Owens Originals, Inc.

Complaint: [redacted]
I am rejecting this response because: THIS WAS THE 2ND TIME I WAS TOLD I WOULD RECEIVE MY REFUND IN 72 HOURS, 1ST TIME I WAITED THREE WEEKS UNTIL I SENT IN ANOTHER COMPLAINT, THIS TIME IT SHOULD HAVE BEEN HERE BY TUES SEPT 13TH AT THEE LASTEST BUT I DID NOT RECEIVE UNTILL THURS SEPT 15TH.KAISER HAS NEVER DONE WHAT THEY SAY THEY WILL DO. I HAVE BEEN DEALING WITH THIS SINCE MARCH!! ME SENDING MY PAYMENT THEM SENDING IT BACK DUETO 2 ACCOUNTS NONE OF WHICH WAS MY FAULT, HAVING TO CALL EVERY MONTH SPENDING HOURS YES HOURS ON THE PHONE ON HOLD WHILE THEY ARE WORKINGON IT AND THEM TELLING ME YA I THINK WE GOT IT AND WE WILL CALL YOU BACK  TOMMOROW WHEN WE KNOW FOR SURE AND NEVER RECEIVING A CALL BACK,NEVER EVER DID THEY CALL BACK MONTH AFTER MONTH. REMEMBER NONE OF THIS WAS CAUSED BY ME! BUT I PAID THE PRICE. ONE TIME YOU PULLED OUT$1294.80 OUT OF MY CHECKING ACCOUNT ON JULY 12 TH WITHOUT TELLING ME WHEN I WAS PAID IN FULL!!! COME ON REALLY! I HAD TO SCRAMBLE TO COME UPWITH MONEY TO COVER THIS MONEY SO I DIDNT BOUNCE CHECKS, REMEMBER I DIDNT GET THIS MONEY BACK UNTIL 9/15/16. AGAIN NONE OF THIS WAS MY FAULT!! I SHOULD AT THE VERY LEAST GET ONE MONTH OF MY PREMIUM  FREE FOR ALL THIS COMPANY HAS PUT ME THROUGH. PLEASE RESPOND WITH AN ANSWER FOR THIS COMPCATION I DONT FEEL I AM ASKING TO MUCH!!  COVER THIS THEN IT TOOK UNTIL 
Sincerely,
[redacted]

June 22, 2016
 
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
 
 
 
Complaint Case #               ...

[redacted]
Consumer:                             [redacted], [redacted]  
Case Opened:                       June 14, 2016
 
 
Dear Ms. [redacted],
 
This is in response to your email received on June 16, 2016, forwarding concerns on behalf of our member, [redacted], regarding termination of her healthcare plan purchased through Connect for Health Colorado (C4).  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.
 
Mrs. [redacted] explained that their policy was cancelled due to non-payment, due to confusion as to when the monthly premium was due. She is disappointed with C4’s unwillingness to work with them, and is requesting that Kaiser Permanente (KP) consider allowing for coverage to continue once the account is paid to be current.
 
We have formally documented and shared Mrs. [redacted]’s concerns with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership, to include the Department Manager. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused to her and her family by this overall matter.
 
I additionally forwarded Mrs. [redacted]’s reinstatement request to our Member Issues Resolution Team (MIRT), as they specifically address On-Exchange issues. On June 21, 2016, the MIRT Business Analyst submitted for reinstatement consideration. I regret to inform that the Membership Administration responded that they will not honor the Mrs. [redacted]’s request, and they provided the following explanation:
 
The Non-compliant verbiage only applies to members who have dunning notices or past due letters. This is a new enrollment, and there is no indication that the member attempted to make a payment. All KP notices are compliant and the member was termed correctly. The member is paid until Apr 2016, and proper notifications were issued before plan termination on 6/7/2016 (grace period is 30 days). We can reconsider the request, if proof of payment after 4/28/16 can be provided. Thank you.
 
Please ask Mrs. [redacted] to review the Membership Administration response and contact me directly, if she has any related questions. Again, please express my sincere apologies for her consequential frustration, as I realize that this is not the resolution she was seeking.
 
The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to our members.  Grievances expressed by our members do not affect their coverage in any way.  If the above noted member is dissatisfied with the resolution, they have the right to request a second review.  Please have them put the request in writing to:
 
Kaiser Permanente
Member Services
[redacted]
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-[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.
 
