August 31, [redacted] Revdex.com Serving Denver/Boulder EFlorida Ave., Ste Denver, Colorado Complaint Case # [redacted] Consumer: [redacted] Case Opened: [redacted] Dear [redacted] , This is in response to your email received on August 24, forwarding concerns on behalf of our member; [redacted] regarding his request to have a refund for the premium payment that was made for his policy through Connect for Health ColoradoWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates a refund has been approved and sent to member for $on credit card ending XXXX- [redacted] on August 30, Please note that Kaiser Permanente is allowed to make changes to member accounts only as provided and documented by Connect for Health Colorado Kaiser Permanente cannot make any changes to a health plan purchased through Connect for Health Colorado without authorization from Connect for Health Colorado If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe 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: I am rejecting this response because:Most of the serious issues for my original complaint still existI will not accept an explanation of the circumstances that Kaiser finds itself in as a resolution to the issueGiven Kaiser's record in my case, every issue needs to be resolved before any acceptance occursThe issues as I see them now:I received a notice in the mail on Saturday, Feb 20th, and dated February 12, 2016, that says my coverage will be terminated if a payment of $3,isn't received by March 14th, I find myself right back where I was in December of with this issueKaiser has been aware of these erroneous charges for at least two months, has agreed, and said these incorrect charges would be removed prompltyDemanding payment for monies not owed, with the threat of termination, seems to be fraudulent to me at this pointThis issue needs to be fixed immediatelyThis is my second written complaint for this issueMy wife, ***, still has an active bill on her account for services rendered that do not reflect charges as per our policyThe guarantor Acct # is 1061328, and her health record number is The amount total amount billed is $My estimate for services due should be equal to or less than $Any and all bills needs to be corrected to reflect our insured status in and immediatelyBilling amounts and dates on my account do not reflect actual payments made, though the total is correctPlease correct thisMy current bill on the kaiser site has a due date of 2017.Thank you for your prompt attention, and resolution of these issues Sincerely, [redacted]
December 14, [redacted] [redacted] *** Complaint Case # [redacted] Consumer: [redacted] M [redacted] Case Opened: 11/28/Dear Mr [redacted] , This is in response to your email received on December 8, forwarding concerns on behalf of member; [redacted] M [redacted] regarding his rebuttal regarding Kaiser Permanente (KP) not renewing outside providers for chiropractic careWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfactionBased on the review, Mr [redacted] received a call from the Regional Director of Complementary Medicine Services on Wednesday, December 13, During the call, Mr [redacted] scheduled an appointment in the Complementary Medicine (CCM) departmentHe was provided the CCM direct phone number, the Business Office Assistant's name and the Highlands Ranch medical office addressMrFlora expressed he was happy that the CCM chiropractor will be able to view his records and was satisfied with the plan If the Revdex.com or the member has any questions, please contact me at ###-###-####Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] ***Complex Case Resolution SpecialistMember Experience
February 28, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 15, Dear Ms [redacted] This is in response to your email received on February 17, 2016, forwarding concerns on behalf of our member, [redacted] ***, regarding lingering claim discrepancies We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Ms [redacted] concerns with the appropriate Claims Department leadership, to include the Supervisor Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration caused by previously requesting assistance, yet never having the issues satisfactorily resolved I also submitted for an account audit from through current, which I have attached to the Revdex.com case for Ms***Each year benefits are summarized, and claims were reprocessed, as to go toward the Individual Deductible/OPM, rather than the Family Deductible/OPM Should Ms [redacted] have any remaining account questions, please ask her to contact the Claims Department, as they will be able to assist with audit clarifications, specific claim inquiries, and requests to have any claim Explanation of Benefits (EOB) mailedPlease thank Ms [redacted] for her patience with this overall matter, as I realize that she has been waiting for requested claim assistance and information for some time nowI am also available, should the member like to contact me directly The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
February 12, [redacted] Dispute/Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 11, Dear Ms [redacted] This is in response to your email received on February 12, 2016, forwarding concerns on behalf of our member, [redacted] , regarding documents which he has been trying to retrieve from Kaiser Permanente (KP) We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] concerns with the appropriate Member Services Contact Center (MSCC) Department leadershipI reviewed the January 20, call documentation, and was able to confirm that the MSCC representative intended to mail him his Evidence of Coverage (EOC) packetPlease apologize to the member for inconveniently being mailed the EOCToday, February 12, 2016, I did personally print/mail Mr [redacted] his requested EOCShould he not received the packet within a week, he is welcome to contact me directly for follow through The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
