money or anything just the coverage we applied for and by the advice of Kaiser Reps we got off the Exchange.  Now in worse position.The resolution is simple please reinstate prefer back to 1/1/16 if not as recommended by [redacted] in California 2/1/16.  We feel for some reason we are being discriminated against and our Health Coverage is being held hostage.  This wait is long enough and not good for our health at all costs.
Sincerely,
[redacted]

Dear [redacted], This is in response to your email received on August 7, 2016, forwarding the rebuttal to our original response provided on August 5, 2016, on behalf of our member, [redacted].  Ms [redacted] brought several points to our attention in her rejection of the response.  ·         Level of care provided by the primary care physician.  o   Tests were ordered that were unnecessary while her primary care physician was out of the office. o   Ms. [redacted] states it is her choice whether to complete tests ordered by physicians as no medical proof has been provided that the testing is needed. o   Concerns of billing the insurance company for medically unindicated testing have been brought up.  o   Ms. [redacted] is concerned with the director of the clinic reviewing her grievances when she has never seen the director of the clinic.  ·         Kaiser Permanente staff following dress code. ·         Concerned about responses from Kaiser Permanente when one person is to have been assigned to work with her.  ·         Wait times when calling the call center. ·         Quality of the mobile application. We value the opportunity to review and respond to the grievance. We also apologize for the member’s continued dissatisfaction. On August 8, 2016 I sent a letter to Ms. [redacted] stating I informed several members of her physician’s leadership team; Chief of Internal Medicine, Nursing Manager, and Medical Office Director of concerns related to her care.  The information provided to the leadership team addressed the issues of tests being ordered that were unnecessary.  Prior to this date Ms. [redacted] had expressed doubt about procedures recommended by her primary care physician.  At that time I communicated with the nurse manager who confirmed the testing was medically indicated.  The leadership team continues to discuss care needed by Ms. [redacted] and intend on partnering with her regarding her care.  Kaiser Permanente is not in the practice of billing insurance companies for unnecessary treatments.  The insurance company will not pay for services that are not medically necessary. Should Ms. [redacted] choose to select a new primary care physician, she may contact Kaiser Permanente Physician Selection Services at ###-###-#### to discuss selecting a different physician who is accepting new patients. The complaint Ms. [redacted] filed April 13, 2016 regarding a staff member’s attire and hair color was addressed with appropriate managers of the department.  Members are not notified of the outcome of any disciplinary action stemming from a complaint. I am the point of contact for Ms. [redacted]’s concerns.  My direct phone number is ###-###-####.  I have been in communication with Ms. [redacted] previously, both by phone and mailed correspondence.  New concerns that are submitted, whether by calling, emailing or through the Revdex.com are directed to me to address.  Ms. [redacted] is welcome to contact me directly at any time. Concerns of wait times at the call center will be addressed with the managers of the department.  Several avenues are available for communicating with Kaiser Permanente staff.  Use of kp.org is recommended for non-emergent, non-urgent questions and concerns – both for medical staff and member services.  In order to reach the physician specifically regarding care, Ms. [redacted] may call ###-###-####.  Again, I am available to assist Ms. [redacted] as well. Ms. [redacted]’s dissatisfaction with the mobile site has been communicated to the Manager of Digital Operations in June of this year. The member’s communication is appreciated, as it allows us to try to remedy this entire situation. 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 Member Experience

March 7, 2018                           ...

                          [redacted]      
[redacted]
[redacted]
[redacted]                                      Complaint Case #              [redacted]                                   ...⇄ Consumer:                            [redacted] Case Opened:                      02/20/2018   Dear Mr. [redacted],   This is in response to your email received on February 20,2018 forwarding concerns on behalf of member; [redacted] regarding his concern regarding Kaiser Permanente (KP) not providing the correct premium billing statements for his health plan. 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] grievance with the appropriate leadership.   Based on the review, Mr. [redacted]s account was on a Failed bill report the root cause for the member not being billed timely. The system has been addressed and to prevent further issues a new policy was created for the member to speed up the process to resolve the member's issue. I do see that the bill went through smoothly on the new policy for the month of March. I have confirmed that there are no past due letters. And the account has a net due of $0.00 and New policy [redacted]     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 [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

December 30, 2015
[redacted]
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case # 75272338
Consumer: [redacted]
Case Opened: December 18, 2015
Dear Ms. [redacted]
This is in response...

to your email received on December 21, 2015, forwarding concerns on behalf of our member, [redacted], regarding a disputed service bill received. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
We have formally documented and shared Mrs. [redacted] concerns with the appropriate leaders at the Patient Financial Services (PFS) Department, to include the PFS Supervisor. On behalf of Kaiser Permanent (KP), I am very sorry for any frustration and inconvenience that may have been caused to the member by this matter. I reached out, via telephone to the member, to further inquire about the disputed bill, as I was not able to locate the amount specified in her complaint. Feedback received from PFS confirms that the $2,327.56 bill was mailed in November and December 2015 to the member for services received from November 12, 2014 through November 15, 2014. The charges, however, were corrected on December 15, 2015, which is why I was not able to locate the amount. Apparently, there were issues with Connect for Health Colorado (C4), causing a discrepancy in the member's health plan coverage details. Therefore, the bills mailed were being processed as a non-member. The corrected plan information is showing to have been updated in our system on December 14, 2015, at which time the claims were filed for the first time to the insurance, and the charges consequentially corrected.
Should the member have any additional questions pertaining to services received within KP, please advise her to contact PFS at [redacted]). The Claims Department ([redacted]) will be able to assist with questions about services received outside of. KP.
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

Complaint: [redacted]
I am rejecting this response because:Yesterday, I was pleased to finally receive my refund check in the mail. Thank you for helping me with that. However, the same day I also received a bill from Kaiser. It seems that after writing my check, they immediately added that amount to my balance rather than subtracting it. I want Kaiser to zero out my balance and send me confirmation immediately that I owe them exactly $0. I would do this through your system except I can't figure out how to reopen my complaint. Attached is a copy of the bill I received. Thank you, [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. The aforementioned credit has been applied. Thank you for your assistance. 
Sincerely,
[redacted]