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 18, 2016[redacted]Dispute Resolution SpecialistDenver/Boulder Revdex.com[redacted]Complaint Case # [redacted]Consumer: [redacted]Case Opened: October 5, 2016Dear [redacted],This is in response to your email received on October 5, 2016, forwarding concerns on...

behalf of our member, [redacted], regarding a request for refund of health plan premiums paid after the Kaiser Permanente health plan coverage terminated. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.[redacted] explained that his last day of Kaiser Permanente health plan coverage was July 31, 2016. Although he was informed that the August premium would not be deducted through auto-payment, $407.83 was deducted. [redacted] states he has called multiple times requesting the refund. Each time an inquiry was made, different explanations were provided as to the time frame of when the refund could be expected.We have formally documented and shared [redacted]’s concerns with the appropriate leadership of our Member Issue Resolution Team (MIRT), to include the Vice President. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration and hardship that may have been caused by this overall matter.I additionally forwarded [redacted]’s refund request to MIRT, as they specifically address issues related to health plans purchased through Connect for Health Colorado. On October 17, 2016, the MIRT Business Analyst was able to confirm the total refund due of $407.83. The refund is in process and is estimated to be issued in the next one to three business days. I will continue to monitor [redacted]’s account to ensure the refund is issued.Please ask [redacted] to review the response and contact me directly if he has any related questions. Again, please express my sincere apologies for the conflicting information when contacting Kaiser Permanente and hardship [redacted] endured.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]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 SpecialistCustomer Experience

May 17, 2016
*
[redacted]
Trade Practice 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 May 12, 2016,
forwarding the rebuttal to our original response, on behalf of our member, [redacted]. The member is requesting
to have his On-Exchange issues resolved.
We value the
opportunity to review and respond to their grievance and apologize for the
member’s dissatisfaction.
Our Member Issues Resolution Team (MIRT) has advised that
Mr. [redacted] billing history was updated on May 16, 2016. The member is now
billed correctly from 12/1/2015 to current (6/1/2016) and shows a correct net due
amount of $386.61 (June); account is paid through 5/31/2015.
If the premium payments are still not being deducted from
the member’s credit card, please ask him to verify the information entered for
the automatic withdrawal. The payment system is not a feature that we will be
able to adjust/change on his behalf. Should Mr. [redacted] have any further
questions relating to his account, please advise him that I’d be happy to
assist.
The member’s
feedback is essential to our commitment of continuous improvement in delivering
the highest quality, most appropriate and compassionate care.  Our goal is to deliver excellent service to
our members.  Grievances
expressed by our members do not affect their coverage in any way. If the above noted member is dissatisfied with
the resolution, they have the right to request a second review.  Please have them put the request in writing
to:
Kaiser Permanente
Member Services
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

July 10, 2017
                         ...


                         
[redacted]      
[redacted]
[redacted]
[redacted]
                                  
 
Complaint Case #              [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      07/06/2017
 
Dear [redacted],
 
This is in response to your email received on July 6, 2017 forwarding
concerns on behalf of member; [redacted] regarding his
request for Kaiser Permanente to reinstate 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. Peelgrane grievance
with the appropriate leadership.
 
Based on review Membership Management has
approved reinstatement. Member's health plan was reinstated with no gaps in
coverage. A reinstatement bill and EFT form were sent to the address on file.
Member must pay $1216.24 before August 10, 2017.
 
 
 
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 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]

October
2, 2017
 
                         
[redacted]
[redacted]
[redacted]...

[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                         [redacted]
Case Opened:                     09/18/2017
 
Dear Mr. [redacted],
 
This is in response to your email received on September 18,
2017 forwarding concerns on behalf of [redacted] regarding charges $2040.92
billed to [redacted] for emergency he treatment received on June 18, 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 [redacted]’s grievance
with the appropriate leadership.
 
Research indicates the claims received from [redacted]
Medical Center, and Carepoint Emergency Medicine was appropriately denied for
service date June 18, 2017.
 
Mr.
Jensen, was seen and treated on June 18, 2017, at [redacted] Medical Center,
Emergency Department.  The claims received
for the services were appropriately denied because [redacted]’s coverage with Kaiser
Permanente, terminated May 31, 2017. Feedback received from the Policy
& Contract Administration Department, confirms that there is no coverage
available to the member past their disenrollment date.  [redacted]’s new coverage would be
responsible for the ER visit and they would need to give authorization for any
follow up visits he would want/need with a Kaiser Permanent’s Colorado Physician
Medical Group physician.
 