March 10, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 25, Dear Ms [redacted] , This is in response to your email received on February 18, 2016, forwarding concerns on behalf of our member, [redacted] , regarding the incorrect premium amount being automatically deducted from his account We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Mr [redacted] concerns with the appropriate Consolidated Service Center/KPIF On-Exchange Department leadership, to include the overseeing ManagerI am very sorry for any frustration or inconvenience that may have been caused to Mr [redacted] by this overall matterA case has been posted with Kaiser Permanente’s (KP) Member Issues Resolution Team (MIRT), as they assist specifically with issues pertaining to plans purchased through Connect for Health Colorado (C4)Your plan is currently reflecting as termed on February 29, MIRT was able to confirm that our third party billing company (HPS) corrected the member’s premium amount to the $that it should beOn March 9, 2016, HPS advised that they are re-running the bill, which will result in a refund to process for the member I will continue to follow through with MIRT, until the case has been satisfactorily resolvedPlease inform Mr [redacted] that I am available to contact personally, should he be seeking an update as to where the refund is the processAgain, I am very sorry for the continued problems experienced, and I am also happy to answer any additionally related questions The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338- Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 3, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: April 4, Dear Mr [redacted] , This is in response to your email received May 1, advising that a reply email had not yet been received regarding our member, [redacted] , and her concerns submitted to the Revdex.com on April 4, Unfortunately, we haven’t any record of receiving Ms [redacted] ’s previous Revdex.com, due to changes in our notification preferences that we were not aware ofWe have since confirmed with you that our preference has been changed back to email notificationWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Ms [redacted] stated that she has been disputing two $charges billed for nurse visits in primary care on 10/12/and 1/16/She also explained her belief that a premium payment applied towards Kaiser Permanente (KP) services, which she did not owe forThe member also advised that she paid for an appointment that should’ve been a free preventive visit, as well as requested a review of charges for her husband Ms [redacted] ’s concerns have been documented and shared with appropriate Patient Financial Services (PFS) Department, to include the SupervisorAdditionally, our Medicare Team confirmed that Ms [redacted] was Medicaid eligible in January 2017, however, it was not assigned to a providerMs [redacted] was Medicaid eligible effective February 1, through current, and the benefits are assigned to KP In regards to the two nurse visits, PFS forwarded the matter to our Coding Department, and the two $charges have been voided from Ms [redacted] ’s accountI can also see that the member made a payment in the amount of $I’ve outreached PFS inquiring what services the payment applied towardsIf the date of service was not processed according to the benefits on file, I will ensure that they are and call the member to advise if any account credit/refund dueShould the member like to have a detailed audit of her and/or her husband’s accounts, please ask her contact the Member Service Contact Center (MSCC) with both of their medical record numbers and submit the audit request(s) clarifying the time frame in which she is seeking that the audit be conducted for The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any additionally related questions, please contact me at [redacted] Also, the MSCC may be contacted by calling: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:I feel that if part of the surgery had to be performed again (which it did) I shouldn't be liable for the chargesAlso, if a company's employees (more than one) give incorrect information, the customer should not be the one to suffer as a result Sincerely, [redacted]
[redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: November 9, Dear Mr [redacted] , This is in response to your email received on November 10, 2017, forwarding concerns on behalf of our member, [redacted] , regarding the lack of communication he has received which has put his credit at risk We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mr [redacted] explained phone calls would not be returned over the last five months Direct calls have not been answered, and when calling the Kaiser Permanente Member Services Contact Center representatives were unfamiliar with the case and unable to assist We have formally documented and shared Mr [redacted] ’s concerns with the leadership of Kaiser Permanente’s Case Resolution DepartmentIn speaking with Mr [redacted] directly, I have had the opportunity to apologize to him for the frustration caused by this overall matterMr [redacted] informed me of billing issues experienced after having a referral for care Despite the referral, he has received several bills that were not clear Upon contacting the provider of the services, I have requested the account be placed on hold to prevent any collection activity while the bills are being reviewed I will continue to work with Mr [redacted] to resolve the billing concerns he has The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ###-###-#### Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Customer Experience
Revdex.com: At this time, 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, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/2/ Dear [redacted] , This is in response to your email received on August, forwarding concerns on behalf of our member; [redacted] regarding his request for reinstatementWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ’s grievance with the appropriate leadership Research indicates that [redacted] ’s coverage with Kaiser Permanente was terminated May 31, for non-payment [redacted] ’s May premium of $was not received until July 05, Kaiser Permanente has approved [redacted] ’s request for reinstatement A reinstatement bill was mailed to the member on August 11, The total premium payment due is $for April through September This payment is due by September 11, If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I never saw any documentation (billing, not just a recap of my annual charges from K/P) showing a credit had been applies to my billing from K/PI checked my records and I did not receive a billing for date of service June 2017, so it looks like they gave me the refund with out telling meHow was I supposed to know? Thank you for your help in clearing this up Sincerely, [redacted] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me, under the condition that I be notified when they have completed processing the claim with their Claims DepartmentIf I do not receive a notification that this claim has been successfully completed, I will reject the response because this is the same step we have been working on for months Sincerely, [redacted]
October 12, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Rebuttal Opened: October 5, Dear [redacted] , This is in response to your email received on October 5, 2016, forwarding the rebuttal to our original response provided on October 4, 2016, on behalf of our member, [redacted] The member is advising that Connect for Health Colorado (C4) will not change his plan term date to July 31, He is requesting that Kaiser Permanente (KP) initiate the term date change and immediately refund any monies due back We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction The Member Issues Resolution Team (MIRT) Business Analyst working this case has requested an escalated refund in the amount of $665.72, which is expected to take 3-business daysThe 7/31/term date request has been received by C4, and they are submitting the request on their end; the account will still need to be worked on after the refund for billing and cash adjustment are complete Please thank [redacted] for his continued patienceI also encourage the member to call me directly with any additionally related questions or for an update on this case The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
Initial Business Response / [redacted] (1000, 6, 2015/12/02) */ December 2, [redacted] Dispute Resolution & Helpline Specialist Denver/Boulder Revdex.com P.OBox XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXX Consumer: [redacted] , [redacted] Case Opened: November 25, 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, service chargeWe 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 leadershipThe 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 neededThough the disputed charge was appropriately billed in accordance with the member's Evidence of Coverage, Kaiser Permanente has removed the outstanding balanceAs of today, the member's account has a $balanceShould 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 careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX Also, you may contact Member Services: Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] M [redacted] Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal / [redacted] (2000, 8, 2015/12/11) */ (The consumer indicated he/she ACCEPTED the response from the business.)
February 21, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 01/16/ Dear Mr [redacted] , This is in response to your email received on February 17, forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to honor the cancellation date of December 1,for the health plan purchased through [redacted] In addition, correct and remove any past due balances for the months of December and January We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Mr [redacted] ’s grievance with the appropriate leadership The member’s disenrollment has been updated to reflect a term date of November 30, The members billing for December and January premiums have been adjusted off to reflect a zero balanceKaiser Permanente does not report past due premiums to any credit agencies If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Member Experience
January 31, [redacted] Member ID Number: [redacted] Dear Mr [redacted] , Kaiser Permanente’s Customer Experience Department received your submission to the Revdex.com on January 10, 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 concernsI have reviewed the initial grievance filed with the Member Services Contact Center on July 28, 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, An audit of claims for services [redacted] received in 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, 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
April 26, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: April 19, Dear Ms [redacted] , This is in response to your email received on April 21, 2016, forwarding concerns on behalf of our former member, [redacted] Mr [redacted] wife, [redacted] submitted an email explaining that they her husband is being billed by a collections agency for date of service September 10, She disagrees with the charge, being that the copay was paid at the time of serviceAdditionally, a general bill or past due notice was never received prior to the collections letter We value the opportunity to review and respond to this matter and apologize for their overall dissatisfactionI’ve outreached the Kaiser Permanente (KP) Patient Financial Services Department for further research and clarification of the collections billI’ve been advised that the $copay was paid for Mr [redacted] September 10, office visit with [redacted] , PA., at Westminster Family PracticeThe member had an x-ray following that visit, which billed out for $Per the member’s Evidence of Coverage, the x-ray was billed appropriately towards the plan deductible: DEDUCTIBLES The following Deductibles apply under your plan: Embedded Medical Deductible: $500/Individual per year $1,500/Family per year Does not apply to Out-of-Pocket Maximum X-ray, Laboratory and Special Procedures You Pay Diagnostic and therapeutic X-rays (Subject to medical Deductible; Applies to Out-of-Pocket Maximum) 30% Coinsurance The bill is documented as having been mailed to the address we have on file for the member from his group plan employer: WCR Kennesburg, CO Our Health Connect system shows the member’s address as being in Fort Lupton, which is a system that can be changed by KP staff However, our Membership Administration system shows the Keenesburg address, and this information can only be changed by the submitted request from the group plan employer I am very sorry for any frustration that may have been caused to the member and his wife by this overall matterPlease encourage them to contact me directly, should they have any additionally related questions Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