In addition, emergency room services would not fall under
the scope of a post-operative visit.  Kaiser
Permanente cannot honor [redacted]’s request to cover service date June 18,
2017. [redacted] will need to supply the treating providers with his new
carrier information.
 
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]

February 23, 2016
[redacted]
Trade Practice Specialist
Denver/Boulder Revdex.com
P.O. Box 48179
Denver, Colorado 80204
Complaint Case #              ...

11129150
Consumer:                            [redacted]
Case Opened:                      February
9, 2016
[redacted]
This is in response to your email received on February 10,
2016, forwarding concerns on behalf of our member, [redacted], regarding
the termination of his paid 2016 Kaiser Permanente (KP) healthcare plan
purchased through Connect for Health Colorado (C4). We value the opportunity to review and respond to this 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 team, to include the overseeing manager. I am very sorry for any
frustration that has been caused to Mr. [redacted] by this overall matter, as well
as for the time awaited for the enrollment issue to be resolved.
C4, KP, and HPS (our third party billing vendor), all 3
communicate member problems with their accounts by way of a posted case and
review of the added notes by a representative of each party. For KP, the Member
Issues Resolution Team (MIRT), is the case owner, and the Case Resolution Team
(CRT) acts as the liaison between our members and MIRT to provide members with
relevant information and case updates. I realize that the timeliness of
resolving issues that pertain to healthcare plans purchased through C4, have
NOT been ideal. For this, I am sincerely apologetic, as I understand the
urgency of needing to settle issues affecting an individual’s healthcare
insurance. 
MIRT has unfortunately been greatly affected in its ability
to resolve these cases quickly for 2 reasons. They are dealing around the clock
with more cases than ever planned for or expected; new MIRT representatives
continue to join the team in an attempt to resolve cases. Secondly, they must
(via the posted case) outreach C4 to confirm any eligibility/benefit
discrepancies, as KP is not able to change any information for plans purchased
through C4 until advised to do so by them. Any monies issues are then
communicated through HPS, as they are responsible for correctly updating the
billing system. Though MIRT is able to ensure that KP’s system reflects
eligibility, once confirming the information with C4, they are unable to
personally change monetary figures. None of this is an excuse for Mr. [redacted] being
inconvenienced by our processes, but rather an explanation as to provide a
clearer picture of the situation. Upper management is very aware of the
excessive amount of problems that KP is currently attempting to assist members
with, and will hopefully come up with an effective resolution, so that our
members do not have to worry about persistent account discrepancies.
MIRT reviewed Mr. [redacted] 2015 and 2016 account and
provided the following summarized audit:
Premiums due:
August – December 2015: $712.42 x 5 = $1,451.88 + CO
Assessment Fee October – December $3.75, TOTAL is $1,455.63
January – March 2016: $483.96 x 3 = $3,562.10 + CO
Assessment Fee January – March $5.40, TOTAL is $3,567.50
TOTAL due for 2015
& 2016: $5,023.13 (after below listed adjustments are made)
TOTAL paid by member
for 2015 & 2016: $4,439.97 (after below listed adjustments are made)
Balance due: $583.16
Next necessary steps include:
Change
2015 effective date from 9/1/2015 to 8/1/2015, as systems do not match.Balance
forward a payment that did not transfer from previous billing vendor (Conexis)
to current billing vendor (HPS).Reinstate member for 2016 plan immediately
*CASE HAS BEEN SUBMITTED AS URGENT*
I ask that Mr. [redacted]
contact me directly for the case updates as often as he would like, until
ultimately and satisfactorily resolved. Again, my apologies for the frustration
and inconvenience caused to our member, and I am diligently following up with
checking the status of this case daily.
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: 11138497
I am rejecting this response because:Once my premium billing discrepancy is resolved, I will consider the matter closed. Please reference letter dated March 7, 2016. Also, [redacted] birthdate is JUNE 9, 2015. It is not spelled [redacted], and he wasnt born on June 8 2015 (last letter) or September 9, 2016 (this letter). Thanks, 
Sincerely,
[redacted]

Initial Business Response /* (1000, 6, 2015/11/19) */

November 19, 2015
[redacted]
Trade Practices & Helpline Specialist
Denver/Boulder Revdex.com
P.O. Box XXXXX
Denver, Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: [redacted], [redacted]
Case Opened: November 4,...