August 22, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/13/ Dear [redacted] , This is in response to your email received on August 14, forwarding concerns on behalf of our member; [redacted] regarding her request for an adjustment on her account in the amount of $We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ***’s grievance with the appropriate leadership Research indicates that [redacted] was billed $for non-preventive services including diagnostic labs and X-ray’s ordered for a specific symptom and or diagnosis, on July 12, at the [redacted] Medical Offices The preventive labs she also had were all processed appropriately with no cost-shareThe amount of $334.62, [redacted] ***’s responsibility, was appropriately applied as her member cost-share, per her Deductible Health Maintenance Organization (DHMO) health plan If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
January 26, Revdex.com Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: January 12, Good morning, This is in response to your email received on January 13, 2016, forwarding concerns on behalf of our member [redacted] , regarding the termination failure of his KPIF/Off-Exchange healthcare plan We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and Mr [redacted] ’s complaint details with the appropriate Consolidated Service Center/KPIF Membership Administration Department, to include the overseeing ManagerMy sincere apologies for the frustration Mr [redacted] has expressed pertaining to the matter The Membership Administration Department has agreed to retro the health plan cancelation to reflect December 31, I realize that the member is seeking a cancelation date of October 31, 2015, as he has been attempting to cancel for some time nowThough we are unable to locate any previously submitted cancelation forms, the member has explained to me that he did in fact fax them to the number that a Kaiser Permanente employee had provided him withI am currently in the process of reviewing calls between the member and the Member Service Contact Center, as well as with the Membership Administration DepartmentShould I find any misinformation provided, I will submit the retro date change request according to the information he was given and contact him immediatelyAgain, I am very sorry for this inconvenience, and Mr [redacted] ’s is encouraged to contact me with any additionally related questions The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
August 31, [redacted] Revdex.com Serving Denver/Boulder EFlorida Ave., Ste Denver, Colorado Complaint Case # [redacted] Consumer: [redacted] Case Opened: [redacted] Dear [redacted] , This is in response to your email received on August 24, forwarding concerns on behalf of our member; [redacted] regarding his request to have a refund for the premium payment that was made for his policy through Connect for Health ColoradoWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates a refund has been approved and sent to member for $on credit card ending XXXX- [redacted] on August 30, Please note that Kaiser Permanente is allowed to make changes to member accounts only as provided and documented by Connect for Health Colorado Kaiser Permanente cannot make any changes to a health plan purchased through Connect for Health Colorado without authorization from Connect for Health Colorado If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe 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: I am rejecting this response because:Most of the serious issues for my original complaint still existI will not accept an explanation of the circumstances that Kaiser finds itself in as a resolution to the issueGiven Kaiser's record in my case, every issue needs to be resolved before any acceptance occursThe issues as I see them now:I received a notice in the mail on Saturday, Feb 20th, and dated February 12, 2016, that says my coverage will be terminated if a payment of $3,isn't received by March 14th, I find myself right back where I was in December of with this issueKaiser has been aware of these erroneous charges for at least two months, has agreed, and said these incorrect charges would be removed prompltyDemanding payment for monies not owed, with the threat of termination, seems to be fraudulent to me at this pointThis issue needs to be fixed immediatelyThis is my second written complaint for this issueMy wife, ***, still has an active bill on her account for services rendered that do not reflect charges as per our policyThe guarantor Acct # is 1061328, and her health record number is The amount total amount billed is $My estimate for services due should be equal to or less than $Any and all bills needs to be corrected to reflect our insured status in and immediatelyBilling amounts and dates on my account do not reflect actual payments made, though the total is correctPlease correct thisMy current bill on the kaiser site has a due date of 2017.Thank you for your prompt attention, and resolution of these issues Sincerely, [redacted]
December 14, [redacted] [redacted] *** Complaint Case # [redacted] Consumer: [redacted] M [redacted] Case Opened: 11/28/Dear Mr [redacted] , This is in response to your email received on December 8, forwarding concerns on behalf of member; [redacted] M [redacted] regarding his rebuttal regarding Kaiser Permanente (KP) not renewing outside providers for chiropractic careWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfactionBased on the review, Mr [redacted] received a call from the Regional Director of Complementary Medicine Services on Wednesday, December 13, During the call, Mr [redacted] scheduled an appointment in the Complementary Medicine (CCM) departmentHe was provided the CCM direct phone number, the Business Office Assistant's name and the Highlands Ranch medical office addressMrFlora expressed he was happy that the CCM chiropractor will be able to view his records and was satisfied with the plan If the Revdex.com or the member has any questions, please contact me at ###-###-####Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] ***Complex Case Resolution SpecialistMember Experience
February 28, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 15, Dear Ms [redacted] This is in response to your email received on February 17, 2016, forwarding concerns on behalf of our member, [redacted] ***, regarding lingering claim discrepancies We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Ms [redacted] concerns with the appropriate Claims Department leadership, to include the Supervisor Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration caused by previously requesting assistance, yet never having the issues satisfactorily resolved I also submitted for an account audit from through current, which I have attached to the Revdex.com case for Ms***Each year benefits are summarized, and claims were reprocessed, as to go toward the Individual Deductible/OPM, rather than the Family Deductible/OPM Should Ms [redacted] have any remaining account questions, please ask her to contact the Claims Department, as they will be able to assist with audit clarifications, specific claim inquiries, and requests to have any claim Explanation of Benefits (EOB) mailedPlease thank Ms [redacted] for her patience with this overall matter, as I realize that she has been waiting for requested claim assistance and information for some time nowI am also available, should the member like to contact me directly The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
February 12, [redacted] Dispute/Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 11, Dear Ms [redacted] This is in response to your email received on February 12, 2016, forwarding concerns on behalf of our member, [redacted] , regarding documents which he has been trying to retrieve from Kaiser Permanente (KP) We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] concerns with the appropriate Member Services Contact Center (MSCC) Department leadershipI reviewed the January 20, call documentation, and was able to confirm that the MSCC representative intended to mail him his Evidence of Coverage (EOC) packetPlease apologize to the member for inconveniently being mailed the EOCToday, February 12, 2016, I did personally print/mail Mr [redacted] his requested EOCShould he not received the packet within a week, he is welcome to contact me directly for follow through The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
March 10, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: February 25, Dear Ms [redacted] , This is in response to your email received on February 18, 2016, forwarding concerns on behalf of our member, [redacted] , regarding the incorrect premium amount being automatically deducted from his account We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Mr [redacted] concerns with the appropriate Consolidated Service Center/KPIF On-Exchange Department leadership, to include the overseeing ManagerI am very sorry for any frustration or inconvenience that may have been caused to Mr [redacted] by this overall matterA case has been posted with Kaiser Permanente’s (KP) Member Issues Resolution Team (MIRT), as they assist specifically with issues pertaining to plans purchased through Connect for Health Colorado (C4)Your plan is currently reflecting as termed on February 29, MIRT was able to confirm that our third party billing company (HPS) corrected the member’s premium amount to the $that it should beOn March 9, 2016, HPS advised that they are re-running the bill, which will result in a refund to process for the member I will continue to follow through with MIRT, until the case has been satisfactorily resolvedPlease inform Mr [redacted] that I am available to contact personally, should he be seeking an update as to where the refund is the processAgain, I am very sorry for the continued problems experienced, and I am also happy to answer any additionally related questions The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338- Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 3, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: April 4, Dear Mr [redacted] , This is in response to your email received May 1, advising that a reply email had not yet been received regarding our member, [redacted] , and her concerns submitted to the Revdex.com on April 4, Unfortunately, we haven’t any record of receiving Ms [redacted] ’s previous Revdex.com, due to changes in our notification preferences that we were not aware ofWe have since confirmed with you that our preference has been changed back to email notificationWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Ms [redacted] stated that she has been disputing two $charges billed for nurse visits in primary care on 10/12/and 1/16/She also explained her belief that a premium payment applied towards Kaiser Permanente (KP) services, which she did not owe forThe member also advised that she paid for an appointment that should’ve been a free preventive visit, as well as requested a review of charges for her husband Ms [redacted] ’s concerns have been documented and shared with appropriate Patient Financial Services (PFS) Department, to include the SupervisorAdditionally, our Medicare Team confirmed that Ms [redacted] was Medicaid eligible in January 2017, however, it was not assigned to a providerMs [redacted] was Medicaid eligible effective February 1, through current, and the benefits are assigned to KP In regards to the two nurse visits, PFS forwarded the matter to our Coding Department, and the two $charges have been voided from Ms [redacted] ’s accountI can also see that the member made a payment in the amount of $I’ve outreached PFS inquiring what services the payment applied towardsIf the date of service was not processed according to the benefits on file, I will ensure that they are and call the member to advise if any account credit/refund dueShould the member like to have a detailed audit of her and/or her husband’s accounts, please ask her contact the Member Service Contact Center (MSCC) with both of their medical record numbers and submit the audit request(s) clarifying the time frame in which she is seeking that the audit be conducted for The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any additionally related questions, please contact me at [redacted] Also, the MSCC may be contacted by calling: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Complaint: [redacted] I am rejecting this response because:I feel that if part of the surgery had to be performed again (which it did) I shouldn't be liable for the chargesAlso, if a company's employees (more than one) give incorrect information, the customer should not be the one to suffer as a result Sincerely, [redacted]
[redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: November 9, Dear Mr [redacted] , This is in response to your email received on November 10, 2017, forwarding concerns on behalf of our member, [redacted] , regarding the lack of communication he has received which has put his credit at risk We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mr [redacted] explained phone calls would not be returned over the last five months Direct calls have not been answered, and when calling the Kaiser Permanente Member Services Contact Center representatives were unfamiliar with the case and unable to assist We have formally documented and shared Mr [redacted] ’s concerns with the leadership of Kaiser Permanente’s Case Resolution DepartmentIn speaking with Mr [redacted] directly, I have had the opportunity to apologize to him for the frustration caused by this overall matterMr [redacted] informed me of billing issues experienced after having a referral for care Despite the referral, he has received several bills that were not clear Upon contacting the provider of the services, I have requested the account be placed on hold to prevent any collection activity while the bills are being reviewed I will continue to work with Mr [redacted] to resolve the billing concerns he has The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ###-###-#### Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Customer Experience
Revdex.com: At this time, 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, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/2/ Dear [redacted] , This is in response to your email received on August, forwarding concerns on behalf of our member; [redacted] regarding his request for reinstatementWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ’s grievance with the appropriate leadership Research indicates that [redacted] ’s coverage with Kaiser Permanente was terminated May 31, for non-payment [redacted] ’s May premium of $was not received until July 05, Kaiser Permanente has approved [redacted] ’s request for reinstatement A reinstatement bill was mailed to the member on August 11, The total premium payment due is $for April through September This payment is due by September 11, If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I never saw any documentation (billing, not just a recap of my annual charges from K/P) showing a credit had been applies to my billing from K/PI checked my records and I did not receive a billing for date of service June 2017, so it looks like they gave me the refund with out telling meHow was I supposed to know? Thank you for your help in clearing this up Sincerely, [redacted] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me, under the condition that I be notified when they have completed processing the claim with their Claims DepartmentIf I do not receive a notification that this claim has been successfully completed, I will reject the response because this is the same step we have been working on for months Sincerely, [redacted]
October 12, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Rebuttal Opened: October 5, Dear [redacted] , This is in response to your email received on October 5, 2016, forwarding the rebuttal to our original response provided on October 4, 2016, on behalf of our member, [redacted] The member is advising that Connect for Health Colorado (C4) will not change his plan term date to July 31, He is requesting that Kaiser Permanente (KP) initiate the term date change and immediately refund any monies due back We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction The Member Issues Resolution Team (MIRT) Business Analyst working this case has requested an escalated refund in the amount of $665.72, which is expected to take 3-business daysThe 7/31/term date request has been received by C4, and they are submitting the request on their end; the account will still need to be worked on after the refund for billing and cash adjustment are complete Please thank [redacted] for his continued patienceI also encourage the member to call me directly with any additionally related questions or for an update on this case The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
Initial Business Response / [redacted] (1000, 6, 2015/12/02) */ December 2, [redacted] Dispute Resolution & Helpline Specialist Denver/Boulder Revdex.com P.OBox XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXX Consumer: [redacted] , [redacted] Case Opened: November 25, 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, service chargeWe 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 leadershipThe 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 neededThough the disputed charge was appropriately billed in accordance with the member's Evidence of Coverage, Kaiser Permanente has removed the outstanding balanceAs of today, the member's account has a $balanceShould 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 careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX Also, you may contact Member Services: Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] M [redacted] Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal / [redacted] (2000, 8, 2015/12/11) */ (The consumer indicated he/she ACCEPTED the response from the business.)