2015
Dear Ms. [redacted]
This is in response to your email received on November 4, 2015, forwarding concerns on behalf of our member, [redacted], regarding an awaited healthcare premium refund. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.
The member case scenario has been forwarded to our Consolidated Service Center/KPIF Department that assists with issues pertaining to plans purchased through Connect for Health Colorado. The details were thoroughly researched, as to confirm the refund amount due back to Mr. [redacted].
The payment premium calculation confirms that the member is due a refund of $768.39, once the correct termination date is reflected of April 30, 2015. Kaiser Permanente (KP) has submitted to the Connect for Health Colorado vendor that the December 31, 2015 end date be appropriately changed. Once the termination date is corrected, the requested refund will process. Unfortunately, KP is not able to provide a date as to when this will be complete, though I welcome the member to contact me directly for progress updates.
Please apologize to the member for any consequential inconvenience and frustration experienced. Should any related issues or concerns arise pertaining to Mr. [redacted]'s plan, I'd be happy to personally assist, as to avoid continued inconsistent information being provided.
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate [redacted] 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] Street
Aurora, [redacted] 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 /* (3000, 8, 2015/11/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
There is still no resolution in sight. I have been given this answer for months...they admit they owe a refund but give every excuse out there as to why they can't send me a refund. They have been holding onto almost 800 dollars, of my money, for 6 months. Its not theirs and they need to issue the refund check immediately or my next step is to hire an attorney. I've contacted connect for health Colorado on multiple occasions and they have confirmed that they have sent the correct termination date to kaiser months ago.
Final Business Response /* (4000, 10, 2015/12/04) */
December 4, 2015
[redacted]
Dispute Resolution & Helpline Specialist
Denver/Boulder Revdex.com
[redacted] Box XXXXX
[redacted] Colorado XXXXX
Complaint Case # XXXXXXXX
Consumer: [redacted], [redacted]
Case Opened: November 18, 2015
Dear Ms. [redacted]
This is in response to your email received on November 18, 2015, forwarding the rebuttal to our original, on behalf of our member [redacted]. The member is requesting a more immediate refund of premiums be received.
On December 4, 2015, the Member Issues Resolution Team (MIRT) advised that the Mr. [redacted]'s expected refund will go out early next week. There was a delay with the Kaiser Permanente Finance Department, due to a new procedure being implemented to handle the influx of recent refund requests. Please apologize to the member for the inconvenience experienced, and he is welcome to contact me with any further questions or concerns relating to this matter.
The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate [redacted] 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] South [redacted] Street
[redacted] 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

February 21,
2017
 
[redacted]
 
Complaint
Case #              ...

[redacted]
Consumer:                            [redacted]  
Case Opened:                      February 20, 201
 
Dear Ms. [redacted],
 
This is in
response to your email received on February 21, 2017, forwarding concerns on
behalf of our previous member, [redacted], regarding a disputed 2013 claim.
We value the opportunity to review and respond to their grievance and apologize
for the member’s dissatisfaction.
 
Ms. [redacted]
states that she is being billed for her December 13, 2013 through December 21,
2013 hospital stay, which had already been preauthorized and claims paid. Ms.
[redacted] is requesting that Kaiser Permanente (KP) pay the claims per her health
benefits at the time of service.
 
Ms. [redacted]’s
concerns have been appropriately documented and shared with the Claims Department
leadership, to include the Sr. Manager. Please apologize to the member, on
behalf of Kaiser Permanente (KP), for any frustration that may have been caused
by this overall matter.
 
We were able to
confirm that the disputed claim ([redacted]) was submitted to KP on
December 31, 2013 and paid correctly, per the health insurance we had on file.
Ms. [redacted]’s coordination of benefits was changed in our system on August 24,
2016, reflecting that [redacted] was her primary insurance during the
disputed December 13, 2013 date of service; payment from KP as the primary
insurance carrier was rescinded, as KP was the secondary insurance and the
$48.786.18 was the Allowed/Total Not Covered amount. The provider billed the
member’s primary insurance, and they denied the claim due to timely filing. The
member submitted the [redacted] denial to KP, which KP would not agree to
pay.
 
Ms. [redacted] was
responsible for providing the hospital/provider with her complete health
insurance information. She will need to contact the billing provider to prove
that she did in fact provide them with both her [redacted] primary
insurance and KP secondary insurance information needed for accurate billing
purposes – and within the time frame necessary (timely filing) for them to
appropriately bill [redacted].
 
I am sincerely
sorry that KP is unable to further assist Ms. [redacted] with this claims issue. She
will need to communicate with the billing provider to see how they would be
able to additionally assist her or the next step she needs to take with them in
this claim dispute.
 
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 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. 
 
[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 had a
choice for their healthcare, and we thank them for choosing Kaiser Permanente.
 
Sincerely,
 
[redacted]
Member
Experience




















 
 
 


 
Tell us why here...

Revdex.com:The address change was  submitted months prior on occasions.  At the time of notice from Collections, the employer was no longer allowed access to the site to change the address.A breakdown of the billing would have solved all before sending to collections.  The balance will be paid to Kaiser. 
I have reviewed the response made by the business in reference to complaint ID 11401135, and find that this resolution is satisfactory to me.
Sincerely,
[redacted]
*

September 29, 2016
 
                         
[redacted]
[redacted]
[redacted]
[redacted]...

[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:          [redacted]
Case Opened:        [redacted]
 
Dear [redacted],
 
This is in response to your email received on September 15, 2016 forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to pay the balance owed on his biopsy completed on February 24, 2016 at [redacted] 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.
 
The member states that if he had the procedure completed within the Kaiser Permanente network, his out of pocket costs would have been approximately $2,790.00. The member at the time of services was on a DHMO plan with a $500/Individual deducible and a 20% Coinsurance for Outpatient surgery at designated outpatient facilities (Subject to medical Deductible; Applies to Out-of-Pocket Maximum).
 
The review of the charges are as follows for [redacted]
Facility charges:    $3,186.20
             $474.15- Deducible
             $2,712.05- Co-insurance
Professional charges: $659.74
                                 $13.56 Deducible
                                 $646.18- Co-insurance
I have contacted [redacted] Patient Account Services and has confirmed the member currently has an outstanding balance of $2,686.20. The member has made a $500.00 payment.
 
 
 
 
 
The leadership as agreed to pay the difference between his charges for the outside provider and his quoted $2,790.00. I will issue a payment directly to [redacted] in the amount of $1,055.94. This is a onetime only good will gesture.
 
The member was advised on the referral letter that was mailed on February 22, 2016 the following information:
 
You are responsible for payment of the applicable copayment(s) or coinsurance. Please refer to your Evidence of Coverage, Plan Document or Federal Employees Health Benefits Program Brochure as it applies to you for how much you pay for services or contact Member Services.
 
 
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 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]

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 16, 2017
 
                         
[redacted]
[redacted]
[redacted]
[redacted]
 
 
Complaint Case #               [redacted]                                   ...⇄
Consumer:                            [redacted]
Case Opened:                      09/14/2016
 
Dear [redacted],
 
This is in response to your email received on August 8,2017 forwarding
concerns on behalf of our member; [redacted] regarding his
request for Kaiser Permanente to pay the balance owed on his biopsy completed
on February 24, 2016 at [redacted] We value the opportunity to review and respond
to their grievance and apologize for the member’s dissatisfaction.
 
Research confirms a check in the amount of $1,055.94 was
issued to the provider ([redacted]) on October 12,2016. The check cleared our bank on
October 18,2016. The check number is [redacted]. The check was mailed to: [redacted] 
 
I have requested a copy of the front and back of the check
and will provide it to [redacted] for the provider to research and apply the payment
to the members account.
 
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 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]

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 will submit the requested written account to the address KP provided.
Sincerely,
[redacted]

Complaint: 11155486
I am rejecting this response because:I have not received the refund yet. 
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I appreciate the timely response from Kaiser Permanente and am not surprised with the lack of resolution.  I would like to make clear that we have been with Kaiser Permanente for several years and am only a new member because your organization mandated it.  We had our coverage dropped when Obama Care became active and were told we had to get coverage through Connect for Colorado.  Kaiser Permanente would not honor our current coverage and would not let us go through them to get a plan.  Going through Connect for Colorado started our account which made us a new member.  We changed our plan last year through Connect for Colorado which again started a new plan.  The first year of billing with Obama Care was a complete mess but we were patient.  However with the beginning of the new year, Kaiser Permanente changed their billing practices in which you had to pay a month ahead as opposed to having the payment by the last of the month.  Again I am aware I was a little late on the payment but a letter 30 days prior with no subsequent reminder, the payment got overlooked.  I was trying to make the account current with a payment but was told my family could not be reinstated, all this for a one late payment.  My family is now unable to get health care coverage until open enrollment for Obama Care in November.  I am extremely disappointed by how this situation is being handled and wanted to make clear that we are not new members, we have been members for many years.
Sincerely,
[redacted]