February 21, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 01/16/ Dear Mr [redacted] , This is in response to your email received on February 17, forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to honor the cancellation date of December 1,for the health plan purchased through [redacted] In addition, correct and remove any past due balances for the months of December and January We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared Mr [redacted] ’s grievance with the appropriate leadership The member’s disenrollment has been updated to reflect a term date of November 30, The members billing for December and January premiums have been adjusted off to reflect a zero balanceKaiser Permanente does not report past due premiums to any credit agencies If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Member Experience
January 31, [redacted] Member ID Number: [redacted] Dear Mr [redacted] , Kaiser Permanente’s Customer Experience Department received your submission to the Revdex.com on January 10, 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 concernsI have reviewed the initial grievance filed with the Member Services Contact Center on July 28, 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, An audit of claims for services [redacted] received in 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, 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
April 26, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: April 19, Dear Ms [redacted] , This is in response to your email received on April 21, 2016, forwarding concerns on behalf of our former member, [redacted] Mr [redacted] wife, [redacted] submitted an email explaining that they her husband is being billed by a collections agency for date of service September 10, She disagrees with the charge, being that the copay was paid at the time of serviceAdditionally, a general bill or past due notice was never received prior to the collections letter We value the opportunity to review and respond to this matter and apologize for their overall dissatisfactionI’ve outreached the Kaiser Permanente (KP) Patient Financial Services Department for further research and clarification of the collections billI’ve been advised that the $copay was paid for Mr [redacted] September 10, office visit with [redacted] , PA., at Westminster Family PracticeThe member had an x-ray following that visit, which billed out for $Per the member’s Evidence of Coverage, the x-ray was billed appropriately towards the plan deductible: DEDUCTIBLES The following Deductibles apply under your plan: Embedded Medical Deductible: $500/Individual per year $1,500/Family per year Does not apply to Out-of-Pocket Maximum X-ray, Laboratory and Special Procedures You Pay Diagnostic and therapeutic X-rays (Subject to medical Deductible; Applies to Out-of-Pocket Maximum) 30% Coinsurance The bill is documented as having been mailed to the address we have on file for the member from his group plan employer: WCR Kennesburg, CO Our Health Connect system shows the member’s address as being in Fort Lupton, which is a system that can be changed by KP staff However, our Membership Administration system shows the Keenesburg address, and this information can only be changed by the submitted request from the group plan employer I am very sorry for any frustration that may have been caused to the member and his wife by this overall matterPlease encourage them to contact me directly, should they have any additionally related questions Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
August 22, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/13/ Dear [redacted] , This is in response to your email received on August 14, forwarding concerns on behalf of our member; [redacted] regarding her request for an adjustment on her account in the amount of $We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ***’s grievance with the appropriate leadership Research indicates that [redacted] was billed $for non-preventive services including diagnostic labs and X-ray’s ordered for a specific symptom and or diagnosis, on July 12, at the [redacted] Medical Offices The preventive labs she also had were all processed appropriately with no cost-shareThe amount of $334.62, [redacted] ***’s responsibility, was appropriately applied as her member cost-share, per her Deductible Health Maintenance Organization (DHMO) health plan If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto 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 matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
January 26, Revdex.com Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: January 12, Good morning, This is in response to your email received on January 13, 2016, forwarding concerns on behalf of our member [redacted] , regarding the termination failure of his KPIF/Off-Exchange healthcare plan We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and Mr [redacted] ’s complaint details with the appropriate Consolidated Service Center/KPIF Membership Administration Department, to include the overseeing ManagerMy sincere apologies for the frustration Mr [redacted] has expressed pertaining to the matter The Membership Administration Department has agreed to retro the health plan cancelation to reflect December 31, I realize that the member is seeking a cancelation date of October 31, 2015, as he has been attempting to cancel for some time nowThough we are unable to locate any previously submitted cancelation forms, the member has explained to me that he did in fact fax them to the number that a Kaiser Permanente employee had provided him withI am currently in the process of reviewing calls between the member and the Member Service Contact Center, as well as with the Membership Administration DepartmentShould I find any misinformation provided, I will submit the retro date change request according to the information he was given and contact him immediatelyAgain, I am very sorry for this inconvenience, and Mr [redacted] ’s is encouraged to contact me with any additionally related questions The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience